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Åkerman, E., Larsson, E. C., Essén, B. & Westerling, R. (2019). A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden. Sexual & Reproductive HealthCare, 19, 64-70
Open this publication in new window or tab >>A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden
2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 19, p. 64-70Article in journal (Refereed) Published
Abstract [en]

Objective: Poor sexual and reproductive health (SRH) among immigrant women is often related to limited access,or suboptimal use of healthcare services. This study investigates the knowledge about and use of sexual andreproductive healthcare services among immigrant women in Sweden

Method: A cross-sectional study of 288 immigrant women. A structured questionnaire was distributed amongimmigrants speaking Arabic, Dari, Somali or English registered at Swedish language schools for immigrants.Data collection took place in 19 strategically selected schools in Sweden. Descriptive statistics, chi-square tests,and logistic regressions were used for the analysis.

Results: About one-third of the immigrant women reported lack of knowledge of where to go for contraceptivecounselling. Experiencing lack of emotional social support and not having had children was associated with thislack of knowledge. An even higher proportion (56%) lacked knowledge of where to go to be HIV tested, and thiswas associated with not having participated in a health examination. Almost 25% stated that their culture keptthem back from using contraception.

Conclusion: Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrantwomen participating in Swedish language schools for immigrants could be considered as a missed opportunity,as all citizens in Sweden have free access to these services. New health policies and strategies should aim toincrease knowledge of SRH services among immigrants. Swedish language schools could play an important rolein increasing knowledge of SRH-related information as many new immigrants become students during their firstyears in Sweden.

Keywords
Health services accessibility, Sexual and reproductive health, Contraceptive counselling, Immigrant, Social capital, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-376260 (URN)10.1016/j.srhc.2018.12.005 (DOI)000465365500011 ()30928137 (PubMedID)
Funder
Public Health Agency of Sweden
Available from: 2019-02-03 Created: 2019-02-03 Last updated: 2019-05-29Bibliographically approved
Paulsson Do, U., Edlund, B., Stenhammar, C. & Westerling, R. (2019). How 15- to 16-year-old Swedish adolescents experience social relationships and health-related behaviours: A qualitative study. Scandinavian Journal of Public Health
Open this publication in new window or tab >>How 15- to 16-year-old Swedish adolescents experience social relationships and health-related behaviours: A qualitative study
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims: Health-related behaviours are associated with social relationships. Adolescence is a time when healthy and unhealthy behaviours are established. There is a need to investigate adolescents' views on how social relationships are related to health-related behaviours of adolescents in the Scandinavian welfare system. This study aimed to explore Swedish adolescents' experiences and thoughts of how social relationships in different social environments are related to health-related behaviours.

Methods: A total of 36 adolescents aged 15-16 years were interviewed in seven focus-group sessions. Qualitative content analysis was used for analysis of the transcribed interviews.

Results: Two themes - social context and personal management - emerged. Swedish adolescents describe that their health-related behaviours as being partly shaped by their own personal management but mainly by the social contexts that surround them. Social contexts were expressed as playing a role in the adolescents' health-related behaviours, as they provide fellowship, pressure, dependability and engagement. Fellowship with friends and family was expressed as providing healthy behaviours and high levels of well-being. Fellowship with friends was particularly important for physical activity. Close relationships were stated to influence health-related behaviours. Pressure from friends, teachers and social media were described as mainly influencing unhealthy behaviours and, to some extent, low levels of well-being. However, adolescents' personal ability illustrated how adolescents shaped their own health-related behaviours.

Conclusions: The study results contribute to the understanding of Swedish adolescents' views on how social relationships can shape their health-related behaviours. The findings may be useful to school professionals in supporting adolescents to improve well-being and healthy behaviours.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-390229 (URN)10.1177/1403494819858230 (DOI)31213155 (PubMedID)
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-16Bibliographically approved
Berglund, E., Lytsy, P. & Westerling, R. (2019). Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: A cross-sectional population study. Health & Social Care in the Community, 27(5), 1260-1270
Open this publication in new window or tab >>Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: A cross-sectional population study
2019 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 27, no 5, p. 1260-1270Article in journal (Refereed) Published
Abstract [en]

Despite the well-known associations between local environment and health, few studies have focused on environment and healthcare utilisation, for instance healthcare seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long-term illness, and associations with health-seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004-2014, an annually repeated, large sample, cross-sectional, population-based survey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descriptive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refraining from seeking care and non-adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refraining from seeking care (adjusted OR 1.16, 95% CI 1.00-1.22), and non-adherence (adjusted OR 1.22; 95% CI 1.13-1.31). Refraining from going out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51-1.67) and non-adherence (adjusted OR 1.26, 95% CI 1.17-1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non-adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal caregiver status are associated with lower health-seeking behaviour and non-adherence to prescribed medication.

