The provision of holistic person and family-centered care in the audiological rehabilitation of adolescents and young adults (AYA) requires in-depth consideration of identity construction. The purpose of this research study was to describe the lived experience of identity construction among deaf AYA. The thoughts, perceptions, and feelings of AYA on their identity and the processes underlying the construction of identity, with a focus on navigating disability, social relations and roles, community assimilation and self-perception were explored.A qualitative interpretive phenomenological approach was adopted. Participants were a purposive sample of 5 AYA, aged 15 to 19 years. Participants had moderate to profound deafness and were enrolled in schools for the deaf where they partook in semi-structured phenomenological conversations, detailing their lived experiences with identity construction.The superordinate themes of creating a self-concept, belonging, stress and being deaf emerged from participants' narratives. Identity construction occurs concurrently at several levels. At the personal level, AYA create self-conceived ideals of who they are. At relational level, identity is fostered through person-to-person and person-to-group interactions. At societal level, AYA navigate inherent challenges with hearing impairment and their positionality as deaf individuals.Understanding the nuances of identity construction gives insights for further research and highlights the self-ascribed identity domains and related psychosocial variables that appeal to person and family-centered care, uncovering opportunities and barriers to successful delivery. Findings have implications for the transitional care of deaf AYA that is responsive to their needs. Adolescence precedes young adulthood and bridges the transition from childhood to adulthood , 2. GenePsychologists and social scientists describe identity as an adopted self-concept influenced by the conjunction of society and self . IdentitThe provision of PFCC is grounded on empowering persons and families to be equal partners and collaborators in their healthcare, where their preferences, needs, beliefs and culture are upheld . When apThe global need for audiological rehabilitation is on the rise. An estimated 34 million children under 15 years require audiological rehabilitation services and over 1 billion AYA are at risk for noise-induced hearing loss due to hazardous listening practices . NeedlesThe identity formation of deaf AYA has diversified from the traditional d/Deaf perspective. Deaf is written with an upper case “D” to denote a communal identity for persons who subscribe to being part of a cultural group that uses sign language and upholds Deaf culture . The terLiterature also documents the impact of school experience and cultural group dynamics on the development of identity among deaf AYA. Chen  indicateIn the African and larger world context, studies generally orient around hearing status and the cultural dynamics of hearing and Deaf cultures as defining measures of identity, reinforcing a rigid view of identity. Identity formation is more complex. Evidently, identity is constructed through self-perception, engaging with disability, building relationships, adopting social roles, and assimilating into communities , 23–25. 2.The research study was approved by the University of Cape Town Faculty of Health Sciences Human Research Committee, reference number: 071/2021 for meeting all ethics requirements. To invite learners from local high schools for the deaf, permission was sought and granted by the Western Cape Department of Education. Schools were auditory-verbal  schools that used spoken language for learning and signing schools that use South African Sign Language (SASL). Further permission was granted by headmasters at the respective schools.A qualitative interpretive phenomenological approach was adopted. At the core of interpretive phenomenology is a need to not only describe phenomena but interpret the meaning of phenomena according to those who experience them . The res2.1.Learners who had reduced hearing sensitivity of more than 35 dB in the better hearing ear were eligible to participate . Records2.2.To ensure informed consent, an informative presentation was given to prospective participants in collaboration with an accredited SASL interpreter. The presentation disclosed the study aim and objectives, information about phenomenological conversations, privacy and confidentiality, the risks and benefits of the study and how collected information would be used or disseminated . ParticiParticipants would not benefit directly from being part of the study, but research findings would lay a foundation for further research and benefit the larger community of deaf youth. Where participants experienced distress during conversations, provision for counselling was available through the school therapist. For confidentiality and privacy, all data relating to the study such as recordings, transcripts and analysis sheets were kept in a secure password protected online storage platform. The participants, as well as any identifiers were anonymized using pseudonyms in the transcripts. All study personnel (SASL interpreter and transcriber) signed binding confidentiality forms.2.3.Semi-structured, phenomenological conversations were conducted at the respective schools during the learners' free time. The school space was a comfortable and familiar setting for participants. At the schools, a secluded, quiet, well-lit, and ventilated classroom was used for these conversations. A secluded venue allowed for complete privacy for the duration of the phenomenological conversations. It was necessary to have a well-lit space to allow for optimum communication, whether signed or speech reading. A phenomenological conversation guide consisting of semi-structured open-ended questions and probe questions was used. Participants were asked to narrate as openly as possible their own personal experience with identity construction as deaf persons. Of the five participants, three were signing. Where participants were signing, the SASL interpreter relayed spoken and signed language accordingly. The duration of conversations was 45–50 min. Follow-up phenomenological conversations were scheduled when more information was needed from participants. Part of the data collection routine included writing reflections in a journal. There, I expressed where my head space was after a phenomenological conversation, what stood out and what insights I got. The reflections were also an outlet of sort; allowing me to let out any emotional or psychological baggage before moving onto the next conversations in . Data sa2.4.Data analysis was completed by the researcher. To initiate the interpretation process, collected audio material was transcribed through a professional service. The audio information collected was the voice of the SASL interpreter which was simultaneously translated from SASL grammar (used by the signing participants) to spoken English. Transcripts were doublechecked for accuracy by the researcher. Field notes as well as non-verbal information such as gestures, facial expressions, moods, and emotions gathered from video recordings of phenomenological conversations were also added to give context to the phenomenological texts.The process of interpretation used guidelines for IPA as outlined by Smith et al. . The iniTo increase confidence in the research findings, trustworthiness was applied through various strategies which were credibility, dependability, confirmability, and transferability respectively . For cre3.3.1.Participants were a purposive sample of Deaf and Hard-of-hearing (DHH) AYA aged 15–19 years. All participants were enrolled in local schools for the deaf in Cape Town in the grades 9–11. Of the 5 participants, 3 were profoundly deaf while the other 2 were Hard-of-hearing. At the conclusion of analysis, 4 superordinate themes and 13 emergent themes emerged from participants' narratives of their lived experience of identity construction. The quoted narratives of participants are written in italics. 3.2.Participants expressed their lived experience of identity construction as a process of creating a self-concept. The self-concept was an amalgamation of defining variables which pertained to the personal development of AYA's identities. The understandings were embodiments of AYA's self-identities captured in how they carried themselves , the roles they assumed , and who they wanted to be (aspirations).3.2.1.Thabo: “A person who is calm, but also strives for success.”Lilly: “Okay. I’m a nice person. I like to play with small children and make jokes and like, go outside with children and make like lot of stuff they can make fun, and find interesting stuff to do.”Juliet shared: “I do not really know about that, so if people want to accept me, they can and if they think I am a bad person, or if they think I am a good person. You know it is up to them to think negatively or positively. I am who I am.”I am who I am” is meaningful. This stance was affirming of Juliet's self-ascribed identity.The expression of “Through their self-identities, participants distanced themselves from disability. Participants conceptualized their deafness as a unique trait, but not one that he limited their function.Juliet: “Deafness is a disability but for me as a person I feel like I am perfect. I can do everything except hear, it is just hearing.”Thabo explained: “I don’t like to consider it as a disability. I just consider it as just one of those things that made me just different to other people. Yes.”Having a relationship with God gave participants perspective and insight about who they were. Equally, the notion of cultural identity was also regarded as representing who they are and where they come from. The spheres of identity that orient around culture, spirituality or faith were highlighted as significant aspects of identity.Thabo shared his perspective: “I think it’s important because as a person we should always have, we all … and where we come from so that’s where the factors of being Xhosa and being Christian. So, I know that I am a Christian but, and I also have an ethnic background Xhosa, so I do speak this, do speak this language and I can say that it is who I am. My background is always who I am as a person and where I come… and where I come from, so it does factor into my life.”Juliet: “Yes I definitely have a relationship with God.”3.2.2.The skills that AYA had allowed them to push boundaries and participate in spaces that were mostly exclusive to hearing persons. Assuming leadership roles was evidence of the advanced ability to take on identities that required them to represent the interests of members of their various communities, whether at school or the larger society. Superficially, the participants were typical teenagers, enjoying lighthearted activities, but more deeply, AYA's skills and talents were reflections and expressions of their identities.Carren: “Maybe there is a medal or an award