Twelve women agreed to participate and were interviewed. Five participants volunteered after reading the study flyer, the rest were recruited through snowballing. Of the 12 interviews, eight were conducted with the assistance of the bi-lingual researcher T. N. All interviews were conducted face-to-face. Ten interviews were conducted in the participant’s home and two in an interview room at Monash University. The characteristics of the participants are shown in tables 1 and 2. Most were in their late fifties, postmenopausal and half of the participants were married. Seven women had completed their primary education and three women were engaged in paid employment.
[Table 1 near here]
[Table 2 near here]
Four themes emerged from the data: Menopausal experiences - It’s natural, it’s normal; Influences of culture on the experience of menopause; Barriers for menopause-related health literacy; and Barriers and enablers for optimal menopause-related health care.
Menopausal experiences - It’s natural, it’s normal
All participants described menopause and their menopausal experience as a natural transition and any symptoms they had were either minimised or simply accepted as part of this phase of life. Many respondents mentioned not understanding what the concerns were and why anyone would actually talk much about menopause.
I think is natural so [laughs] … nothing happens to my health, so everything is normal. (Hung - translated)
I feel like we don’t need to do anything, and just accept it and its normal… I didn’t worry [about menopause] just because I talked to other friends who used to experience it. And they told me already about it, that’s why I think, that’s normal. (Hien - translated)
In fact, most participants who experienced emotional symptoms that they attributed to menopause laughed about how they affected them.
I feel uneasy and very easy to get angry with someone. If they talk to me [laughs heartily, keeps laughing and then laughingly says] leave me alone don’t talk to me too much. (Tara)
If they [people] do something, I not feel like that, and I angry with them. I have a bad temper [laughs]. Now it’s okay …but sometimes I [still] get angry with people for no reason. (Hanh)
Last month my husband said something and I feel very angry. I was in the kitchen and I threw dishes on the floor and broke them all [laughing.] (Thi - translated)
The underlying belief that menopause is a normal phase of life is further reflected in the self-care strategies participants employed. Exercise, dietary changes, and traditional herbs were mainly used to manage any symptoms and menopausal health.
I drink the water. Sometimes I just go out for exercise [and] I just drink tea, some, some tea some herb. That’s what I learned and I apply [laughs]. (Hanna)
Some people advised me to go to the Chinese herbalist so then I take some medicine from them just like a bag Chinese herbal … [and] I feel better. We use some flower I don’t know what is it [called] and, I will cook and boil and then we extract the water and we drink [it]. (Hanh)
I don’t know we have some medic… um traditional herbs … and I prefer that, not the medication. (Tien - translated)
The perception of menopause as normal and transient was reinforced by advice and recommendations given by the Vietnamese-speaking GPs participants had consulted, most of whom did not offer any medical intervention.
One, one day I asked my female doctor and they, she, I remember she said to me that’s normal, every woman has to go through the, the time. Some woman got difficulty [time], some woman get easy [time]. (Hanna)
The doctor said that when you have irregular period … last for like 1, 1 or 2 years and it’s fine. (Hung - translated)
On the occasions where GPs prescribed medications, participants were reluctant to take them. This applied equally to medication for menopause-related symptoms and to other medications such as analgesia and sleeping tablets. Their reluctance was based on fears of unwanted side effects and a belief that the medication was not necessary.
I go to see the doctor and the doctor said that everything functioned well so she asked me about my age and she thinks that maybe I have menopause and she prescribed some medication for me, [but] I didn’t take it, and I didn’t care for it … (Linh - translated)
I went to the family doctor and I tell him about like it is difficult to sleep and he gives me some medication and when I take the medication I sleep so well. But I think if I take the medication it will reduce my memory and it makes the symptoms more severe that’s why I didn’t use it. (Tien—translated)
Influence of culture on the experiences of menopause
Participants were asked about how they thought their culture of origin affected their experience of menopause. They did not elaborate whether there are cultural differences in perceptions of menopause between Australia and Vietnam because they were unaware of how people born in Australia view menopause. However, participants’ reflections indicated that their experience of menopause was influenced by both Vietnamese and Australian culture.
Most participants reported that their personal experiences are similar to their Vietnamese contemporaries; they seek support from friends and family and mainly use traditional therapies to manage any bothersome menopausal symptoms.
