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Abstract

While a growing body of research has examined immigrants’ health generally, less is known specifically about the impact of immigration policy on the health of Chinese immigrants, the second-largest foreign-born population in the United States. This is due, in part, to the lack of methodologically well-trained, cross-cultural researchers who have both the cultural and linguistic expertise and health knowledge to engage with Chinese immigrant populations. This paper addresses this gap by examining Chinese cross-cultural researchers’ roles in the qualitative phase of the Research on ImmiGrant HealTh and State policy (RIGHTS) project, which sought to assess how immigration policies shaped Chinese and other immigrants’ experiences in healthcare and other related sectors in California. We used reflexivity to assess Chinese cross-cultural researchers’ positionality of insiderness and outsiderness and its influence on the process of data collection (i.e., recruitment, conducting interviews, transcription, and translation). Our reflexivity guides the assessment of the opportunities (e.g., expanding the recruitment pool, engaging participants more effectively in interviews, ensuring data integrity, and discussing heterogeneity within the Chinese immigrant community) and challenges (e.g., the difficulty of recruiting low-income and undocumented immigrants, addressing participants’ in-depth thoughts, the time-consuming nature of transcription and translation, and the assessment of power dynamics) in conducting immigrant health research with the Chinese community. These results highlight the need for cross-cultural researchers to help build trusting relationships with ethnic-minority communities, thus gaining new insights and advancing knowledge within the field of ethnic minority health research. These insights can guide future investigations of Chinese and other immigrant communities as research on immigration policy and health expands.

Keywords

positionality reflexivity cross-cultural research ethnic-Chinese contexts immigrant health research

Introduction

There is increasing attention in the United States on the relationship between immigration policies and health as evidence grows that immigrants’ access to healthcare, health outcomes, and health behaviors are associated with their legal status and vulnerability under restrictive policies (Castañeda et al., 2015; Torres & Young, 2016; Wallace et al., 2019; Young & Pebley, 2017). The challenges posed by immigration policy and legal status are associated with a negative impact on immigrants’ access to healthcare and insurance (Amuedo-Dorantes et al., 2013; Ortega et al., 2007; Torres & Young, 2016), greater likelihood of depression or psychological distress (Arbona et al., 2010; Gee et al., 2016; Roche et al., 2018), delay in receiving prenatal care for pregnant women (Arbona et al., 2010; Korinek & Smith, 2011), and worse childhood development outcomes among immigrant children (Stevens et al., 2010; Yoshikawa et al., 2008).

Much of this research has been conducted with Mexican immigrants, the largest foreign-born population in the United States (Budiman, 2020). Less is known about the health of Chinese immigrants, the second-largest foreign-born group (Budiman, 2020). In 2018, China was the top country of origin for new immigrants entering the United States (Budiman, 2020). Chinese immigrants have unique immigration patterns, history, language, and culture that are associated with distinguishable health risk factors (Tong & Sentell, 2017). They experience unique health disparities, including limited access to culturally relevant care and linguistic barriers (Tsoh et al., 2016). Limited by English ability, Chinese immigrant voices, especially low-income and undocumented groups, are often hidden within ethnic enclaves (Li, 1998). There is a need to examine their health-related experiences of migration and barriers to care in light of the nation’s increasingly restrictive immigration policy environment.

Chinese immigrants may have different beliefs surrounding health concepts, values, and practices compared with the mostly non-Chinese researchers who conduct studies on Chinese immigrants and immigration policy (Rumbaut, 1999). Thus, involvement of Chinese cross-cultural researchers may help ensure representation of voices from the Chinese community and enhance the trustworthiness of data while conducting research with Chinese immigrants. Cross-cultural researchers are individuals who socialize in the indigenous community or culture they investigate and endorse similar values, perspectives, and knowledge of the community (Banks, 1998). Similar to bicultural and bilingual researchers, cross-cultural researchers possess language abilities and cultural competence, and hold and balance the practices, values, and identifications of both US culture and their heritage culture. Different from bilingual and bicultural researchers, cross-cultural researchers cross multiple cultural boundaries beyond two kinds of languages and cultures, this status related to their years of residency in the United States, their citizenship status, and their extent of acculturation. These multiple aspects position cross-cultural researchers within the spectrum of insiderness and outsiderness in relation to both indigenous and US cultures. The inclusion of Chinese cross-cultural researchers in studies of immigration policy and health can serve as an essential bridge between Chinese research study participants and the broader community of scholars and health practitioners, especially those who are non-Chinese researchers. However, there is a lack of Chinese cross-cultural researchers in immigrant health studies (Suh et al., 2009). Even if they are included, cross-cultural researchers often contribute only to certain phases of research, such as recruitment or interviewing, rather than the development of study design, choice of data collection instruments, and other conceptual and methodological phases (Berman & Tyyska, 2011). As a result, cross-cultural researchers often have limited methodological guidance (Tsai et al., 2004).

