Asians in New Zealand: Migration, Mental Health, and Service Use - Research Proposal Example

Asians in New Zealand: Migration, Mental Health, and Service Use First Last of The rate of the population of Asian immigrants in New Zealand is increasing at a rate faster than most of the ethnic groups in the country. Because researchers have observed that ethnicity, the process of migration, and other factors, have considerable impact in the lives of the migrants all over the world, especially on their mental health and their behaviors toward it, this research will attempt to present the relationships of migration, mental health, and the use of services among Asian migrants in New Zealand to establish trends, compare with existing data, and become the basis for the policy making. Introduction Mental health is one of the most critical aspects which contribute greatly to the overall health and well being of an individual and the public as a whole. Even so, current trends show that most people have the tendency to neglect its irrefutable importance whether due to personal or cultural beliefs, lack of knowledge, and many others (Lee, Juon, Martinez, Hsu, Robinson, Bawa, & Ma, 2009, p. 144). As this is so, authorities from national to local levels in New Zealand continue to enact and collaborate with appropriate organizations in the private sector in imposing policies that can increase awareness, prevent, treat and rehabilitate individuals with mental illness as consequences of mental health can affect not only the lives of the mentally ill but also the community around them; creating problems in social, cultural, and economic status and development of the wider population. There are many factors that affect the mental health of the population; factors that are generalized and apply universally. However, the cultural diversity of New Zealand’s population, “which has become a lot more diverse in the last 10 years” (“Cultural Diversity,” n.d.), results to some unique circumstances that negatively affect the health, especially mental health, and well being of its settlers; reflecting the need of significant policy considerations. In the most recent release of national statistics, comparisons of the 2001 and 2006 illustrate a considerable difference in the number of the members of the ethnic minority groups. Statistics on culture and identity demonstrate that compared to the majority ethnic group (European) settlers which has significantly declined, figures representing the minority ethnic groups -- specifically Asians, MELAA (Middle Eastern, Latin American and African) and Other Ethnicity -- have increase in the last five years (“QuickStats about Culture,” 2006). Along with this increase in the number of newcomers settling in New Zealand, racial and ethnic discrimination has also become more and more apparent that the national government has introduced policies promoting racial harmony (Human Rights Commission (HRC), n.d.). Yet, racism, racial discrimination, harassment and abuse, in addition to other sociocultural factors (e.g., traditions, beliefs, and religions) that burden migrants in their stay in the foreign places like New Zealand, continue to persist that “particular health and welfare needs” as well as problems on “the accessibility of services” on health care and others still characterize this particular populations (HRC, n.d.). With this trend, the urgency to review and revise existing or create new policies that can improve social and economic conditions for the migrants arises. Putting all these in consideration, this paper will assess the mental health of the Asian migrants of New Zealand -- the fourth largest ethnic group settling in the country -- how they perceive it, and the course of their mental health services use. Literature Review According to a study, migration, or the movement of people from one country or locality to another (“Migration,” 2008), can expose people to several forms of stresses that can trigger mental health disruption. These stresses may include but are not limited to racism, poverty, poor educational attainment, and unequal access to social and economic opportunities (Steffen & Bowden, 2006, p. 16). Such issues, among others, and their effects to the mental health and behavior of the migrants have received extensive attention from scholars, especially from the fields of social science and health care, all over the world as patterns of similarities and the differences have surfaced. Among the most common topics in these researches were the prevalence of migration and racism, the development of mental health illness among migrants, how it become affected by and has affected the existing circumstances, the migrants’ patterns of mental health services use in different stages of life, and the social response to the presence of the minority groups in the community (Bhugra & Jones, 2001; Mossakowski, 2003; Williams & Williams-Morris, 2000; Littlewood, 1986; Abe-Kim, Takeuchi, Hong, Zane, Sue, Spencer, Appel, Nicdao, & Alegria, 2007; Garland, Lau, Yeh, McCabe, Hough, & Landsverk, 2005; Hu, Snowden, Jerrell, & Nguyen, 1991; Steffen & Bowden, 2006). Historical background. The history of human migration can be traced back to the earliest times of human existence. Evidences like tools and fossils support that early human populations were always on the