Vietnam is an agrarian country with a rich history of its own culture despite influences from Chinese domination as well as French colonial rule. Immigration from Vietnam was rare prior to the Vietnam War. However, since that time large numbers of foreign-born Vietnamese have immigrated to the United States so that today they represent the fifth largest immigrant group (Fedstats, 2006).

It has been over 30 years since the first wave of an estimated 132,000 Vietnamese refugees settled in the U.S. after the fall of Saigon (now called Ho Chi Minh City) (Rutledge, 1992). The first influx of immigrants came to the Unites States between 1975 and 1977 settling in traditional gateway cities, such as San Francisco, Boston, Chicago, and New York (Rutledge, 1992). This first wave of post- Vietnam era immigrants was more likely to be educated and to speak English. The second wave of 127,000 refugees began in 1978 and was referred to as "boat people" due to fleeing their homeland in small wooden boats. The third wave of Vietnamese occurred as a result of the 1987 Amerasian Homecoming Act (Rutledge, 1992). Immigrants arriving in the United States after the first wave were more likely to have come from lower socioeconomic backgrounds, have fewer years of formal education and be less fluent in English (REFT, 2002; Tran & Yeo, 2004).

More recent immigrants have had a pattern of diffuse settlement throughout the United States. From 1990 to 2000, the number of immigrants from Vietnam increased by 82% with over half living in either California or Texas (Grieco, 2004; Yeo, Tran, Hikoyeda, & Hinton, 2001). In 2000, the majority of Latin American and Asian-born United States immigration were between the ages of 65 and 74; if this trend continues the older foreign-born immigrants will be primarily from Latin- America and Asia rather than from Europe (Grieco, 2004).

Quality of Life

Quality of life is often identified as synonymous with life satisfaction. In turn, life satisfaction is considered to be the most crucial subjective assessment of life quality by the individual (Ferrans & Powers, 1985; George & Bearon, 1980). Flanagan (1978, 1982), based upon an analysis of 6500 critical incidents, identified these dimensions as reflective of quality of life: 1) physical well-being; 2) relations with other people; 3) participation in social community and civic activities; 4) personal development and fulfillment; and 5) recreation..

Another view that is similar considers quality of life a modern counterpart to the "good life." The researchers consider measures of quality of life useful in depicting successful aging or certain patterns of aging (George & Bearon, 1980). George and Bearon suggested classifying quality of life instruments based on these four underlying dimensions, two subjective and two objective: 1) life satisfaction and related measures; 2) self-esteem and related measures; 3) general health and function status ; and 4) socioeconomic status. They emphasized both types of measurements should be used to assess quality of life.

A more recent concept in the quality of life literature is health-related quality of life (HRQOL), which corresponds to physical well-being, the first dimension identified by Flanagan. HRQOL refers to the physical, emotional, and social effect of health conditions (Coins, John, Hennessy, Denny, & Buchwald, 2006). This study focused on the broad conception of quality of life rather than HRQOL.

Purpose

The goal of this study was to gain understanding of the meaning of quality of life among female Vietnamese immigrants older than 55 years of age. Since there is no literal translation of the American concept of "Quality of Life," the term "good life" was used to represent Quality of Life in this study. The specific aims are to:

1. Compare the women's expectations of the "good life" with their perception of the "good life" at present.

2. Identify themes and categories which represent the "good life".

3. Identify satisfying and important aspects of the "good life".

4. Identify changes in the "good life" since leaving Vietnam.

5. Identify factors or behaviors which can improve the "good life".

6. Compare the domains derived from this ethnographic analysis of the "good life" to the Quality of Life domains identified by Flanagan (1978, 1982) as well as George and Bearon (1980).

METHOD

Design

An ethnographic approach was used to guide the process of data collection and analysis. The research protocol was approved by the university institutional review board and was conducted in accordance with established ethical research standards. The study consent form was translated from English to Vietnamese by one translator and then back translated from Vietnamese to English by another translator in order to verify congruence in the two consent documents.

Study participants (see Table 1) included thirty-three women between the ages of 56 and 85 (mean 68) residing in an urban conclave of a mid-size city in the mid-west. The majority of the women were legal permanent residents (94%), lived with a spouse or adult child (85%), arrived in the Unites States between 1991 and 1995 (51%), and came to the United States as immigrants sponsored by relatives (65%). There were few naturalized U.S. citizens (6%;) due to the language barrier.

