Civic communicators' view of and approach to health promotion for newly arrived migrants in Sweden

Evaluation of an integration community project for asylum seekers in Sweden: physical activity adherence and changes in character traits and life satisfaction

Asylum seekers' traumatic experiences in combination with discrimination, social isolation, and exclusion in the host country leads to low adherence from health and integration initiatives. Along with their inability to seek health care and physical inactivity, this situation increases their mental illness and, most importantly, decreases their well-being. In fact, the lack of well-being (e.g., life satisfaction) is a better marker of mortality and morbidity than the presence of mental illness. In this context, one of the major single determinants of well-being is character, a dimension of personality that stands for self-regulation, adaptation, and intentional conscious behavior (i.e., goals and values). Host countries often implement integration initiatives including activities aiming to attenuate mental illness, but only a handful are evaluated and reported, with even fewer addressing character development, increases in life satisfaction, or adherence. Our aim was to evaluate the integration initiative "Health for Everyone-Sport, Culture, and Integration", a 10-week physical activity community project. Specifically, we investigated changes in life satisfaction and character traits (i.e., Self-Directedness, Cooperativeness, and Self-Transcendence) and if these variables, at baseline, predicted adherence and changes in physiological health (i.e., cardiorespiratory fitness, skeletal muscle mass, body fat mass, and visceral fat). Participants (n = 269) answered (pre and post measurements) the Satisfaction with Life Scale, the Short Character Inventory, and undertook physiological tests. In addition, their attendance to the physical activity sessions was registered throughout the project (i.e., adherence). Participants showed no significant increases in Self-Directedness, Cooperativeness, or life satisfaction, but significant decreases in Self-Transcendence. Moreover, higher life satisfaction and lower Self-Transcendence at baseline predicted higher adherence to the activity. However, neither character traits nor life satisfaction predicted changes in physiological health. We argue that low frequency physical activity initiatives may improve this population's physical health because participants probably have a sedentary life and low levels of physical health due to their asylum conditions (e.g., unemployment, low income, poor housing and social network). Furthermore, physical activity per se may not improve the well-being of asylum seekers. Hence, promoting well-being and character development might require person-centered initiatives focusing on the whole individual in order to fit programmes to the needs and life situation of this population.

[Health service needs of migrant women from a basic health area: A qualitative study]

OBJECTIVES

To know the needs and lack of information on health issues of Maghrebi women.

SUBJECTS, MATERIAL AND METHOD

Design: Qualitative study technique nominal group (TGN).

SUBJECTS

14 North African women from Association for Solidarity and Rapprochement of Cultures (ASAC) from the rural clinic of La Aljorra who knew and understood Spanish, older age, and lived in the town for more than 3 years. Material and method TGN asks: «What daily health issues for you and your family worry you the most and do you need answers?» Individual reflection and list that were discussed among them, joining the group consensus. Subsequently, they were prioritized individually and a definitive list of their prioritized health needs was made.

RESULTS

Thirty-six percent of the ASAC associates attended. At first, 17 topics were written on health needs for which they wanted a response. The final topics chosen and grouped by them were 6: 1) Contraceptive methods; 2) Relationship problems; 3) Thyroid; 4) How to cure the sciatic nerve?; 5) Anemia and 6) Stress. 70% related to the area of sexuality.

CONCLUSIONS

1) Qualitative research is an adequate consensus method to obtain information on little-known topics and directly from the person involved; 2) The Moroccan migrant woman considers information about sexuality and couple relationships very important; 3) Another pathology unknown to them and emerging in the area is thyroid; 4) Stress and its repercussions; 5) Sciatica and its consequences are also important when being agricultural workers.

Can extended health communication improve newly settled refugees' health literacy? A quasi-experimental study from Sweden

Structural and contextual factors such as limited work and housing opportunities negatively affect the health and well-being of newly settled refugee migrants in receiving high-income countries. Health promotion initiatives aiming at strengthening health and integration have been tried out within the Swedish Introduction program for refugee migrants. However, longitudinal evaluations of these interventions are rare. The aim of the current study was to compare the effectiveness of a regular and an extended civic orientation course with added health communication and examine whether the latter would improve self-rated health and psychological well-being, health literacy and social capital among newly settled refugee migrants in Sweden. Pre- and post-assessment questionnaires were collected from the intervention group receiving the extended course (n = 143) and a control group receiving the regular course (n = 173). Linear mixed models and chi-square analyses showed a significant increase with a small effect size (0.21) in health literacy in the intervention group. However, there were no significant changes in emotional and practical support, general self-rated health or psychological well-being. The findings indicate that added health communication provided embedded in the civic orientation course can increase health literacy. However, further longitudinal studies are needed to confirm the sustainability of the observed effect and examine whether these short-term improvements in health literacy translate to long-term advances in health and integration.

"Putting words to their feelings"- civic communicators' perceptions and experiences of an in-depth course on mental health for newly settled refugee migrants in Sweden

BACKGROUND

Newly settled refugee migrants face psychological stressors stemming from pre-, during- and post-migration experiences. In Sweden, mental health promotion is part of the health module in the civic orientation classes for newly settled refugee migrants. Training courses are offered to civic communicators and workshop leaders to facilitate communication about mental health; however, the training is seldom evaluated. In the current study, we aim to explore civic communicators' perceptions and experiences of an in-depth mental health training course in relation to observed needs among newly settled refugee migrants.

METHOD

We interviewed ten civic communicators that had partaken in the in-depth training course on mental health. All respondents had prior migratory experience and worked as civic communicators in their native languages. The interviews were semi-structured and data were analyzed using thematic analysis.

RESULTS

Three themes were identified: (1) Intertwined mental health needs related to migration, (2) Multi-layered barriers to addressing mental health, and (3) Becoming aware of the mental health journey. One overarching theme was arrived at through synthesizing the three themes 'Acquired new tools to lead reflective conversations about mental health and well-being'.

CONCLUSION

The in-depth mental health training course led to the attainment of new knowledge and new tools enabling civic communicators to lead reflective conversations about mental health and well-being with newly settled refugee migrants. Mental health needs were related to pre- and post-migration experiences. Barriers to talking about mental health included stigma and a lack of arenas to promote the mental health of refugee migrants. Increasing knowledge among civic communicators can facilitate the promotion of mental self-help capacity and resilience among newly settled refugee migrants.