Interview survey of physical and mental changes and coping strategies among 13 Vietnamese female technical interns living in Japan

Abstract

We conducted a case study to assess 1) physical and mental changes; 2) self-assessments of symptoms; 3) coping strategies; and 4) adaptation to physical and mental changes by semi-structured interview survey among Vietnamese female migrant workers working in Japan under the Technical Intern Training Program. We found they experienced female-specific physical changes, and some interns’ symptoms worsened because they did not consult anyone about their symptoms. We propose increasing opportunities to learn about possible physical and mental changes caused by migration and to improve health literacy, including prevention, coping, help-seeking, and consultations about health concerns among female technical interns.

The International Labor Organization (ILO) estimated that there were 164 million migrant workers worldwide and female migrant workers accounted for 41.6% in 2017 (ILO, 2018). Female migrant workers are making crucial contributions to destination countries as well as in their countries of origin (ILO, 2019).Migrants often face challenges regarding health conditions and rights of access to adequate medical-healthcare services (Nørredam, 2015; Simich et al., 2007). Furthermore, female migrants encounter reproductive health concerns and underserved conditions in addition to general health challenges (Barkensjö et al., 2018; Schmied et al., 2017). To deal with such global challenges, the member states of World Health Organization (WHO) agreed on a global action plan to promote the health of refugees and migrants in 2019 (World Health Organization, 2019).

The Japanese government established the Technical Intern Training Program (TITP) to provide an opportunity for people from 14 Asian countries to learn and transfer techniques and skills accumulated in Japan to contribute to their countries’ further development. The number of technical interns in Japan has increased consistently since 2011. In October 2018, there were 308,489 technical interns, which represents an increase of about 20% since 2017 (Ministry of Health & Labour & Welfare, 2018). Vietnamese interns are predominant, constituting of more than 50% of the total, and the second largest sending country is China, constituting of about 20% of the total. The interns are dispatched to a company for their assignment after completing a short training course, and they can stay in Japan for a maximum of 5 years. These interns in effect help fill labor shortage, especially in a wide range of manufacturing industries, such as food processing, garment manufacturing, and electrical equipment assembly, although this is not necessarily the intention of the TITP. Therefore, many small and medium-sized companies throughout Japan participate in the program, their owners signing up to receive technical interns.

In this way, the population of technical interns in Japan has been growing and becoming more multinational, especially in rural areas because subcontract factories expecting technical interns are often situated in the countryside. All technical interns are eligible for medical insurance for the whole nation in Japan so that they can freely access medical institutions within a reasonable fee (National Institute of Population & Social Security Research, 2019). However, the interns may not actually have adequate access to medical-healthcare including information resources, and in particular, may suffer especially from reproductive concerns due to their sensitive nature, although there are some nonprofit organizations that provide support and consultation to foreign residents in Japan (Fujita et al., 2020). Furthermore, according to a composition ratio by employee size of technical intern training institution, 65.0% of workplaces that accept technical interns are micro-enterprises which have under 19 employees in 2017 (OTIT, 2019). This is noteworthy since in Japan, the law does not require a workplace with 50 employees or less to assign to a health supervisor. Inevitably then, most interns find themselves with limited resources regarding medical-health consultations and services.

Background

Oita prefecture is located in a non-metropolitan area of the southern part of Japan, and the population is about one million inhabitants. In October 2018, there were 6,254 foreign workers in Oita Prefecture (Oita Labor Bureau, Ministry of Health & Labour & Welfare, 2018), and this number had grown in each of the previous 6 years. Technical interns made up 49.5% of foreign workers. About 80% of these interns were from Vietnam, making them the largest group of technical interns (Oita Labor Bureau, Ministry of Health & Labour & Welfare, 2018). Similar to national trend, the proportion of Vietnamese technical interns in Oita has also increased.

Immigrants have been considered a vulnerable population in terms of health (Helman, 2007; Zysberg, 2005). When living in a foreign country, migrants need to adjust to the society of destination countries and to acculturate. Acculturation causes acculturative stress, which leads to a reduction in health status (Berry et al., 1987). Researchers of previous studies have found that there is a correlation between acculturation or acculturative stress and the state of immigrants’ health (Chae et al., 2014; Lee et al., 2011; Mariño et al., 2001). Moreover, women are more prone to acculturation and acculturative stress than are men (Hilario et al., 2014; Mehta & Beri, 2017; Zisberg, 2017).

