"Pray to all four directions": a qualitative study of syncretic care seeking by Vietnamese families for their children with autism spectrum disorder.

PURPOSE: The aim is to understand what therapies and interventions families in a low and middle income (LMIC) country, such as Vietnam resort to in their attempts to seek care for their children with ASD and why they choose these therapies. METHODS: We undertook semi-structured qualitative interviews with 27 parents of children with autism and an online survey of 112 parents as part of a broader ethnographic study over one year augmented with recent interactional observations and a review of social media. RESULTS: There is limited access to formal interventions for families with children with ASD in Vietnam. Rather, families resort to syncretic care using an average of 6.8 different interventions per child. These included: speech therapy; physical therapy; prescribed medicines; and ABA as well as geomancy, special dietary regimes, biochemical testing, stem cell therapies and religious and cultural practices. Despite having low incomes, the families surveyed spent an average USD 345 per month on interventions, many of which are not evidence-based. Desire to care and potentially "cure" their children within a context of stigma associated with ASD drives parents to seek all possible interventions for their children. CONCLUSIONS: There remains a large gap in access to appropriate evidence-based interventions or trained therapists for families. Further information for parents, culturally appropriate guidelines for effective interventions, more trained rehabilitation professionals and regulation is required.IMPLICATIONS FOR REHABILITATIONWithin low and middle income countries (LMIC), such as Vietnam there is a lack of intervention services, difficulties in accessing appropriate specialists, poor quality care and the costs of care.Families seek a range of formal interventions and costly informal therapies as well as culturally specific practices to care for their child/ren and require information on effective therapies.In LMIC training programs to build capacity for allied health professionals need to be implemented on the latest evidence-based therapies.It is important to develop culturally appropriate Vietnamese guidelines to support interventions for children with ASD.

Norms of Masculinity and the Cultural Narrative of Intimate Partner Violence Among Men in Vietnam.

Semi-structured interviews with 31 men in Hung Yen Province in Northern Vietnam are used to elucidate a conceptual narrative to understand men's perceptions and perpetration of intimate partner violence (IPV) in Vietnam. This narrative suggests that cultural definitions of masculinity and changes in women's participation in the labor force have contributed to status conflicts that normalize IPV as part of masculine superiority. The narratives of both IPV perpetrators and non-perpetrators demonstrate how violence is incorporated into the cultural definition of masculinity and illustrates how men use this definition to minimize their own and other men's perpetration. We suggest that attempts to reduce IPV in Vietnam must address constructions of masculinity and the socio-historical context of IPV by providing gender-sensitivity training and opportunities for men to evaluate critically how constructions of masculinity in their families and communities contribute to IPV perpetration.

'Closer to my world': Children with autism spectrum disorder tell their stories through photovoice.

One of the challenges in doing research with individuals with autism spectrum disorder (ASD) is the difficulty in communication. This study employed a modified form of photovoice with a group of young people with ASD in Hanoi, Vietnam, to provide a means of meaningful participation in research about their lives, experiences, and needs. We describe the process of conducting photovoice with nine children with ASD from June 2011 to May 2012, many of whom had limited verbal communication skills. More than 2100 photos were taken by children. Undertaking photovoice with children with ASD required some modification of the method. In particular we consider the difficulties in analysing and interpreting the photographs produced by children with ASD. Due to the ambiguities of the visual images produced we found content analysis of photographs alone was inadequate. There was a discrepancy between our initial interpretations of the photographs and our understandings derived from information from interviews with children, parents, carers, and our own observations. Our study points to the need to understand context through multiple methods and the potential of photovoice as a means to mediate communication and participation in research for groups with communication difficulties.

Living with autism spectrum disorder in Hanoi, Vietnam.

There is limited understanding of Autism spectrum disorder (ASD) in Vietnam. This ethnographic study aimed to explore how ASD is represented and managed in the cultural, social and economic contexts of Vietnam, and describe the experiences of families with children with ASD in Hanoi, Vietnam. This study was conducted from 2011 to 2012 in Hanoi and employed a range of methods, including participant observation, in-depth interviews with 27 parents of children with ASD and 17 key informants, and online survey. This study found that within Hanoi, Vietnam, ASD has been culturally and socially constructed as a 'disease', 'karmic demerit' and 'family problem' rather than a life-long developmental disorder that needs support from government. Children with ASD and their families experience various forms of stigma and discrimination. There are limitations in assessment and diagnosis of ASD. Parents of children with ASD have little access to services for their children, and the limited political and economic supports exacerbate their difficulties. This study highlights some of the ways in which the understandings and management of ASD vary cross culturally. It also suggests further attention is required to the provision of appropriate public education, low cost interventions and support for family advocacy groups.

Qualitative study of an operations research project to engage abused women, health providers, and communities in responding to gender-based violence in Vietnam.

This article describes an action research project designed to engage women, health providers, and communities to respond to gender-based violence (GBV) in Vietnam. Based on results from in-depth interviews and group discussions, it considers the extent to which the project approaches were empowering for abused women. The results underscore the problems entailed in introducing systematic screening for gender-based violence into government health facilities in the low-resource setting of Vietnam, the importance of combining ideational change and rights components with support for abused women, and the difficulty of engaging male perpetrators.

The harmony of family and the silence of women: sexual attitudes and practices among rural married women in northern Viet Nam.

Women in Viet Nam have long had to face various sexual and reproductive health problems, ranging from abortion to reproductive tract infections (RTIs) and sexual coercion. These issues have increasingly been addressed by scholars in the fields of public health and social sciences through sexual and reproductive health research and in other ways. Despite this, there remains a lack of in-depth information on attitudes and practices regarding sex and sexuality of Vietnamese women today. This paper in part responds to the knowledge gap by reporting on findings from qualitative research on sexual attitudes and practices among rural married women in a Northern rural community, measured against the broader social and cultural context. Twenty-five women in total were interviewed; and two focus group discussions were conducted. The findings show that women generally believe that men are (or should be) the initiators in sexual relations. Many women feel reluctant to refuse sex to their husbands or communicate openly about sex and sexuality. However, this paper also demonstrates that women are not totally passive in sexual relations. Women in this study used a range of strategies to negotiate their sexual life, and sometimes 'silence' is used as a form of agency in order to maintain harmony and happiness within the family.