Barriers Faced by Vietnamese Australians in Accessing Healthcare Services for Dementia
Dementia and Alzheimer’s disease is a syndrome that is the result of degeneration of the brain. About 298,000 Australians are affected from dementia and 12% constitutes the “people from culturally and linguistically diverse (CALD) backgrounds” (Access Economics, 2009; Australian Institute of Health and Welfare, 2012). The Vietnamese population in Australia was 221,114 in the year 2011. Thus, it makes the sixth-largest CALD population in Australian (Australian Bureau of Statistics, 2013). The Vietnamese migrated to Australia from their war-torn homeland as a means of escaping the bad situation. This unique migrating may affect the Vietnamese in seeking appropriate healthcare services in Australia. When dementia services are not utilized properly, there is the consequential highest levels of morbidity, hospitalization, mortality, and caregiver burden (Brodaty and Donkin, 2009; Low et al., 2011).
This paper seeks to understand the barriers to utilization and access to healthcare services by this Vietnamese group of people dealing with dementia in Australia. On the basis of the nature of the dementia condition, sufferers of dementia are reliant to a great extent on external support for their everyday living (Brodaty and Donkin, 2009 ; Fleisher and Corey-Bloom, 2010). About eighty-eight percent of the dementia sufferers display BPSD or behavioral and psychological symptoms of dementia such as delusions, wandering, aggression, anxiety, and depression (Brodaty et al., 2003). Such BPSD symptoms add to the caregiver burden, especially so, when the services of the Dementia Behavioral Management Advisory Service (DBMAS) are not utilized by people.
Vietnam’s family culture and traditions are mostly influenced by Buddhist, Taoist, or Confucianistic faiths and beliefs(Alzheimers Australia, 2008; Nguyen and Nguyen, 2010). The Vietnamese have great respect and regard for the older people. The family members mostly assume the responsibility of caring for the older people in the community (Alzheimers Australia, 2008). There are four main tenets to the underlying belief system of the Vietnamese; they’re the:
Yearning a good name;
Allegiance to family;
Respect for elder and the old; and
Love for learning (Diversicare, 2009, p. 8)
These belief systems lead to a family-centered approach to caring for the old and the sick in the Vietnamese families. In turn, they may also inhibit the Vietnamese seeking professional help for caring for the dementia suffers in Australia. According to Confucianism, the elders and the sick must be cared for well and parents obeyed completely.
One important barrier to access health care services among migrants in Australia is their low levels of proficiency in the English language (Chang et al., 2014). Vietnamese caregivers may also be inhibited from developing their health literacy and accessing appropriate health care services for dementia due to such language barriers. Health literacy is a term that stands for the ability of indivudlaula to understand process and obtain information pertaining to health and make the right decisions. In a study by the Australian Bureau of Statistics, the number of people from Vietnamese groups who could speak good English was 39.5% in 2011.
Impact of Vietnamese Culture on Accessing Healthcare Services for Dementia
A number of aged care and care packages for dementia in Australia are government funded (Department of Health and Ageing, 2012a,b)
The Australian aged care service included the low-care programs like the CACP or the Community Aged Care Packages and high-care programs that included EACH or the “Extended Community Aged Care at Home” and the EACH-D or the :Extended Community Aged Care Dementia” programs.
Additionally, the NRCP or the National Respite from Caregivers Program supported the CALD caregivers. Also, ethno-specific aged care services have been employed as a method or tool to overcome barriers due to language in accessing health care services by the CLAD populations in Australia. This measure helps to provide culturally and linguistically appropriate health care for CALD group older members in the Australian continent. Service providers under this measure normally rely on cultural and bilingual care workers to deliver coordinate care to the aged.
Thus, ethno-specific aged care services must be approached and utilized by the daughter of Chin Kyi, so that she can be taken care of by bilingual and bicultural caregivers in Australia .However it should be noted that the CALD communities that have been newly established like the Vietnamese coummtyiy had only few bilingual staff and very minimal services to deliver appropriate health care services (Lai, 2007; Lee and Farran, 2004).
The stigma assorted with dementia among the Vietnamese community is another barrier that restricts them for accessing health care services properly (Liu et al., 2008).
Stigma is defined as ‘the prejudicial views or negative stereotypes that individuals may hold about people with certain distinguishing characteristics or attributes’ (Alzheimer’s’ Australia, 2012, p. 5.). Stigma has many forms and is a complex construct. Family stigma refers to ‘the stigma experienced by individuals as a consequence of being associated with a relative with a stigmatic mark’. Stigma among the Vietnamese adds additional burden to the caregivers of sufferers of dementia and inhibits caregivers from seeking help or utilizing healthcare services for dementia.
Evidence points out that stigma may lead to a negative influence on caregivers hailing from family-oriented cultures such as the Vietnamese cultures, as they hold great importance to the family name. Family caregivers face additional burden in the CALD communities where dementia was considered a mental illness or insanity rather than the degeneration of the brain.
However, in the case of Ms. Chin Kyi, the daughter seemed to have considered dementia a part of normal ageing and was trying to access the appropriate services for long-term care for her mother who was we suffering from dementia.
Language Barriers
The CALD community members may be affected by the acculturation level in the country they have come to adopt. The acculturation level is related to the social networks the caregiver has and the capacity to access and utilize health care resources and information. On the basis of the acculturation theory of Berry (2003), there exists four levels of acculturation.
Asmsilaition is achieved when immigrants give up their culture and imbibe portions of the host culture. Secondly, immigrants, when they adopt the host country’s culture to an extent while maintaining their own culture, may be said to achieve integration.
