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"It is a challenge to do it the right way": an interpretive description of caregivers' experiences in caring for migrant patients in Northern Sweden
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0001-7087-1467
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. (Arcum)
2012 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, 433- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Experiences from nations with population diversity show extensive evidence on the need for cultural and linguistic competence in health care. In Sweden, despite the increasing diversity, only few studies have focused on challenges in cross-cultural care. The aim of this study was to explore the perspectives and experiences of caregivers in caring for migrant patients in Northern Sweden in order to understand the challenges they face and generate knowledge that could inform clinical practice.

METHODS: We used an interpretive description approach, combining semi-structured interviews with 10 caregivers purposively selected and participant observation of patient-provider interactions in caring encounters. The interviews were transcribed and analyzed using thematic analysis approach. Field notes were also used to orient data collection and confirm or challenge the analysis.

RESULTS: We found complex and intertwined challenges as indicated in the three themes we present including: the sociocultural diversity, the language barrier and the challenges migrants face in navigating through the Swedish health care system. The caregivers described migrants as a heterogeneous group coming from different geographical areas but also having varied social, cultural and religious affiliations, migration history and status all which influenced the health care encounter, whether providing or receiving. Participants also described language as a major barrier to effective provision and use of health services. Meanwhile, they expressed concern over the use of interpreters in the triad communication and over the difficulties encountered by migrants in navigating through the Swedish health care system.

CONCLUSIONS: The study illuminates complex challenges facing health care providers caring for migrant populations and highlights the need for multifaceted approaches to improve the delivery and receipt of care. The policy implications of these challenges are discussed in relation to the need to (a) adapt care to the individual needs, (b) translate key documents and messages in formats and languages accessible and acceptable to migrants, (c) train interpreters and enhance caregivers' contextual understanding of migrant groups and their needs, (d) and improve migrants' health literacy through strategies such as community based educational outreach.

Place, publisher, year, edition, pages
2012. Vol. 12, 433- p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
URN: urn:nbn:se:umu:diva-64326DOI: 10.1186/1472-6963-12-433PubMedID: 23194441OAI: diva2:600147
Available from: 2013-01-23 Created: 2013-01-23 Last updated: 2016-05-24Bibliographically approved
In thesis
1. A world on the move: challenges and opportunities for hiv/aids and tuberculosis care and prevention among vulnerable migrant populations in Sweden
Open this publication in new window or tab >>A world on the move: challenges and opportunities for hiv/aids and tuberculosis care and prevention among vulnerable migrant populations in Sweden
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Migration is a global phenomenon that characterize today’s globalized world. Although, the relationship between migration and health in the host countries is not always negative, many countries, including Sweden are concerned about possible spread of infectious diseases of public health significance such as HIV/AIDS and tuberculosis (TB). Moreover, apart from disease profiles, migrants also have different socio-cultural backgrounds, which may challenge health care access and provision.

Objectives: To investigate, identify, and delineate potential challenges of relevance in the care and prevention of communicable diseases of public health significance in general and particularly HIV/AIDS and TB among migrants from countries where these infections are endemic, and eventually generate knowledge that could inform policies and practice.

Methods: Data for this thesis were collected in four of the five counties of the Northern region in Sweden. Quantitative and qualitative methods were used including a survey of 268 migrant students in two language schools (I & II); an interview study with 10 care providers caring for patients with migrant backgrounds and observations of care encounters (III) and an interview study with 15 care providers experienced in screening migrants (IV). Descriptive and logistic regression analyses were used to summarize survey data whereas a thematic analysis approach was applied to the qualitative data within the interpretive description framework.

Results: The students scored on average low on both HIV/AIDS and TB knowledge and displayed misconceptions and negative attitudes towards the two diseases and infected/sick persons. Knowledge level and attitude could be predicted by prior knowledge, years of previous education and geographic origin. In contrast, no association was found between being screened and the level of TB knowledge or attitude towards TB and infected/sick persons. However, fear of being deported appeared to be the main predictor of reluctance to seek HIV/AIDS care after controlling for socio-demographic factors, knowledge level, stigmatizing attitudes and fear of disclosure. Health care providers described complex and intertwined challenges that influenced both care delivery and receipt. The challenges described included language, the socio-cultural diversity within migrant groups and between migrants and the caregivers. These often resulted in divergent perceptions and expectations about care and caring. The participants highlighted the complexities of caring for diverse patients within different institutions with conflicting policies and frameworks. They also described the difficulties the migrants face in navigating the Swedish care system.

Conclusions: This thesis illuminates complex challenges in the care of migrants. The findings emphasize the need for multilevel strategies in order to remove identified barriers. This requires accommodating diversity by improving care providers’ cultural competence and migrants’ health literacy. It further requires policies and practices that emphasize health services responsiveness in order to provide equal access and equitable care. Finally, it entails revisiting existing policies and legislative frameworks to promote a change in ways of thinking about and approaching migration, HIV/AIDS and TB issues, to address the specific vulnerabilities of mobile populations in a world on the move.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2013. 78 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1555
HIV/AIDS, Tuberculosis, Caregivers/caregiving, Culture/cultural competence, Discrimination, Diversity, Immigrants/Migrants, Interpretive description, Language/linguistics, Interpreters, Thematic analysis, Screening, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
urn:nbn:se:umu:diva-67636 (URN)978-91-7459-570-3 (ISBN)
Public defence
2013-04-19, Sal 135, Allmänmedicin, Byggnad 9 A, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Available from: 2013-03-27 Created: 2013-03-25 Last updated: 2015-04-29Bibliographically approved

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