In Japan, we have been accepting technical interns while improving employment conditions, however the interns are not acknowledged as immigrants. They therefore face many obstacles such as strict restrictions on the rights of choosing jobs and moving places, in addition to the physical and mental stress they would experience from working in an unfamiliar foreign country. In fact, 9,052 among the 424,394 technical interns in Japan have fled from their designated work place in 2018, signifying the hardship they face. The Ministry of Justice (MOJ) reported that nonpayment of wages and burden of catastrophic debts in home countries as major reasons of abscond (MOJ, 2019). We consider that such technical interns are vulnerable in Japan, however the actual conditions of their health have not been sufficiently investigated. This is mainly because the sending organizations in the home countries send the technical interns to workplaces via the supervising organizations in Japan, making it difficult for outsiders including researchers to approach and gain access to the interns in general.

Despite these logistical difficulties, we consider that the current health conditions and health-seeking behaviors and/or coping strategies among Vietnamese female interns should be evaluated as an entry point to establish appropriate transcultural medical-healthcare provision system as a strategy related to universal health coverage in Japan. Therefore, we approached these women working in unfamiliar cultures in restricted situations by accessing their supervising organizations and then interviewing these women independently. Building on Lazarus and Folkman (1984) transactional model of stress, we conducted semi-structured interviews with 13 Vietnamese female technical interns to assess the current status of the following: 1) physical and mental changes experienced; 2) self-assessments of symptoms; 3) coping strategies; and 4) adaptation to physical and mental changes.

Considering the lack of research on immigrants on non-Western countries compared to Western countries, we believe that by understanding the cultural and societal adaptation and adjustment among Vietnamese women in Japan – a non-Western country – we can contribute essential material for considering the global health support system for female migrant workers. By clarifying the actual health conditions and health-seeking behaviors and/or coping strategies among female technical interns working in Japan where the immigration system is still immature and particular from that of Western countries, we can provide material necessary in considering the health of the vulnerable female immigrants working worldwide.

Materials and methods

Study participants

In September 2018, we placed telephone calls to the five supervising organizations designated as “excellent” by the Organization for Technical Intern Training in Oita Prefecture that accepted Vietnamese technical interns and asked for their cooperation in this study. We obtained agreement to participate in this study from two of these organizations, after explaining our objectives, the contents of the interview guide, and a description of the ethical considerations. The managers in these two supervising organizations then asked their female technical interns to participate in the research using the written request form. These female interns were in the second term of technical intern training, meaning that they had been in Japan for at least two years.

A total of 13 Vietnamese female technical interns volunteered to participate in the study. All participants were in Japan under the TITP for the first time. We individually contacted the 13 interns to explain our purpose, confidentiality and the ethical considerations of the study in verbal and written form, and we were able to obtain their written informed consent prior to conducting the interviews. We also asked for permission in advance to record the participants’ comments in audio format, and received consent from all participants.

Data collection

Between October and December 2018, we conducted individual face-to-face interviews with participants outside of work hours at their workplaces or in their dormitories in a private room where the participants’ responses could be kept confidential. The authors conducted the interviews in a mix of beginner-level Japanese – which the participants had studied before coming to Japan – and Vietnamese. The first author, a female registered nurse with experience volunteering as a medical interpreter (English-Japanese), conducted all interviews using a semi-structured interview guide, with the assistance of a female Vietnamese-Japanese interpreter. Prior to conducting the interviews, the interviewer received training regarding qualitative data collection by a supervisor experienced in qualitative research. The interviewer then trained the interpreter/research assistant on the study objectives and procedures, the interview guide, and the ethical considerations.

We included questions about 1) demographic characteristics; 2) experiences of physical and mental changes since coming to Japan; 3) self-assessments of these physical and mental changes; 4) experiences of consultation about or dealing with these changes; and 5) the outcomes of these changes in the interview guide. Following Lazarus and Folkman (1984) transactional model of stress and coping, we defined physical and mental changes as stressors when a person feels something different or unusual, causing them to feel unwell.