Keywords
adherence, healthcare utilisation, housing type, informal caregiving, neighbourhood, social support
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-394258 (URN)10.1111/hsc.12758 (DOI)000482452200045 ()31016806 (PubMedID)
Funder
Stiftelsen Olle Engkvist Byggmästare
Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-10-11Bibliographically approved
Wångdahl, J., Westerling, R., Lytsy, P. & Mårtensson, L. (2019). Perspectives on health examination for asylum seekers in relation to health literacy - focus group discussions with Arabic and Somali speaking participants. BMC Health Services Research, 19, Article ID 676.
Open this publication in new window or tab >>Perspectives on health examination for asylum seekers in relation to health literacy - focus group discussions with Arabic and Somali speaking participants
2019 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, article id 676Article in journal (Refereed) Published
Abstract [en]

Background: Asylum seekers coming to most countries are offered a specific health examination. A previous study concluded that a considerable proportion of those taking part of it in Sweden had poor experiences of the communication in and the usefulness of this examination and had poor health literacy. The aim of this study was to explore in greater depth the experiences of the health examination for asylum seekers among Arabic- and Somali-speaking participants in Sweden. A secondary aim was to examine experiences and discuss findings using a health literacy framework.

Methods: Seven focus group discussions were conducted with 28 Arabic and Somali speaking men and women that participated in a health examination for asylum seekers. Data were analyzed by latent content analysis.

Results: One overarching theme - beneficial and detrimental - was found to represent the participants' experiences of the health examination for asylum seekers. Three categories were identified that deal with those experiences. The category of "gives some good" describes the examination as something that "gives support and relief" and "cares on a personal level." The category of "causes feelings of insecurity" describes the examination as something that "lacks clarity" and that "does not give protection." The category "causes feelings of disappointment" views the examination as something that "does not fulfil the image of a health examination" and "does not focus on the individual level."

Conclusion: The health examination for asylum seekers was experienced as beneficial and detrimental at the same time. The feelings were influenced by the experiences of information and communication before, during and after the examination and on how health literate the organizations providing the HEA are. To achieve more satisfied participants, it is crucial that all organizations providing the HEA become health literate and person-centered.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Health check-up, Health communication, Health literacy, Migrants, Qualitative research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-395687 (URN)10.1186/s12913-019-4484-4 (DOI)000487103800009 ()31533817 (PubMedID)
Funder
Stiftelsen Olle Engkvist Byggmästare
Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2019-10-24Bibliographically approved
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2018). Comprehensive health literacy is associated with experiences of the health examination for asylum seekers - A Swedish cross-sectional study. Paper presented at 1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh.. European Journal of Public Health, 28, 136-136
Open this publication in new window or tab >>Comprehensive health literacy is associated with experiences of the health examination for asylum seekers - A Swedish cross-sectional study
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 136-136Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-358417 (URN)10.1093/eurpub/cky048.075 (DOI)000432430700391 ()
Conference
1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh.
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Wångdahl, J., Westerling, R., Lytsy, P. & Mårtensson, L. (2018). Experiences of the health examination for asylum seekers - focus group discussions with Arabic and Somali speaking refugees in Sweden. European Journal of Public Health, 28, 135-136
Open this publication in new window or tab >>Experiences of the health examination for asylum seekers - focus group discussions with Arabic and Somali speaking refugees in Sweden
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 135-136Article in journal, Meeting abstract (Other academic) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-358415 (URN)000432430700389 ()
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Åkerman, E., Essén, B., Westerling, R. & Larsson, E. (2018). Healthcare-seeking behaviour among Thai-born women in Sweden: a qualitative study. European Journal of Public Health, 28, 159-160
Open this publication in new window or tab >>Healthcare-seeking behaviour among Thai-born women in Sweden: a qualitative study
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 159-160Article in journal, Meeting abstract (Other academic) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-358419 (URN)000432430700463 ()
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Berglund, E., Westerling, R., Sundström, J. & Lytsy, P. (2018). Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment. BMC Medical Informatics and Decision Making, 18, Article ID 106.
Open this publication in new window or tab >>Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment
2018 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 18, article id 106Article in journal (Refereed) Published
Abstract [en]