Procedure

Network sampling methods were utilized to recruit study participants. Women were primarily recruited from members of the Vietnamese Senior Citizens Association and their interpersonal networks. Potential participants were contacted in person or by telephone regarding participation in the study. Women who were 55 years of age or younger were excluded from participation.

[TABLE 1 OMITTED]

Following informed consent procedures, one- to two-hour interviews were conducted in the home of the study informant. The first author, who is fluent in Chinese, and a Vietnamese speaking interpreter conducted the interviews in either Chinese or Vietnamese according to the preference of the study participant. The interpreter was trained in interview techniques including encouraging expression of study participant's thoughts and beliefs through use of silence, reflection and restatement. Prompts for each of the interview question were provided in order to enhance discussion of the dimensions of each question. All interviews were audio-taped and transcribed verbatim. The interviews conducted in Chinese were transcribed verbatim from Chinese into English by the first author.

A semi-structured interview guide was utilized to elicit perspectives of older Vietnamese American women regarding "quality of life" or "the good life." Follow-up probe questions were utilized to clarify and validate information in order to provide rich descriptions of the women's stories. All transcripts were reviewed for accuracy and nonverbal behaviors and verbal nuances were added to enhance the completeness of the written transcripts. Field notes were written following each interview. Second, and in certain instances third interviews were held with some participants as a means of member-checking or verifying information (Lincoln & Cuba, 1985).

Data Analysis

Ethnographic content analysis was performed using "unitizing coding." The analysis involved measures to ensure credibility of the findings. Next, units that related to the same content were clustered and categorized into provisional categories (Luborsky, 1994). From these categories conceptions of meanings within the categories emerged from the interview narratives.

[TABLE 2 OMITTED]

RESULTS

The undergirding themes of resiliency and security emerged reflecting the participants' unique cultural social context of survival, immigration and adaptation. Within the theme of resiliency were the categories of social support, hope and overcoming barriers to independence. The theme of security contained the categories of contentedness and functional status (see Table 2).

Resiliency

Each of the women interviewed described tremendous hardships and reported withstanding adversity prior to immigrating to the United States. They described difficult living conditions in Vietnam and many assumed the role as sole provider for the family as sons and husbands were sent to re-education/concentration camps. Informants also shared stories of stress, worry and uncertainty after coming to the United States. Overall, they reported being satisfied with life in the United States in comparison to the harsh subsistence of life in Vietnam. For many Vietnamese, when North Vietnam came under the rule of the communist government in 1954, they fled to South Vietnam and experienced stress, worry and uncertainty of being uprooted. Those left behind in North Vietnam faced a worse fate of decades of authoritarian rule, poverty and harsh living conditions. The following are exemplars of interviews from three women who reported tremendous suffering:

A woman who came to the United States during the influx of boat people in 1980 said, "I have no happy days in Vietnam, everything (was) taken by communists."

A 77 year old woman who was sponsored by her son and came in 1989 said, "I have been taking care of them (the sons) for 13 years because they were in jail (concentration camp). Whenever one can come out (to America), they did, and 1 stayed behind to (take) care of the rest."

"Yes, of course life in Vietnam is busy (to make a living). In Vietnam it is so hard on the body to work.... we all depend on manual labor, not like Americans use machines a lot. We haul, lift, work all day long, there is no shift, no hours (shift limit)....... Yes, it was always better in South Vietnam than North. .......... ..If I were in Vietnam or China now, I will be still working in the rain, in the sun, day-in day-out, worked to death and still not make enough to eat.." shared a 70 year old who arrived in 1984 during the boat people influx.

Social support. A 56 year old woman who had immigrated to the United States one year ago explained, "(religion means) love, friendship, they (the Baptist sponsors) are very kind, willing to help anyone, they introduced me (to others) in the church. Religion is from the heart, whenever I suffer I pray. I feel peace, I feel hope".

Hope. Religion was often mentioned together with family values as spiritual support and based on pragmatism or showing gratefulness to the sponsor in some circumstances.

"The important things in life are religion and family teachings. I like to educate my children to believe in God to help family members and then others."

Overcoming Barriers to Independence. A negative case of this concept is represented by a narrative snared by a 67 year old woman hospitalized for gall bladder surgery who had to wait to flag a Vietnamese speaking housekeeper passing by in order to tell someone that she was in pain.

