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Acculturative Stress in Filipino Migrant PDF
Acculturative Stress in Filipino Migrant PDF
To cite this article: International Journal of Culture and Mental Health (2013): Acculturative
stress in Filipino migrants with functional English: implications for health promotion, International
Journal of Culture and Mental Health, DOI: 10.1080/17542863.2013.812131
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International Journal of Culture and Mental Health, 2013
http://dx.doi.org/10.1080/17542863.2013.812131
Introduction
Migrants experience multiple simultaneous changes when they settle in a new
country, which can be challenging to their health and family relationships. This often
requires new settlers to harness both internal and external resources as they adapt to
a new cultural milieu. The adjustment that migrants experience, and the ongoing
interactions with the dominant paradigm of their host country, is termed accultura-
tion (Berry, 1997). In the process of this adjustment, conflicts may arise within the
person, resulting in a negative psychological and emotional state known as
acculturative stress (Belizaire & Fuertes, 2011; Berry, 1997). Immigrants with higher
levels of adaptive coping experience less acculturative stress and report higher
health-related quality of life (Berry, 1997). Published studies have also shown that
acculturative stress has a negative impact on both physical (Hubert, Snider, &
Winkleby, 2005; Jasso, Massey, Rosenzweig, & Smith, 2004) and mental health
(Hovey, 2000a; Wrobel, Farrag, & Hymes, 2009) and has been linked with the
development of chronic diseases (Finch, Hummer, Kol, & Vega, 2001), lower self-
rated health (Finch & Vega, 2003), depressive symptoms and suicide ideation
(Hovey, 2000a; Wrobel et al., 2009).
Although the lack of language skills of the host country is a significant
contributing factor in mediating the experience of acculturative stress (Spoonley,
Peace, Butcher, & O’Neill, 2005), it is not the only determinant. Other contributing
factors include the motivation to migrate, culture-related issues, social support
systems, economic stress, perceived discrimination and racism (Berry, 1997). In a
recent study among Filipinos in Australia, Hannah and Lê, (2012) found that in
addition to language and communication barriers, area of origin in the Philippines,
the length of residency and mismatched expectations of healthcare hinder their
ability to access health services. Very few studies in Australia explore acculturative
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‘blended’ with the Western host culture to be almost invisible, being neither fully
Asian nor Western (Sanchez & Gaw, 2007). Hence, it is not surprising that there is
limited health research data on the Filipino population in Australia, despite the trend
of increasing migration. This is highlighted by a database search on migrant groups
to Australia described below.
In a Medline search using the three highest non-English migrant source countries
in Australia as keywords ‘Chinese’, ‘Vietnamese’ and ‘Filipino’ (truncated into
different spelling variations) plus ‘health’ and ‘Australia’ from 2000 to 2010 found
73 studies on the Chinese, 62 studies on the Vietnamese and 9 studies on the Filipinos,
which are summarized in Table 1. A key omission in the Australian literature is the
absence of focus beyond gender-based discrete issues, while the studies on the Chinese
and Vietnamese populations covered a broader range of physical and mental health
issues across different age groups. Given the trend of migration from the Philippines, a
wider focus on the health needs should be undertaken to reflect the current population
profile as demonstrated by the ABS data. The limited research provides opportunities
for more extensive studies, especially in an increasing migrant population group.
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D. Maneze et al.
Study Type of study Health focus Findings and conclusion
1 Carolan, M., Steele, C., & Margetts, H. Cross-sectional survey: 143 women with Knowledge about Filipino and Vietnamese women were
(2010). Knowledge of gestational gestational diabetes from Vietnamese, gestational diabetes found to have the least knowledge about
diabetes among a multi-ethnic cohort in Indian, Filipino and Caucasian (GDM) and food GDM and food values. English language
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Australia. Midwifery, 26(6), 579588. backgrounds. values. skills alone was not associated with
greater understanding of GDM.
2 Carolan, M., Steele, C., & Margetts, H. Cross-sectional survey. Same sample as Attitudes towards Filipino and Vietnamese were found to
(2010). Attitudes towards gestational Reference 1, administered with the gestational diabetes. value tight glucose control the least
diabetes among a multiethnic cohort in ‘Diabetes Attitude Scale’. because of lower education level
Australia. Journal of Clinical Nursing, suggesting lower understanding of
19(1718), 24462453. glycaemic control. English fluency was
not associated with higher valuing of
tight glucose control.