Background Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient's perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people. Methods In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n=1041, response rate 58.6%), the respondents, aged between 40 and 75years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event,DoE): 1month, 6months or 18months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy. ResultsLonger DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18months, 6months and 1month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72-7.30) for a DoE of 6months, and 6.08 (95% CI 3.61-10.23) for a DoE of 18months compared with a DoE of 1month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy. ConclusionsLay people's willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Medical decision-making, Risk communication, Risk perception, Necessity-concern framework
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-371868 (URN)10.1186/s12911-018-0662-2 (DOI)000450786000002 ()30458757 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-03-11Bibliographically approved
Larsson, K., Roshanai, A. & Westerling, R. (2018). Ordinarie hälsokommunikation inom Stockholms län. Uppsala: Uppsala universitet
Open this publication in new window or tab >>Ordinarie hälsokommunikation inom Stockholms län
2018 (Swedish)Report (Other academic)
Abstract [sv]

En viktig metod för att främja hälsa hos nyanlända migranter är hälsokommunikation på det egna modersmålet. Flera initiativ har tagits för att utveckla hälsokommunikationen med migranter i Sverige. Särskild Hälsokommunikation har införts i flera delar av landet, däribland i Stockholms län. Sedan 2015 är hälsokommunikation integrerad i Samhällsorienteringen i Stockholms län, för de flyktingar som omfattas av etableringslagen.

I denna rapport presenteras en utvärdering av utvecklingen av den tidigare etablerade ordinarie hälsokommunikationen som ges av Stockholms läns landstings hälsokommunikatörer i tolv kommuner i länet. Syftet är att utvärdera vilka utvecklingsbehov som finns för den ordinarie hälsokommunikationen.

Genom intervjuer med aktörer inom landsting och kommuner har vi undersökt hur de aktuella kommunerna ser på organisation och finansieringsmodeller för ordinarie hälsokommunikation. Vidare har en enkätundersökning bland deltagare i hälsokommunikationen genomförts med syfte att kartlägga vad som kännetecknar deltagarna i den ordinarie hälsokommunikationen utifrån sociodemografiska och hälsorelaterade faktorer.

Utvärderingen pekar på flera utvecklingsområden för den ordinarie hälsokommunikationen.

Denna hälsokommunikation skulle exempelvis i större utsträckning kunna fördjupas och inriktas mot specifika målgruppers behov. Det finns också utrymme för att utveckla samverkan med andra aktörer som når målgrupperna, såsom Arbetsförmedling, hälso- och sjukvård och socialtjänst, samt att nå manliga migranter och yngre vuxna i större utsträckning.

Innehåll och metodik kan anpassat till målgruppens bristande hälsolitteracitet, d.v.s. förmåga att få tag på, förstå, värdera och använda sig av hälsoinformation. Det finns även ett intresse av att utveckla den lokala förankringen av verksamheten, samtidigt som den centrala samordningen och stödet har en viktig funktion. Rollfördelningen mellan de centrala funktionerna och de lokala aktörerna kan förtydligas och långsiktiga avtal anpassas till detta.

Place, publisher, year, edition, pages
Uppsala: Uppsala universitet, 2018. p. 38
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-382433 (URN)
Available from: 2019-04-25 Created: 2019-04-25 Last updated: 2019-10-11Bibliographically approved
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2018). Poor health and refraining from seeking healthcare are associated with limited comprehensive health literacy among refugees: a Swedish cross-sectional study. International Journal of Public Health, 63(3), 409-419
Open this publication in new window or tab >>Poor health and refraining from seeking healthcare are associated with limited comprehensive health literacy among refugees: a Swedish cross-sectional study
2018 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 63, no 3, p. 409-419Article in journal (Refereed) Published
Abstract [en]

Objectives: The objectives of the study were to explore the distributions of comprehensive health literacy (CHL), general health, psychological well-being and having refrained from seeking healthcare among refugees in Sweden. Further objectives were to examine associations between CHL and the above mentioned factors.

Methods: A cross-sectional study was conducted among 513 refugees speaking Arabic, Dari and Somali. Participants in the civic orientation course in Sweden responded to a questionnaire. CHL was measured using the HLS-EU-Q16 questionnaire. Uni- and multivariate logistic regression was used to investigate potential associations.

Results: The majority of the respondents had limited CHL, and about four of ten had reported poor health and/or having refrained from seeking healthcare. Limited CHL was associated with having reported poor health and having refrained from seeking healthcare. 

Conclusions: A considerable proportion of the refugees in Sweden have limited CHL, and report less than good health and impaired well-being, or that they have refrained from seeking healthcare. Further, CHL is associated with the above mentioned factors. Efforts are needed to promote refugees' CHL, optimal health seeking behavior, and health.

Keywords
health literacy, general health, psychological well-being, refrained from healthcare, refugees
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-333397 (URN)10.1007/s00038-017-1074-2 (DOI)000428236500012 ()29480325 (PubMedID)
Note

The study was co-financed by the County Administrative Board in Stockholm.

Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-06-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3734-6756

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