Midwives’ views on factors that contribute to health care inequalities among immigrants in Sweden: a qualitative study

Abstract

IntroductionEthnic and socioeconomic inequalities in the Swedish health care system have increased. Most indicators suggest that immigrants have significantly poorer health than native Swedes. The purpose of this study was to explore the views of midwives on the factors that contribute to health care inequality among immigrants.MethodsData were collected via semi-structured interviews with ten midwives. These were transcribed and related categories identified through content analysis.ResultsThe interview data were divided into three main categories and seven subcategories. The category “Communication” was divided into subcategories “The meeting”, “Cultural diversity and language barriers” and “Trust and confidence”. The category “Potential barriers to the use of health care services” contained two subcategories, “Seeking health care” and “Receiving equal treatment”. Finally, the category “Transcultural health care” had subcategories “Education on transcultural health care” and “The concept”.ConclusionsThis study suggests that midwives believe that health care inequality among immigrants can be the result of miscommunication which may arise due to a shortage of meeting time, language barriers, different systems of cultural beliefs and practices and limited patient-caregiver trust. Midwives emphasized that education level, country of origin and length of stay in Sweden play a role when an immigrant seeks health care. Immigrants face more difficulties when seeking health care and in receiving adequate levels of care. However, different views among the midwives were also observed. Some midwives were sensitive to individual and intra-group differences, while some others viewed immigrants as a group of “others”. Midwives’ beliefs about subgroup-specific health services vs. integrating immigrants’ health care into mainstream health care services should be investigated further. Patients’ perspective should also be considered.

From Immigrant to Patient: Experiences of Bosnian Immigrants in the Swedish Healthcare System

“…The findings in our study are in the line with other studies which showed that some participants could not access information because they were unfamiliar with the structure of the Swedish healthcare system. Lacking linguistic skills and difficulties in communication with care providers, for example regarding information about their disease and involvement in treatment, caused frustration and increased the risk of misunderstandings, miscommunication and inequalities in healthcare provision (27,28,29). All of the informants belonged to the same cultural-geographical area.…”

“…Previous studies about the healthcare system among refugees showed that immigrants in Sweden have significantly poorer health than native Swedes (17). And may therefore have increased need for healthcare services (18,19).Previous studies made in Sweden about refugees coming from Burundi, Colombia, Iraq, Kazakhstan, Poland, Kosovo and Syria, showed that the main problems were related to feelings of being uninformed and being sent to various levels of care, which resulted in lack of trust, and feelings that no one took overall responsibility (20).…”

Assistência ao parto de mulheres imigrantes: a vivência do enfermeiro obstetra/obstetriz

“…Assim como alguns estudos já realizados (Tobin, Lawless, 2014;Akhavan, 2012), as barreiras na linguagem foram identificadas como um desafio para a assistência às mulheres imigrantes. Na fala da enfermeira obstetra Maria, podemos entender como ela tenta se comunicar com uma paciente em trabalho de parto:…”

“…No estudo de Akhavan (2012), a linguagem foi um instrumento fundamental para promover uma comunicação eficaz, onde as enfermeiras relatam que seria muito melhor se a paciente falasse a língua do país e que mesmo com intérpretes a comunicação é difícil, mas também trazem que não importa se a paciente sabe ou não a língua, que a enfermeira deve prestar um bom cuidado e adaptar suas formas de comunicação.…”

“…O uso de intérpretes é questionado em alguns estudos (Tobin, Lawless, 2014;Akhavan, 2012), é uma ferramenta que as enfermeiras relatam ser importante para promover um bom cuidado, mas também pode trazer algumas desvantagens, quando os profissionais não sabem o quanto da informação foi traduzido pelo intérprete e a precisão da informação que foi passada e recebida. Durante as entrevistas realizadas, os participantes também relataram suas experiências com intérpretes, mostrando também esses dois lados do uso de intérpretes.…”