that I want to get and so I will practice here at the school and the teachers help me with that. So, I have gym and I prepare sufficiently, then they often choose me to be involved in those things with the hearing. I have competitions against the hearing people.”Juliet: “I really love art. I grew up always loving art so now my goal is to be a designer.”Lelethu: “I was selected as an ambassador for the Deaf people.”3.2.3.There was variation and diversity in participants' prospects. The participants' self-awareness demonstrated independent thinking and engagement in the process of individuation as they had developed distinguished ideals of who they wanted to be.Thabo: “I would like to become a lawyer.”Juliet: “Yes, I want to be an art teacher.”In the study, only Lilly was not yet certain of what she wanted to do in the future. This exploration phase is a necessary stage, however staying in this status for an overly extended period can be an indicator for possible identity crisis and thus could possibly become a call for concern.Lilly: “There is a lot, but I still have to choose till next year. So, I’m thinking to be a lawyer, or an airport manager, or a social worker, or a doctor. Those are the main things I’m thinking to do.”Through aspirations, participants wanted to be a representation. This was especially driven by feelings of underrepresentation and lack of deaf role models in the spaces they currently occupied such as school and those that they wanted to occupy in the future such as workplaces.Thabo: “I just saw that there are not a lot of people that are deaf that are lawyers, so I just want to bridge that gap a bit.”Juliet: “I am just so comfortable with you know the concept of teaching children art. As a teacher you know I would prefer that Deaf children do not have a hearing teacher, but rather that they can have a Deaf teacher. Yah, there should be more of that in schools.”3.3.The theme of belonging was expressed in the physical sense of being within a space that was welcoming and in the more abstract sense as seen through the actions and attitudes of others onto them. Participants acknowledged spaces, people and actions that fostered collective or communal identities. Within such settings, AYA felt seen and accepted as part of a bigger whole.3.3.1.School was the predominant space within which AYA's identities were fostered and nurtured. The participants all attended special schools for the deaf, one oral and the other signing. At school AYA felt a sense of sameness, referring to the common experience of deafness. Due to longevity within the school environment, the school also became an incubator where AYA safely developed and solidified their identities along the course of time.Thabo: “You know, what I can say is that as here in this school, everybody understands what everyone is going through because we all know, we’ve all, we’ve all felt deaf, we’ve all seen, and we now know how, and everybody can just bond over that.”Juliet: “Yah, at the school many Deaf friends. Okay so my friendship group, we have grown up together as a group. From Grade R we were very small growing up together until now you know.”Lilly: “It’s like my home because I’ve been there since Grade R until Grade 9, so I’ve known all, most of the teachers because they were here since I was small.”3.3.2.The freedom to engage represented participants' ability to participate without barriers in their close social circles and in the greater community. Participants also expressed how they engaged in different activities with peers or explored new connections. Exploration allowed AYA to gather the building blocks from which they constructed their identities.Lilly said:“And then we go play and do a lot of stuff man. And we help each other with work.”When referring to how she spends time with friends Carren:“I have learnt there from so many of the different other connections that were there. They take photos of us once we are there in Nala. Oh, when I was there for the first time, you know to see all these new things, I felt so happy that was the absolute first time I have been there. As a deaf person I felt so proud to be involved in that golf experience from the school, and we won the cup.”3.3.3.Good relations with friends, family and teachers were critical. They encouraged participants and helped mold them into who they wanted to be. Through these relations, they felt supported and accepted for who they are.Juliet: “And my friends help me with problems, I think that they are my brothers and sisters.”Juliet: “From school especially, yah, from school because it is the teachers who have taught me what to do and everything. They have showed me how to live as a person and what my dreams should be for the future.”Lilly: “They always accept me the way I am. They always like call me for a conversation then I make topics and I make jokes.”Thabo:“My relationship with my cousins is pretty good, they treat me as one of them. We are pretty close and we… they just as well, they also treat me normal. They treat me like a normal human being.”3.3.4.Throughout the participants' narratives, Deaf and hearing communities were juxtaposed. In their perspective, there were two worlds; the deaf world, with which they were acquainted and the outside world, a reference for the hearing world to denote this existing division.Thabo: “They just call… at this school they see me as just a person who has, who is hard-of-hearing, but all the time, they don’t … but they just understand everything. But outside, people who don’t know this, they just tend to look at me—and because of this [points at hearing aid] they just tend to look at me and they just, and they wonder what is it?”These contrasting perspectives influenced the participants' sense of belonging. The separateness of worlds was internalized, causing participants to get the perception that in the hearing world they were in fact seen as the outsiders; denied and deprived of being a part of the outside world. There was a sense that AYA wanted to be included and recognized equally as people.Lelethu: “It is very very different the hearing and Deaf worlds. So often hearing people will tell me news or something even about drugs or something, or something or anything new information comes about. We don’t get that information, so Deaf people need encouragement.”Thabo: “That we are deaf, but you can still be friends, we can still be people. We don’t have to be outsiders.”3.4.The experience of identity construction was stressful for participants. As they reflected on their identity construction journeys, participants experienced many negative feelings and stigmatization. The convergence of emotional strain and stigmatization radically affected the psychological wellbeing of participants.3.4.1.Not being able to hear and communicate left participants feeling frustrated. In these moments of frustration, participants felt very despondent, almost helpless at their situations.Carren:“So my mom, I do not actually know my mom, my mom does not actually know me, who I am as a person, so yah she struggled to teach me things.”Lelethu:“It is very emotional and lots of ups and downs because sometimes I can’t hear.”Juliet: “They were trying to tease me, but you know I cannot communicate with them anyway, so yah, they would laugh at me, and I would be very quiet.”For Lilly, the frustration of not hearing also made her shrink with embarrassment as she was faced with a teacher who scolded her for having hearing difficulties.Lilly: “So after, the teacher always shout at me that I must listen and do the work, so I didn’t, I couldn’t hear because I didn’t know that I was deaf or what’s going on.”3.4.2.In their immediate communities, participants experienced blatant discrimination and prejudice. Participants were labeled, judged and minimized by hearing peers for being deaf. The labels used to describe them had negative connotations, belittled their abilities and were said with no regard of their feelings.Lilly: “They would say that I’m dom and stupid and… I don’t know what to say.”Juliet: “So, they would be teasing, ‘oh look! this is you sign, and you can’t hear and oh you are blind or you cannot use your voice’ and they would laugh at me.”Thabo: “There are… there were some… but not right now. There was some… so I don’t really want to explain about it.”Surprisingly, even when aided and capable of hearing well, Lilly was still subjected to bullying about her hearing ability. The persistence of negative beliefs even with her aided hearing abilities was evident of the deep-rooted negative attitude that exists within the hearing society.Lilly: “Because people like to say, ‘you don’t understand, you don’t hear anything!’ But I’m telling them, you won’t even hear a small sound, but I can hear it. They just don’t believe me, but I don’t know how must I explain to them.”3.4.3.The unpleasant situations that participants were confronted with left them in a state of isolation.Lelethu:“I feel isolated, there is no one there with me because before when I was younger there were people there, but now it is like everyone has forgotten about me. So, at home I just feel really alone, like never going out to visit any of my friends of enjoying myself.”Lilly:“I was feeling so, [shaking head] not nice, because every time when I look something I couldn’t understand, or just, I can’t even talk to people or make friends or do anything with them because I couldn’t hear or do anything. So yes.”It was particularly hard for participants to interact in immediate spaces and in their communities which were predominantly hearing. Participants were left with no option but to withdraw from social interactions.Lilly: “In the community I didn’t like to play outside. I always sit at home and watch TV, or I just go and sleep. And they would come to me and ask ‘Are you fine or what?’ I couldn’t reply, then I just keep quiet and watch TV.”Lelethu:“I felt that… and being adopted especially it felt that …you know… I needed an interpreter to always understand, to be able to experience life, to be able to go out and just do things. But, I cannot do that, so I’ve had to stay at home.”According to participants they also experienced fatigue from explaining themselves to others. This was consistently happening in their daily lives.Lilly: “Yoh, [shaking head], I would just get tired because you have to explain every time to other people.”Thabo: “Then sometimes I get irritated always having to explain.”Carren: “It does not really bother me. I just am kind of tired of them asking me questions, rather they ask my mother.”3.5.The nature of being deaf introduced unique but shared experiences amongst participants. It meant that some experiences were inherent in their lives just by virtue of being deaf. Therefore, participants' experiences with coping, using assistive hearing devices and having social concerns were ongoing and consistently part of their being.3.5.1.Given the challenges they faced as deaf AYA, they had to find ways to adapt and cope with their challenges. Across the board, participants mostly ignored stigmatization and chose to walk away and remove themselves from prejudice-driven encounters.Juliet: “I just ignore it as that being their choice. I just continue doing what I am doing so if they tease me, it does not phase me. Yah, I go to my room or something.”Carren: “I just ignore them, so hearing people, or yah actually I just continue walking.”Maintaining a positive mindset was a critical act for participants. It gave them a positive outlook on their lives, helping them to remain focused and motivated despite their hardships.Thabo: “Just tell, I will try to change that negativity, try to change it into something positive.”Lilly:“For me, I don’t put wrong stuff like saying bad things about me—I just keep the positive stuff so I can do what I really want to do. Because if you keep saying to yourself you won’t do it and it’s just making you not going for it because nothing in the world, you just say you can’t do it, but you can do it—try your best. For yourself, not for other people.”3.5.2.Hearing aids were accepted and seen as enablers and tools for access. They granted participants opportunities and alleviated some of the limitations they experienced. Overall, participants showed a positive attitude towards HA use, showing hearing aid acceptance.Lilly: “They mean a lot because without that [shaking head] I wouldn’t be a person because that thing [referring to hearing aid] help me a lot so I can hear better and yes …”Carren:“I became deaf from that sickness and started using a hearing aid, and then yah. So, I have been able to hear a little bit and people have taught me how to hear and to practice with the hearing aid and that has helped me.”3.5.3.In their narratives, participants shared several social concerns which they felt had direct implications on them as deaf individuals. At their relatively young age, participants were already thinking about their chances of employability in the future. These thoughts emanated from knowing that employability in South Africa was potentially a challenge for them.Lelethu: “I like it because I would think there is a lot of work opportunities, there are interpreters there. So, because there is more people, there is also more access to money there, whereas in South Africa I feel Deaf people are not getting jobs but Sweden I believe it beats the Western Cape.”Carren: “Because I have been taught so many things about my future, and I understand about my outside world and how to get access to a job. So, all those things have been really good to me.”Narratives reflected the dire socio-economic dynamics in their communities, which formed part of the participant's backgrounds. Where participants came from, poverty and crime were rampant. Poor socioeconomic conditions may impede access to safety and special needs that are foundational for identity construction.Juliet: “I felt there was a lot of suffering and yah it… and also hunger, not being able to have food at home. And you open the fridge and there is nothing in there and things haven’t been bought or maybe there is only soup that we keep getting all the time (teary).”The lack of public awareness and insight about deafness manifested into communication barriers and no accommodations for AYA. This was obviously also a major hindrance to accessing basic public services and posed a risk to their health.Lelethu: “Yes, because you need an interpreter in these sorts of instances to allow that to happen. So even as a Deaf person going to the policeman yourself, you need to use paper and write on a page to communicate with them. Even at the doctor, even if you want medication, they will give you the wrong medication and then you are sick and they don’t understand what you are saying, you have to explain so many things.”4.An elaborate discussion of this study's findings demonstrates an in-depth understanding of the experience of identity construction for AYA who are DHH. Insights from the findings are relayed in relation to relevant scholarly literature. Further, study implications on the practice of PFCC for audiological rehabilitation as well as areas for further research are suggested.4.1.Creating a self-concept as a theme can be seen in participants elaborate reflections, self-perceptions and how they address the pertinent question on identity ‘Who am I?’ Participants in the current research study had cultivated a level of self-awareness sufficient to effectively express personal beliefs about themselves. Research shows that a self-concept comprises of personality traits, personal belief systems, physical traits, social roles and the prospective self . In the 4.1.1.Personal characteristics included AYA's personality traits, perception of disability, as well as culture and faith. In the current study, personality traits were attributed to AYA's temperament, their drives, likes and preferences. Historically, deficiency in the personality development of deaf children was associated with lack of spoken language, and more recently with the lack of early language acquisition and negative attitudes of caregivers towards deafness , 35. HowFor deaf persons, the construction of identity involves determining one's stance with the concept of disability. Disability adds dynamics to the process of identity formation, affecting one's ideations about themselves, their physicality and social groups . ParticiIndeed, in the current study most participants' self-concept involved a sense of identity in their religious beliefs. Equally, identification with cultural groups, being Xhosa, Zulu, mixed race or bicultural was important. Across cultures, faith and religion are enshrined in people's self-conceptualizations, mold their choices on how to navigate life and how they cope with disability , 43. Whi4.1.2.A significant tenet of AYA's self-concepts in the current study included their skills and talents. AYA's narratives about their skills, talents and aspirations depicted AYA's present and potential social roles. To consolidate a stable self-concept, AYA must construct in abstract the person whom they will become . The parOverall, creating a self-concept, depicts the personal layer of identity that informs AYA's self-ascribed identities. The self-concept emerged highest in the hierarchy of importance among AYA's identity domains. There is a need for audiologists to be mindful of AYA's self-identity due to its direct impact on care and audiological health outcomes . In audicreating a self-concept theme as a finding in the current study decodes and contextualizes consideration of who the person is into functional and palpable meanings for AYA who are DHH, such as their personality traits, perception of disability identity, religiosity, skills and talents and vocational aspirations. Demonstrating an awareness and understanding of AYA's self-concept is a practice of person-centeredness. When integrated into counseling strategies and other audiological interventions, an improvement in rapport, a balance in power dynamics and empowerment of AYA who are DHH may be seen. The current study findings encourage placing AYA's identity narrative at the center of their audiological care.Core PFCC concepts that may enhance this understanding such as consideration of the beliefs and preferences of the person being treated can seem superficial or intimidating. The 4.2.Belonging for participants in the current study was reflected in the creation of collective identities and the push forces underlying them. A study with university young adults in America showed that a sense of belonging brought a sense of security, positive attachments and heightened meaningfulness in life . Likewis4.2.1.The school setting was an intersection for AYA's shared identities and experiences with fellow peers. All participants in the current study were enrolled in special schools for the deaf. A myriad of suitable conditions such as commonality, togetherness and being understood allowed AYA in the study to foster a sense of belonging within the school space. Olsson and Gustafsson  indicateContradictory perspectives are presented by researchers who state that special schools deprive children from creating a sense of belonging due to limited interaction with hearing peers as well as the nature of curricula which moulds around the limitations of children with disabilities , 58. Con4.2.2.The acquisition of spoken and signed language enhanced feelings of belonging for participants in the current study. When communication efficacy was high, it made AYA feel included and truly affiliated with their communication partners. Notably communication was also a source of pride as it also represented participants' communal identities within the hearing and Deaf cultures. Additionally, the reciprocation of communication encouraged a kinship with others. For instance, the relational identity of being a friend, or a family member strengthened during these social engagements. Participants' experiences showed that being a friend and being related to accordingly as a family member shaped how they perceived themselves and where they belonged.Communication also facilitated exploration, and the ability to explore prompted new ideas, perspectives and experiences which enriched their identity development. Through exploration with peers, participants were able to decipher what resonated with them and could be committed to vs. what to reject. Early identity theories and recent research established that for AYA to consolidate and commit to identities, exploration is a key process , 64. One4.2.3.In the current study peer relationships took precedence, followed by significant family members and educators. Positive identity development was linked to integral relationship qualities such as being supported, accepted, and being understood. Support was rendered to AYA in the current study in the form of provision for emotional, financial, and psychosocial needs. Being accepted and understood represented unconditional love and a mutual understanding that went beyond being deaf. Bain et al.  and MehrOverall, the theme of belonging highlights what a conducive space for PFCC would entail, from the partners involved and the qualities that qualify individuals as important partners in the care of AYA who are DHH. These important partners form a critical part of AYA's help seeking behavior. Evidently, family and caregivers support the personal development of AYA through emotional, psychosocial, and financial support. Family-centeredness requires family and caregivers to be supported adequately by clinicians to fulfill these roles . HoweverInterestingly, peer relations take precedence to family and other caregivers. Other DHH peers can contribute insights to the care of AYA due to the value of shared experiences. Studies show that, AYA become less family-oriented in these developmental stages, becoming more peer reliant . Given t4.3.It is widely known that deafness is associated with a decline in psychosocial wellbeing , 71, 72.4.3.1.Stigmatization involves the act of imposed segregation and marginalization of individuals