Thirdly, immigrants turn into being isolated when they mingle with their own community members and not the people from the mainstream culture (Boughtwood et al., 2011). Next, as a fourth point, when they remain isolated from their own culture and do not interact much with people from the mainstream culture, they tend to become marginalized.
Barriers to acculturation in a Australia include poverty, low English proficiency, and unemployment and low education profile. Many of the Vietnamese in Australia are refugees, they do not willingly participate in the acculturation process compared to a person from Vietnam with skilled status. It has been pointed out that caregivers and suffers of dementia from CALD background face a number of barriers to effective utilization of healthcare services for dementia in Australia.
Furthermore, barriers to using dementia services are unique to each community of the CALD groups, as they are culturally and socially constructed. Studies that deal with dementia caregivers and sufferers from the Vietnamese pollution in Australia are minimal, and there is uncertainty and little knowledge of their unique experiences.
The requirement for linguistically and culturally appropriate dementia education programs
The daughter of the MS. Chin Kyi, who suffered from dementia, made it known she knew of dementia. There was no specific term for dementia in Vietnamese language; they instead used the term ‘lug l ? n’ (confusion) to describe the symptoms of dementia. As a daughter of the parent who suffered from dementia, she showed good knowledge of the signs and symptoms of dementia. She had a little bit of misunderstanding of dementia and said it was more of part of ageing than a disease.
Also, there was observed a gap between the GP caring for the patient and the care worker who attended to MS Chin Kyi. The GPs must necessarily be educated to work with the members of the CALD community and for this special education was needed.
Stigma Associated with Dementia
The local radio programs can be used to disseminate information about dementia to the CALD community members. Further, the education programs in English could be translated o the CALD community languages. This would enable better care and understating of dementia by CALD community members.
A willing attitude to ask for help and seek it was observed in the caregiver daughter of Ms Chin Kyi, provided the help conformed to the faiths of the Vietnamese culture. Most often, Vietnamese caregivers do not seek residential care services as caring for the elderly was one of the main cultural beliefs amongst them. However, in the case of Ms Chin Kyi, the daughter was willing to talk about the dementia condition her mother faced and was seeking long-term care for her in Australia.
Culturally, the Vietnamese protect their dignity and do not discuss dementia in public. However, this attitude of shame and hiding was replaced by confronting and talking the issue openly as the daughter revealed that “my family has been in Australia for quite a while…there is nothing therefore to hide when it comes to dementia…”
The family caregivers of the Vietnamese community in Australia usually have a limited knowledge on the government-aided aged care packages, which can be used to care for the dementia affected person. It was found that the local Vietnamese welfare organisation could not provide all of these aged care services. Family caregivers also are unaware of how to approach other service providers for packages.
In Ms. Chin Kyi’s case, she was facing severe BPSD symptoms but luckily her daughter was seeking long-term care at an aged care facility for her mother in Australia. This residential care would definitely relieve the burden of the daughter who was the family caregiver until now. Thus, dementia education, support, and counseling services would go a long way in helping the daughter find a suitable aged care service for her mother Ms. Chin Kyi, who was suffering from dementia.
This study by authors delved into the challenges in care for dementia patients by both Vietnamese caregivers and careworkers. The study led to a good comprehension of the barriers and enablers Vietnamese caregivers dealt with while caring for the elderly with dementia. Such studies are less in number as other studies previously done explored only cohorts of populations. Findings this study has contribute help in providing research evidence to the improved dementia care for Vietnamese in Australia who suffer from dementia and their carers too. Family caregivers seemed to consider dementia as a normal sign of ageing and not a disease.
Acculturation Level of Vietnamese Australians
Although the caregivers in the Vietnamese families understood dementia and their signs; they were hesitant to approach healthcare professionals for treatment, diagnosis, and care services in Australia. In such situation, a delayed diagnosis of dementia is normally the consequence. A low level of comprehension of signs and symptoms of dementia has been observed among the CALD groups in Australia compared to the normal mainstream peoples. This is the reason why dementia is misunderstood by the caregivers of the CALD communities and help is not sought by them from healthcare professionals in Australia for dementia. It is vital that timely diagnosis of dementia is made, so that the prevention of dementia-associated comorbidities, reduction in hospitalization, and admission to aged care homes can be achieved.
There is particular delay in diagnosis of dementia in CALD populations. General practitioners contribute to the delay in diagnosis of dementia because a careful investigation of symptoms of dementia is absent (Brodaty et al., 2003; Callahan et al., 2006). As interviewed the care workers in this study, the lack of coordination between the GPs and the care workers in Australia for the CALD communities may have led to the delay in diagnosis of dementia. Therefore, it is vital that there exist partnerships between the General practitioners and the careworkers to lead to early diagnosis and appropriate use of the aged care services in Australia.
Conclusion
In the case study given, Ms Chin Kyi is of Vietnamese origin and is suffering from dementia. She is unable to speak fluent English. The daughter of Ms Chin Kyi fully understands the signs of dementia and is seeking long-term care for her mother in Australia.
There are a number of barriers to obtaining long-term care for Ms Chin Kyi who is a Vietnamese settled in Australia and is suffering from dementia. She has poor English knowledge and so cannot communicate with carers who know only English in the residential home. Thus, it is pivotal that Ms Chin Kyi is looked after by bilingual carers, who know both the Vietnamese language and English.
Also, most Vietnamese do not know how to seek help for dementia from healthcare professionals in Australia. This issue can be resolved by having radio shows in the evenings that can help the Vietnamese in the Australian continent understand dementia and the services offered by the government.
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