Mid Sweden University

Background and aim: Early action is important for promoting newly arrived migrants’ health. Politicians are major actors in decision-making that affects health outcomes in the population. Therefore, the aim of this study was to explore local and regional politicians’ considerations of newly arrived migrants’ health in political decision-making: whether politicians reflect on or discuss the effects of decision-making specifically on newly arrived migrants’ health, whether considerations differ between municipality and regional politicians, and how knowledge and attitudes are associated with such considerations. Subject and methods: A cross-sectional quantitative study was conducted. A total of 667 municipality and regional politicians from northern Sweden responded to a questionnaire developed based on interviews with politicians. Bivariate analyses were performed using χ2 tests, the independent samples t-test, and the Wilcoxon signed-rank test. Multivariate analysis was performed using binary logistic regression. Results: Politicians considered the effects on newly arrived migrants’ health significantly less frequently than those on the total population’s health. Regional politicians discussed such effects more often than municipality politicians. Knowledge (odds ratio [OR] = 1.343), attitude (OR = 5.962), previous experience working on public health issues (OR = 1.784), and female gender (OR = 1.787) were positively associated with considering effects on newly arrived migrants’ health in decision-making. Conclusion: Politicians play important roles in health promotion, and most consider health-related effects in their decision-making. However, about a third do not consider such effects. General health-related knowledge and attitude are important factors that could be affected or changed during political assignments. 

Newly arrived migrants in Sweden risk facing ill health. Politicians at the local and regional levels are involved in many decisions regarding the social determinants of health. The aim of this study was to explore politicians’ views on different societal actors’ responsibility and possibility to promote newly arrived migrants’ health. Data were collected through online questionnaires completed by 667 politicians from municipality and regional councils in northern Sweden. Bivariate analysis was performed using the Wilcoxon signed-rank test. Multivariate analyses were performed using cluster analysis and binary logistic regression analysis. The results show that politicians generally rate societal actors’ responsibility and possibility to promote the general population’s health higher than newly arrived migrants’ health. Moreover, they consider societal actors’ responsibility to be greater than their possibility to promote health. Factors significantly contributing to politicians’ high ratings of societal responsibility and possibility are attitude (odds ratio [OR] = 2.156, 95% confidence interval [CI]: 1.306–3.558), specific knowledge of newly arrived migrants’ health status (OR = 1.528, 95% CI: 1.005–2.323), personal interest in public health (OR = 2.452, 95% CI: 1.460–4.119), being a municipality politician (OR = 1.659, 95% CI: 1.031–2.670) and being female (OR = 1.934, 95% CI: 1.333–2.806). This study shows that politicians generally rate societal responsibility and possibility to promote newly arrived migrants’ health rather high. Personal characteristics are important for politicians’ high or low ratings of responsibility and possibility, suggesting insufficient structural support for politicians in health promotion.

For newly arrived migrants, integration is important in promoting health and decreasing health inequities. In a Swedish context, civic orientation is a program to promote integration and increase the chance of employment for newly arrived migrants. The aim of this project was to explore how civic communicators view and approach health promotion in their work with newly arrived migrants in the civic orientation program in Sweden. Data were collected through interviews with eight civic communicators working with newly arrived migrants in civic orientation in the north of Sweden. The interviews followed a semi-structured interview guide and were transcribed verbatim and analyzed using thematic analysis. The analysis resulted in the main theme “To dress the participants for a (healthy) life in Sweden,” with two sub-themes “Knowledge—a key to health” and “Being a guide for participants in a new context.” In their work with civic orientation for newly arrived migrants, civic communicators are involved in health promotion by preparing their participants for a life in Sweden. They work to empower their participants to be able to make informed decisions and live healthy lives by both providing information to enhance knowledge and skills. They also work to guide them through the complexity of being in a new situation and country. 

