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Civic communicators' view of and approach to health promotion for newly arrived migrants in Sweden
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV).
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV).ORCID iD: 0000-0001-5134-4338
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV).ORCID iD: 0000-0003-3664-8290
2022 (English)In: Frontiers in Public Health, E-ISSN 2296-2565, Vol. 10, article id 931685Article in journal (Refereed) Published
Abstract [en]

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. 

Place, publisher, year, edition, pages
2022. Vol. 10, article id 931685
Keywords [en]
civic orientation, empowerment, health education, health promotion, migrants
National Category
Social and Economic Geography Health Sciences
Identifiers
URN: urn:nbn:se:miun:diva-45825DOI: 10.3389/fpubh.2022.931685ISI: 000838067900001Scopus ID: 2-s2.0-85135568183OAI: oai:DiVA.org:miun-45825DiVA, id: diva2:1687572
Available from: 2022-08-16 Created: 2022-08-16 Last updated: 2024-09-04Bibliographically approved
In thesis
1. Health promotion in the integration of newly arrived migrants in northern Sweden
Open this publication in new window or tab >>Health promotion in the integration of newly arrived migrants in northern Sweden
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Migrants, especially forced migrants, have an increased risk of ill health. Having a structural focus on health is crucial for battling health inequities. Actors outside the healthcare services are important to promote health, and both policy and political context are thus key to promoting the health of newly arrived migrants in Sweden. The aim of this thesis was to explore approaches to health promotion within the multi-level governance of the integration of newly arrived migrants in northern Sweden.

Methods: Different methods of data collection and analysis were used in the thesis. For Study I, policies relevant to Sweden’s Establishment Program were analyzed using discourse analysis. For Studies II and III, a questionnaire on politicians’ views on their roles, responsibilities, and possibilities to promote the health of newly arrived migrants was created based on interviews with politicians. In total, 667 politicians answered the questionnaire, and both bivariate and multivariate analyses were used. For Study IV, a secondary analysis of focus group interviews was performed. The interview transcripts were analyzed using content analysis. Finally, Study V consists of interviews with civic communicators who work within the civic orientation for newly arrived migrants in Sweden. Thematic analysis was used to analyze the transcribed interviews. 

Results: The policy documents that described the Establishment Program in Sweden contained no explicit definition of health. The discourses of health showed a medicalized and individualized view of health, where ill health was considered a risk (Study I). Politicians more often considered health effects for the general population as a whole, rather than for newly arrived migrants specifically. Factors contributing to whether they considered health effects for newly arrived migrants included self-rated knowledge, attitude, being female, and having previous experience working in public health (Study II). Further, politicians rated societal responsibility and the possibility to promote health as higher for the population as a whole compared to newly arrived migrants specifically. The odds of rating societal responsibility and the possibility to promote health as high were associated with the factors attitude, specific knowledge of newly arrived migrants’ health status, personal interest in public health, being a municipality politician, and being female (Study III). Authority officials considered health promotion to be desirable within the Establishment Program, but the study results also raised complex issues within the existing organizations. The respondents described unclear roles but also organizational changes that could improve the possibility of working to promote health (Study IV). Finally, the civic communicators described that they viewed and approached health promotion through wanting to prepare the participants for a healthy life in Sweden. They described knowledge, but also their role as a guide for the participants, as important parts of their work (Study V). 

Conclusion: Within the integration of newly arrived migrants in Sweden, health promotion (and the possibility of health promotion) was invisible within the policy context. Within the political context, the focus on migrants’ health (specifically newly arrived migrants) tended to be invisible. This situation caused various uncertainties, such as a lack of definitions and assignments, for officials who worked directly with newly arrived migrants. Those who work closely with newly arrived migrants tended to have a better view of how health could be promoted through integration in Sweden.