on the basis of being deaf and stems from the perception of deafness as a liability within the hearing community . In the 4.3.2.Participants in the current study experienced isolation, and withdrawal. Participants felt that their immediate community secluded them and that they struggled to fit in. Moreover, AYA found it hard to foster and sustain peer relations within their communities due to significant communication barrier. Other researchers reported similar findings in studies where deaf adolescents were shown to experience depression, anxiety, anger, isolation, behavioral disorders, social withdrawal, and listening fatigue among others , 77. In Mainly, participants' stressors arise from experiencing communication barriers, a distinct challenge that can also threaten the delivery of PFCC. Participants in the current study were all born from hearing parents. Global statistics on the parental hearing status of deaf children is lacking, however, data from a study in America showed that 95% of deaf children were born to hearing parents . This crSimilarly, when audiologists and other health professionals are not equipped to communicate effectively with deaf AYA, it is a major barrier that can hinder the provision of PFCC. Communication breakdown when caring for deaf persons undermines the significance of adequate communication as a patient need and identity domain. Research shows that health professionals lack deaf awareness and training in sign language, thus often experience communication difficulties with DHH persons . This al4.4.What is it like for AYA to be deaf? From a phenomenological stance, deafness was not only a physiological impairment but an actual context within which participants in the study made meaning of their being. Being deaf introduced extraordinary dynamics which AYA had to learn to accept and cope with.4.4.1.just continue walking”. Walking away denoted low help-seeking behavior among AYA. Adolescents and young adults are said to be unlikely to ask for help regarding the challenges they experience (In a bid to cope with stigmatization, participants tended to “perience . In a reperience . Interesperience  study ciperience  reported4.4.2.It has been reported that deaf individuals are less likely to get jobs and retain them because of communication difficulties, limited education, lack of professional training and negative employers’ attitudes . DespiteLack of public knowledge about deafness enabled stigmatization. Additionally, public ignorance subsequently led to lack of reasonable accommodations for deaf AYA in public spaces. According to a participant in the current study who was an ambassador for Deaf children's rights, this was a prevalent concern and major barrier to accessing public services such as hospital or police services. Social concerns were also exacerbated by the poor socio-economic dynamics in which participants in the study were brought up. Poverty in general is rife in South Africa and threatens the wellbeing of children with chronic conditions and disabilities . It is eBeing deaf is a way of being that AYA cannot dissociate from. Understanding being deaf as a way of life and not just a communication disorder frames audiological rehabilitation anew, in a manner that encompasses the person in their context. It allows appreciation of the unique needs of AYA that result from their positionality and socialization in a majority hearing world. Being deaf requires AYA to cope with certain challenges, thus making positive coping strategies a need for their wellbeing. Challenges inherent in the socialization of deaf AYA such as public ignorance, lack of accommodations and poor socio-economic circumstances are not mere barriers to identity construction but threats to their livelihoods and personhoods, directly implicating PFCC.4.5.Generalizability is not expected in phenomenological research. Participants' experiences may not reflect the experiences of all AYA who are DHH. However, findings can be contextualized to settings that are similar to the study. All participants were enrolled in special schools for the deaf. Lack of heterogeneity in the type of school attended may give a more positive perspective about the experience of identity construction due to AYA's access to early intervention, efficient communication and being in a space where they can relate with peers. Future research can enroll more participants and explore the impact of relationships, poor socio-economic background, and stigmatization on identity construction among AYA. Research evaluating peer and family-led interventions as well as programs for coping styles and assertiveness training among AYA who are DHH is necessary.5.The experience of identity construction is layered. It is a complex and dynamic process that is actively initiated in adolescence and young adulthood. Participants' narratives gave insight into how AYA who are DHH construct their identities and further provided the nuances of why they develop certain identities. Personal ideations are most revered by AYA, amplifying their own voices against externally ascribed identities. The study objectives of understanding AYA's self-perception, social roles, relations, and community assimilation as well as navigating disability were addressed through the themes of creating a self-concept, belonging, stress and being deaf. As much as deafness poses some challenges, psychosocial variables have more significance in AYA's identity construction and overall quality of life. Understanding these psychosocial variables brings significant contribution to the practice of PFCC by contextualizing it to this unique population group. It is paramount to recognize rehabilitation professionals such as audiologists as key role players in identity construction, in their capacity to influence positive identity construction, facilitate the construction of prospective identities and mitigate identity crisis across different points of care. From a phenomenological stance, cultivating cultural humility among practitioners is prompted through reflexivity, openness and non-bias, and honoring the lived experience, thus framing anew the patient in their entirety as the person. For deaf AYA to function to their fullest capacities, audiologists should be cognizant of AYA's psychosocial needs and collaborate with other professionals and necessary stakeholders to enhance the audiological rehabilitation of AYA.


A nationwide Movement Control Order (MCO) was enforced in Malaysia on 18 March 2020 in view of the global COVID-19 pandemic. Malaysia implemented various public health measures and later raced against time to administer COVID-19 vaccines when they became available. As a result of various public health measures to curb the spread of the virus, people in Malaysia faced unprecedented circumstances and new challenges. This study addressed the knowledge gap in our understanding the experiences, coping strategies and perspectives of the people in Malaysia about infection countermeasures by investigating their experiences during the COVID-19 pandemic.A sequential mixed method approach was used to conduct an online survey and in-depth interviews among residents in Malaysia. A total of 827 respondents participated in the online survey from 1st May to 30th June 2020. Nineteen in-depth interviews were conducted online and by phone with key informants and members of the public, who were selected through maximum variation purposive sampling between 2nd May 2020 to 20th December 2021. The semi-structured interviews employed a phenomenological approach and transcripts were analysed using thematic analysis. The survey data were analysed using descriptive statistics in Stata 15.0.The survey reflected significant economic impacts of the pandemic, the maximum number of days that people could cope during the MCO, and their coping strategies, which generally entailed changes in lifestyle. The internet and social media were vital platforms to mitigate against the impact of public health measures. Thematic analysis of the interview data revealed participant experiences and perceptions of COVID-19 and public health measures in four main themes: (1) work and business; (2) emotional impact (3) coping with change and (4) the COVID-19 vaccine.This study provides insights into the experiences, coping strategies and perspectives of people in Malaysia living through the first-ever MCO during the COVID-19 pandemic. Such insights into COVID-19-related public health measures are pertinent for successfully planning and implementing future responses to pandemics.The online version contains supplementary material available at 10.1186/s12889-023-15892-5. Malaysia is an upper middle-income country with a population of 32 million people. The population is made up of people of various ethnicities such as Malays, Chinese and Indians. A significant gap exists on the perspectives of the people in Malaysia during the COVID-19 pandemic. A nationwide Movement Control Order (MCO) was enforced under the country’s Prevention and Control of Infectious Diseases Act 1988 on 18th March 2020. The MCO required people to adhere to safety measures such as social distancing, wearing masks, contact tracing, and limiting in-country and international travel. The Malaysian government has attempted to administer COVID-19 vaccine and booster shots as rapidly as possible since receiving the first shipment of vaccines in February 2021.In view of the global COVID-19 pandemic, the Malaysian government also implemented several biomedical and safety measures. The first MCO to restrict the spread of the virus, implemented between 18 March and 28 April 2020  I can already make plans, you know. Sometimes I can have online meetings with my customers, make life easier for me so sometimes things will be easier for me also.” (P18)“Meeting clients and now you have to use phone calls. When we talk to suppliers, we can’t meet face-to-face, we have to call them and we have to [arrange for] delivery mostly through Grab or this LalaMove [delivery services]. A lot of things need to be arranged now. I would say, there’s a big change and a lot of challenges because there is a lot of restrictions so… I have to plan properly… we are not allowed to work in the office, so there are a lot of things that we need to postpone and cancel.” (P02)However, others, found this more challenging given the different capacities to explore other means of reaching their clients and suppliers.