The purpose of this study is to provide methodological insights into the process of conducting research on ethnic-Chinese contexts, in particular immigration policy and health of Chinese immigrants. In this study, Chinese cross-cultural researchers cross multiple cultural lines based on the extent to which they engage in both the Chinese and non-Chinese communities in the United States. As Chinese cross-cultural researchers, we use reflexivity to assess our relative positions as insiders and outsiders during the data collection of Chinese immigrant health (i.e., recruitment, conducting interviews, transcription, and translation) in the Research on ImmiGrant HealTh and State policy (RIGHTS) project. We discuss our positionality in relation to the Chinese participants, the broader research team, and within our group of Chinese cross-cultural researchers. In this paper, we first describe our study and its methodology. We introduce the perspectives of reflexivity and positionality, which provide the basis for assessing the process and lessons of our Chinese cross-cultural research. We then discuss our reflections, highlighting our experience of (a) cultural and linguistic factors influencing Chinese immigrants’ engagement in immigrant health research, (b) interactions between cross-cultural researchers and participants during interviews, and (c) how to ensure the data quality of cross-cultural research. The results and implications can guide cross-cultural researchers in future studies of Chinese immigrant communities and other immigrant communities as the research on immigration policy and health continues to expand.

Description of RIGHTS project

The RIGHTS project is a mixed-methods study that seeks to understand how California’s immigrant policy environment influences immigrants’ access to healthcare. We describe here the qualitative phase of the study. Through analysis of in-depth interviews conducted in 2018–2019, the study identifies how California’s health and welfare, education, labor, and law enforcement policies shape Chinese and Mexican immigrants’ daily lives. All team members had expertise in areas of health policy or immigrant health before joining the study, including student researchers and faculty members. Student researchers include both Chinese and Latinx cross-cultural researchers, who conducted interviews and analyzed data with Chinese and Latinx participants. Our sub-team of three Chinese cross-cultural researchers are all undergraduate and graduate students who can speak both Chinese (Mandarin and/or Cantonese) and English fluently. All faculty members are investigators of the study and are mostly bilingual English-Spanish speakers; none of faculty investigators are familiar with Chinese culture and languages. Therefore, all Chinese transcripts were translated into English, while most Spanish transcripts were not translated, as most faculty investigators understand Spanish. One of the investigators, the project manager, a Latinx cross-cultural researcher, provided a uniform training to Latinx and Chinese cross-cultural researchers on the study aims, its qualitative methodology, and interview skills. The training focused on general topics related to qualitative research and interviewing participants from immigrant communities as a whole, such as how to build rapport and probe. However, there was no cross-cultural training, cultural awareness training, or culturally tailored training specific to the Chinese immigrant community offered to the Latinx and Chinese cross-cultural researchers. Below, we describe the study protocol for the key phases that are the focus of this paper.

Recruitment. Chinese immigrants were recruited through the study’s Community Advisory Board, personal networks, and cold calls to Chinese community institutions. Twenty-eight participants were recruited, of which 22 were female (79%); 14 were aged 30-60 (50%); 24 were naturalized citizens or permanent residents (86%); 19 were from Mainland China (68%), two were from Hong Kong (7%), and seven were from Taiwan (25%) (see Table 1).

Table 1.

General information about the Chinese participants in the RIGHTS project, 2018-2019.

Participants’ characteristics		Number of participants
Recruitment sites	From personal contacts	8
	Community Advisory Board referrals	10
	Cold calls	10
Interview languages	English	5
	Mandarin	18
	English and Mandarin	3
	Cantonese	2
Gender	Male	6
Gender	Female	22
Age	18–30	8
	30–60	14
	>60	5
	Unknown	1
Legal status	Naturalized/overseas born US citizen	12
	Permanent resident/Green card holder	12
	Working visa (H1-B, L1/L2)	3
	Undocumented	1
Birth countries/Regions	Mainland China	19
	Hong Kong	2
	Taiwan	7
Transcriber	Chinese cross-cultural researchers	15
Transcriber	Transcription company	13

Interviews. Jointly, the full research team developed a semi-structured interview guide in English which we then translated to Chinese. Participants chose their preferred language for the interview (Table 1). Interviews lasted 60–90 minutes and were audio recorded. In addition to regular debriefing with the project manager and the entire team, we wrote a memorandum of observations, reflections, and insightful moments from each interview (Dhillon & Thomas, 2019; Greene, 2014).

Transcription and translation. Interviews were transcribed in their original languages by a member of our Chinese cross-cultural researcher team or by a transcription company. Once the transcribing process was completed, we translated the Mandarin and Cantonese interviews to English to make them accessible to the broader research team.

The Approach of Reflexivity and Positionality

Reflexivity is a term that has emerged from qualitative and ethnographic research (Hickson, 2016; Taylor & White, 2001). Reflexivity recognizes the influences of the researcher’s background, assumptions, and expectations on the research process and outcomes (Hickson, 2016), and calls for the need to be more open and accountable to how one has participated in research and produced knowledge (Subedi, 2006). Cross-cultural researchers can be considered “human research instruments” (Cohen & Crabtree, 2006), whose reflexivity of the research process helps develop culturally appropriate research protocols to conduct multicultural research (Lu & Gatua, 2014). In this study, our team of cross-cultural researchers used reflexivity to describe our capacity for self-awareness that affects how we understood who we are, our values, and how they influenced the study data collection process (Hickson, 2016; Taylor & White, 2001). As a team, we represented the heterogeneity of the Chinese immigrant population living in the United States. Our backgrounds, identities, and values not only motivated us to create a space for participants to express their experiences in their own words and engage actively with cultural sensitivity, but highlighted the diversity among those we recruited and who participated.