3 Small, R., Lumley, J., & Yelland, J. Interview-based study of 318 women Depression measured Less depression in Filipino women
(2003). Cross-cultural experiences of (107 Filipino) 69 months after birth to by the Edinburgh compared with the other two groups.
maternal depression: Associations and explore socio-demographic, obstetric Postnatal Depression Positive association between depression
contributing factors for Vietnamese, and postnatal health and support Scale. and migrating for marriage. Contributing
Turkish and Filipino immigrant women variables associated with maternal factors for depression among Filipinos
in Victoria, Australia. Ethnicity & depression. include isolation (homesickness) and
Health, 8(3), 189206. marital problems.
4 Small, R., Lumley, J., & Yelland, J. Interview-based study. Same sample as Depression and Vietnamese and Filipino women were
(2003). How useful is the concept of Reference 3, assessed for their physical somatisation of found to have low prevalence of
somatization in cross-cultural studies of and mental health using SF-36 and depression symptoms. depression and somatic symptoms.
maternal depression? A contribution depression scores (using Edinburgh
from the mothers in a New Country Postnatal Depression Scale).
(MINC) study. Journal of Psychosomatic
Obstetrics & Gynecology, 24(1), 4552.
5 Small, R., Yelland, J., Lumley, J., Brown, Interview-based study of 318 mothers Satisfaction with Lower satisfaction with the maternity
S., & Liamputtong, P. (2002). Immigrant six months after giving birth, about maternity care services. care services among Filipino women but
women’s views about care during labor maternity care experiences. were given the opportunity to visit ward
and birth: An Australian study of before operation and discuss options with
Vietnamese, Turkish and Filipino caregivers which was attributed to
women. Birth, 29(4), 266277. English language skills.
Table 1 (Continued )
Queensland. Australian and New Zealand mental health and illness. family ties and transition issues from a
Journal of Psychiatry, 36(5), 681687. collectivist to individualist society.
7 Thompson, S., Hartel, G., Manderson, Prospective follow-up survey of 346 Mental distress as Higher prevalence of mental distress
L., Woelz-Stirling, N., & Kelaher, M. Filipino women for potential predictors measured by the GHQ- among the study sample compared to
(2002). The mental health status of of psychological distress and changes 28. national survey data, but lower than
5
6 D. Maneze et al.
exacerbated by the cultural value of ‘hiya’, or saving face, which compels migrants to
keep the stresses within themselves and avoid airing their ‘dirty laundry’ in public
(Wolf, 1997). In addition, traditional health customs that may be observed in the
home country, especially during significant life events, such as childbirth, may not be
congruent with Western practices and may be a barrier to health seeking behaviour
(Small, Rice, Yelland, & Lumley, 1999; Stewart, Das, & Seibold, 1998). Furthermore,
as a consequence of migration, lifestyle acculturative adjustments such as dietary
changes are found to exacerbate the risk of chronic diseases like diabetes and
hypertension (Dela Cruz & Galang, 2008; Popkin, 1993).
There are reports in the literature that some of the Filipino ‘1.5 generation’
migrant children (those who were born in the host country or migrated at a very early
age) struggle with cultural identity (David & Okazaki, 2006) and experience familial
conflicts due to cultural differences between generations and intercultural values
changes (Portes & Rumbaut, 2001; Wolf, 1997). Migrant adolescents have difficulties
shuffling between cultures, leading to confusion and identity crisis (Kim, Brenner,
Liang, & Asay, 2003), which may have an adverse impact on their mental health and
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for social networking and possess very traditional views of marriage and family and
a distorted view of Filipino women as portrayed by media (Kelaher et al., 2001).
This image of Filipino women as ‘mail-order brides’ has created a negative
perception in this country and has stereotyped and stigmatised Filipino women in
Australia (Saroca, 2007). The pejorative image alienates and marginalises these
women and encompasses all Filipino women in Australia, regardless of how they
migrated, whether they have Australian or Filipino husbands or even how long they
have been married. This perceived stigma makes them feel judged even by their own
community, ashamed, isolated and unable to seek help (Saroca, 2007), which could
limit their visibility. The lack of social support among newly arrived migrants,
particularly those who arrived on spouse visas, is a contributing factor to
acculturative stress. In a study of postpartum depression among new immigrant
Filipino mothers in Australia, depression was found to be primarily brought about
by having marital problems and feeling unsupported (Small, Lumley, & Yelland,
2003). Access to professional counselling services was limited by cultural stigma,
strong reliance on religious coping and lack of knowledge of available services
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(Sanchez & Gaw, 2007). Stewart et al., in 1998, explored the postpartum experience
of 30 Filipino women in Brisbane, Australia, reporting that in addition to language
and communication problems, cultural differences in perinatal care were major issues
in the unsatisfactory childbirth experience. Similarly, a study by Small, Yelland,
Lumley, Brown and Liamputtong (2002) found that 61% of Filipino women rated
their maternity experience as less satisfactory and less positive because of the
caregivers’ attitude, which was perceived to be unhelpful, unfriendly and unkind.