The interviewer and interpreter met with each participant on the day of the interview, and each interview lasted 40-50 min. All interviewees participated in a single interview; no one was asked to participate in additional rounds of data collection.

Analysis

We audio-recorded and transcribed all the interviews. First, the first author extracted narratives that referred to physical or mental changes, self-evaluation, and coping strategies from the verbatim transcripts of each of the 13 participants and assigned a code to each narrative using expressions that could clearly identify the content of the narrative. Through discussion among the authors (the first, second, and fourth authors), we classified the codes by their similarities, and generated categories and subcategories. We then examined the relationships among the categories, and identified the number of participants by whom the content of the subcategories was mentioned. Finally, we focused on the menstrual disorders that were most frequently mentioned under “physical and mental changes” and organized the narratives into “self-assessments,” “coping strategies,” and “consequences” for each of the 13 participants.

Ethical approval

The Committee on Research Ethics and Safety of Oita University of Nursing and Health Sciences approved the study protocol. (Authorization number: 18-62).

Results

Overview of the participants

The average age of the participating interns was 23 years (range: 20 to 28 years), and the average length of stay in Japan was 2.5 years. Eleven participants were unmarried, one was married, and one participant’s marital status was unknown. All participants worked at a manufacturing plant assembling electronic devices, as assigned by the supervising organizations. At the time of the interviews, 10 participants worked the day shift, and three worked the night shift. Six of the 10 participants who worked the day shift said that they also had experience of working on a night shift.

We extracted 30 categories and 56 subcategories from the verbatim transcripts of the interviews.

Physical and mental changes after coming to Japan

Eleven interns had experienced physical and mental changes since they came to Japan. All 11 of these interns had experienced menstrual disorders, which were the most common physical changes among the women interviewed. Irregular menstruation was the most common menstrual disorder symptom, and one intern reported having amenorrhea for half a year. Eight of the 11 interns experiencing menstrual disorders had not experienced menstrual disorders in previous periods of their lives. Acne or eczema was the second most common physical change, which was experienced by eight interns, of which four experienced severe acne or eczema. None of the eight interns had experienced facial acne or eczema before coming to Japan. (Table 1)

Table 1. Participants’ sociodemographic characteristics and physical and mental changes.

ID	Age (years)	Marital status	Period of stay in Japan (months)	Work shift/Night shift experience	Menstrual disorders experienced	Physical and mental changes	Time between coming to Japan and onset
A	24	Unmarried	36	Day/Yes	Oligomenorrhea	Severe acne, Joint and muscle pain	3 months later
B	23	Unmarried	36	Day/Yes	Short menstruation	Severe acne, Sleep rhythm disturbance, Work pressure	5 months later
C	25	Unmarried	30	Day/Yes	Irregular menstruation	Eczema, Joint and muscle pain, Fatigue	24 months later
D	23	Unmarried	36	Day/Yes	Irregular menstruation	Acne, Fatigue, Joint and muscle pain, Reduced appetite	12 months later
E	21	Unmarried	36	Day/Yes	Irregular menstruation	None	12 months later
F	28	Unknown	36	Day/No	None	None, Irritation
G	22	Unmarried	24	Day/Unknown	Irregular menstruation	Extreme homesickness, Sleep rhythm disturbance, Weight gain	12 months later
H	21	Unmarried	30	Night	Amenorrhea	Eczema	1 months later
					Hypermenorrhea	Frustration
I	22	Unmarried	30	Day/Yes	None	None
J	20	Unmarried	24	Night	Oligomenorrhea	Severe acne, Sleep rhythm disturbance, Dry skin	1 months later
K	23	Unmarried	36	Day/Unknown	Oligomenorrhea	Eczema, Dry skin, Hair loss	6 months later
L	27	Married	24	Night	Short menstruation	None	12 months later
M	20	Unmarried	24	Day/Unknown	Irregular menstruation	Severe eczema	2 months later
					Hypermenorrhea	Joint and muscle pain

We have shown the categories and subcategories for the physical and mental changes experienced, together with the number of cases reported in each subcategory in Table 2.