move, revealing patterns that associate migration with “changes in the global climate” (Sullivan, 2010). Recently, however, human movement has been correlated with social and economic reasons -- creating consequences in the different aspects of the migrants’ lives (Federal Office for Migration, 2010). The history associating racism, migration, and mental health has already been established in the more recent times. Nevertheless, no substantial data can provide accurate background on when the earliest observations of the relationship between migration and mental illness had been first recorded. In the start of the 18th century, New Zealand was taught as one of the most unlikely place to live in. It was “seen by Europeans as the most remote country on Earth ... only exceptional reasons led people to set for such a distant corner of the globe” (Phillips, 2009). Despite that part of the past, the country is currently one of the world’s hottest spots for migration; making it one of the most multicultural countries after a century from the start of the Great Migration in the late part of the 19th century. Policies on assisted migrations for students and workers resulted to the surge of migrants from the different parts of the globe; resulting to the “world’s second highest proportion of immigrants in its workforce” (Phillips, 2009). Migrants created their own communities; and consequently, triggered the developments of “some adverse political response,” and social and economic conflicts between the natives of and the newcomers to New Zealand due to the differences in language, beliefs, traditions, and concepts. As a result, the diversity has created implications on their health and well being and their behaviors towards it (Phillips, 2009; Ho et al., 2002, p. vii). Asian settlement in New Zealand. According to reports, the Asian settlers in New Zealand, specifically the Chinese, have the longest settlement history in the country for reasons such as employment, education, and other socioeconomic factors (Ho et al., 2002, p. 8). In addition, they contribute to the “fastest-growing ethnic community in New Zealand today” (Ho et al., 2002, p. 3). In fact, the National census in 2001 noted that the number of Asian immigrants doubled within the span of ten years only. Ho et al. (2002) also added that in this fourth largest ethnic group in New Zealand’s population, the Chinese, Indian, Korean, Cambodian, and Vietnamese communities were the five topmost prevalent groups. In the 2006 census, on the other hand, the Filipinos and Japanese societies replaced Cambodians and Vietnamese communities in the fourth and fifth place, respectively (“QuickStats about Culture,” 2006). All the same, authors suggested that the recent migration response is primarily due to the change in the country’s immigration policies to attract “immigrants with professional skills and capital for investment, irrespective of race and country of origin” (Ho et al., 2002, p. 4). This was employed in 1986. Asian Culture and Mental Health. Aside from the factors that affect the mental health and the use of its services among Asian migrants which will be explained later, it is important that the Asians’ view of mental health is presented to see its effects on the vulnerability of the population to mental health and how their beliefs concerning mental illness influence their behaviors towards it during their stay in New Zealand and in other possible migration destinations. Certain shifts show that despite the difference in their origins, majority of the Asian people often keep mental illness to their selves either consciously or unconsciously to prevent family disgrace. This might be due to the fact that Asians put “great emphasis on harmony and family integration,” and maintaining this bond means that each of them shall protect the image of the rest of the members which will not be possible in the presence of a mental illness (Sue, as cited in Hylton, 2008). The view of mental illness as a social stigma has got to do with this. Scholars in the United States stated that Asians are very particular about “saving face” than expressing their true emotions “to preserve the public appearance of the patient and family for the sake of community propriety” (“Cultural Factors,” n.d.). As a consequence, many of the Asian descendants in the US manifest mental pressures through physical signs like hypertension, headache, and other cardiovascular diseases (“Cultural Factors,” n.d.; Ho et al, 2002, pp. 36-37). These assumptions were also observed in some of the studies focusing on Asian immigrants in New Zealand. Key factors affecting mental health among Asian migrants. In a study by Kramer, Kwong, Lee, & Chung (2002), Asian migrants living in the United States showed a pattern of characteristics that were said to affect their mental health and service use. Kramer et al. (2002), and Funk, Drew, and Saraceno (2009) agree that difference in language, religious beliefs and spirituality, age, gender, and unemployment contribute to the inequalities in Asian immigrants’ mental health. Karlsen and Nazroo (2002) pointed out that racial discrimination also adds to the risk of becoming mental ill. Other studies, on the other hand, presented instances wherein the factors mentioned did not only lead to mental illness among the migrants but also caused interruptions