BACKGROUND: War-related injury is a growing clinical and public health concern in occupied Palestinian territory, especially in the Gaza Strip. However, little research has been done into the quality of care and management of war injuries in public hospitals. We explored the perceptions of health-care workers about these factors in Palestinian health-care facilities in Gaza. METHODS: This was a qualitative descriptive study. Data were obtained in four focus group discussions attended at public health facilities by 30 purposively selected health-care providers, comprising 14 head surgeons, and 16 head nurses, aged 38-55 years. A semi-structured topic guide was developed by the authors for the study based on earliest literature, and was critically reviewed by a panel of experts to ensure the trustworthiness of the qualitative guide and to minimise complexity and enhance clarity of the questions for participants. Audio recordings of discussions were transcribed verbatim, translated, and analysed with a thematic analysis approach. The study was approved by the Palestinian Health Research Council and facilitated by the Ministry of Health. FINDINGS: A consensus was expressed that, despite some positive aspects in the system, fundamental changes and essential improvements were needed to advance the care and facilitation of war injury management. Some respondents had serious concerns about the health-care system, suggesting that it needs to be comprehensively rebuilt. Unanimous views were expressed about the important barriers to effective management and quality of care: shortages of resources, medicines, and funding; underuse or absence of specific and unified clinical practice guidelines; no official commitment by the Ministry of Health to adopt updated clinical guidelines; few incentives and poor motivation, poor communications; blockade and siege; division of health systems in the country; overcrowding of patients with war injuries in hospitals with limited capacity; spreading of infection due to poor cleanliness; shortages in fuel and power supply; and low wages, which negatively affected staff motivation. Respondents also reported inadequate sharing of care and cooperation between different health-care facilities. INTERPRETATION: The perceptions about barriers to management of war injuries and the quality of care provided were similar across Palestinian health-care facilities in the Gaza strip. Our findings suggest that fundamental changes and comprehensive reform of the health-care system are needed to make the care of patients with war injuries more effective and efficient. One of the important strengths of this study is that it addressed the perspective and opinions of different key health professionals, which made it possible gain deeper and better understanding of how war injuries are managed in the Palestinian health system. In addition, the outcomes of the study were based on diverse information. However, the analysis of the qualitative data may represent challenges, and be more complicated and time consuming than a quantitative approach.None. 

BACKGROUND: Improving access to optimal quality of care is a core priority and ambitious health policy goal in spite of impediments, threats and challenges in Palestine. Understanding the factors that may impede quality of care is essential in developing an effective healthcare intervention for patient with non-communicable disease (NCD) or war-injured survivors. METHODS: Qualitative interviews were performed using a purposive sampling strategy of 18 political-key informants, 10 patients with NCD and 7 war-injured survivors from different health facilities in Gaza Strip. A semi-structured interview guide was developed for data collection. The interviews were audio recorded and transcribed verbatim. Important field notes of the individual interviews were also reported. Thematic-driven analytic approach was used to identify key themes and patterns. RESULTS: From the policy maker's perspective, the following important barriers to accessing optimal healthcare for patients with NCD or war-injured survivors' treatment were identified; 1) organizational/structural 2) availability 3) communication 4) personnel/lack of staff 5) financial and political barriers. Patient with NCD or war-injury had similar experiences of barriers as the policy makers. In addition, they also identified socioeconomic, physical and psychological barriers for accessing optimal healthcare and treatment. CONCLUSIONS: The main perceived barriers explored through this study will be very interesting and useful if they are considered seriously and handled carefully, in order to ensure efficient, productive, cost-effective intervention and delivery of a high-standard quality of care and better disease management.

As a group, newly arrived migrants in Sweden face inequities in health compared to the general population. Successful promotion of population health requires awareness of and focus on health from several sectors of society. In light of this, the aim was to study the views of local authority officials on collaboration in health promotion activities for newly arrived migrants. Data was collected through five focus group interviews with 23 local authority officials working with the integration of newly arrived migrants in the Establishment Program in a municipality or at the Employment Services in northern Sweden. An inductive qualitative latent content analysis was performed, and the analysis showed that the participating officials considered health promotion as desirable in the Establishment Program, but it also raised complex issues within the existing organisations. The officials described unclear roles, but also possible changes to the organisation that would improve the possibility of working to promote health. The present study adds to the relatively limited knowledge of health promotion in integration activities and offers clinical relevance for policymakers through the officials’ suggestions for improvements in the Establishment Program. It also raises important questions for further research. 