Abstract [sv]

Bakgrund: Migranter, mer specifikt de som tvingats på flykt, har en ökad risk för att uppleva ohälsa. För att minska ojämlikheter i hälsa är fokus på de strukturella determinanterna för hälsa viktigt. Aktörer utanför hälso- och sjukvården är viktiga för att främja hälsa, både policy- och politiskt sammanhang är därför viktigt när det gäller att främja nyanländas hälsa i Sverige. Syftet med denna avhandling var att undersöka hur hälsofrämjande perspektiv tar sig uttryck inom de olika samhälleliga strukturer som är involverade i integrationen av nyanlända i norra Sverige.

Metoder: Fyra olika metoder användes i avhandlingen. Två studier (Studie II & III) var kvantitativa där data samlades in via en enkät som skickades ut till alla politiker i kommun- och regionfullmäktige i norra Sverige. Totalt svarade 667 politiker och deras svar analyserades genom bivariata och multivariata analyser. Tre studier (Studie I, IV & V) var kvalitativa till sin design. Studie I var en diskursanalys av policydokument relevanta för etableringsprogrammet. Studie IV var en sekundäranalys av intervjumaterial från fokusgruppsintervjuer med handläggare från arbetsförmedlingen och kommuner. Analysen gjordes med innehållsanalys. Studie V var en intervjustudie där transkriberade intervjuer med samhällskommunikatörer analyserades genom en tematisk analys.

Resultat: De policydokument som formar etableringsprogrammet i Sverige innehöll inga uttryckliga definitioner av hälsa. Diskurserna av hälsa visade en medikalisering och individualisering av hälsa, samt att hälsa främst var sedd genom risken för ohälsa (Studie I). När det gäller politikers syn på att främja hälsa så visade studierna att de oftare tog hänsyn till och funderade över befolkningen som helhet än för nyanlända specifikt. Faktorer som påverkade om de uppgav att de reflekterade över hälsoeffekter för nyanlända i sitt beslutsfattande var: självskattad kunskap, attityd, att de var kvinnor och att de hade tidigare erfarenhet av att arbeta med folkhälsorelaterade frågor (Studie II). Politiker skattade också samhällsansvaret och möjligheten att främja hälsa som större för befolkningen som helhet. Där var attityd, kunskap om nyanländas hälsa, personligt intresse i folkhälsorelaterade frågor, att de var kommunpolitiker och kvinna faktorer som avgjorde att de skattade samhällsansvaret och möjligheten högre (Studie III). Myndighetshandläggare beskrev att hälsofrämjande var viktigt, men komplicerat. De beskrev otydliga roller i förhållande till hälsofrämjande arbete, men hade också många lösningar på de problem som de stötte på. Slutligen beskrev samhällskommunikatörer att de tog sig an hälsofrämjande inom samhällsorienteringen genom att de rustar deltagarna för ett (hälsosamt) liv i Sverige. De såg kunskap och förmedling av kunskap till deltagarna som viktig för hälsa, och de såg sin egen roll som en guide för deltagarna som befann sig i ett nytt sammanhang.

Slutsats: Hälsofrämjande och möjligheten till hälsofrämjande har blivit osynliggjort inom integrationen av nyanlända i Sverige. Inom det politiska sammanhanget så har istället, då det finns ett hälsofokus, migrationsperspektivet blivit osynliggjort. Detta har skapat otydligheter, så som brist på definitioner och uppdrag, för personer som arbetar med nyanlända inom etableringen. De individer som arbetar närmast nyanlända har en tydligare bild av hur hälsa är och kan främjas inom integrationen av nyanlända i Sverige.  

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2022. p. 124
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 375
Keywords
Health in All Policies, Health Promotion, Integration, Newly arrived migrants, Salutogenesis
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-46178 (URN)978-91-89341-76-0 (ISBN)
Public defence
2022-10-28, C310, Holmgatan 10, Sundsvall, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2022-09-30 Created: 2022-09-30 Last updated: 2022-09-30Bibliographically approved

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Svanholm, SaraCarlerby, HeidiViitasara, Eija

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