Positionality has been defined as where one stands in relation to “the other” and where researchers have predominantly been either “insiders” or “outsiders” (Merriam et al., 2001). Cross-cultural researchers are often treated as insider researchers (Merriam et al., 2001); However, further classifications, such as Indigenous/External-insider (Banks, 1998) or Partial-insider (Subedi, 2006), reflect that the level of insiderness depends on the extent to which researchers hold the values, perspectives, behaviors, beliefs, and knowledge of their cultural community. Although previous studies have noticed the insider researchers’ outsiderness, the cross-cultural researchers’ outsider traits, and the associated benefits have seldom been discussed in the literature (Chavez, 2008; Greene, 2014). Rather than a fixed or insider-outsider dichotomy, there is liquidity to researchers’ identities (Thomson & Gunter, 2011), which can be considered as blurred boundaries of insider/outsider (Perryman, 2011), insider/outsider continua (Obasi, 2014), inbetweener (Milligan, 2016), or insider-outsiderness continuum (Dhillon & Thomas, 2019). Due to differences within each layer of social, cultural, language, and educational backgrounds between the researcher and the participants, a researcher’s positionality is fluid, constantly shifting between insider and outsider roles (Gregory & Ruby, 2011; Naples, 1996; Subedi, 2006).

In this study, our own identities and experiences resided along a continuum of insiderness and outsiderness. Our research sub-team of three Chinese cross-cultural student researchers included a US-born citizen whose parents were from Taiwan, a first-generation immigrant from Hong Kong, and an international scholar from Mainland China. We are all multilingual Chinese-English speakers, including one Mandarin and Cantonese native speaker fluent in English, one Mandarin native speaker fluent in English, and one English native speaker fluent in Mandarin. We worked closely with the project manager who was a US-born Latina who did not speak Chinese. As cross-cultural researchers, we were able to share unique insights with the larger research team, ensuring their analyses and interpretations of the data were closer to the participants’ true voices to maintain the trustworthiness of the data that we collected.

Below we describe our reflections on our positionality throughout the research process. Our reflexivity on our social and cultural positioning is a part of the essential data that provided a complete picture of the study (Chan, 2017; Harrison, 2009; Jackson & Mazzei, 2012; Rogers, 2004). Reflexivity was critical to assess our positionality (Greene, 2014) during immigrant health research, and our assessment of our positionality aims to inform methodological guidance for other Chinese cross-cultural researchers.

Reflections on Cross-cultural Researchers’ Positionality in the Field

Cultural and Linguistic Factors Influencing Chinese Immigrants’ Engagement

Chinese social favors “Ren Qing”

Participants were much more willing to engage in the study when a trusted contact bridged communication between the study team and prospective participants. Often, participants felt a desire to help, out of a sense of community and the belief that they were doing a “favor” for friends. “Ren Qing” directly translates into “people affection.” It refers to highly regarded social favors in the Chinese culture in which individuals do their utmost to fulfill requests motivated by a strong sense of loyalty and obligation, even if such requests are made by distant acquaintances who are also from the same homeland (Yen et al., 2017). In Chinese culture, there are two concepts that define trust, cognitive trust and affective trust, with the latter arising from feelings of collective identity and kinship (King & Wei, 2018). Because of this cultural foundation, traditional Chinese behaviors adhere to certain principles that build trust, including demonstrating and maintaining “Ren Qing” and “guanxi” (a Chinese term for connection/relationship) (King & Wei, 2018).

In one example, a coworker of one author’s parents had friends in the Orange County. As a result, the author was able to recruit from a distant extension of her social network in this area. The local contact first reached out to the author’s parents’ friends and received approval for the author to communicate and recruit the friends. These participants often inquired if the author needed more contacts, evolving into snowball sampling. “Ren Qing” is an indicator of trust, especially when using personal networks. Fostering trusting relationships with participants is a necessary prerequisite for researchers to be considered insiders (Chan, 2017; Gregory & Ruby, 2011). The familiarity of certain practices, settings, and communities helped us to promote a sense of trust and we were able to leverage our insiderness to establish affective trust with and gain access to a specific population.

Interestingly, participants recruited from personal networks were often surprised to receive the incentive ($25 dollars) because their willingness to participate was not motivated by compensation but to this sense of conferring a social favor. Although, ultimately, the number of participants recruited from personal networks was not as high as those from community-based organizations, we observed that the refusal rate was much lower from personal networks. Utilizing personal networks for recruitment was one effective strategy and, consistent with other studies, was likely because of the established trust within our networks of other Chinese individuals (Lu & Gatua, 2014; Ojeda et al., 2011; Suh et al., 2009).

Connecting to specific Chinese subgroups

Apart from recruiting through a personal network, we fostered trusted relationships with several community-based organizations, including a senior citizen center, a mental health and community organization, a church, and a Buddhist temple, who helped reach out to prospective participants. For example, one organization invited us to table at a health fair for the Chinese community, increasing our exposure and acceptance by the community. We successfully recruited one-third of our Chinese participants owing to the safety and trust established by the organization’s reputation. We requested their assistance to connect with a broader Chinese community among whom we were a cultural member but a social stranger (Greene, 2014). Meaning, rather than being fully outsiders, we were potential insiders “with an outward glance” (Harman, 2011, p.127).

