Table 2.

Summary of themes

Theme and subtheme	Mandaean	Assyrian	Vietnamese
Ethnocultural identity
Spiritual culture	Baptism and ablutions served to renew their connection with their sect and alleviate pain: We Mandanis have faith within our hearts. I practice my daily religious rituals which make me feel relaxed from within and comforts my pains; you just raise your hand and supplicate. The Mandeni religion is very strong and I believe in it. I love my religion very much (M1, p4, female). Perspective to suffering: I can say that there is a situation more serious than being handicapped in hands or legs, which is being so by the Lord (M2, p21, female).	Faith offers solace from the pain and a sense of hope: It will be accepted and then she will leave it in Gods capable hands, because he is the strongest Doctor. Even the Doctors say God is more powerful he is healing people (A1, p17, female). Perspective to suffering: We should praise God that we are still able to walk and move around we are not bound to a chair or a walking apparatus. We shower and look after ourselves. Praise be to God (A2, p37, female).	N/A
Gender and family culture	Woman is a strong figure who can bear up more than men (M1 and 2, p2 and 23, male and female). Woman as homemaker, support for the husband, carer for children and the doctors in the house (M1, p2, male). Woman prioritises herself as second: All effort relies on women in managing the house and the children…If she is ill, no matter how much ill, when there is a baby that needs her to feed him, she would go to him, even crawling (M1, p2, male).	Traditional gender roles of the woman as homemaker: A woman born in Iraq suffered terribly, she has raised with discipline her children at home and even for those few hours at home she did not sit, her work did not cease from this job to another home duty… (A1, p18, female). Man’s role is provider, to work and bring home money (A1, p11, male).	Traditional gender roles of woman as homemaker: I have to take care of my children, do the housework. So I need to face with the pain (V2, p30, female). Family is highly valued and extends beyond the nuclear family. All extended family are valued for their role and contributions: We will help each other! Or my nephews and nieces can help (V1, p7, female).
	Balanced relationship between husband and wife with the expectation that if they understand each other, they will complete each other (M2, p26, female). Extended family unit, with the obligation to care for elderly family members: Well, in our culture, I am obliged to serve my husband's parents and so for the husband to his wife's parents, because it is shameful for us even to send the old to the nursing home (M2, p20, female).	Culture promotes cohesive family units: My husband’s family have been here for over 40 years all their children are born here and studied and work here, but every weekend they manage to get to get together and are there if anyone is of need of help (A2, p38, female).
Social–community connectedness	Community is viewed in collective terms, united by shared ethnoreligious values and experiences: if he belongs to the sect, we have a fund for such issues…We put money in the fund, they [referring to the elders] distribute it according to the case (M1, p2, male). Strong blood relationships, mediated by marriage within the sect, reinforce community relationships: We are a small community, and the majority of us are relatives (M2, p20, female).	Spirituality mediates the community connectedness. Religious institutions form an access point for community engagement and foster a sense of belonging: We should ourselves try mixing with our community may it be in our churches, at different functions and meetings because by doing this we tend to forget about our medical conditions (A1, p17, female). Collective perspective reflected by participants’ view of each other as quasi-kin ‘brother’ and ‘sister’: Just as my brother 11 and sister 17 have spoken about, people… (A1, p18, female).	Society/community is hierarchical: Expectation of respect for elders and those in positions of social standing, especially medical professionals: …will do everything I am advised and do not dare (V1, p9, female) question a medical opinion. Collectivist culture. Knowledge, remedies and resources should be shared: Vietnamese proverb says “Only when baby cries that the mother decides to feed”. Just like in this case, we need to tell people that we have pain so that if they have good treatments, they will tell us (V1, p8, female).
Migrant or refugee identity
Cultural and religious persecution	Struggle for ethnocultural survival related to the ethnic cleansing campaign in Iraq where Mandaeans ‘were targeted’ (M1, p2, male). Identity as Mandaean was synonymous with ethnoreligious persecution and associated with a fear of ethnocultural extinction: According to us, Mandaeans, we were mistreated in Iraq, we didn’t have a voice, people were scared to call themselves Sabians. Most of them would say they were Christians, but in truth we are Sabians. What that meant is that we were outside the Muslim religion, so the fact that we had to repress what we were is what would cause pain (M2, p25, female).	N/A	N/A
Personal turmoil and living with war	Loss of loved ones as a result of war. Fear for personal and family safety. Harsh and deprived living conditions that played a role in the development of pathology: As soon as Saddam Hussein declared comprehensive war, they immediately shot the oil. We spent four years in Iraq sleeping in cars and in the street. Iran shot us with chemicals of all sorts. We ran away, they beat our house in the fourth year. It was destroyed…We spent years moving from one place to another (M1, p3, female).	Loss of loved ones as a result of war. Fear for personal and family safety: We have come from a country that we have seen many trials and challenges, and because our heart has been broken, so when we have all these pains surfacing it all seems normal to us. We have seen and got used to wars, fear and killings and so when it comes to pain and suffering it means nothing to everyone around you especially in our community (A2, p39, female). Harsh and deprived living conditions that played a role in the development of pathology.	N/A