in their physical, emotional, social, and economical health and well being (Krieger, 1990; Krieger & Sidney, 1996; Williams, Bhopal, & Hunt, 1994; Steffen & Bowden, 2006; Williams & Hunt, 1997). Language. Language is one way of expressing one’s ideas and feelings. Although there are many ways to communicate, differences in language result to difficulties in maintaining healthy relationships with other people (Abe-Kim et al., 2007; Bhugra & Jones, 2001; Garland et al., 2005). In Ho et al.’s (2002) study, self reports accomplished by Asian migrants in 2001 revealed that regardless of the time of stay, members of the ethnic group settling in New Zealand continue to use varied languages except from English and Māori, the language of native New Zealanders, which is believed to be one of the reasons why misunderstandings between migrants and non-migrants continue to persist in New Zealand (HRC, n.d.). Other significant patterns show that “the proportions of their adult populations who could not speak English and Māori increase with age” (Ho et al., 2002, p. 12). Additionally, the rate of language differences also increases among recent immigrants. One study, on the other hand, did not include language as one of the key factors since the authors identified close correlations between ethnicity and language. Instead treating language and ethnicity as separate factors, Hu et al. (1991) counted both as one. Age. Many scholars agree that age is one of the key factors that can identify the vulnerability of person or group of persons to mental health conditions and other behaviors. While it helps identify the strengths of each group, age, at the same time, serves as an indicator of the special health needs of the individuals classified to belong to a specific age category and developmental stage, or whether a person is a child, an adolescent, an adult, or an elder. For example, people aged 18 to 24 years old were found to be more prone to alcohol or drug addiction than the children of earlier years or those who are in the later stages in life (Hu et al., 1991). In another case, Nazroo found that young descendants of Carribean, Indian, or Paskitani individuals aged below 11 years old who were born in the United Kingdom developed anxiety, depression, and suicidal thoughts at a rate higher than any young members of the other ethnic groups put under study (as cited in Bhugra & Jones, 2001, p. 219). Kramer and colleagues (2002), however, claimed otherwise as they cited that the younger members of a group have the highest adaptability rate; and hence, will experience lesser mental difficulties in adjusting with the new culture outside their ethnicity -- an assertion supported by McKenzie and associates in a study they conducted in Britain last 2008. They found that the older the people migrate, the less likely they will adapt to changes; and hence, a higher sensitivity to stresses which can lead to unhealthy mental responses (as cited in Kalathill, 2008). Access to mental health care services was also found to be negatively correlated with increased age (Kalathill, 2008). Gender. The World Health Organization (n.d.) believes that “gender is a critical determinant of mental health and mental illness.” Like age, gender is considered as an important aspect in the process of migration since it is one factor that may indicate one’s ability to cope with the changes that come with it. Aside from the inherent vulnerabilities of the female population in different settings, researches have concentrated in uncovering the reasons behind the women’s more unique responses in going through life-changing processes such as migration. Evidences showed that they face and experience more complex cases of adjustments than their male counterparts in adapting with the places they have migrated to. Yet, with the opportunities that the current era has in store for the female gender (e.g. equal access to education, introduction to the workforce), the process of migration is now thought to be a positive experience to women. Several studies included in Pedraza’s (1991) review also revealed so. Pedraza (1991) as well noted that in some cases, women subjects responded better to migration than the men as they gain independence in the land of the foreign. While figures validate these assumptions, reports about migrants being abused due to the beliefs about the superiority or inferiority of a gender have never completely perished; making the female gender more vulnerable to inequalities in health. As a matter of fact, a study conducted in 1999 involving Chinese migrants revealed that women, indeed, were more predisposed to minor mental disorders such as anxiety, depression, and panic disorders mainly due to their gender (Abbott, Wong, Williams, Au, & Young, 1999). Employment. While recent upsurge in migration is said to be caused by the opportunities in employment and education offered by different migration destinations, researchers from the 1980s found that “recent movers typically have the lowest status” and spend at least a generation or two before their lives improve and then move up to the next level of the social strata (Brenner, 1982, p. 75). Employment and the kind of work of the migrants, in turn, play a big role in the determination of such status. International authorities (e.g. WHO and the United Nations) advocating