While the insider status granted us a “ticket” to access the Chinese community, our outsiderness to certain subgroups, such as low-income and undocumented Chinese immigrants, posed challenges for this approach. Many undocumented Asian immigrants, including Chinese immigrants, have a sense of distrust toward institutions, even among family members (Sudhinaraset et al., 2017). Despite the variety of approaches and efforts, we were most successful in reaching Chinese populations who were documented or naturalized immigrants and only recruited one undocumented Chinese immigrant through a Community Advisory Board referral. Due to the small sample of undocumented immigrant participation, it is difficult to draw conclusions about the undocumented Chinese immigrant experience as one individual’s response may not reveal consistent trends.

Our outsider position, however, was also used to our advantage. For example, in some interviews, we found that Chinese immigrants from Taiwan viewed Chinese immigrants from Mainland China as “others,” and vice versa, with both groups believing that the other received preferential treatment from legal and healthcare systems. Due to our outsiderness (i.e., originally from Mainland China, Hong Kong, and Taiwan) in relation to these two groups, we were able to explore this phenomenon of “within-group discrimination” by taking a distanced position and approaching participants and questions without judgment (Woodward, 2008). A strength of our outsider positioning in these experiences was the ability to hold a curious and unbiased attitude with the unfamiliar, the ability to ask taboo questions, and being seen as non-aligned with subgroups, thus enabling us to elicit details (Merriam et al., 2001).

Linguistic Diversity and Flexibility

The diversity of our linguistic and cultural insiderness contributed to our ability to obtain a sample representing a breadth of Chinese immigrants. Within our team we were capable of using different languages (i.e., English and Chinese) and dialects (i.e., Mandarin and Cantonese), and also had diverse cultural backgrounds (i.e., Mainland China, Hong Kong, Taiwan). When approaching potential participants or community gatekeepers, we were more readily accepted when communicating fully and fluently in a familiar language or dialect. For example, at least one of us participated in meetings with the Community Advisory Board and other community organizations along with the project manager. For participants who had largely reported language barriers in other settings, they quickly shed their concern about linguistic barriers to participation. This language flexibility also allowed us to establish rapport during the interviews (Ganga & Scott, 2006; Hockey, 1993; Mercer, 2007). Participants felt more comfortable and were able to use the language comfortably to express their thoughts. For example, when one author was conducting an interview with Esther,¹ the author began with Mandarin but, unlike most of the participants, Esther immigrated to the United States when she was a child and spoke about some topics more comfortably in English. While the author initially assumed the interview would be conducted in Mandarin, it was critical that the author was attuned to the participant’s migration trajectory and shifted languages accordingly.

Our linguistic diversity and flexibility reflected a spectrum of insiderness and outsiderness. Within our Chinese cross-cultural team, our respective identities in relation to Chinese participants were not static. We were social strangers to the subgroups who did not share our same characteristics. Our insider or outsider positioning shifted along a continuum depending on how many personal characteristics we shared with participants, such as language/dialect, cultural background, and lived experience.

Interactions Between Cross-Cultural Researchers and Participants During Interviews

Probing Questions

Because we were embedded with participants in a similar Chinese cultural context, we were well-positioned to probe during interviews to elicit issues and thoughts that did not otherwise explicitly emerge. Chinese culture is generally not as straight-forward as Western culture in terms of communication styles (Yuan, 2006). For example, “Hanxu”—“beating around the bush”—is appreciated as it indicates politeness and respect to others (Fang & Faure, 2011; Y. Li, 2011), especially in relation to social strangers or respected authorities, such as an academic interviewer (Cortazzi et al., 2011). As such, Chinese immigrants often express ideas indirectly and are reluctant to share their “true” thoughts (Y. Li, 2011). As Chavez (2008) suggests, insider researchers are able to understand the cognitive, emotional, and/or psychological precepts of participants. Our familiarity with the indirect Chinese approach in communication allowed us to be sensitive about the meanings behind participants’ words and actions and to select appropriate timing for clarifications to ambiguous responses. We incorporated “why” and “how” questions, requesting participants to share specific examples. For example, when one author asked Cheung about her experience moving to the United States, she made a general comment, “Well, I’m very happy after I came here.” The author followed up, “Why do you feel happy here?” to elicit more detail. Cultural insights, in addition to observations of facial expressions and body language, allowed us to anticipate when there was an opportunity for probing (Gu, 2020).

