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Utilisation of two health systems: A cross-sectional study on Swedish-Thai women’s choice of contraceptive counselling and HIV testing
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: To investigate the need and use of sexual and reproductive health (SRH) services andanalyses to what extent the use of SRH services in Sweden is associated with healthcarecontact in the country of origin or knowledge of the health system in the new country. Methods: A cross-sectional study using postal questionnaire to all Thai-born women (age 23-60) in Stockholm, residing in Sweden since 2014. Chi-squared and logistic regression wasused for analysis. Results: The response rate was 52.3% (n=266). The majority reported a significant need for information related to SRH-services. Most contraceptive using women (70%) bought theircontraceptives in Thailand. Older women and women who lacked knowledge of where to go for contraceptive counselling were more likely to have bought contraceptives in Thailand.However, use and need of contraceptive counselling in Sweden was higher among younger women. Nevertheless, women who had never been HIV tested in Thailand (40%) continued not to be tested in Sweden. Conclusions: Our findings indicate that the Swedish health system does not correspond to Thai women’s needs for SRH services and information, since the majority bought their contraceptives in Thailand, and those who were never HIV tested continued not to be in Sweden. From a public health perspective and to achieve the goal of “healthcare on equal terms”, future interventions must focus on making health services and information moreaccessible for Thai immigrants.

Keywords [en]
Sweden, migration, Thai women, health services accessibility, sexual and reproductive health, contraceptives, HIV testing
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
URN: urn:nbn:se:uu:diva-376261OAI: oai:DiVA.org:uu-376261DiVA, id: diva2:1285243
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-12
In thesis
1. Challenges and opportunities for sexual and reproductive healthcare services for immigrant women in Sweden
Open this publication in new window or tab >>Challenges and opportunities for sexual and reproductive healthcare services for immigrant women in Sweden
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aims to obtain an understanding of immigrant women’s access to healthcare services in Sweden in relation to sexual and reproductive health and rights (SRHR). Data were obtained from three different quantitative cross-sectional studies using self-administrated questionnaires and one qualitative study based on in-depth interviews. The sample consists of immigrant women, predominantly refugees from Afghanistan, Iraq, Syria, and Somalia in Study I (n=288) and Thai immigrant women in Studies II–IV: Study II (n=804), Study III (n=19) and Study IV (n=266). The results indicate that social capital factors seem to play an important role in knowledge about sexual and reproductive health (SRH) services. About one-third of immigrant women reported lack of knowledge of where to go for contraceptive counselling. Lack of knowledge was associated with experiencing lack of emotional social support and not having children. An even higher proportion lacked knowledge of where to go for HIV testing, which was associated with not having participated in a health examination. In a sample of Thai immigrant women, lack of knowledge about SRH services was associated with living without a partner, having low trust in others, having predominantly bonding social relationships and belonging to the oldest age groups. In all studies, the majority had not been tested for HIV or participated in contraceptive counselling. Among the Thai women, despite expressing a need for SRH care, most participants had not sought this type of care. Women found it challenging to seek care in Sweden due to lack of knowledge about the healthcare system and language difficulties. The majority of Thai women reported a significant need for information related to SRH services. Women who had never been HIV tested in Thailand had increased odds of not being tested in Sweden.

Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrant women is a missed opportunity, as all citizens in Sweden have free access to these services. Providing information on SRH services to all immigrants in their native language, regardless of immigration status, is an important step in achieving equal access to SRH care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 86
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1540
Keywords
Immigrant, Migrant, Access, Healthcare, Equal, Social capital, Contraceptive counselling, HIV testing, HIV, Sexual and reproductive health and rights, Sweden.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine; Health Care Research
Identifiers
urn:nbn:se:uu:diva-368357 (URN)978-91-513-0573-8 (ISBN)
Public defence
2019-03-25, A1:111a, BMC, Husargatan, ingång A11, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2019-03-01 Created: 2019-02-05 Last updated: 2019-03-18

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