the standards of health have established that socioeconomic backgrounds, determined by employment and occupational status, income, education, living environment, and others, are good indicators of health. These, too, are factors that impose the people’s capabilities in achieving their optimal well being whether they are migrants or not. In his report, Brenner (1982) implied that the “social status and economic development” will be improved or diminished by employment and unemployment, respectively. He stated that in the existing studies, many scholars agree “that the level of a country’s socioeconomic development is highly predictive of its population’s life span and, partly by derivation, its mortality rate at nearly all ages” as “inverse relationships between socioeconomic status, however defined, and morbidity and mortality continue to prevail” (Brenner, 1982, pp. 75-76). Abbott et al. (1999), Kramer et al. (2002), and Karlsen and Nazroo (2002), among others, believe so, too. Religion and Spirituality. There are already a vast number of studies focused at identifying the impact of religion, religious practices and beliefs to people’s mental health, mental health care practices, and the use of modern mental health services (Paley, 2008; Bhugra & Becker, 2005; King, Weich, Nazroo, & Blizard, 2006; Owen & Khalil, 2007). Bhugra and Becker (2005) pointed out that even in migration, people continue to become greatly influenced by the beliefs and traditions of their respective cultures and religions because “religious rituals and beliefs, even if not followed as an adult, make up a key component of an individual’s cultural identity” and serve as the bases of people’s actions towards and perceptions about things or ideas (p. 21). Accordingly, the religious and spiritual beliefs and practices observed by people, whether immigrants and non-immigrants, may impose considerable effects on people’s recognition of signs and symptoms and the presence of mental illness, its treatments, and their views towards it. In another context, problems on the lack of access to religion and religious practices for immigrants, especially in conjunction with the other sociocultural factors of the process of migration, “can lead to poor self-esteem, an inability to adjust, and poor physical and mental health” (Bhugra & Becker, 2005, p. 23). Scholars Merchant, Gilbert and Moss (2008), even also attempted to explain how adherence to a certain religion and its practices may affect the use of mental health services which may also guide health care practitioners in the treatment process of individuals with different religious cultures. Studies involving Asian communities in New Zealand acknowledge the variance of religious affiliations of the migrants. Some even declared that they have no religion (Ho et al., 2002). Nevertheless, a study by Greenwood, Hussain, & Burns (2000) raised a concern about the term ‘Asian’ being problematic as the term ‘Asian,’ according to them, is a generalized name for an ethnic group which is made up of populations with basically different sociocultural background and religiosity (e.g. Chinese, Filipinos, Indians, etc.) (Greenwood et al., 2000). Racism and racial discrimination. The differences in traits, beliefs, language, and even in manners become more apparent as people of unlike cultures coexist in an area. Instances of racism, racial discrimination and abuse can present themselves in place of the gaps created as a result of the apparent distinctions between individuals or groups of different ethnicity. In an article review of a book about racism and mental health, Crown, Oyebode, and Ramsay (2003) reviewed how the author appreciated the impact of racism to society. This, as cited by them, arose from the “crude distinctions between ‘us’ and ‘them’” by people (Crown et al., 2003, p. 472). Despite the modernization brought by the current era, authorities in New Zealand support that racism, racial discrimination, harassment, and abuse continue to persist in the country; markedly affecting the less privileged, the newcomers, and even those who have stayed longer in terms of opportunities for employment, education, housing and other forms of social functions and needs. These events necessitate them to create policies that can cater to the health and welfare needs of the specific populations affected by emerging circumstances such as poor access to health care (HRC, n.d). Theories. There are several theories proposed to explain the various aspects surrounding racism and mental health which may be considered and even employed in the practice of mental health care. In a summary, Thompson and Neville (1999) presented the Racial Identity Theory, Systems-oriented theories, Discourse Theory, and the Personal theories of Reality and of Therapeutic change to emphasize “how racism has both ideological and structural components and perpetuates itself recursively at the macro- (e.g., group institution) and micro-levels (e.g., interpersonal)” of human living. Hence, each may pose a significant reason why migrants do or do not use mental health services within the contexts in question. The first of the theories suggested by Janet Helms, the racial identity theory or also called as the Color Theory, was initially made to explain the structural differences and similarities between people