Collective Health Decision-Making: Exploring Examples from Chinese Families in Australia

Abstract Australia’s patient-centred healthcare system emphasises individual autonomy, but this approach may not align with families that have culturally collectivist values. One example is Chinese culture, where collectivist values are rooted in Confucian principles of responsibility. Chinese people are the largest non-English-speaking migrant group in Australia, so understanding how Chinese families make health decisions is important for improving communication, access, and participation in preventive care. This study examined how Chinese immigrant families in Australia make health-related decisions, focusing on vaccination and bowel cancer screening, and how cultural and intergenerational factors shape these processes. We conducted semi-structured interviews with 13 Chinese multigenerational families living in Victoria in 2023, each including at least two generations living under one roof. Interviews were conducted in Mandarin for each family with one older parent, one adult child, and both together, and were analysed using reflexive thematic analysis. Four themes were identified: (1) language and cultural alignment, with families relying on Chinese-speaking doctors and culturally familiar information sources; (2) collective effort and interdependence, with adult children often leading or supporting decisions due to English proficiency and familiarity with the healthcare system; (3) intergenerational conflict, particularly when older parents withheld health concerns to avoid burdening their children; and (4) negotiation and implementation strategies by adult children, including using doctors’ authority and arranging appointments. Decision-making patterns ranged from full delegation (to adult child) to shared deliberation, with respect for parental autonomy remaining important. These findings highlight the interplay between cultural norms, family roles, and systemic barriers to accessing healthcare. We demonstrate that strict adherence to Western privacy norms limits access to care for collectivist families. Instead, healthcare services should provide accessible language support, culturally tailored health education, and options for both family-based and independent patient engagement to improve health outcomes in culturally and linguistically diverse populations. Competing Interest Statement The authors have declared no competing interest. Funding Statement Yes Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This research was approved by the Human Research Ethics Committee of the University of Melbourne (Ethics ID number: 26567). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data Availability The interview transcripts generated and analysed during this study contain potentially identifying and sensitive personal information and cannot be shared publicly due to ethical and privacy restrictions. De-identified excerpts relevant to the findings are included within the manuscript and its Supporting Information files. Researchers who meet the criteria for access to confidential data can request access to the full de-identified dataset by contacting the Human Research Ethics Committee of the University of Melbourne (contact via humanethics-enquiries{at}unimelb.edu.au) and the corresponding author.