Covid-19 and pathways to health inequities for families in a socioeconomically disadvantaged area of Sweden – qualitative analysis of home visitors’ observations

Abstract

Background Lack of control over life situations is an important social determinant that may negatively affect parental and child health. This study took place in an area of Stockholm, Sweden with high indications of socioeconomic disadvantage, a large part of the population with foreign background, as well as higher levels of poor health than the county average. It investigated staff perceptions of pathways from situations of low control, potentially leading to health inequities, affecting families enrolled in an early childhood home visiting programme during the Covid-19 pandemic. Methods Semi-structured interviews were carried out with 23 child health care nurses and parental advisors working in a home visiting programme. The data was analysed using Reflexive Thematic Analysis. Results The analysis resulted in five pathways on two explanatory levels, affecting parents’ health and parenting capacity and children’s health and well-being, potentially damaging health and leading to health inequities. The first four pathways related to control at the personal explanatory level: Families facing instability and insecurity; Caring for children in crowded and poor housing conditions; Experiencing restricted access to resources; and Parenting with limited social support. The fifth pathway, Living in a segregated society, covered the collective experience of lack of control on community level. The Covid-19 pandemic was observed to negatively affect all pathways and thus potentially aggravate health inequities for this population. The pandemic has also limited the delivery of home visits to the families which creates further barriers in families’ access to resources and increases isolation for parents with already limited social support. Conclusions The diversity of pathways connected to health inequities presented in this study highlights the importance of considering this variety of influences when designing interventions for socioeconomically disadvantaged areas. The additional negative consequences of Covid-19 indicate the need for sustainable preventive early childhood interventions for families in such areas. The study also emphasizes the need for further research as well as policy action on possible long-term effects of changing behaviours during the Covid-19 period on child health and health equity. Trial registration The study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097).

Differences by region of birth in SARS-CoV-2 vaccine coverage and positive SARS-CoV-2 test among 400 000 healthcare workers and the general population in Sweden

“…A lower level of health literacy may in part explain lower vaccine coverage among foreign-born in non-HCW but would not be expected to explain lower vaccine coverage among foreign-born HCW. Regardless of whether lower vaccine coverage in foreign-born HCW is an effect of mistrust in government and the healthcare system, socioeconomic inequalities, or due to sociocultural beliefs it is important to address vaccine hesitancy as these groups have an increased occupational risk of SARS-CoV-2 exposure [18] , [19] . In an effort to increase vaccination coverage, multilinguistic information campaigns and mobile vaccination centres have been implemented in Sweden to target residential areas with a large proportion of immigrants and a low vaccine coverage.…”

Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden

“…The concept of self-efficacy may be observed within this mechanism as well, but in this instance as part of the Health Belief Model, where the belief in the own capacity to overcome barriers is understood to be one of the variables that influence health behaviour [ 54 ]. Practical examples from the Rinkeby programme related to barriers to services, such as insecurity and social isolation, have been investigated in a previous study [ 55 ]. In addition, the central importance of the establishment of a trustful relation on which the intervention rests, has been widely recognized in the home visiting field [ 23 , 47 , 49 , 56 – 59 ], and research into the concept of trust within the healthcare setting have also indicated how trust on micro and macro levels are interconnected so that a patient’s trust in a provider may positively influence trust in the healthcare institution and thus facilitate the use of such a system [ 60 , 61 ].…”

“…These limitations are also identified in the Rinkeby intervention and context. Previous studies have observed how structural aspects, such as housing policies, are having a direct negative influence on the health of families in Rinkeby [ 55 ], while the home visiting professionals recognise that their capacity to deal with these issues is very limited [ 33 ]. Further, a previous [ 55 ] as well as the present study identified barriers to availability and accessibility to the universal welfare system due to the dismantling of local services in socioeconomically disadvantaged areas.…”

COVID-19 as a social disease: qualitative analysis of COVID-19 prevention needs, impact of control measures and community responses among racialized/ethnic minorities in Antwerp, Belgium

“…Recent research in Sweden among families living in socio-economically disadvantaged urban areas identified the pathways connected to health inequities. These ranged from low control over personal life situations through experiencing instability and insecurity, to having to care for children in poor and crowded housing conditions, struggling with reduced access to resources and limited social support [ 44 ].…”