of the White and Black races. Nevertheless, the theory points out that people of the same “race” share standardized beliefs, qualities and attitudes that affect their views on certain matters (e.g., racism and mental health) despite the presence of factors that create innate diversity in each personality; hence, a racial identity. This, as cited by Thompson and Neville (1999), will be used by individuals as a person “negotiates racial situations and/or defines self and others” (p. 205). Another theory is the Systems Oriented -- which has four sub-theories. Generally, these four theories propose the same point: that human beings’ personal systems are always in the interaction with their environments, and vice versa; and experts have been using this idea in identifying how racism is viewed in each race and how racism affects the ethnic group members’ behaviors (Thompson & Neville, 1999, p. 176). The dissimilarities in the sub-theories, however, present themselves in the context of how the variables affect each other. The Discourse Theory, on the other hand, suggests that it is not only important for the members of the minority groups to speak the language of the dominant culture in an area to properly express themselves in their everyday ordeals. Instead, discourse theorists see the deeper importance of language to people, especially to the migrants, in voicing “the various realities of one’s encounters” because with it comes the determination of their “own identity and subjectivity” (Thompson & Neville, 1999, p. 181). Finally, the Personal theories view the person as a separate entity from a general population of people forming communities and sharing the same culture. As the name suggests, these theories denote that every person has his or her isolated views on reality, knowing, and change because the central concerns of their daily experiences always have the tendency to cover their “personal welfare” only (Thompson & Neville, 1999, pp. 203-204). Rationale of the Study. With the aid of this literature review, this research will present collected data on the relationships between migration, race and other significant factors, and mental health and the use of services among Asian migrants in the different locations in New Zealand; and compare it against the data and knowledge established in the prior researches of the same kind, especially those executed in developed countries like the US and the United Kingdom, among others, where migration is highly prevalent. This is done to point out similarities and differences in the relevant areas of concern. Methodology A vast number of researches have already focused on the relationship of migration, race, and mental health and services use, ranging over a wide span of time and covering mostly the places where there is high prevalence of migration. As it has been emphasized earlier, the multicultural characteristic of New Zealand’s population makes this research appropriate in supporting or refuting established facts about migration, mental health, and the use of services among the Asian immigrants with regard to their ethnicity. To do so, this research will mainly utilize a descriptive quantitative design. According to Taylor (2005), this method will pave way to the making of objective conclusions about the relationships among the variables revolving the phenomena in question. By conducting structured interviews and using pretested survey-type questionnaires to gather the data needed, “personal contacts with subjects are kept at a minimum” (Taylor, 2005, p. 91), and thus, biases will be prevented. These methods, too, are deemed beneficial in effectively interpreting and analyzing the collected data from Asian migrants in New Zealand about the prevalence and the experiences involved in the process of migration and their dealings affecting their mental health and services use which serve as the main purpose of this study. Nevertheless, the need to undergo the complex processes of manipulating the collected data are hailed unnecessary as this research will only serve to describe and report on the observed trends concerning the variables of this study. Still, the minimal integration of the qualitative method is nonetheless essential since information on how the participants view mental health and illness at the personal level is also needed to completely relate the data vital to the fulfillment of the purpose of this research. It is believed that the use of a quantitative method alone will be inefficient in serving the purpose since quantitative methods only follow a non-contextual approach of data interpretation. Participants This research will implement a non-probability convenience sampling method in selecting a research sample of 200 Asian migrants living in the different locations within New Zealand as the method is effective in “demonstrating that a particular trait exists in the population” (Castillo, 2009). The national censuses of 2001 and 2006 and the literature review of Ho et al. (2002) will be used to identify the individuals and groups which will be subjected to study. Equal number of members from the five major ethnic groups (Chinese, Indian, Korean, Filipinos and the Japanese) making up the overall Asian ethnicity in New Zealand will be determined through these sources. The participants will be given the pretested