We commonly found that Chinese immigrants did not proactively share experiences regarding police or immigration enforcement. It has been argued that insider researchers have a pre-existing knowledge of the contexts of the research and participants, which often leads them to adopt the best approaches that encourage participants to feel more comfortable discussing issues and sharing their points of views (Aguilar, 1981; Bell, 2014). We found this to be true when approaching immigration-related topics that may have been considered culturally sensitive and that were concealed by indirect conversation. To encourage participants to speak more about what could be an uncomfortable topic such as law enforcement, one author brought up the example of her mother: “My mom is also not very interested in the politics here. She’s more into the Taiwanese politics,” to stimulate participants to rethink differences between the United States and their country of origin and to express their own opinions about it. This is consistent with what Merriam et al. (2001, p. 411) describes as insider researchers’ ability to “project a more truthful, authentic understanding of the culture under study.” Our similar experiences and comparative perspective between the United States and the immigrants’ countries of origin again demonstrated the benefits of insiderness. During the occasions where the Chinese immigrants were reluctant to describe immigration-specific experiences, we positioned ourselves as allies and shared our related personal experiences to make them feel connected with us.

Addressing Participants’ In-Depth Thoughts

Despite our cultural sensitivity and shared experiences with participants, it was still difficult at times to elicit participants' in-depth thoughts regarding their identity as immigrants and immigration policies. Some Chinese immigrants avoided talking about their negative experiences and presented a “rosy” picture of their lives in the United States. For example, Merry provided positive answers when she was asked to depict her life after moving to the United States. She expressed glorification of the country’s government throughout the interview, even though the questions attempted to understand her challenges as an immigrant. There is a common saying in China that “home ugly cannot be rumored,” as Chinese culture tends to discourage sharing of private and negative matters that may result in loss of face (Gao & Ting-Toomey, 1998; Pan, 2000). Similar to other studies, we found that participants tended to provide only brief and vague responses to avoid revealing their true feelings, especially on topics which they may have felt could cause shame (Chan, 2017; Cortazzi et al., 2011; Liu, 2006).

Some participants also tended to use a “model” answer to please the interviewer, or to provide seemingly boiler-plate responses. For example, when one author was conducting an interview with Lisa, Lisa attempted to provide the “best” answer for each question. She would ask, “What do you want to know?” or “What do I need to say,” instead of naturally sharing the details of her story. It emerged that Lisa received an exam-oriented education, popular in China, prior to attending graduate school in the United States. Lisa might have been used to giving standard answers to each question even though the interview was not an exam. This aligns with previous research (Chan, 2017; Cortazzi & Jin, 2006) where participants were likely to simply provide “standard” answers to satisfy the researcher in order to rapidly complete the interview when they do not have a trusted relationship with the researchers. In these studies, there was an inherent sense of power difference between cross-cultural researchers and participants that required negotiation and renegotiation in the interview process to reduce “inequities” between the researcher and the researched (Merriam et al., 2001). Even though we—the cross-cultural researchers—were assumed to be insiders due to familiarity with the community, such instant access did not guarantee an automatic trust and willingness on the part of the Chinese immigrants to openly discuss sensitive topics such as their true feelings toward negative immigration experiences, which oftentimes positioned us as outsiders.

Knowledge and Experiences Related to the US Healthcare System

Many researchers may go into the field with limited knowledge or experience on the research topic, which can make it difficult to assuage participants’ concerns or can result in possibly misleading findings (Ojeda et al., 2011). Compared to the senior researchers in the RIGHTS team who were experts in immigrant health and healthcare, as well as some participants with frequent health system contact, our Chinese cross-cultural research team was in a relative outsider position. Variations in knowledge and experience within our team illustrated the liquidity between insiderness and outsiderness that can exist among the Chinese cross-cultural researchers. For instance, we found that many participants referred to health insurance cards as “Red and Blue Card.” One author realized that she had shared, experiential knowledge of the healthcare system because of her own experience, having used Medi-Cal and having heard this terminology. She had not only already been exposed to this jargon in the Chinese community in California but had personally lived the struggles of the application process. As a result, in relation to the other cross-cultural researchers, she was able assume a more complete insider position—a true indigenous insider who holds the values, perspectives, behaviors, beliefs, and knowledge of their community (Banks, 1998). On the other hand, the other author was an international student who had only ever had a university health plan, but that allowed her to recognize the difficulties of non-US citizens in navigating the healthcare system. Another author was not only a US citizen but was also a public health graduate student, and could complement the Chinese research team with a broader perspective of the US healthcare system. Even within a single Chinese cross-cultural team, we fell along unique points on the spectrum of insiderness and outsiderness.

Ensuring the Data Integrity

Adapting the Interview Guide

To improve the richness and quality of data, the interview guide can be updated throughout the data collection process (Castillo-Montoya, 2016). We were engaged in the interview process to gain insights into the situational contexts of Chinese immigrants and sought to assure culturally appropriate research (Berman & Tyyska, 2011). Therefore, early in the study, changes were made to our interview guide based on our feedback. The principal investigators of the RIGHTS team were complete outsiders to Chinese culture and language. Therefore, as cross-cultural Chinese researchers, we played the lead role in incorporating nuanced ideas for adaptation. After conducting several interviews, we began to identify common topics that were emerging uniquely among the Chinese participants. We presented these observations to the broader research team as areas needing changes. For example, we found that some participants still described the US-born citizens, particularly those who are Caucasian, as “foreigners,” which was the same terminology they used when in their country of origin. As a result, we added the following questions to better understand this phenomenon: “Do you feel you are an American or a foreigner? Since you have been here for a long time, how much do you feel that you belong here?” This question helped explore the sensitive topic of immigrants’ identity. We also took the general question “How is your life in general?” (which was eliciting detail from the Mexican respondents, but not the Chinese respondents) and developed tailored questions specific to the Chinese immigrant experience: “How is your career in the US?”; “What is your education journey in the US?”; “Where are your family members?” In contrast to the storytelling culture of the Latinx community (Reese, 2012), we found that the Chinese immigrants were reluctant to share explicit details unless prompted for specific details. Rather than considering our insiderness as a source of personal biases (Lu & Gatua, 2014), we were able to understand the potential challenges surrounding discussion of “American” identity and Chinese immigrants’ reluctance to share explicit details. Adapting the interview guide allowed us to ask more specific questions, which helped check the validity of the changes against our own experiences. We constantly checked with the broader team who are experts with qualitative research to ensure that the interview questions were framed in fidelity-consistent yet culturally appropriate ways. We were given a high degree of autonomy in determining the flow of the data collection process and adapting the interview guide.