When I used to work in Vietnam, I used to work in a bank as the bank officer and I had some colleagues, some were younger and some were older than me and some of them they experienced menopause and then they talked to me about the experience. Now I know what will happen and that’s why I find it easy to overcome, that I don’t have any shock. A few years ago, I had a friend who is younger than me and she got menopause some symptoms, and I can advise her and … [I said] it is common don’t worry about it. (Hien - translated)
I also talk to some friends and um and just to ask whether they have similar symptoms. And I found that people have different symptoms of menopause. (Minh - translated)
In Vietnam the people use Chinese herbal Vietnamese herbal to treat with the menopause. (Hanh)
Participants reflected that there are few health services and little health information for women in Vietnam, particularly menopause-related health care and health information. This was thought to be partially due to a lack of government policies and health care funding.
I don’t know if now they have changed any, but I think that they not um concentrate on the heal … the people’s health. They don’t talk any about menopause, yeah, … they don’t think that this is important with them the woman’s um you, you have to take care of yourself. (Tara)
… there is no more, not many information. (Thi - translated)
Hanh, reflected on how the lack of health promotion programs in Vietnam influences people’s health behaviour. She believed that this is why people in Vietnam only seek medical care for illnesses.
Mm, most of Vietnamese they didn’t worry about the future what happen in future … just when they get pain or something, something very strange in their body. But they [Vietnamese-born people] didn’t worry about the… that new that sickness that will happen to them. Like most of people just feel pain, feel something wrong with the body [and then] go to GP straight away. [They] no worry about the future or worry about information about that sickness or something … most Vietnamese people doesn’t worry about their health. (Hanh)
All participants had embraced the Australian health care system by attending cervical and breast-screening programs which are offered free of charge to women. Some sought information from their GPs about menopause-related symptoms.
I will follow the recommendation and guidelines in Australia, the medical um Western approach. I hope that I can, when the symptoms are more severe I will go the family doctor and ask her advice how to improve them. (Quy - translated)
Barriers for menopause-related health literacy
When asked about when, why and how participants sought information about menopause it was apparent most used the experiences of their peers or female relative as their main source of information.
I asked my friends and some elders who know about that, but they [said] that’s normal every women experiences that. (Thi - translated)
I didn’t search for any information just talking to friends and they share some experience. (Tien - translated)
Only some searched for menopause-related health information from other sources. Those who did accessed it from a Vietnamese language website or the local library. Both sources had perceived limitations. The internet only offered general health information and the menopause-related books in the library were in English and participants reported that their ability to understand and apply the knowledge was limited.
I am mh … not very well in English that’s why I checked reading about information. When this one I understand and I apply for me and this one I don’t understand so I leave it. (Hanna)
In addition to the apparent difficulties in accessing and understanding information, participants showed limited ability to evaluate the health-related information they had accessed. Information was judged based on whether it suited the individual’s life philosophy as demonstrated by Tara.
I think that everyone has to … to know that [what] food is delicious or not. [You] have to read the book to know is it a good book or not. So I think that people who recommend to me but I still believe in the my [looking for word] um, um my thinking, my reading and my trusting. Someone who drink water or drink orange [juice] will know what the different taste. If we not drink it, we don’t know is good or is bad. You could not say before … yourself [have] experienced [it].
Appraising health information offered on the internet poses particular challenges for individuals with low health literacy as it is difficult to judge the quality of the information and the credibility of its source.
Participants who had accessed information from Vietnamese language websites and from YouTube were asked how they knew that these sources were trustworthy. The websites were judged as reliable because they were hosted by the Vietnamese government. Although the information gathered from YouTube had been published by lay people, some participants had implemented the recommendations. They were aware that it was difficult to determine the reliability of this source. But because the recommendation they had followed related to eating specific foods, they believed that this could not be dangerous and therefore judged it as safe as indicted by Tien:
… like it’s just food. It’s not harmful it’s … you can try. (translated)
When asked whether the information was easy to use and relevant to participants’ values Tara commented:
If something [is] useful I write it down and follow it if I can. And if not, if I could not follow it maybe just a little bit follow then … [laughs]
A follow up question to ascertain what additional sources of information participants accessed revealed that most identified their GP as a trustworthy and reliable source of information and consulted her or him when they experienced health concerns which they believed were menopause-related.