questionnaires and be subjected to a structured interview as the primary steps in collecting the data for interpretation (Appendix C). The length of the immigrants’ stay will also matter; hence, the need to further divide the samples into recent and long-term groups of immigrants. “Recent immigrants refer to people who were born overseas and have been resident in New Zealand for less than 10 years” (Ho et al., 2002); while long-term immigrants are those who have been in the country for more than 10 years. Please see Appendix A for the sample size determination. Materials > Digital voice recorders > Calculators or statistical softwares > List of the Asian migrant samples, and their addresses; grouped according to the place of origin. > Research proposal letter outlining the purpose of and procedures needed in accomplishing the research. > Informed consent forms (Appendix B). The signed forms indicate that participants give full consent in the actions taken relevant in the research process. With this also comes the confidence of the research subjects that confidentiality will be maintained. > Questionnaire (Appendix C). The questionnaire will be used in collecting the data needed about the participants and their experiences regarding migration, their view of mental health, their patterns of mental health services use, and the factors affecting these. Procedure Pre-testing. Prior to letting the actual research participant utilize the questionnaires created for the research paper, a pretesting of the questionnaire was done with the collaboration of two individuals with an Asian descent and who have experiences and knowledge about human services to distinguish the particular areas of the questionnaire which may need improvement to promote effective turnout of data for the paper and diminish bias as well as leading questions. Although the questionnaire received a general approval, a number of minor adjustments on the format of the questions recommended by the testers were considered. Consulting the literature review Mental Health Issues for Asians in New Zealand was also one of the recommendations in determining relevant areas of concern which must be emphasized in the formulation of the questions. Ethical Approval. The researchers will seek for the approval of the University of Canterbury Human Ethics Committee (HEC). This committee “reviews all proposals that are conducted within the University or outside of the University that do not involve an educational setting for research” (HEC, n.d.). This will be done to ensure that all the steps undertaken are within the bounds of logical, ethical, and cultural reason. The respective representatives of the chosen population will also be approached for guidance before, during, and after the paper is accomplished. The participants will also be asked to sign the informed consent forms. Confidentiality/Anonymity. Each participant will be randomly given the questionnaire with prescribed characters. Upon receiving the questionnaires and at the start of the structured interviews, these prescribed characters will be determined only by the assigned interviewer and the participant. The characters, which serve as the personal codes of the participants throughout the study, will be recorded in the master list which will then be kept from the knowledge of the public. This will ensure the participants that any relevant data not needed in the paper will not be disclosed to maintain confidentiality and protect their safety. Measures. The identification of the place of origin is vital in finding relevant trends within the Asian ethnicity groups. The length of stay is also important in further examining patterns of mental health, mental health services use, and the factors affecting these within the subgroups making up the community of Asian immigrants in New Zealand. Quantification through tabulation and percentage interpretation will be used. The dependent variables like mental health service use and the development of mental health illness will be based through the factors established in the literature review, and which will be ranked for further interpretation. The importance and weight of the independent variables and covariates such as the preferred health practices, the length of stay, and the membership to one specific ethnicity within the Asian ethnicity will also be specifically stressed. Withal, the open-ended questions will provide in-depth explanations why specific trends exist. Results Quantitative components. The quantitative data collected about the origin, the frequency of the mental health services use, and the preferred health practices will represent an important data source that will serve as the foundation of the research paper. With the figures that the questionnaires and the structured interviews will come up with, relevant relations on the prevalence of these variables with the factors causing them will be distinguished. Bivariate and multivariate methods of analysis will be used in achieving this effort of presenting existing relationships between two or more variables. These processes will aid in accomplishing the goals which were set prior to the conduction of the actual research. With the migrants’ identification of what they perceive to be the cause of any negative inclinations of the associated events and circumstances with regard