“This course is like a compass to us” – a qualitative study on newly settled migrants’ perceptions of civic and health orientation in Sweden

Al-Adhami et al. BMC Public Health (2021) 21:1606 https://doi.org/10.1186/s12889-021-11654-3 RESEARCH Open Access “This course is like a compass to us” – a qualitative study on newly settled migrants’ perceptions of civic and health orientation in Sweden Maissa Al-Adhami1*, Katarina Hjelm2, Josefin Wångdahl2 and Elin C. Larsson3,4 Abstract Background: Migrants face structural, socio-political barriers in their resettlement processes that negatively affect their health. Migration also adversely impacts resources such as social capital and health literacy that are of importance for health and integration into society. Hence, there is a need for health promotion in the early postmigration phase. In Sweden, newly settled refugee migrants who have received a residence permit are offered an Introduction programme including a civic orientation course. The program is intended to facilitate access to the labour market and promote integration. The aim of the study was to explore participants’ perceptions and experiences of a civic orientation course with added health communication. Methods: We performed six focus group discussions: two in Arabic, two in Farsi and two in Somali. The discussions were facilitated by native speaking moderators. Participants were 32 men and women recruited from civic orientation classes in the county of Stockholm. We used an interview guide with semi-structured questions. The data were analysed using a method for content analysis for focus group discussions. Results: Three main categories were identified: (1) ‘The course gives valuable information but needs adjustments’, which includes that the civic and health orientation is needed earlier, during the asylum phase, and that planning and course content need adjustments. (2) ‘The health communication inspired participants to focus on their health’, which includes that the health communication was useful and inspired uptake of healthier habits. (3) ‘Participation in the course promoted independence and self-confidence’, which includes that the course gave insights into society and values in Sweden, and promoted independence and new social contacts. Conclusion: This study adds knowledge about the users’ perspectives on the potential of civic orientation to promote the health and integration of newly settled migrants, describing ways in which civic orientation with added health communication promoted health and empowerment. However, the content and delivery of the course need adjustment to better fit the migrants’ life situations and varying pre-existing knowledge. Keywords: Newly settled migrants, Civic orientation, Health promotion, Health communication, Migration * Correspondence: 1 Department of Women’s and Children’s Health/Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Al-Adhami et al. BMC Public Health (2021) 21:1606 Background Sweden is one of the countries that has received the largest number of refugee migrants in the EU/EES region [1]. Migrants face structural, socio-political barriers in their resettlement processes such as marginalisation and lack of adequate housing and employment, which affects their health, independent of prior health status [2, 3]. In Sweden, newly settled migrants, with a residence permit based on refugeeship or subsidiary protection status, partake in a national Introduction program [4]. There is a need and a potential to promote health of migrants in the early post-migration stage [5, 6]. One platform, reaching a large part of the newly arrived migrants, is the Civic Orientation (CO), which is a mandatory part of the Introduction program [4]. Health promotion, defined here as actions enabling increased control over and the improvement of one’s health [7], implemented early in the post-migration phase, could mediate ill health caused by systemic inequities and act as a buffer for stressors experienced by migrants [2, 5]. For instance, mental ill health e.g. depression and anxiety are commonly reported, and linked to poor socioeconomic conditions [8], lengthy asylumseeking processes [9], and experiences of discrimination and isolation [2, 10]. Furthermore, unequal health outcomes between migrant groups and native population are reported beyond the early resettlement process, e.g. mental health, cardiovascular disease and reproductive health outcomes [11–13]. Similarly, resources such as social capital, i.e. trusting relationships, social support and networks [14] and health literacy i.e. abilities and resources to find, understand, assess and apply health information [15] are weaker among newly settled migrants than among native born [16, 17]. These resources impact health outcomes and health care utilisation, and the resettlement process as such as they influence participation and empowerment in general [14, 15]. Research on health promotion for newly settled migrants have shown that there is an array of public and non-profit services and programs, e.g. for mental health [18], but that access to these programs is limited by structural barriers [19, 20]. Furthermore, it has been suggested that research on migrants’ health would benefit from continuity and international comparisons [18]. Studies such as this, examining large-scale introduction activities, available across countries and seldom viewed from the migrants’ perspectives on health promotion, are therefore needed. National Introduction programs focusing on newly settled migrants with a refugee background, also referred to as Establishment Programs or Civic Integration Programs, are common in European and OECD countries [21]. In Sweden, the program includes activities such as Swedish language training, CO, labour market counselling Page 2 of 11 and other activities aimed at facilitating establishment on the labour (...truncated)