Background: Palestine, like other low-income countries, is confronting an increasing epidemic of non-communicable disease (NCD) and trend of war injury. The management of health problems often presents a critical challenge to the Palestinian health system (PHS). Understanding the perceptions of healthcare providers is essential in exploring the gaps in the health system to develop an effective healthcare intervention. Unfortunately, health research on management of NCD and war injury has largely been neglected and received little attention. Therefore, the study aimed to explore the perspectives of healthcare providers regarding NCD and war injury management in the PHS in the Gaza Strip. Methods: A qualitative study approach was used, based on four focus group discussions (FGDs) involving a purposive sampling strategy of 30 healthcare providers from three main public hospitals in Gaza Strip. A semi-structured topic guide was used, and the focus group interviews data were analyzed using manifest content analysis. The study was approved by the Palestinian Health Research Council (PHRC) for ethics approval. Results: From the healthcare providers perspective, four main themes and several subthemes have emerged from the descriptive manifest content analysis: functioning of healthcare system; system-related challenges; patients-related challenges; strategies and actions to navigating the challenges and improving care. Informants frequently discussed that despite some positive aspects in the system, fundamental changes and significant improvements are needed. Some expressed serious concerns that the healthcare system needs complete rebuilding to facilitate the management of NCD and war-related injury. They perceived important barriers to effective management of NCD and war injury such as poor hospital infrastructure and logistics, shortage of micro and sub-specialities and essential resources. Participants also expressed a dilemma and troubles in communication and interactions, especially during emergencies or crises. The informants stressed the unused of updated clinical management guidelines. There was a consensus regarding poor shared-care/task sharing, partnership, and cooperation among healthcare facilities. Conclusion: Our findings suggest that fundamental changes and significant reforms are needed in the health system to make healthcare services more effective, timely, and efficient. The study disclosed the non-use of clinical guidelines as well as suboptimal sectorial task-sharing among different stakeholders and healthcare providers. A clear and comprehensive healthcare policy considering the gaps in the system must be adopted for the improvement and development of care in the PHS.

There is a need for more knowledge about positive health determinants in the school setting. The overall aim of this study was to analyse if positive self-reported health is associated with experiences of school among high-school students. Data originated from the health dialogue questionnaire answered by students in grade 1 of high school. A total of 5035 students participated from the academic years 2013 to 2016. Logistic regression with positive odds ratio (POR) was used to analyse associations between positive self-reported health and school experiences. There was an association between positive self-reported health and school experiences among students. Positive mental health was the strongest predictor for positive school experiences. To frequently participate in Physical Education, have a positive body image and satisfactory sleep nearly doubled the students' odds for positive school experiences. The results also revealed gender differences; boys more often reported positive experiences of school and positive health than girls. Positive self-reported health is associated with positive experiences of school, particularly mental health. Moreover, these findings have significant implications for how students experience school and demonstrate the importance of including health-promoting interventions in systemic school improvement, meeting both girls' and boys' needs.

Seasonal employees at ski resorts represent a high-risk population for the use of alcohol and drugs, as well as other negative lifestyle behaviours. These employees work and live in a context where the customers are on holiday and hence alcohol is used frequently. To our knowledge there is a gap in the literature regarding alcohol and drug consumption among seasonal employees. Particularly studies in the context of ski resorts are lacking. The overall purpose of our study was to evaluate a policy-based intervention at a ski resort area in Sweden. The intervention was led by a project leader together with managers from different tourism industries, the health sector, social service and police. Components in the intervention were e.g. policy development and implementation, education of managers and creation of a manager network.  In total, 48 enterprises participated. A questionnaire, concerning alcohol and drug use and social aspects, was distributed before and after the intervention. The firs questionnaire was answered by 611 (47%) respondents and 423 (34%) respondents the follow-up questionnaire after two years. In addition, five persons in the project group was interviewed after the intervention.  Based on survey data, comparisons before and after the intervention showed several positive results. The  results show a significant reduction of hazardous drinking and an  increased awareness of the companies’ alcohol- and drug policies among the employees. No significant effects on drug consumption were found. The project group reported better knowledge about alcohol and drugs. However, most important was the increased collaboration between managers in tourism industries. The intervention also resulted in new norm breaking ideas such as a sober end of the season instead of the traditional “drinking the bar dry” and managers taking employees out on hiking instead of going out for a beer.

The conclusion is that seasonal tourism industries need to work with hazardous alcohol- and drug consumption from a “whole village perspective”. Successful health promotion work among seasonal employees, needs collaboration between private and public sector and should be related to cultural norms as well as working- and living conditions in the particular context, in this case the tourist resort.