Security

The following narratives describe the harsh subsistence of life in Vietnam in contrast to feeling satisfied about a "comfortable life" in the United States.

"Every month I went to see them (the sons in concentration camp) and brought food to them.......... When my husband escaped (illegally), there was only me and one child left, the government came and checked and questioned me.... and used (conscripted) me for free labor."

"Here, one has everything; there is food to eat, clothing and living quarters, and government (Security Supplement Income check) takes care of you. I hope after I die, government helps me. . .give me some aid. I hope they will pay for my funeral, life is better in U.S. because there is government support."

Contentedness. Experiences prior to coming to the United States framed present perceptions of Quality of Life. Although the majority or the women interviewed lived in poverty by United States standards, their past experiences influenced present perception of contentedness among these women.

"Life is very good, I don't have to work yet I have some money (the government check), it is much better here, here government helps you, in Vietnam you have to work very hard (just) to live."

Functional status. For the women who experienced declining function status, they perceived it as inevitable and part of the aging process as reflected in the following narratives.

A 61 year old woman stated, "I begin to feel old when I am 60, my heart rate is more irregular. My head easily forgets so I think something is wrong with me. Maybe as we grow older, it's like a car, old machine and (no longer) new machine."

A 70 year old woman said, "Growing old and living in America is better, anytime I feel sick, I can go to the doctor and I have a (medical) card. In Vietnam, (there is) nothing..."

[TABLE 3 OMITTED]

QUALITY OF LIFE CONCEPTULIZATION

The conceptual categories derived from this ethnographic analysis of the good life were compared to the quality of life domains indentified by Flanagan (1978, 1982) as well as George and Bearon (1980). None of the women mentioned recreation or leisure in their narratives and the results support a partial fit to the QOL dimension in the literature (see Table 3).

DISCUSSION

Due to language barriers, the majority of the participants were not in the workforce; therefore, the women were not in the social security system and were dependent on government assistance in the Security Supplement Income (SSI) system. The women and many family members had limited or no English proficiency (LEP). The years of life in Vietnam before immigration to the United States continue to shape the elder's perspective of Quality of Life. While their standard of living may be modest by United States standards, the harsh circumstances and oppression of their daily lives prior to immigration serve as a basis of comparison as they examine present circumstances.

It is important to understand the elder's perspectives of needs and services which affect quality of life. Lack of awareness of available services, as well as limited English language proficiency may result in unnecessary delays in accessing resources. When seeking services in the United States these women were unfamiliar with western practices such as scheduling appointments and bringing necessary verifying information. In large part, these services were not available in Vietnam and those services which were available, such as, physician's visits were accessed on a walk-in basis. Further examination of the community in which these women live will provide needed guidance regarding the preferences of resources such as community based lay advisors or information which is distributed through local Vietnamese media sources.

LIMITATIONS

The average length of residence in the U.S. was seven years at the time of the interview; therefore, the findings are relevant to short or medium term adaption. A potential threat to the validity of the study was the setting of the interviews. Even though the home offered a familiar comfortable setting for the participant, it was also a place where the neighbors or the husband would join in and observe the interview. These interruptions were sometimes distracting to the researcher although the presence of another person was not a concern to the interviewees when asked.

References:

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Tran, J. U. & Yeo, G. (2004). Older Vietnamese Americans. In A. G. Society (Ed.), Doorway thoughts: Cross-cultural health care for older adults (Vol. 1, pp. 55-67). Boston: Jones & Bartlett.

Yeo, G., Tran, J. N. U., Hikoyeda, N., & Hinton, L. (2001). Conception of dementia among Vietnamese American caregivers. In N. G. Choi (Ed.), Social work practice with the Asian American elderly (pp. 131-152). New York: Haworth Press.

Author affiliation:

NANCY CHU, PHD, GCNS-BC & A. RENEE LEASURE, PHD

Author affiliation:

Nancy Chu, PhD, GCNS-BC, is an Associate Professor in the College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. A. Renee Leasure, PhD, z's Associate Professor in the College of Nursing, University of Oklahoma Health Sciences Center Research Investigator, Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma. Corresponding Author: Or. Nancy Chu, College of Nursing, University of Oklahoma Health Sciences Center, 1100 N Stonewall, Oklahoma City, Oklahoma 73117.