Barriers and enablers for optimal menopause-related health care
Although most participants perceived that menopause-related health care is not a priority in Vietnam and learned about menopause from female family members or friends, they had taken up the opportunities for health screening offered by the Australian health care system. Some had consulted their Vietnamese-speaking GP about menstrual changes and others used consultations for non-menopause-related health problems to ask about menopause.
I go to the family doctor not for the menopause purpose, I just wanted to have a screening test of the not ovarian, it just the … pap test, yeah and then by the way I asked the family doctor, I only have worries about whether if we have menopause after 50 years old whether it is good for your health. And she said it is okay if you are 48, the normal range. That is why she only answered the question this one, and she didn’t give any further information. (Minh - translated)
Participants expressed regret that GPs did not discuss the implications of menopause for their physical and emotional health. They reported that in Vietnam doctors have a high standing in the community and they were therefore ‘shy’ about asking their GPs menopause-related questions. To allow Vietnamese-born women to be educated about menopause participants suggested that GPs need to initiate conversations about menopause.
I think the, the doctor have to welcome, has to ask them first, invite question. They [women] silent, in you know in my culture. We only respect, high respect doctor, something like that. Maybe they [doctors] decide to ask her [patient] about that [menopause], they say okay, okay, they just say yeah, yeah, yeah they not show, show emotion like the emotion or they not show something, they, they keep inside. Like me they [do] not ask important questions with [the] doctor, or they don’t want to answer any questions. And they [women] shy and [that’s the] reason why women that were born in Vietnam are unlikely to come out and straight up [say or ask] what they need and what they want and what worries them. That’s the point, I think the main point. (Hanna)
She [the doctor] didn’t give any further information. I would hope to receive the advice from the doctor, she explains further about the symptoms, the problems, the all the health problems as well, not only menopause and um, give advice what to do but actually like according to our Asian culture so [but] we are more likely to be shy and the doctor just don’t say, so the doctor should come forward with the information and not wait for the person to ask. (Minh - translated)
Participants described their preference to consult with female health care practitioners and the difficulties in finding a female Vietnamese-speaking GP.
No, I will not trust a male doctor because I prefer a female doctor to check over my general health. (Xuan—translated)
… but actually, he is a man and off course he is Vietnamese so he can understand what I said. But he is a man so it’s difficult for me to share, share some woman’s problems. So I am looking for a female doctor who can speak Vietnamese, but it’s hard. (Linh—translated)
Many participants described their GPs as being time poor and rushed and some even felt that they were only interested in writing a prescription and were not inviting questions.
… to tell you the truth that is my, the GP are not help much because they have less time for any patient. Ah … they just have about 5 minutes or 10 minutes for one patient and so that’s not enough time for us to ask anything. They just check, uh … how do you feel and she writes a prescription. (Tara)
The doctor is seemingly busy so that’s why I don’t, I was so shy to ask more questions. (Minh—translated)
Finally, language competency was the most commonly identified barrier for access to health care. Eight of the 12 participants were unable to converse in English and the four remaining participants recognised the limitations in their English language proficiency and as a result also chose Vietnamese-speaking GPs.
I think all, all Vietnamese especially Vietnamese no speak English, because we go, normally, we go to the Vietnamese doctor. And she can … she check with us, [in] my, my language. (Hanna)
One participant recounted her experience of having a mammogram. Because she was able to follow the simple mammogram procedural instructions the health practitioner assumed that she also understood the more complex follow-up instructions. However, this was not the case and she felt inadequately informed about what she was expected to do next. The language barrier theme was recurring and anecdotes highlighted how it hampered access to optimal care.
Last time when I went to the hospital and my children took me there she [daughter] just helped her with the administration information and with the officer there. And when I go inside [clinical room] they just stay outside and I work with the doctor and luckily it’s a female doctor, and um cause she said to me you can take of your coat and I understand it and sometimes she said that like just sit uh, sit close to the machine or something she just helped me to do this, so I think she [health care practitioner] maybe [think] she don’t need interpretation because of that. But the limitation is, I just can have um a medical check-up of my body but when I want to ask information about me, I don’t understand English, so yeah that’s the problem. (Linh)