Capturing Subtle Cultural Meanings

As the study progressed into the phases of transcription and translation, and cross-analysis with the Mexican participant interviews, we served as a critical bridge to bring participants’ thoughts and cultural knowledge to the entire research team. For example, “Zuo Yue Zi” refers to postnatal care for women during the first month after childbirth in traditional Chinese culture. Researchers outside of Chinese culture have often mis-translated this into “postpartum confinement,” a term that may not best reflect custom (Lee & Brann, 2015; Raven et al., 2007) that includes practices such as not showering, not using air conditioning, and eating specific meals. (Chan, 2017) suggests that certain beliefs of Chinese research participants are best explained using Chinese epistemologies, such as Confucian ideologies, for which it is often impossible to provide a direct equivalent in English. Our insider knowledge facilitated group discussion comparing findings from the Chinese and Mexican subgroups. When we explained “Zuo Yue Zi” to the whole team, the Mexican researchers talked about specific postpartum customs discussed by Mexican immigrant participants and identified similarities and differences. We served as a “cultural broker,” bringing the insider knowledge of Chinese society to the broader research team and stimulating comparisons with the other immigrant group. Our insider positioning captured the subtle meanings that were helpful for data interpretation and further data analysis. This cultural brokering role is beyond being simply an interpreter or a translator; instead, we became the “key informants” that identified and channeled the values and beliefs of our community (Temple & Young, 2004).

The degree of diversity within ethnic and linguistic groups is important but often neglected during translation. This is because of a stereotypical understanding of cultures as fixed and homogeneous entities, such as “Western” or “Chinese” culture (Shklarov, 2007). Though we came from the same ethnic population, our Chinese cross-cultural team had diverse cultural and linguistic backgrounds. Some idioms might only exist in particular dialects. For example, there was a linguistic expression of “seeing ghosts when you’re broke” in Cantonese, which means the poorer you are, the worse luck you expect; however, Mandarin speakers may not understand it. In this example, the Cantonese-speaking author was a more complete insider than the other team members because of her first-hand knowledge of meanings and cultural values beyond the semantic language that existed in the Cantonese ethno-cultural group. The intended meanings of stories are often lost, in particular, during cross-cultural interpretation in situations where the researcher and participants do not share the same cultural and contextual understandings (Chan, 2017; Cortazzi & Jin, 2006; Temple & Young, 2004).

Triangulation and Ambiguity Reduction

As Merriam et al. (2001, p. 414) describes, “Every researcher struggles with representing the ‘truth’ of their findings as well as allowing the ‘voices’ of their participants to be heard.” This is particularly challenging during transcription and translation. Language itself is a translation first from a non-verbal world (Merriam et al., 2001). We implemented triangulation and ambiguity reduction practices to assure the accuracy and quality of the transcripts. Triangulation refers to “the researcher’s use of multiple sources, methods, investigators, and theories” (Lincoln & Guba, 1985). We had different researchers conduct the interview, transcribe the audio, and do the translation for the same interview, all for the same interview. Given each of our unique cultural experiences, this allowed each of us to have “contact” with and engage in interpretation of the findings. We each experienced some ambiguities due to grammatical variances between Chinese and English expressions. Often we had to insert subjects (e.g., I, we, he, she, and it) to complete the sentences for the respondents who did not specify the subjects in the conversation (Suh et al., 2009). By rotating our roles in the transcribing and translating process, we were able to countercheck the transcripts to clarify unclear audios and avoid biases in the transcription which could make an impact on further data interpretation and analysis. More importantly, such rotation allowed us to exhaust our dual positionality perspectives. On the one hand, the outsider perspective is reflected by our heterogeneity with diverse backgrounds and personal experiences, which might lead to different perspectives in the process of transcription and translation. On the other hand, the insider perspective made us more committed to getting accurate meanings for the same interview and reducing the ambiguity of the transcript through triangulation.