“Despite being afraid of the daily cases reported around my residential area... I still have to go to the office …I have to take more precaution and sometimes I have to give some advice to my subordinates …to [take] some precaution” (P03)Participants who were providing essential services did not experience closure of the workplace. For example, P08, a retired healthcare worker, reported occasionally needing to go to the hospital to carry out voluntary work “helping anybody who needs some medical concierging” during the pandemic. Another respondent who provided essential services said that they feared having to go to work because of resulting risk of contracting COVID-19:“Let’s say they’re going to close up everything, then what about the economy? …for those with a fixed salary, they have no reason to worry since their salary is uninterrupted. But how about, those like us, depending on contracts or daily jobs to get our income. In fact, we’re badly affected. There are two groups of people, the government servants, they are very happy because they are getting the salary. And then I think the private sector they are a bit stressful, like some of my friends…their companies actually told them that they have to agree to the pay cut, if not [in] three months, they [will have to] close up the business” (P04)The survey also found that those who depended on contract and freelance work and those who had other income or no income were equally affected by the loss of earnings Many participants reported that the pandemic and lockdown had had an emotional impact on them. Respondents feared getting exposed to or contracting COVID-19. Additionally, not adhering to public health measures (PHMs) appeared to inflict fear among respondents. The MCO banned social gatherings, disallowing people to have large gatherings for any reason to prevent clusters of infection. One respondent said he was “quite scared to go out” (P11) as this could risk him getting exposed to the virus.“I am watching TV every day. About the lockdown, see what happens. And then see one day, 600 people get buried. Knowing this and safety is above all else. And then the worst part is, there is this thing about the people, a group can be infected but there are no symptoms. They are infected but they don’t cough…they don’t have symptoms… but they go around spreading the virus.” (P13)“Before MCO started... I was quite active, I used to go out a lot. I will go to the library, I will go to the temple, and then I will visit my friends. I’ll go to town and meet my friends, and chit-chat in the coffee shop. But now, I’m tied you know...” (P11)Due to the MCO, respondents expressed feeling frustrated, tied, and a sense of loss because of the constraints experienced due to the public health measures and restrictions imposed.“…able to see that the petrol price is dropping RM 1.25 but not able to pump the petrol. So, it’s like… I want to go out but I can’t go out.” (P01)“I think the negative thing is everything is restricted, not allowed to go out, having dinner outside, you know, going travels, yeah. You know, jogging in the evening, going hiking, everything is restricted. So your daily outdoor activities, because ah, I loved to go outdoors, hiking, jogging and things and all. So that is the main thing that affects ah, my personal life.” (P17)“Oh. You eat, sleep and eat.]. We had to. We had nothing to do. Correct. We had nothing to do. We cannot go out. We cannot meet people. Yeah. You have to eat sleep, sleep and eat. Yeah. Okay. Get on with it.” (P12)The frustration that was felt by the respondents was also said to be due to the limited activities which they could perform within the confines of their homes. P12 expressed that therefore, the only activities that he could settle for were eating and sleeping at home.“Previously, if it’s anyone’s birthday, we would like to eat outside, but now we can’t do that. So, we feel like now that’s been taken away, more limited choices.” (P09)Apart from feeling frustrated with their daily routines, some respondents expressed feeling a sense of loss and deprivation. Participants felt that they could not do the things that they wanted or used to do and a sense of loss and missing out on the things they could not do due to the pandemic. One participant said the opportunity to participate in meaningful, enjoyable and important activities and routines that were a part of his life before the pandemic had been “taken away” (P09), further explaining:“Oh, sure, a lot of difference. Presently, we just send greetings on phones to a few friends. Not like before, we can go to the temple, meet friends personally, shake hands and wish them [a happy new year], pray at the temple itself... special prayers. Even my own grandchildren’s birthday I couldn’t attend.” (P11)The sense of loss also includes missing out on important events and milestones in life such as celebrations and events. As gatherings and inter-state crossings were not allowed for non-immediate family members, his relatives and friends could not attend the wake to pay their last respects. He felt a sense of loss as such events cannot be postponed. Similarly, another participant experienced missing out on milestones, saying:Most participants reported a lifestyle change, which included alterations in the way that they lived, worked, and socialised with the rules of the MCO, such as travel restrictions, school closure, limited business operations, and closure of places of worship and recreation. Thus, people in Malaysia had to stay at and operate from home. Although people were confined to their homes, our survey found that more than half of the respondents posited they could cope without meeting their friends and family in person, without going out in public and except for essential needs or work for more than four weeks Table  15]..15].Most respondents coped by connecting with others, engaging in their hobbies or learning new skills, finding alternative ways for things they enjoy, self-care and watching movies or series Table  15]..15].“I play badminton a lot so like every week at least like three or four nights outside until like 10 o’clock. But now, we’re not allowed to go out after eight, so we need to stay at home obviously not allowed to play badminton as well, so I have to make sure I keep my fitness and also do more exercises [at home] to keep myself healthy.” (P02)Since most places that allowed social gatherings  were closed during the MCO, interview participants had to find alternative ways to continue their activities.“I used to go out, meet friends all these things. Nowadays, I just stay at home. I just spend my time just reading newspapers, watch television. Just relax.” (P11)“Once in a while, I go to the temple in the evening, and I tell them they cannot be gathering here, so we started doing some live streaming.” (P05)Moreover, being confined to their homes, almost all respondents (96.74%) stated that the use of the internet and online social networks were important or very important to them. For example, a leader of a temple explained that since the temple had to be closed, many people resorted to praying at the fence of the building. As a result, live streaming was later organised to enable worshippers to participate in temple activities online:“I have a new routine. Of course, I wake up a bit later than usual, and then… I cook breakfast every morning, sometimes… I still can go to Family Mart or 7-Eleven [convenient stores] to grab something for the children if I’m too tired, but now I am totally unable to do that. So, it’s all about cooking, cooking and cooking.” (P01)In contrast to the habit of eating out before the pandemic, several participants expressed they prepare meals at home more often during the MCO given the travel restrictions and government advice to stay home. Doing so would also minimise or avoid the risk of exposure to COVID-19 although it deprived them of their favourite meals from restaurants.“Because previously I don’t cook every meal. I cook maybe like, two, three, days in a week. This time, I cook every day. Literally every day and every meal.” (P06)“I think the difficult decision was in terms of like, initially we were like ordering food, using GrabFood to minimize the contact, because I don’t expect my wife to cook every day. I mean I cook as well, so we don’t expect to cook every day. Sometimes, you want to eat something from outside, but now we can no longer buy food like how we did before the pandemic, and we need to minimize contact with outsiders.” (P07)“I’m getting healthy food now. My wife tends to cook daily, until and when I tell her, today you take a break, then we’ll buy food.” (P05)Cooking meals at home was also perceived by some to have brought about positive effects, as one respondent explained that eating homecooked meals means eating healthier.As evident from the quotes above and other participant interviews, women appeared to bear the majority of the extra work involved in cooking and preparing meals during lockdown.“Ah, you see, because I’m at this age, all my ex-colleagues are all same age, about the same age, so we go WhatsApp. WhatsApp becomes very useful.” (P13)People also reported using online and social media to maintain their social relationships by connecting with others.“During MCO, I don’t go to campus... so I have online lunch with my friends.” (P06)“They told us it is voluntary, in the form they also say it is voluntary, but in reality, they force us. I am forced to take the vaccine… I will try to avoid it for as long as I can. But if they threaten to suspend me from my job, I will still have to take it. I have no choice.” (P19)Participants demonstrated mixed feelings and expressed different perspectives regarding the COVID-19 vaccine. Some were in support of taking the vaccine while others were vaccine-hesitant. For instance, the national uptake of the vaccine as of July 2021 over the duration of the in-depth interviews was 54% but at least 80% of adults have received a COVID-19 vaccine as of February 2022.“Vaccine depends on the body of the people. There are many side effects. There are no advantages only disadvantages such as death, damages, and disabilities. One of my colleagues without any history of heart disease got a heart attack after getting the vaccine, another one got gastric issues. Is this a coincidence?” (P19)Some respondents felt that the COVID-19 vaccine does more harm than good.“It is not compulsory to take. If possible, I don’t want it. I am so scared. I had allergies, I hear people say for boosters, the effects will be worse. I heard from people who had it.” (P09)“It’s not going to be a cut and dried um, vaccine story, because we have seen vaccines that have not been successful, notably in dengue virus, and therefore the same thing can happen to this virus, this particular virus. In the case of the Influenza virus, there are many vaccines available, but each year, different viruses can crop up, can mutate, which means the previous vaccines may not be effective. So, the vaccine is not going to be the ready answer.” (P08)Two respondents expressed that taking the COVID-19 vaccine is risky as they believed it had not passed sufficient clinical trials.“Vaccine is still in the trial stage… if something goes wrong, they don’t give us compensation. We suffer the consequences ourselves…The only thing we can do is protect ourselves. For those who took the vaccine voluntarily. They did not do enough research, or they did not get enough information. Maybe the information came late. It is their luck if nothing happens, then they are lucky…The vaccine may cause more harm than good.” (P19)“Now I feel that I already have the 2 doses, so it is enough. And I will follow the SOPs so it is quite safe.” (P09)Other respondents were less apprehensive and welcomed the vaccine as it offered some protection from the virus.