Table 2. Physical and mental changes and stressors experienced by Vietnamese female technical intern trainees after coming to Japan.

Category	Subcategories	N
Menstrual disorders	Menstrual cycle got longer; then a state of amenorrhea persisted, and it was no longer possible to calculate the menstrual schedule.	4
	Menstrual cycle became irregular after coming to Japan, although it was regular in Vietnam.	6
	Experiencing dysmenorrhea and menorrhagia.	1
	Irregular menstruation was very bothersome.	2
Acne or eczema experienced for the first time	Acne or eczema caused pain and itchiness.	5
	Eczema got larger and increased.	3
	Never experienced acne or eczema in Vietnam.	2
Feeling frustrated when work does not go well	Feeling depressed because of pressure in manufacturing products.	3
	Experiencing reduced appetite because of distress over work.	1
	Getting irritated because their communication in Japanese was not understood at work.	1
Sleep rhythm disturbance	Feeling uneasy about small things and being unable to sleep well when thinking about family and feeling lonely.	1
	Difficulty falling asleep and experiencing a lack of sleep until getting used to shift work.	3
Dry and painful skin	Having dry, itchy skin and a sore throat in winter.	3
Hair loss	Hair loss starting 6 months after coming to Japan.	1
Weight gain	Gaining weight after coming to Japan.	1
Joint and muscle pain from work	Work caused neck, back, and leg pain.	4
Fatigue from working in shifts	Fatigue from working in shifts	1
Extreme homesickness	Being extremely homesick.	1

N: number of instances of each subcategory.

We have listed below the selected descriptions given by the interns as examples of some of the categories. Here, we have demonstrated the categories in italics and square brackets, and introduced the descriptive remarks in quotation marks. In addition, we have presented unique intern identifiers following each interview extract in parentheses.

Menstrual disorders

Eleven interns experienced menstrual disorders, and one of these interns reported having amenorrhea for half a year. Most of these women had not experienced menstrual disorders before. Six interns observed that their [menstrual cycle became irregular after coming to Japan, although it was regular in Vietnam], and this assessment was the most common. Furthermore, for four interns, their [menstrual cycle got longer; then a state of amenorrhea persisted, and it was no longer possible to calculate the menstrual schedule].

• “My period came late a year after I came to Japan.” (E)

• “My period came later and later; then it did not come for 6 months.” (H)

• “I am no longer able to calculate my next menstrual bleeding.” (M)

• “I felt pain in my abdomen during my period, although I never had such pain in Vietnam.” (M)

Acne or eczema experienced for the first time

Eight interns experienced facial acne or eczema of varying degrees and said that they had never had such symptoms before coming to Japan.

• “Only my face swelled after I came to Japan, because of acne.” (A)

• “Acne was painful and itchy.” (A)

• “A rash on my back grew and increased 2 years after I came to Japan.” (C)

• “Acne was reddish, and I felt pain, especially while I was working.” (H)

• “I had acne right after I came to Japan, although I had never had it before.” (M)

Feeling frustrated when work does not go well

Each supervising organization provides Japanese language lessons for one month after the technical interns arrive in Japan. However, most of the participating interns were not fluent in Japanese, and some reported experiencing a language barrier. They also reported feeling pressure or frustration on the assembly line or involving imposed quotas.

• “I felt pressure to perform well for the people behind me.” (B)

• “I felt that there was a language barrier when I could not understand what I was told by my Japanese boss.” (F)

• “My mood often changed – like feeling sad or very irritated – and I did not want to talk to anyone when I was required to meet my quota.” (H)

Extreme homesickness

The interns lived in a dormitory with other Vietnamese interns. However, they reported feeling homesick after being in Japan for a year, and some described a [sleep rhythm disturbance] because of sleepless nights.

• “I cried because I was extremely lonely, thinking about my family all the time.” (G)

• “I have been anxious about small things.” (G)

Other physical changes

Three interns felt [dry and painful skin] during their first experience of the cold winter in Japan. Many of the interns had not worked before, and they described feeling [joint and muscle pain from work] or [fatigue from working in shifts]. Most interns reported not being careful about what they ate, with some regularly skipping breakfast and others eating only fattening noodles. Because of their unbalanced diet, one said that they had experienced [weight gain] since coming to Japan.