In-House and Outsourced Transcription

It has been argued that methodological issues in cross-cultural qualitative research mainly arise in the translation processes (Larkin et al., 2007; Twinn, 1997, 1998). This is in part because researchers may add their interpretations in the process of selecting appropriate words to represent participants’ perspectives during the translation process (Temple & Young, 2004). However, we found that the transcription process, which is generally assumed to be technical and literal, was also a phase that could be shaped by interpretation and, similarly, requires attention to contextual details and interpretations. The complexity of Chinese characters increased the difficulty in the transcription process as there are various systems for inputting Chinese language (Mishra, 2013). Similar to the Chinese dialects, there is geographical variation in keyboards; Mainland Chinese use the PinYin (phonetic) system whereas Hong Kong/Taiwan uses stroke input and stroke form encoding. Due to limited capacity, nearly half of the interviews were outsourced to a transcription company, adding a study cost that was not initially anticipated. Dhillon and Thomas (2019) suggest that hiring a professional transcription company, an absolute outsider to the study, can reduce biases and maintain neutrality to the process of data analysis in addition to saving researchers’ time. However, we found it was still time-consuming to standardize the quality of transcriptions. Compared to the professional transcribers, we were insiders to the study, positioned to ensure the data quality. Though the transcription company had bilingual capacity, they were outsiders to the participants and lacked the study context. For example, some participants mentioned the names of non-profit organizations where they sought services. The professional transcribers frequently wrote these words verbatim or marked them as “inaudible.” Therefore, we had to review each professionally transcribed interview to ensure that the transcriber had appropriately transcribed key topics related to the study. We maintained the trustworthiness of data through counterchecking, identifying words, and filling gaps in the transcripts through discussions within our Chinese team.

Discussion

This paper documented methodological insights identified by members of a cross-cultural research team engaged in research among Chinese immigrants. As Chinese cross-cultural researchers, we used reflexivity to assess our relative positions as insiders and outsiders during recruitment, conducting interviews, transcription, and translation. Recognition of our spectrum of insiderness and outsiderness was consistent with previous studies’ findings that researchers’ identities are fluid, hybrid, and socially constructed (e.g., Bhabha, 2012; Chan, 2017; Hall, 2000; and Langer-Osuna & Nasir, 2016). Our insiderness as cross-cultural researchers helped us recruit participants from personal networks and community organizations (Lu & Gatua, 2014; Ojeda et al., 2011; and Suh et al., 2009); provide opportunities to enlarge the recruitment pool and allow us to establish better rapport during the interviews (Van Mol et al., 2013); probe meaningful questions (Merriam et al., 2001); capture subtle meanings and ensure the data quality in the processes of transcription and translation (Van Mol et al., 2014); and create commitment to deriving accurate meanings from the interviews and reducing the ambiguity of transcripts through triangulation (Greene, 2014). Conversely, the characteristics associated with outsiderness enabled us to maintain curiosity and openness in obtaining information and insights when exploring topics that were unfamiliar (Merriam et al., 2001; Van Mol et al., 2014); and maintain to a certain extent distance or detachment from the Chinese immigrant community by reducing potential assumptions that may have arisen when looking at the data collected (Chavez, 2008; Woodward, 2008).

The spectrum of insiderness and outsiderness was related to our diverse backgrounds and experiences (e.g., where we originally came from, languages and dialects that we were familiar with and used, time in the United States, health care knowledge and experiences). These diverse backgrounds and experiences particularly aligned well with the heterogeneity of the Chinese participants.

Our reflections in this paper contribute to the literature of examining heterogeneity inside the Chinese immigrant community. The vast majority of large-scale research studies collecting data on Asian populations in the United States do not account for the heterogeneity of Asian immigrants, resulting in overgeneralized conclusions and harmful impacts on policy and health outcomes (Adia et al., 2020). Among Chinese immigrant populations, there is within-group heterogeneity that is frequently overlooked. For example, we found that there exists within-group discrimination (e.g., between participants from Mainland China and Taiwan). Our position as Chinese cross-cultural researchers allowed us to capture such heterogeneity and be sensitive to this phenomenon. Our reflections show that the spectrum of positionality is necessary, effectively engaging with and capturing within-group variation across cultural values and norms (Lewis, 1973).

Our relative insiderness and outsideness positions were also based on the underlying power dynamics of who we communicated with. Our reflections on the stages of the research process contribute to greater understanding of the impact of power dynamics both between researcher and participants, but also within the research team. Consistent with the previous studies, the power-based relationships framed inequalities not only between the researcher and the researched (Merriam et al., 2001), but also between the cross-cultural researchers and the broader research team, owing to the fact that cross-cultural researchers are usually only included to participate in certain aspects or phases of a research project (Berman & Tyyska, 2011). In the RIGHTS study, the investigators supported us to take the lead in the data collection phase since they were complete outsiders to the Chinese community and were most familiar with Latinx immigrants. For example, one of the investigators, the Latinx project manager, did not provide culturally tailored training in qualitative studies, but, instead, engaged in continuous debriefing with each of us after conducting each interview. This allowed the project manager to provide ongoing training and support based on specific, emerging challenges (e.g., probing) within the context of the interview’s content. Therefore, the existing power differences between investigators and our student researchers were greatly minimized when investigators deferred to and relied upon our cultural knowledge and experiences. With a high degree of autonomy delegated from the broader team, when connecting with participants, we were also able to decide on the extent of power that we negotiated and shared with participants in accord to the nuances and details. We are social strangers or respected authorities whose insiderness was compromised by our positionality as researchers (Cortazzi et al., 2011; Padilla-Goodman, 2010). Researchers who share the participants’ cultural identity and have a conventional academic background possess a dual perspective that might enable them to consider both the needs of the participants and the expectations of the academic research community (Chan, 2017; Cortazzi & Jin, 2006).