They found that immigrant women were less likely to experience the maternity care
they wanted.
Self-rated English language proficiency may not be associated with an adequate
level of understanding of health issues. This is evidenced by the study of Carolan,
Steele and Margetts (2010) comparing a cohort of multiethnic women in Melbourne
regarding their knowledge of gestational diabetes mellitus (GDM) and food values.
They found that the small sample of Filipino women (n 13), despite having high
self-rated English skills, had the least knowledge and scored the lowest in attitude
toward seriousness of GDM, concluding that English language proficiency alone
does not equate to better comprehension of gestational diabetes.
In addition to many sources of acculturative stress in the new country, Filipino
women who married Australian men are also expected by their Filipino families
overseas to provide financial help. This cultural obligation can contribute to marital
conflicts and marriage breakdowns (Woelz-Stirling et al., 2000). The inability to
provide financial help to their family in the Philippines may cause feelings of anxiety
and inadequacy, leading to depression.
Abella, 2002). Pull factors for developed countries such as Australia include higher
income with overtime and penalty rates, better work conditions, technological
advancements and opportunity for family migration to counties with more stable
socio-politico-economic environments (Lorenzo, Galvez-Tan, Icamina, & Javier,
2007).
In a study of 32 Filipino migrants in Australia and New Zealand, the majority of
participants claimed they did not experience employment difficulties, yet 46%
commenced studies for a certificate, diploma or degree when reaching the host country
(Siar, 2011). This was attributed to the difficulties migrants experienced of being
gainfully employed in an occupation related to their previous education or training
upon arrival. Foreign credentials may not be recognised, resulting in a partial or
absolute failure of recognition of prior learning (Dean & Wilson, 2009). In Australia,
only 6.5% of skilled migrant professionals from the Philippines use their qualification
in their current employment (Hawthorne, 2003). The pressure to find employment
almost immediately is increased by changes to immigration policy, where social benefits
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are withheld in the first two years of settlement (Junankar & Mahuteau, 2005).
In general, migrants are not well informed about the local labour market or the
norms in obtaining a job, such as resume structure and interview techniques. This lackof
local knowledge may narrow their employment opportunities and limit them to less
favourable jobs, which may be high-pressured work with irregular hours, low salary or
limited job mobility, thus decreasing their job satisfaction (Junankar & Mahuteau,
2005). De Castro, Gee and Takeuchi (2008a) found in a study among Filipino
Americans that job-related stress and frustration had an adverse impact on the health
of new arrivals, lowering self-rated physical and mental health and leading to anxiety,
depression and suicidal ideation (De Castro, Rue, & Takeuchi, 2010). This finding is
consistent with the findings reported in an Australian study showing that those
immigrants who are underemployed, job mismatched or whose qualifications are not
needed for the job, have more mental health issues (Reid, 2012). In addition, experience
of discrimination within the workplace based on being Filipino is found to be associated
with occupation-related injury, illness and poorer health (De Castro et al., 2008b).
with functional English language are often unnoticed, thus overlooking the influence
of culture and its impact on health issues.
Acculturative stress is an established factor in the development of chronic illness
in immigrants. Among Filipinos, this is aggravated by socioeconomic pressures,
which influence prioritisation of economic and environmental needs over health
issues. Lifestyle changes such as the adoption of a Western diet exacerbate the
development of lifestyle diseases (Antecol & Bedard, 2006; Kandula, Kersey, &
Lurie, 2004), which necessitates a culturally relevant strategy that is acceptable to the
target population.