“When the government announced that the vaccine was available to everyone, I stayed up until midnight to wait for the website to open so that I could book an appointment. All my friends were also eagerly waiting for the vaccine.” (P06)This study presents in-depth information on the lived experiences and views of residents in Malaysia on the COVID-19 pandemic, the impact of public health measures implemented during the MCO, and perceptions toward the COVID-19 vaccine. Participants in this study held diverse views about the government’s response, especially the implementation of various phases of movement restrictions across the country. However, most participants posited experiencing significant challenges during the period, ranging from financial to social constraints, fears, and loneliness. As a result, they engaged in diverse coping strategies to address the challenges emanating directly from the pandemic and indirectly from the measures enacted by the government. These coping strategies comprised practical and socio-cultural ways of tackling the issues.Most participants in the survey and interview sessions reported experiencing significant financial, social and emotional challenges during the pandemic. Specifically, the drastic loss of income and reduction of working hours indicates that COVID-19 affected both people on fixed and flexible salaries. For instance, the informal sector workers and tourism account for more than half of the workforce population in Malaysia, contributing about 15% of the GDP before the pandemic . WithoutWhile financial interventions and packages have had a cushioning effect on reducing the financial impact of COVID-19 in many countries, little to no impact of such interventions was reported in others . For insFurthermore, findings from this study suggest the need for the government to expand their financial and social support programmes to meet the needs of vulnerable and often neglected populations who are likely to disproportionately suffer the adverse impacts of COVID-19 public health policies. Examples include informal workers, freelance workers, transnational migrants, older and younger people, those residing in large households, and individuals living in informal settlements , 23, 26.The second theme in this study pertains to the emotional impact of the pandemic as most participants remained indoors and were afraid to go out except when purchasing necessary goods or during emergencies. Qualitative findings highlight the emotional impact of COVID-19 among respondents, which stemmed mainly from the fears of getting exposed or contracting the virus. These findings coincide with the reports from similar research conducted in Thailand, Slovenia, and Vietnam , 24 in wWhile sharing their lived experiences of isolation and loneliness as pertinent challenges, we observed that these events were strongly linked to fears of infecting loved ones or contracting the virus themselves. These results corroborate the studies conducted in Thailand, where limited social contact arising from an interruption to social interactions was considered the most challenging effect of COVID-19 public health measures , 25, 27.The coping strategies employed by participants to address the negative effects of public health measures implemented by the government were mainly two-fold; practical and socio-cultural lifestyle changes. Practically, participants engaged in social distancing and physical guidelines recommended by health agencies to prevent exposure. They also took active steps to care for their emotional well-being, and mental health, and reduce the economic implications of the public health measures. Examples included connecting with others via the Internet, engaging in hobbies or learning new skills, self-care, finding alternative ways for things they enjoy, and watching movies or series. The pandemic was a shock to the world, but it also catalysed novel and creative approaches which might strengthen individual and community resilience . Recent The most profound usage of the Internet was relayed by a participant following the switch from normal visits to Indian temples to online sessions, thereby representing socio-culturally embedded practices to cope with COVID-19. Our results echo other findings on the relationship between social support and religious coping in the context of COVID-19 , 29. LikUnderstanding COVID-19 vaccination intentions and perspectives are pertinent to achieve population-level immunity and putting an end to the pandemic . Ever siA safety trial was organised by the Malaysian government in order to address the concerns associated with the COVID-19 vaccine and its uptake among residents . NotwithSince we did not specifically investigate the predictors of vaccine acceptance, motivation, and barriers among the participants, the underlying factors for vaccine acceptance or hesitancy among participants of this study are not well understood. Nevertheless, some of the reports in other related studies might provide a clue. Moorty et al.  concludeOur study is one of the few studies that examined the lived experiences, coping strategies and perspectives of people in Malaysia regarding the impact of COVID-19 and its associated public health measures. Additional strengths in this study include the use of a mixed method approach and the application of weighting strategies of the survey samples during the analysis. These procedures enabled us to gather robust data from the participants, which is a step forward relative to previous local studies that utilised either a quantitative or qualitative method. For the survey, participants’ characteristics such as socio-economic status, educational levels, whether or not they have/had COVID-19 and other health-related information were not gathered. This was a strength and also a limitation. We hoped that participants were more honest in their answers and were more willing to participate because minimal personal information was collected. Indeed, our sample size exceeded our target sample size of 600. The limitations of this strategy are well-acknowledged, for example we could not compare the responses of who have experienced COVID with those who have not.Other limitations are also noted. The self-reported nature of the survey may also introduce response bias. Face-to-face data collection could not be conducted due to COVID-19-related restrictions, thus individuals who were either illiterate or lacked access to online technology were not considered in this study. Hence, the present findings may align towards economically advantaged and more educated persons in Malaysia. Despite using weighting strategies during the data analysis, results from this study are not generalisable to Malaysia’s population since the study did not aim to recruit a nationally representative sample. Other limitations include response bias emanating from recall, self-reporting nature, and using cross-sectional study designs, reflecting that our data elucidate the prevalence of specific events and opinions rather than any form of causality. As for the qualitative part of the study, we acknowledge that most of our participants have tertiary education and of Chinese ethnicity. We were not able to conduct in-person interviews due to the MCO hence those we could only interview people who had mobile phones or computers with internet access.This study provides insights into the experiences, coping strategies and perspectives of people in Malaysia living through the first-ever MCO during the COVID-19 pandemic. Such insights into lived experiences of COVID-19-related public health measures are important for successfully planning and implementing responses to future pandemics. Participants in this study shared different perceptions and experiences on the measures implemented, indicating that COVID-19 measures had unequal impacts on different social groups. These findings are important in assisting policymakers and healthcare administrators better understand the impact of these public health measures. Our data contributes to the body of evidence needed to inform context-specific policy decisions in future COVID-19 waves and future pandemics.The extent to which various sectoral groups accept and adhere to stringent public health measures is crucial for mitigating the spread of COVID-19 and optimising societal outcomes during the present COVID-19 outbreak. With the introduction of the national immunisation programme as recommended by the World Health Organisation (WHO), the issues of vaccine hesitancy need to be elucidated by identifying factors contributing to these perceptions among the population. Building people’s trust in the government’s management of the national vaccination programme and ensuring transparent dissemination of information on the vaccine efficacy and its potential side effects may assist in addressing some of these issues.Our study demonstrates unequivocally that public health measures impacted various social groups in Malaysia during the COVID-19 pandemic. Furthermore, the results indicate which groups are most impacted by the pandemic in its early stages, necessitating protection from further health and social inequities. Thus, it is critical to consider appropriate health and socio-economic protection schemes such as financial stimulus packages and mental health services for targeted populations including informal sector workers and young people.Below is the link to the electronic supplementary material.Supplementary Material 1