Categories of self-assessment of stressors

We extracted seven categories and 16 subcategories as self-assessments of physical changes, and have listed the number of cases in each subcategory in Table 3. In terms of [self-assessed causes of symptoms] regarding menstrual disorders, some interns thought that [differences in water and temperature caused acne and menstrual disorders] or [switching to the night shift caused irregular menstruation and skin problems]. However, there were interns who were [not wanting to see a doctor when experiencing irregular menstruation because of feeling embarrassed] because of [embarrassment about acne and irregular menstruation].

Table 3. Self-assessment of physical and mental changes and stressors.

Category	Subcategories	N
Thinking of the causes of symptoms	Differences in water and temperature caused acne and menstrual disorders.	7
	Switching to the night shift caused irregular menstruation and skin problems.	4
	Appearance of symptoms and their extent depend on one’s mental state.	3
	Symptoms are not related to each other.	2
	Irregular menstruation occurred at the same time as other symptoms appeared.	2
	Unable to figure out the cause of symptoms.	3
Determining that they need to see a doctor	Decided to see a doctor because symptoms worsened or they wanted to get better.	2
	Decided to see a doctor because the medical level was better in Japan than in Vietnam.	2
Seeing how symptoms progress for a while and then considering whether they need to see a doctor	Thinking it unnecessary to see a doctor despite experiencing symptoms because of concern about medical expenses.	1
	Seeing a doctor half a year after symptoms appeared.	2
Embarrassment about acne and irregular menstruation	Wanting to hide acne and eczema.	1
	Not wanting to see a doctor when experiencing irregular menstruation because of feeling embarrassed.	3
Suffering from worsening symptoms	Being troubled or worried about symptoms.	2
	Thinking that symptoms got worse.	1
Deciding it is unnecessary to consult Japanese coworkers or supervisors	Never thought of telling a Japanese supervisor about headaches resulting from weather changes.	2
No worries	Getting used to physical and mental changes so that they could feel normal even with symptoms.	4

N: number of instances of each subcategory.

Categories of coping and help-seeking behaviors

We extracted seven categories and 12 subcategories as coping and help-seeking behaviors toward physical and mental changes (stressors), and have listed the number of cases in each subcategory in Table 4. Five interns each exhibited the coping and help-seeking behaviors of [consulting Vietnamese friends] and [actively using Japanese clinics and medicine] in response to physical and mental changes. Three of the 11 interns experiencing menstrual disorders reported [consulting Japanese supervisors], and three reported [never consulting anyone about menstrual disorders].

Table 4. Coping and help-seeking behaviors.

Category	Subcategories	N
Consulting Vietnamese friends	Consulting Vietnamese friends about symptoms, medicines, and whether to see a doctor.	5
Consulting Japanese supervisors	Consulting Japanese supervisors or asking them for a doctor’s appointment.	3
Looking up clinics, medicines, and the words of a doctor by themselves	Searching online for information about clinics and over-the-counter medicine.	2
	Asking a doctor to write down an explanation in Japanese and looking up the words later on their own.	2
Actively using Japanese clinics and medicine	Continue seeing a doctor and taking medicine until symptoms improve.	5
	Always having the documents necessary to see a doctor whenever they feel sick.	3
Taking Vietnamese medicine	Trying traditional methods and using Vietnamese medicine.	3
	Just going to bed without taking any pills for a headache.	1
Maintaining their condition in their own way	Avoiding expenses by not going to a clinic.	2
	Always having noodles because they are not in the mood to cook.	1
	Surfing the Internet on their cell phones when they cannot go to sleep.	1
Never consulting anyone about menstrual disorders	Never consulting anyone about menstrual problems.	3

N: number of instances of each subcategory.

Coping and help-seeking behaviors and the consequences of physical and mental changes and stressors

We extracted six categories and 10 subcategories as consequences of physical and mental changes (stressors), and have listed the number of cases in each subcategory in Table 5. Eight interns who had a medical examination and took medication reported [getting better after taking a prescription medication]. However, eight interns reported that their [symptoms continued, then worsened] (multiple answers were allowed).

