Understanding Recently Arrived Chinese Late-life Migrants' Experiences of Healthcare Access and Utilisation in Aotearoa New Zealand During and Beyond the Covid-19 Pandemic: A Mixed-Methods Study

Abstract

This mixed-methods study investigated the experiences of recently arrived Chinese late-life migrants in accessing and utilising healthcare services in Aotearoa New Zealand (NZ), under both non-pandemic and COVID-19 pandemic conditions. The research objectives were to: 1) to explore the possible factors that inform recently arrived Chinese late-life migrants' healthcare access and utilisation in Aotearoa NZ, in the face of non-pandemic and COVID-19 pandemic environments; 2) to modify and pilot a nationally administered survey on the health service access and utilisation and patient experiences of recently arrived Chinese late-life migrants in Aotearoa NZ, in the non-pandemic and COVID-19 pandemic circumstances; and 3) to propose actionable recommendations for enhancing health service access and utilisation for Chinese late-life migrants and their families in the face of non-pandemic and future pandemic environments. The study followed an exploratory sequential approach, beginning with a qualitative study (phase one) and subsequently building a quantitative study (phase two) based on the qualitative results. The study population comprised Chinese late-life migrants aged 65 and over who had immigrated to Aotearoa NZ within the last ten years.

In phase one, a qualitative descriptive (QD) approach with purposive sampling was used to identify factors influencing participants' healthcare access and utilisation since arriving in Aotearoa NZ. Semi-structured in-depth interviews (n=12: 5 males, 7 females) were conducted. Four themes emerged from the data: 1) "It is the Little Things that Matter the Most," 2) Fractured Patient-Practitioner Relationship, 3) Cultural Beliefs and Attitudes Towards Healthcare Access and Utilisation, and 4) Desire for Healthcare Information. These themes highlight key factors affecting healthcare access and utilisation among Chinese late-life migrants.

Drawing from phase one's insights, phase two involved developing a cross-sectional survey based on the 2017/18 NZ Health Survey to collect quantitative data on healthcare access and utilisation among the target population. Network sampling recruited 63 survey participants (21 males, 42 females). Findings revealed that Chinese late-life participants commonly used primary healthcare over secondary/tertiary services, preferred public institutions, and visited emergency departments for after-hours care. Significant barriers included differences between the healthcare systems in Aotearoa NZ and China, and ineffective communication between migrants and healthcare practitioners. Additional factors such as costs, transportation, support networks, disease urgency, and previous healthcare experiences also influenced healthcare-seeking behaviours. Unlike existing literature, this survey found that having health/medical insurance did not significantly affect participants' likelihood of utilising healthcare services in Aotearoa NZ.

By integrating findings from both phases, three main factors affecting healthcare access and utilisation among recently arrived Chinese late-life migrants in face of the non-pandemic and the COVID-19 pandemic circumstances were identified. First, ineffective communication and cultural conflicts were major predisposing characteristics that fractured patient-practitioner relationships and negatively impacted attitudes towards healthcare. Second, limited enabling resources, such as inaccessible healthcare facilities, long waiting times, lack of public healthcare information, and insufficient family and social support, significantly disrupted healthcare access and utilisation. Third, although the study did not collect participants' health status, it found that their perspectives and experiences of healthcare access were consistently associated with their health conditions.

This study added an in-depth understanding of the factors impacting healthcare access and utilisation among recently arrived Chinese late-life migrants, in general and COVID-19 pandemic circumstances. It had important implications for developing the NZ healthcare system for migrant service delivery, especially during pandemics. The study also offers valuable insights for designing future studies on other late-life migrants' healthcare experiences during future pandemics, both in NZ and globally. Additionally, this study also offered the evaluation of the pilot survey using the Categorical Principal Components Analysis (CATPCA) method, which can identify potential deficiencies in the pilot survey and improve the design of a formal nationally administered survey in future studies.