Using qualitative interviews with three ethnic sub-groups in the Clutha District and Southland Region—the Filipino, Samoan, and Malay communities—we investigate their experiences of settling in small towns. While there is considerable variation in the experiences and aspirations of these ethnic minorities, for each community we demonstrate how local and regional contextual factors shape life aspirations, support infrastructures and settlement trajectories. Particularly drawing upon informal networks and social capital immigrants mediate the considerable challenges they face. Our study also demonstrates the limitations of current policy support and initiatives. Indeed, while local authorities clearly have a significant role in creating the conditions for enabling immigrant settlement in small centres in Southland-Clutha, now the role of government services and community-based support also needs to be considered.Small town New Zealand has, in recent years, experienced an increasing number As with many other OECD countries, over the last 40 years, rural and small-town New Zealand has experienced significant demographic and economic changes Brabyn,  through 2 farmer and small-town populations . Administratively Gore, Southland and Invercargill are part of the “Southland Region”, while Clutha is part of the neighbouring ‘Otago Region’ See Fig. .Fig. 1ThTable In both Clutha and the Southland, the main primary activities are dairy, beef and sheep farming and forestry, while the main secondary industries are processing of dairy, meat and timber Fig. . GrowingDemographically, for most of the last 150 years, the population of the study area was extremely stable in terms of its ethnic composition, with over 85% of the population in 1996 being of European descent, while only 10–11% of the population were Māori, New Zealand’s indigenous population. This also meant that in numerical terms, there were virtually no other ethnic groups of significant size in the area  involving Malay male members and one with four females. One group interview was conducted in Balclutha that involved two male and female Samoans. For Filipino communities, we conducted four one-to-one interviews with three female participants and one male participant. Three group interviews involved both male and female household heads from the same family and one group interview involved four participants from two families.6 For Samoan and Malay communities, the key contact point  limited the recruitment of participants in this study to those with dominant religious affiliations in these communities.All participants were of working age, ranging from their mid-to-late thirties to early-to-mid fifties. With two exceptions where one Malay participant entered New Zealand as a postgraduate student and a Filipino woman as a dependent partner to a New Zealand man, all Filipino and Malay participants entered as temporary labour migrants in the sectors detailed in Table imam and the president of the mosque at Mataura and three Filipino community group leaders in Invercargill city. A staff member from Southland’s regional development agency, Venture Southland, now Great South was also interviewed. All interviews were conducted in English as participants from all three ethnic groups presented conversational English language competence. Interviews were transcribed and interview data were coded to inductively identify key themes that emerged from participants’ descriptions of the three stages of migration.The COVID-19 pandemic at times made the fieldwork difficult and significantly limited the collection of narratives. To tackle this limitation, immigrant narratives were supplemented with existing academic and non-academic studies and with additional details collected through interviews (KI) with community leaders in each immigrant sub-group: the pastor in Samoan church at Balclutha, the It should also be noted that despite the small size of the selected settlements, because migrants come from many different nations, we were not able to fully capture the range of all migrant groups but rather focussed on the experience of the larger communities. In addition, the relatively small sample size means that our results reflect general trends and cannot be taken as representative of the experience of all migrants.The interviews reinforced the notion that the study areas’ economic dependence on primary and secondary industry, and on agriculture and agricultural processing, has been a key migration pull factor for Filipino, Malay and Samoan immigrants. However, these are not unilineal journeys from an immigrant’s home country to a fixed place of settlement; instead, many participants fit the characterisation of stepwise migration, having had several different places of work and residence across the world and within New Zealand before arriving in Southland. For example, many of our participants from the Philippines first found work in the Gulf countries, and with experience in relevant sectors were then eligible to apply to move to New Zealand. Almost all our participants indicated that after entering New Zealand, they moved into small or mid-sized places close to large urban centres—such as Rotorua and Hamilton (near Auckland), Palmerston North (near Wellington) or Ashburton and Rakaia (near Christchurch)—because of the availability of work in agriculture. A few were initially drawn to big cities such as Auckland or Christchurch where there were large, established Filipino or Malay diasporas or extended Samoan family connections. Family connections providing the bridge to pursue new opportunities in New Zealand are particularly common to Pacific Country citizens.Small towns are good places to start off, to raise children and set the footing, you know; they can find a proper home early into their childhood. Besides, I have plenty of time which I couldn’t afford to give them when I was stuck in Auckland’s traffic. [PF3/M/Invercargill]Initially, then, the patterns of immigrant journeys accord with literature suggesting that ethnic connections and social capital significantly influence the settlement decisions of immigrants and assist their employment integration, with previous literature finding that these connections are particularly significant for the settlement decisions of those moving from non-English speaking backgrounds  and stability in the employment sector contributed to their residency visa acquirement in the long run.I was dreaming of the green pasture… I never wanted to be in a busy place because you know, if I looked for that, what’s the point of leaving Kuala Lumpur? I had business over there inside the mall, I came here to do skiing, hiking, surfing, tramping – all those things Kiwi people do. In the end, I wanted peace in life, the very first time I stepped in Roxburgh, I knew, this was the place. And I’m staying there since then. [PM1/M/Mataura]Almost all participants said they moved to regional locations because of work, and later they found these areas catered to their good life aspirations by providing some degree of affordances in their everyday life in areas that large urban centres could not offer. One key attractor is the relative housing affordability that was “unimaginable” in places like Auckland. Cheaper housing costs enabled savings in the early stage of migration, which enabled people to purchase a house relatively earlier than their peers in Auckland or Wellington. Especially for families with children, higher housing prices in larger centres meant an inevitable compromise in the amount of housing space, and some saw this as counterproductive to good family life as children would suffer from a lack of adequate domestic space . Multiple members from the Malay and Filipino communities expressed the view that small towns were conducive to their search for the ‘type’ and ‘quality’ of life that they thought was impossible in metro Manila or Kuala Lumpur. PM1, who had migrated in 2004 and stayed in the small town of Roxburgh since 2005, said,Participants also spoke of the importance of the smallness of their adopted settlements in contributing to their social connections and ease of mobility. One obvious advantage of staying in small towns was that it was relatively easy for some to strategically position themselves in the workplace and from there plan for the long term. Many participants suggested that they felt “lost” in bigger centres—“I lived in Auckland for ten years; there, people do not say ‘hello’ anymore” [PM3/M/Mataura]. There was a lack of the sense of “recognition” of their “good work” both at their workplaces and within their own immigrant community as those places were too ‘busy’ to get “noticed” which previous studies  we started first, these places worked well for us… my husband started as a share milker, then he could move up to become a contract milker and then at one point, he became farm manager of the year. We are hard workers, you know… I started as a farm labourer, then a store worker, to a young nurse to now a care home manager. We now have a place in this society. [PF4/F/Invercargill]Opportunities for re-skilling, particularly for dependent spouses/partners, were perceived as easier because of the relative accessibility to education . This was further reinforced by a high level of motivation that many expressed, e.g. “I am here to find a good life, I must assimilate, I must work towards that” (PF4/F/Invercargill). This drive to work and try hard to integrate and not challenge any abuse they may face in the workplace is not uncommon among first-generation immigrants. In particular, this is a strong discourse among the Filipino diaspora. As one participant, PF1 (F/Invercargill), reflected, “I told my children, if you do not like something (work), love it”. Small towns worked well for these immigrants who were desperate enough to prove their worth to employers and build a reputation in their communal circles. Having the relative luxury of time in small towns to explore alternative career pathways also coincided with such perseverance. One participant recollects her family’s hard work in the last sixteen years, saying,Imam led a session to give the young members greater clarity around religious and cultural boundaries . One participant explained the importance of this regular gathering,Imam – like what you can’t eat, what you wear, but most importantly, how you also become a good Kiwi. We deliberately use English in the session, which the children understand better. [PM3/M/Mataura]This is not just for prayer. If you want to pray, you have a mosque in Invercargill. Why bother driving for an hour to Mataura? It’s like a cultural evening: you share your own food, the children get to meet elderly members and learn etiquette from the Compared to Auckland or other bigger cities, where there are more formalised support systems available within established immigrant clustering, small-town ethnic communities have to self-organise small support networks. For example, the Malay community has established their own support system built around the mosque at Mataura, established in 2017. In the absence of visible residential clusters, the families—who were spread across several regional centres, including Mataura, Gore, Roxburgh, Invercargill, and Queenstown—congregated usually once a month for afternoon and evening prayers. Between the two prayers, they shared ethnic cuisine, and the Imam reinforce during his preaching, “fulfill the obligations of our religion to the point that they do not go against the law of the land.” [PM4/M/Mataura]Two of the authors attended a similar gathering by the same community in Invercargill during July 2021, celebrating the Eid-ul-Adha festival. These gatherings seemed key in educating the younger generations how to navigate multiple identities in Aotearoa as they settle in, to help ensure their Malay and Islamic identities are not in conflict with their Kiwi identities. As we heard the I know every family, and many of them need education – how to maintain the kitchen, the garden, you have to mow your lawn twice a week in this part of New Zealand. We organise sports. Rugby plays a big part for a Samoan to find comfort. We advise on tenancy dispute, police, visa, KiwiSaver [government supported superannuation scheme], how to budget, save for buying house… educating them about small town norms is important, you can’t drink drive and yell on the