Table 5. Consequences of physical and mental changes.

Category	Subcategories	N
Getting better after taking a prescription medication	Symptoms improved after taking medicine or applying cosmetics.	5
	Symptoms took a while to go away despite taking medicine.	1
	Feeling relieved that symptoms improved.	2
Getting better without taking any action	Getting better naturally when experiencing irregular menstruation.	1
Acclimating themselves	Getting used to life in Japan.	1
	Acclimating themselves although working the night shift was hard.	1
Feeling relieved after consulting friends	Advice from friends relieved concerns.	1
Symptoms persist even after consulting a doctor	Nothing changed even after seeing a doctor.	1
Symptoms continue, then worsen	Symptoms experienced in Vietnam worsened after coming to Japan.	5
	Symptoms that started after coming to Japan worsened.	3

N: number of instances of each subcategory.

The links between sociodemographic characteristics, self-assessment, coping strategies, and consequences related to menstrual disorders

We have shown the links between sociodemographic characteristics, self-assessment, coping strategies, and consequences regarding menstrual disorders for each of the 11 individual interns who experienced menstrual disorders in Table 6. For two interns, their symptoms of menstrual disorders worsened, even after switching from the night shift to the day shift. Other two interns who reported [never consulting anyone about menstrual disorders] also noted that their [symptoms continued, then worsened]. The two interns who reported [consulting Vietnamese friends] also said that their [symptoms continued, then worsened]. In contrast, the interns who were [actively using Japanese clinics and medicine], [looking up clinics, medicines, and the words of a doctor by themselves], and [consulting Japanese supervisors] found they were [getting better after taking a prescription medication]. Moreover, the four interns who reported [maintaining their condition in their own way] said that they were [getting better without any action] or by [acclimating themselves].

Table 6. Links between sociodemographic characteristics, self-assessment, coping strategies, and consequences related to menstrual disorders.

ID	Menstrual disorders	Self-assessments	Coping strategies	Consequence
B	Short menstruation	Embarrassment about acne and irregular menstruation	Never consulting anyone about menstrual disorders	Symptoms continue, then worsen
D	Irregular menstruation	Thinking of the causes of symptoms	Consulting Vietnamese friends
K	Oligomenorrhea	Thinking of the causes of symptoms	Never consulting anyone about menstrual disorders
M	Irregular menstruation	Suffering from worsening symptoms	Consulting Vietnamese friends
	Hypermenorrhea
A	Oligomenorrhea	Thinking of the causes of symptoms	Consulting Japanese supervisors	Getting better after taking a prescription medication
		Determining that they need to see a doctor	Actively using Japanese clinics and medicine
H	Amenorrhea	Determining that they need to see a doctor	Looking up clinics, medicines, and the words of a doctor by themselves
	Hypermenorrhea	Suffering from worsening symptoms	Actively using Japanese clinics and medicine
J	Oligomenorrhea	Seeing how symptoms progress for a while and then considering whether they need to see a doctor	Looking up clinics, medicines, and the words of a doctor by themselves
C	Irregular menstruation	No worries	Maintaining their condition in their own way	Getting better without taking any action
E	Irregular menstruation	No worries	Maintaining their condition in their own way
G	Irregular menstruation	Thinking of the causes of symptoms	Maintaining their condition in their own way	Acclimating themselves
L	Short menstruation	No worries	Maintaining their condition in their own way

Discussion

In general, stress is considered a factor likely to affect the menstrual cycle and menstrual pain (Nohara et al., 2011; Sznajder et al., 2014; Zhou et al., 2010). Most interns in the present study did not have work experience in their home country before participating in the TITP. Therefore, starting their careers in their early 20 s in a foreign country with an unfamiliar culture may have had a big impact on their lives and on the conditions of their health. The interns in this study are surrounded by an unfamiliar environment in Japan, and it is natural that they would feel stress because of the need to acclimate themselves to the work environment and to acculturate to the Japanese society. Jang et al. (2013) have reported that female residents of the northern and southern regions of Vietnam have a low risk of dysmenorrhea compared with Vietnamese domestic marriage immigrants in South Korea, suggesting that there is an association between menstrual disorders and acculturation among Vietnamese women living abroad. Similarly, Lee and Im (2017) have reported that acculturative stress levels were significantly associated with severity of premenstrual symptoms among Korean women studying in the United States. According to these previous findings, we considered a possibility that the different menstrual disorders experienced by interns in the present study were related to their individual levels of acculturative stress.

