• Really interesting and important topic with some excellent insights.
• Readability is affected by inconsistent grammar throughout the manuscript.
• The research privileges biomedicine as having an objective truth, with traditional cultural understandings of health being a deficit and requiring people from culturally and linguistically diverse backgrounds to adapt to these biomedical understandings of health. This informs the manuscript at various levels including an assumption of trust in western medicine that could be more comprehensively discussed.

Specific issues:

Abstract
Page 1, Line 25 “There was no patient or public contribution. The study only concerned the providers of the service.” – this is a very unclear statement and that my understanding of the sentence is contradicted by the methods.

Introduction
Page 2, Line 16: “Every culture has a health belief system influenced by culture” – this does not make sense to me.
This paragraph could more usefully acknowledge the reflections and assumptions of the research about biomedicine: how biomedicine this is defined, the cultural implications of biomedicine and how this relates to traditional forms of understandings of health and traditional medicine.
Line 19 – “though” – should this be “through”?
Line 27 – The statement about cultural differences between provider and user incorrectly assumes that healthcare providers are not from the same culture as the patients.

Background: This section provides a limited description of the chronic diseases affecting Vietnamese, with diabetes being the only chronic condition being mentioned.
The aim that is provided is more of a method used rather than a distinct aim and could be made more relevant to the journal.

Design: more reflection as to the rationale for using focused ethnography for this specific research would be useful, and with a revision of the grammar required for readability.

Data collection: there appears a contradiction between “passive participation” and the activities being undertaken. An explanation is needed for the 12 participants: 9 interviews, with one couple declining to participate equals 11 interviews.

Data analysis
Description: how were “in-depth” interviews used to inform the findings? How was the interpretation of the data from Vietnamese into English done – was their back translation? What were the challenges in this?
Rigour and reflexivity: How were “immersed into the culture” determined? More information about the interviewer and researcher should be included in this section particularly highlighting their cultural background and how this affected interpretation of results including their cultural assumptions.

Findings
Characteristics of participants. Line 36 – what “morbidities”? Symptomology is important in responding to chronic diseases.
Themes: I am assuming that pseudonyms are being used, and it would be good to state this. There is an unnecessary mention of “Warwick”
Page 6, line 43 – the comment of the normality of diabetes in older women in Australia begs a question about whether this is an issue of resulting from living in Australia or is it also an issue in Vietnam.
The use of western medicine. This is the first use of the term “Western medicine”. It is important to know the assumptions made by the authors of the scope of “western medicine”?
Page 9, Line 12: contradictory quote: “Western medicine is very slow … Western medicine works faster.” (Mr. Trung).”
Page 9, Line 16: “Although participants described a preference for Western medicine”. More reflection on the research is needed with this with the potential for an acceptability/desirability bias.
Dietary health practices: This section contains much more information in comparison with previous themes and which could be more cohesively presented and edited. This could also include including diet in relation to traditional medicine within the traditional medicine section, and exercise within the exercise section.

Discussion: this is a very well written and comprehensive literature review that uses the data presented in the findings to reinforce previous literature. More compelling would be a fuller discussion about any conflicts between the date and previous literature.
Page 14, Line 50: More information is required of the research understanding of “traditional Vietnamese values”.
Page 15, Line 39: Issue related to independence were not clearly discussed in the findings.
The findings look at the participants as individuals without any discussion about their context with no mention of war, or of relationships with family in Australia or Vietnam, or cross-national knowledge.
Page 16, Line 20: Access to home care support was not mentioned in the findings, and this discussion is confusing as recruitment occurred through a “social care service”.
Limitations: “The role of the principal researcher and her impact on data collection, analysis and interpretation is acknowledged.”” – this needs to be expanded with much more information required. Other limitations include an assumption of living with chronic disease is a biomedical experience, with a small number of people with a limited range of chronic conditions limiting generalisability of the findings. A broader range of experiences and more comprehensive analysis and reflexivity required to support the claims made by the research.
Implications: This section is let down by bad grammar. No discussion about the implications for western clinicians in responding to the needs of these patients.
Conclusions: The statement that “findings from this study also indicated the influence of the physical living context that impacted on chronic disease self-management” is not supported by the evidence presented or its analysis.

I have not been provided with any other reviews of the manuscript. While amendments appear to have been made, most of concerns have not been addressed.

Many of my comments from my review of the 29-Jun-2023 look like they have not been provided to the authors, while other comments appear to have been addressed although not mentioned in the authors response to the reviews. There are numerous editing and grammatical issues needed to be addressed. The limited sample size challenges many of the findings. The research privileges biomedicine as having an objective truth, with traditional cultural understandings of health being a deficit and requiring people from culturally and linguistically diverse backgrounds to adapt to these biomedical understandings of health. This informs the manuscript at various levels including an assumption of trust in western medicine that could be more comprehensively discussed. I am interested to know what the authors mean by “traditional Vietnamese culture” and what assumptions are made by this.