street here, you know. [PSN1/M/Balclutha]Both Filipino and Samoan community networks devised strategies to meet their cultural needs. These often centered around specific churches and religious leaders in Invercargill and Balclutha. A number of subgroups within the Filipino communities organised activities like dance classes, cooking lessons, badminton sessions, etc. that were supported around members’ affiliation with a particular church. These church groups also provide more pastoral care to the members in educating them how to settle in smoothly, as explained by the religious leader in Balclutha,Despite the many opportunities participants shared about being in small towns, they also recognise limitations. It is recognised that participants need to make careful choices of employment pathways regarding what these places can realistically offer for long-term settlement. Participants were aware that young people, the second-generation members, may not aspire to the type of work their parents do, nor might these regional places accommodate their broader life aspirations. The Filipino woman [PF0/F/Balclutha], who migrated in 2013/2014, mentioned, “I am now planning to study at the university again. After that I may leave this place…” that would be able to cater to her newly acquired skills.We accept that in the care homes, the older generations, those who are more than eighty years old, are not comfortable with us. But you must also understand that at their time, they did not see many immigrants around them, so it is hard for them to accept. But over the years, these workplaces learned from us that they need to speak slowly. They need to embrace differences. Immigrants are the backbone of the country. [PF4/F/Invercargill]Literature has consistently demonstrated vulnerabilities and exploitation, most notably among those on temporary work visas and particularly those employed on dairy farms , who gained permanent residency, 16 years after his first arrival to New Zealand. This was a source of considerable frustration for many participants. The regulatory limbo that many immigrants found themselves in is attributable to New Zealand’s immigration policies, rather than a reluctance on the part of employers to sponsor migrants for permanent residency.Recognising the key role immigrants play in addressing employment gaps in the region, employers and regional and local authorities have pursued settlement support programmes to attract new immigrants and help them to settle. For example, Southland’s regional development agency, Great South (formerly known as Venture Southland), developed support initiatives and coordinated the Southland’s Welcoming Community Programme , where long-term residents support the Filipino community in a range of ways, including providing information and mediation on employment issues, advocacy on immigration policy, and organising cultural events such as Philippine Independence Day celebrations. As most Filipinos are Christian, many also attend pre-existing churches in the region, and this  is an important point of linkage with the broader community.The study revealed the degree to which one region in New Zealand has experienced, for the first time, significant levels of ethnic diversity because of new immigrants filling gaps left by historic population contraction and expanded economic activity. The new arrivals display typical characteristics of immigrants, i.e. stepwise migration, and connecting with familiar ethnic networks. That said, the scale of the small centres has played a key role for immigrants in satisfying a range of their material and immaterial needs. This was particularly important for them to affirm that these places could meet their long-term settlement aspirations, therefore, they could take action accordingly by reskilling themselves, and enacting informal support groups and so forth. That said, this data does contain considerable silences and absences with regard to the multiple spatialities and temporalities of immigrant journeys in New Zealand, and it does not account for the clear occupational shifts that occur during the course of settling in small towns. While immigrants generally perceive the move to the small towns in a positive light and a move which improves their life prospects, there are some unique place-based dynamics which were observed.Firstly, despite the initial good life aspirations and skill based economic opportunities that small towns were seen to meet, in the long run, small towns seem to fall short in meeting immigrants’ diverse occupational choices, particularly for the second-generation immigrants, as well as the foreign-born subjects themselves if they have a changed occupational interest after gaining permanent residency. That said, from a place-based perspective, most immigrants satisfy their needs by relying on the opportunities offered by the region that include multiple small towns and farming districts as an assemblage of diverse options.Secondly, despite the increasing cosmopolitanisation of small towns and immigrants’ significant contributions to the regional economy, immigrants still need to navigate through forms of discrimination and racial stereotyping that are entrenched within these towns’ culturally homogeneous past and the imagination about these places belonging to the quintessential ‘Kiwi’ populations. These negative experiences, in many cases, stay clandestine, normalised, and are exacerbated due to migrants’ prolonged temporary visa status tied to their employment. Thirdly, ethnic immigrant settlement in small towns requires tailored support; however, the in situ institutional support, although increasing in recent years, has yet to cater to the culturally diverse immigrant aspirations. Therefore, immigrant sub-groups go on self-organising their support systems to address gaps in the institutional service provision. The smallness of small towns helps find like-minded peers with similar needs, and they build necessary social capital and communication from thereon.Theoretically, our findings reveal important nuances beyond the instrumentalist reasoning behind immigrants' entry and settlement processes in small towns. We show how place-based factors such as environments, lifestyle and, most importantly, social connections shape immigrant entry, settlement support and retention and how the scale of small towns shapes these processes. Social connections were found as an important element in immigrant well-being, as has been observed elsewhere in Australia and Canada  rather than reflecting absolute numbers.In terms of the major ethnicities, the New Zealand Census classifies people as ‘European, “Māori”, “Pacific”, “Asian” and “Other”. In this regard “Pacific” are people who were born in or identify with the Pacific Islands; in the Southland context, this refers primarily to people from Samoa, Fiji, the Cook Islands, and Vanuatu. The category of “Asian”, while collectively referring to anyone born in or of Asian descent, in the study area refers primarily to people from China, the Philippines, and Malaysia Friesen, .Samoan Quota Resident Visa allows 1,100 Samoans to settle annually in New Zealand provided that, 1) a principal applicant (aged 18-45) must have a job offer that pays enough to support the individual including the accompanying partner and dependent children aged 24 and under, and 2) conditions and expectations, such as language proficiency outlined in the Pacific Access Category Visa are met MBIE, .While having “extended job contracts” is an important determinant for a Permanent Resident visa, some participants had lengthy waiting periods to gain residency, which has implications for their wellbeing and may encourage further migration to Canada and Australia Flaws, .


Moving in time to others, as is often observed in dance, music, sports and much of children’s play cross-culturally, is thought to make people feel and act more prosocially towards each other. In a recent paper, Atwood et al.  argued t In their recent paper, Atwood et al.  call intbehaviour, there was still a positive effect of synchrony on prosocial attitudes even when experimenter bias was controlled for . Since then, many more examples of experiments that mitigate for experimenter bias have been published. For example, Cirelli et al. . That is, they suggest that the effect simply comes down to participants’ expectations that synchrony will make them more prosocial and that these expectations are acquired via received cultural wisdom. A wealth of developmental psychology literature  suggests that this is not the case. This literature provides compelling evidence that the origins of the association between synchrony and prosociality are rooted in infants’ early social interactions. Infants spend about 65% of their time actively interacting with others (Užgiris et al., To demonstrate the potential for participant expectancy effects, Atwood et al. asked participants to imagine a hypothetical scenario in which a group of college students in a psychology experiment walk in step together around a college campus, or just walk together around a college campus. Then, participants responded to a series of questions about how those people might feel in the different conditions. Participants judged that the hypothetical walkers would feel more connected, trusting, similar, on the same team, coordinated and synchronised after walking in step with one another, as compared to the control condition, supposedly supporting the authors’ claims. It is already known, however, that imagining a behaviour may yield similar effects to directly experiencing it due to shared neurocognitive mechanisms (Rizzolatti & Craighero, Previous research has shown that infants, who are highly unlikely to be affected by such demand characteristics, expect that people who move in synchrony will be socially closer to each other from 15 months of age (Fawcett & Tunçgenç, In conclusion, experimenter bias and participant expectancy do not explain away the synchrony-prosociality effect. Studies that have eliminated experimenter bias continue to find a positive impact of synchronous movement on prosociality. The expectation that synchrony and prosociality are linked is not a result of spurious received wisdom. Instead, people learn via social interactions throughout their lifespan that increased prosociality and bonding tend to follow from reciprocal, synchronous interactions – just as they might expect to feel more bonded after laughing, crying, embracing or enduring agonising pain together. In other words, people expect things that happen to happen. In the case of the synchrony – prosociality link, it is possible that top-down expectations may play some role in the observed effects of synchrony on prosociality, and we agree that research designs need to account for this possibility. However, to claim that expectations are “substantial” or are the more interesting part of the story is to ignore the literature on the origins of these expectations. In light of these insights, Atwood et al.’s  findings