Immigration is in itself stressful and difficulty in acculturation has been included
in the Diagnostic and statistical manual of mental health IV TR, Axis IV, as an
example of a social environment stress factor (American Psychiatric Association,
2000) Chronic stress leads to depression and was a common finding in all three
Filipino population subgroups, independent of the host country (Finch & Vega, 2003;
Hovey, 2000b). The loss of social network upon migration intensifies isolation. Access
to social support from the community is found to enhance migrants’ well-being and
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adjustment and mitigates the effects of discrimination (Noh & Kaspar, 2003) but
often takes time to establish. Furthermore it has been observed that Filipinos
culturally tend to deny, ignore, somatize or tolerate emotional issues and rely on
spiritual healing because of strong religiosity (Sanchez & Gaw, 2007). Consequently,
there is low utilization of mental health services. Therefore, despite English language
skills in this population, culturally appropriate healthcare strategies are needed to
address cultural issues, reduce disparities and promote healthcare utilization.
Culturally competent health service policies and staff training have been used with
some success to reduce health inequities in and achieve better health outcomes for
migrant populations (Bischoff, 2006). In addition to philosophical strategies to
promote tolerance and cultural competence, there should be a focus on providing
migrants clear instructions on how to navigate the healthcare system and specify a
rationale for screening programs. Visual presentations among Filipinos may increase
the accessibility of key health information as well as looking towards cultural strategies
such as faith-based interventions to access vulnerable populations. Providing the use of
interpreters and translations in ethnic populations with host language facility may be
beneficial provided that these are offered without being patronizing or condescending.
Health promotion strategies will benefit from a focus on respect and tolerance from
health practitioners and flexibility in accommodating cultural practices.
It is also important that health promotion initiatives acknowledge both the
positive and negative aspects of migration and provide support for making cultural
transition, particularly when it affects health.
Increasingly it is recognised that to promote accessibility, acceptability and
appropriate healthcare interventions, these need to be tailored and targeted to the
local community. An example of a health promotion program that implemented
extensive cultural tailoring to increase breast and cervical cancer screenings among
Filipino women in Hawaii was designed by Fu et al. (2003). Several cultural-based
strategies were used, including taking the time to establish rapport by ‘obeying’ the
norms and protocols of social interactions of the Filipino culture, creating a ‘party’
atmosphere rather than an ‘education session’ to cater to the highly social nature of
the community and employing story-telling in the ‘lectures’ given by an educator
from the same culture and gender, who used a combination of dialects spoken by the
group. They also addressed logistics issues, such as providing transportation and
10 D. Maneze et al.
childcare. Proponents of the program attributed their success to the strategies used to
make the program culturally appropriate and sensitive to the target community. They
were able to educate and reach women who previously were not accessing services.
This can be successfully translated in the Australian setting given that the same
cultural issues are faced by Filipinas in this country.
Conclusion
The lack of host language skills is an important factor in inducing acculturative
stress among migrants. Nevertheless, it is not the only factor that brings about
acculturative stress. Other factors, such as motivation to migrate, economic issues,
social support, unemployment and underemployment, cultural differences, gender
stereotypes, perceived discrimination and racism, also contribute to acculturative
stress, which can affect mental and physical health.
Important in health promotion interventions for a multicultural community is
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Notes on contributors
Professor Patricia Mary Davidson is the Director of the Centre for Cardiovascular and
Chronic Care at the University of Technology, Sydney, and Professor of Cardiovascular
Research at St Vincent’s Hospital, Sydney. She is a Fellow of the Royal College of Nursing,
Australia, co-chair of the NSW Health Clinical Expert Reference Group for Cardiovascular
Disease, Immediate Past President of the Australasian Cardiovascular Nursing College,
Chairperson of the Cardiac Nursing Council of Cardiac Society of Australia and New
Zealand, Immediate Past Secretary of the International Nursing Doctoral Education, Counsel
General of the International Council on Women’s Health Issues (ICOWHI), and a Board
member of the National Heart Foundation (NSW).
Associate Professor Yenna Salamonson is the Director of Academic Workforce and Senior
Lecturer at the University of Western Sydney. She is a Clinical Nurse Specialist in Intensive
Care, High Dependency and Coronary Care units. Yenna’s research focuses on nursing
education, cardiovascular nursing and disease management, pharmacology and quantitative
research methods.
Dr Della Maneze, obtained her Doctorate of Medicine in the Philippines. She is currently a
PhD candidate at the University of Technology, Sydney and the Multicultural Health
Promotion Officer SWSLHD.
International Journal of Culture and Mental Health 11
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