Practitioner and Client Explanations for Disparities in Health Care Use Between Migrant and Non-migrant Groups in Sweden: A Qualitative Study

Akhavan, Sharareh; Karlsen, Saffron

doi:10.1007/s10903-012-9581-y

Cited by 30 publications

(44 citation statements)

References 9 publications

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“…In agreement with previous studies [42, 43], HCPs in this study indicated that refugee and migrant women are a diverse group in relation to their migration history and experience, age, education, culture, socio-economic background, country of origin experience in accessing health care, length of stay in Australia and SRH knowledge. However, common concerns around accessing and utilising the available SRH information and services and SRH literacy were indicated in this study.…”

Section: Discussionsupporting

confidence: 92%

Refugee and migrant women's engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives

et al. 2017

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BackgroundIn Australia only 2.2% of published health research has focused on multi-cultural health despite the increase of culturally and linguistically diverse populations. Research on the perceptions and experiences of health care professionals (HCPs) in engaging with refugee and migrant women is also lacking. Given the integral role of HCPs in providing sexual and reproductive health (SRH) care for these populations, an understanding of the challenges they experience is required. Therefore, this study sought to examine the perspectives and practices of Australian HCPs with regard to the provision of SRH care for refugee and migrant women.MethodsEmploying qualitative methods, twenty-one semi-structured interviews were conducted with HCPs representing various professions, work experiences, cultural backgrounds, age and healthcare sectors. The interviews were analysed using thematic analysis and the socio-ecological model was utilised to interpret the data.ResultsThe complexities of HCP’s engagement with refugee and migrant women were identified in three major themes: Being a Migrant; Gender Roles and SRH Decision-making; and Women in the Healthcare System. HCPs discussed the impact of accessing SRH care in women’s country of origin and the influence of re-settlement contexts on their SRH knowledge, engagement with care and care provision. Perception of gender roles was integral to SRH decision-making with the need to involve male partners having an impact on the provision of women-centred care. Barriers within the healthcare system included the lack of services to address sexual functioning and relationship issues, as well as lack of resources, time constraints, cost of services, and funding.ConclusionAustralian HCPs interviewed reported that migrant and refugee women do not have appropriate access to SRH care due to multifaceted challenges. These challenges are present across the entire socio-ecological arena, from individual to systemic levels. Multiple and multidimensional interventions are required to increase SRH utilisation and improve outcomes for refugee and migrant women.

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Section: Discussionsupporting

confidence: 92%

Refugee and migrant women's engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives

et al. 2017

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“…Of importance, however, patients also blame themselves for their lack of knowledge rather than recognize that providers may improve communication to better inform patients of their choices and care processes. Such attitudes may create power disparities between providers and migrants that lead to abuse of patients [36]. In Ghana, a study of differential treatment between the “educated elite” and non-elite “villager” in healthcare settings hypothesizes that these differences are tied to larger social inclusion and exclusion of those who are educated versus non-educated in Ghanaian society at large [14].…”

Section: Discussionmentioning

confidence: 99%

Women’s status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory

Sudhinaraset

Treleaven

Melo

et al. 2016

BMC Pregnancy Childbirth

119

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BackgroundMistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients’ reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients’ perception of the quality of care is dependent, not only on the content of care, but importantly, on women’s expectations of care.MethodsThis study uses rich, mixed-methods data to explore women’s characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women’s social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women.ResultsQuantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge.ConclusionsLack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care.

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“…Evidence from the literature suggests that this continuous growth of foreign born populations with varied cultural traits and health profiles, presents complex challenges for health care delivery due to change in disease profiles, communication problems, diversity of cultures and institutional practices as well as individual past experiences and attributes [6-14]. These challenges are said to influence medical encounters and can result in mistrust that may lead to sub-optimal utilization of health services, frustrations and calamitous errors in diagnosis and treatment regimens [7-10,15,16].…”

Section: Introductionmentioning

confidence: 99%

“…These challenges are said to influence medical encounters and can result in mistrust that may lead to sub-optimal utilization of health services, frustrations and calamitous errors in diagnosis and treatment regimens [7-10,15,16]. Literature on cross-cultural health care indicates that migrant populations present unique challenges to health professionals, and can be a source of frustration for health professionals as they may struggle with uncertainty and apprehension when caring for these patients [6-13,15,17,18]. Previous studies suggest that caring for patients who speak a different language is difficult because of lack of or unavailability of interpreters or problems in accessing interpreter agencies, which in some cases force care providers to use family members as interpreters.…”

Section: Introductionmentioning

confidence: 99%

“It is a challenge to do it the right way”: an interpretive description of caregivers’ experiences in caring for migrant patients in Northern Sweden

Nkulu-Kalengayi

Hurtig

Ahlm

et al. 2012

BMC Health Serv Res

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BackgroundExperiences 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.MethodsWe 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.ResultsWe 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 with varied social, cultural and religious affiliations, migration histories and statuses, all of 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.ConclusionsThe 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.

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Practitioner and Client Explanations for Disparities in Health Care Use Between Migrant and Non-migrant Groups in Sweden: A Qualitative Study

Cited by 30 publications

References 9 publications

Refugee and migrant women's engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives

Refugee and migrant women's engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives

Women’s status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory

“It is a challenge to do it the right way”: an interpretive description of caregivers’ experiences in caring for migrant patients in Northern Sweden

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