to migration, mental health and their ethnicity, this paper will not only achieve its purpose but also aid in the identification of proper interventions to correct or manipulate the variables that have led to some unfavorable conditions affecting ultimately the mental health and the use of these Asian migrants of available mental health services. Qualitative questions. Since several open-ended questions on the migrants’ view of mental health and their perception about the frequency of their use of mental health services are included in the questionnaire and structured interview questions, the research will render a set of data which will allow the researchers to take a deeper examination on why specific turnouts of data prevail. Unusual information that has not been encountered by previous researches may also be recognized and presented. Discussion Limitations. A number of limitations have been identified in the conduction of this research. Firstly, the turnout of the identified sample size (200) depends on several factors. Of the predetermined respondents, an unidentified number can always refuse to participate with the research process despite provisions of sufficient information about confidentiality and safety; and hence, may negatively affect the validity or reliability and the generalizability of the overall research paper as a representative of the wider population. Another problem that may affect the data collected involves the context of language. Misunderstanding of the questions or inability to speak language can serve as considerable barriers that will hinder the purpose of the research paper as the identified data. Factors like distance, time and cost also play a big role in the ability to gather intended information with respect to the scheduled activities for the research process. References Abe-Kim, J., Takeuchi, D. T., Hong, S., Zane, N., Sue, S., Spencer, M. S., Appel, H., Nicdao, E., & Alegria, M. (2007, January). 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Samples per group or ethnicity according to length of stay = 40 / 2 (recent and long-term immigrants) = 20 samples of recent immigrants per group or ethnicity and 20 samples of long-term immigrants per group or ethnicity Appendix B Appendix C Questionnaire Please check the box beside the choice/s that represent/s your answer, as well as the essay type and the follow-up questions provided. Thank you. *Gender: [ ] Male [ ] Female *Length of stay: [ ] Less than 10 years [ ] More than 10 years 1. What is your origin in Asia? [ ] China [ ] India [ ] Korea [ ] Cambodia [ ] Vietnamese [ ] Others (please specify): ________ 2. What is mental health to you? Is it important? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 3. How frequently do you use the mental health services? [ ] Often [ ] Seldom [ ] Have not used any of them 4. Do you think that Asian immigrants only rarely use mental health services offered in New Zealand? If you answered YES, please proceed to question number 5. If you answered NO, please skip question number 5 and proceed to question number 6. [ ] Yes [ ] No Why?_________________________________________________________________ Note: You can choose more than one (1) answer in the following questions. 5. What factors do you think have contributed to this trend? * Socioeconomic Factors [ ] Education [ ] Employment [ ] Location and housing [ ] Poverty * Sociocultural Factors [ ] Racism [ ] Culture [ ] Language * Biological Factors [ ] being Female [ ] being Male [ ] Old age [ ] Physical hindrances (handicap) 6. What factors do you think contribute greatly to the development of mental health illness among Asian migrants in New Zealand? * Socioeconomic Factors [ ] Education [ ] Employment [ ] Location and housing [ ] Poverty * Sociocultural Factors [ ] Racism [ ] Culture [ ] Language * Biological Factors [ ] being Female [ ] being Male [ ] being a student [ ] Old age [ ] Physical hindrances (handicap) 7. What do you think should the government of New Zealand do to encourage use of mental health services among Asian immigrants? [ ] Increase public support for cultural diversity [ ] Provide extensive information before and after migration about resources and opportunities (e.g. employment, housing, schooling, language training, social and cultural relations) of host society (New Zealand) [ ] Improve access to English language education [ ] Encourage and support the development of community support programmes (e.g. employment, housing, schooling, language training, social and cultural relations) [ ] Promote the development of educational materials and professional interpreter services [ ] Increase service providers’ awareness of Asian cultural issues (cultural beliefs, interpretation of mental illness and well being, help-seeking patterns, etc.) [ ] Others (Please specify): ________________________________________________ 8. What health practices do you prefer in treating mental health illnesses? [ ] Traditional, alternative health practice common within ethnic/racial group [ ] Mental health services (e.g., psychotherapy, medical approach) Attn: Several terms and idea indicated in questionnaire are taken from Ho, E., Au, S., Bedford., C. & Cooper, J. (2002, November). Mental health issues for Asians in New Zealand: a literature review. Wellington, NZ: Mental Health Commission. Read More