We revealed variations in coping strategies for dealing with physical and mental changes, even among women with similar circumstances. Individual coping styles and help-seeking behaviors may have been affected by these women’s sociodemographic characteristics, but their level of acculturation to the environment or society and extent of feeling acculturative stress also contributed to determining their consultation decisions and help-seeking behaviors. Some interns in this study did not consult anyone about their menstrual disorders, even when their symptoms worsened. Menstrual disorders can interfere with daily life (Ding et al., 2019) and work life (Health & Global Policy Institute, 2018), thereby also influence quality of life (Iacovides et al., 2014). For migrant workers, including the Vietnamese interns in this study, obtaining accurate health information in a new country is likely to be more challenging than it would be in their home country, especially regarding information about reproductive health. Furthermore, the managers and staff members of the supervising organizations tend to be middle-aged men who might not be sensitive to the concerns and constraints specific to young female interns, leading the young female interns to neglect the physical changes that are specific to women who are of reproductive age. Thus, the managers and staff members of the supervising organizations need to show sensitivity to the physical changes regarding reproductive health of female interns, even if they do not directly ask for help.

In small and medium-sized companies, technical interns are responsible for their own healthcare. However, the healthcare system is different in each company. We assume that the interns in the present study likely had little opportunity to talk with healthcare professionals at their workplaces. The supervising organizations, technical intern training coordinators, and employers should arrange worker-friendly conditions to benefit all interns, regardless of gender, nationality, or language ability, and guarantee health consultation opportunities for technical interns. Unfortunately, female technical interns might hesitate to speak with the Japanese male staff members in charge of the intern coordination about female-specific symptoms related to reproductive health. However, making it possible for Vietnamese female interns to improve their health literacy is essential, and their help-seeking behaviors should be encouraged and enabled as part of the protection of basic human rights in the work environment.

We considered several limitations when interpreting the findings of this study. First, in this study we did not consider the interns’ educational attainment, cultural background, socioeconomic status, or level of health literacy. We require further studies to evaluate the impacts of these factors on workers’ coping styles and help-seeking behaviors. Second, almost all interns participated in the study did the same type of work so our findings may be biased. Female interns work in various environments by occupation, and they might experience different physical and mental changes by type of work not examined in the present study. We need further studies focusing on a wide range of occupations to fully explore the health conditions among Vietnamese female technical interns. Despite these limitations, we believe our findings shed light on the condition of Vietnamese female technical interns’ health and on their coping strategies since coming to Japan. The authors have provided an opening to a better understanding of the physical and mental health of female technical interns, and we hope that our findings will lead to improvements in consultation and healthcare provision in workplaces employing these interns.

Vietnamese female technical interns experience female-specific physical changes, which may be caused by hormone imbalance. Some interns did not consult anyone about menstrual disorders, even when their symptoms worsened. We propose increasing opportunities to learn about possible physical and mental changes caused by migration and to improve health literacy, including prevention, coping, help-seeking, and consultations about health concerns. In our study, we revealed the universal challenges of migrant health and in particular dealt with health issues among female Vietnamese interns in a non-Western country, Japan. We believe that through the findings of our study, we can contribute to the discussion of support systems necessary for the health of immigrant women who are employed in various kinds of work in foreign countries, of which the system for immigrants is still in their infancy.

Acknowledgements

We would like to express our sincere thanks to the 13 Vietnamese technical interns and the two supervising organizations for their participation in this study. We also thank Jennifer Barrett, PhD, from Edanz Group (https://en-author-services.edanzgroup.com/) for editing a draft of this manuscript.

Disclosure statement

The authors declare that they have no competing interests.

Funding

This work was supported by the research incentive fund from Oita University of Nursing and Health Sciences.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [RK], upon reasonable request.