Our cross-cultural researchers’ reflexivity in this study was specifically in the context of a study of immigration policy and health, which also influenced researchers’ positionality. Study of immigration policy and related experiences requires cross-cultural researchers to pay attention to sensitive topics which are either immigration-related or culturally sensitive questions (Ergun & Erdemir, 2010). Since the purpose of the RIGHTS study is to examine immigrants’ experiences of exclusions and challenges in the US healthcare system, some topics related to race/ethnicity, law enforcement, immigrant identity, legal status, and discrimination were sensitive for the immigrant group. Other sensitive topics that also came up were specifically related to Chinese cultures, such as avoiding negative topics regarding mental health (e.g., Tabora & Flaskerud, 1997), chronic diseases (e.g., Kwok & Sullivan, 2006), or inside family ugly rumors (e.g., Hu, 1944). The levels of insiderness and outsiderness are the result of processes of social interaction that take place in a given context, in which individuals create and reformulate boundaries based on perceived commonalities and differences (Van Mol et al., 2014). Though as cross-cultural researchers we adopted the strategy of probing questions, it was still hard to address participants’ in-depth thoughts, especially related to sensitive topics, because we were relative outsiders in addressing these topics compared with the participants.

This study focused on discussing our positionality in the data collection process; however, it is also important to address researchers’ positionality in all stages of the research, including data collection, data analysis, and reporting the research (Hickson, 2016). In future studies that include Chinese cross-cultural researchers, there could be further study to explore Chinese cross-cultural researcher’s positionality in the process of data analysis, especially in comparative studies with other immigrant groups.

In conclusion, this study highlights the need for cross-cultural researchers to help build trusting relationships with ethnic-minority communities, thus gaining new insights and advancing knowledge within the field of ethnic minority health research. These insights (e.g., cross-cultural researcher’s fluid positionality; heterogeneity within cross-cultural researchers; and power relationships among cross-cultural researchers, research participants, and broader research) can guide future investigations of Chinese and other immigrant communities as research on immigration policy and health expands.

Recommendations

Our experiences as cross-cultural researchers suggest the benefits of having at least one lead investigator on the broader team of a Chinese immigrant health study, who has a basic understanding of or is familiar with the Chinese community. In addition, “front-line” cross-cultural researchers engaged in Chinese immigrant health studies should be offered more training to improve their culturally competent health knowledge and qualitative study skills, such as probing questions when conducting interviews with Chinese immigrants. There should also be a greater investment from research and academic institutions to connect with Chinese communities, particularly the hidden undocumented populations. The Mexican team in the RIGHTS study had a “promotora”—a Hispanic/Latinx community health worker—to assist with recruiting and conducting interviews with the Mexican participants, which helped the Mexican team recruit more undocumented participants. The further inclusion of Chinese “promotora” will help establish trusted relationships between the research team and the hidden undocumented Chinese immigrants. Revisiting stipend and financial compensation practices is another area of methodology that could yield varying results in a particular population. Chinese cross-cultural researchers realized that the $25 compensation provided for participating in the study did not appear to be of great interest or incentive to the Chinese participants in the RIGHTS study. Providing toolkits and developing conceptual frameworks for use in future cross-cultural studies would be helpful to guide researchers who are engaged in immigrant health studies, especially those investigating sensitive topics, such as immigrants’ experiences of exclusion.

Footnotes

Acknowledgments

We thank all of the Chinese participants, research team members, Community Advisory Board members, the Chinese community institutions, and the authors’ personal contacts for their important contributions to the Research on ImmiGrant HealTh and State policy (RIGHTS) study. We especially thank Dr. Steven P. Wallace and Dr. Kathryn G. Kietzman for their consistent support and insightful suggestions on this paper.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute on Minority Health and Health Disparities (NIMHD) grant [R01 MD012292].

ORCID iD

Lei Chen

Hin Wing Tse

Maria-Elena De Trinidad Young

Notes

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Cross-Cultural Researchers’ Positionality in Immigrant Health Research: Reflections on Conducting Research on Chinese Immigrants’ Experiences in the United States

Abstract

Keywords

Introduction

Description of RIGHTS project

The Approach of Reflexivity and Positionality

Reflections on Cross-cultural Researchers’ Positionality in the Field

Cultural and Linguistic Factors Influencing Chinese Immigrants’ Engagement

Chinese social favors “Ren Qing”

Connecting to specific Chinese subgroups

Linguistic Diversity and Flexibility

Interactions Between Cross-Cultural Researchers and Participants During Interviews

Probing Questions

Addressing Participants’ In-Depth Thoughts

Knowledge and Experiences Related to the US Healthcare System

Ensuring the Data Integrity

Adapting the Interview Guide

Capturing Subtle Cultural Meanings

Triangulation and Ambiguity Reduction

In-House and Outsourced Transcription

Discussion

Recommendations

Footnotes

Acknowledgments

Declaration of Conflicting Interests

Funding

ORCID iD

Notes

References