Adaptation to life as a migrant/refugee	Refugee will always be a part of their identity: We are like a tree that is uprooted, were brought and were put here. It is impossible we will live here as we used to be in our country! (M1, p4, female). Dispersion of family and community throughout the world. Reflected on social and religious struggles, especially financial hardships, struggle to maintain family units and maintain their cultural responsibilities such as caregiver with their pain. Gratitude for new life in Australia and the support and safety afforded in Australia: You can say, here is nice, people love me, they are nice, they cover on me, there is no problem. Ever since we came here, we are treated kindly. There are physicians, we get salaries, and we thank God. They don’t leave anyone in pain! There is excellent care! (M1, p1, female).	Reflected on the value religious institutions played in facilitating adaptation. Gratitude for the safety and comfort they found in Australian society: Thank God for this country if we feel not well, we have the freedom to go outside walk around and forget about it. We have so many things to do to distract us from our pains/stresses (A2, p38, female).	N/A
Health framework
Traditional beliefs	N/A	N/A	Pain can be caused by an excess or deficiency in ‘âm or du´o´ng’: When I was still a child, my friends advised me not to take off your shoes when you get home after a long time walking in sunshine. Because if you take off your shoes right after they been in hot temperature, coldness from the floor may attack and absorb in your body (V1, p8, female).
			Imbalance occurs by eating too hot food (V1, p6, female), too cold food (V1, p6 and p10, female), too much sour food (V1, p8, female) and too much fruit (V1, p10, female).
Biological/pathological	Biological explanations such as joint degeneration represent one explanation for the cause of pain. Abnormal loading attributed to their ‘hard works’ in Iraq has contributed to the development of pathology: We do hard works in Iraq, such as carrying Gas bottles on shoulders without a trolley, without driving. Taking it all on our shoulders and doing housework. This badly influences us (M2, p19, female). Medicine has a role in determining and treating the source of pain.	Pain is attributed to organic pathology such as discs rubbing on to the nerves (A1, p12, male). Abnormal loading attributed to the hard labour endured and seen and…also the lifting of heavy items like the barrels of kerosene (A1, p18, female) has contributed to the development of pathology. Medical investigations such as X-rays support the biomedical nature of pain. Medicine is responsible for determining and subsequently treating the source of pain: I think and feel that my pain is severe and I have they X-rays that show this (A2, p41, male).	Biomedical explanation such as Phong Thãp or arthritis (V1 and V2, multiple participants), sciatica (V1, p8, female) and soft bone (V1, p6, female) could cause pain. Doctors had a role in investigating these pathological sources with the X-ray test (V1, p6, female).
Social	Social pressures such as financial hardship and inability to fulfil traditional roles had a direct impact and could cause pain.	N/A	N/A
Psychological	Psychological cause: Ethnocultural repression was a cause of pain Reminders of past traumatic events trigger pain. Because the physical pain is the outcome of psychological pressures in the first place. Secondly, is the effort we exert in the house, particularly, the family that has parents with children in this country, want to raise up our children with all our efforts, with what we can afford; most of us are housewives. We provide them with their basic needs, meanwhile, we forget ourselves (M1, p 5, female).	Psychological comorbidity: Mood and emotional health problems influence pain, but are not causative: …the times that we are living in and the life we have lived before…thinking about loved ones who are in another country or scattered around the world’.Depression is evident in our culture (A1, p17, female).	N/A
The lived experience of pain
Spiritual coping	Active religiousness—performing rituals to cleanse the body and mind: I practice my daily religious rituals which me feel relaxed from within and comforts my pains; you just raise your hand and supplicate. The Mandeni religion is very strong and I believe in it. I love my religion very much (M1, p4, female).	Passive religiousness—praying and hoping: she will leave it in God’s capable hands, because he is the strongest doctor. Even the doctors say God is more powerful he is healing people (A1, p17, female).	N/A
Social support seeking	Turning to the community and religious leaders for spiritual and emotional support: We go to the hospital to consult, support and if they need anything, we help them reach it (M2, p28, female). Our Sheiks and our religious people, those who are concerned about us, as soon as I telephone them, tell them what happens to me, I ask their blessing and their appealing. They help me (M1, p4, female).	Seeking out and expecting emotional support from others: a sister should be there to help me, to comfort me emotionally (A2, p39, female).	Actively seeking out solutions and guidance from others within the community: I tell them all [referring to others within the community], I don’t hide anything. Because I hope that if someone knows about this pain, he or she will tell me how to cure it (V1, p9, female).
Cognitive coping	Distraction—engaging in activities, particularly community functions, to direct attention away from the pain: My opinion is that people should help themselves by joining good people or communities, go out a little or if unable to go out, reading a newspaper, on the computer a little, watching TV…etc. So that all these elements help him forget a bit about the pain (M2, p20, female).	Distraction—engaging in activities, particularly community functions, to direct attention away from the pain: We should ourselves try mixing with our community, may it be in our churches, at different functions and meetings because by doing this we tend to forget about our medical conditions (A1, p17, female).	Problem focused coping— Identifying âm and du´o´ng imbalances and directing efforts towards resolving these: The weather changes then I feel tired. The pain gets worse, especially in joints…we can prepare a tub full of warm water, lay inside and relax our bodies. I insist we will feel much better (V2, p34, male). Sometimes I feel pain when I eat too much fruit. Sometimes I decide not to eat fruit and drink less water, I don’t feel much pain…because my body can’t bear “too cold” food (V1, p10, female).

M1 or M2, Mandaean focus group 1 or 2; A1 or A2, Assyrian focus group 1 or 2; V1 or V2, Vietnamese focus group 1 or 2; p, participant number; N/A, not applicable (i.e. theme did not apply for this community).