Sofie Bäärnhielm

Introduction: Civil society organisations (CSOs) can play an important role in crisis management and facilitate effective communication and crisis response. To improve capacity for intercultural health communication in future health crises, it is crucial to learn from CSOs’ experiences during the COVID-19 (SARS-CoV-2) pandemic and from their cooperation with healthcare systems. This study aims to gain insights into CSOs’ experiences of intercultural health communication during the pandemic in two disadvantaged areas in Stockholm, Sweden. We also wanted to explore healthcare staff’s experiences of collaboration with CSOs. Methods: We conducted a qualitative thematic analysis of interviews with informants from 15 CSOs with substantial local pandemic activity. Additionally, we conducted a secondary analysis of qualitative interview data from 21 informants involved in delivering intercultural health crisis communication during the pandemic. Results: CSOs emphasised the importance of effective and trusted communication, which requires more than translation. They highlighted the need for a deep understanding of how language, cultural frameworks and lived experiences shape the reception of public health messages. From the perspective of healthcare staff, the collaboration with CSOs was both necessary and transformative. The partnership with CSOs was a process of “joining forces, “in which mutual learning and shared responsibility strengthened the overall intercultural communication strategy. Conclusion: In times of crisis, CSOs have the capacity to act as community-based knowledge brokers by strengthening trusted, understandable intercultural communication and fostering a sense of community. However, CSOs are not just an extension of the public health authorities, but independent actors with a unique ability to communicate and build trust. Collaborative structures between CSOs and healthcare need to be firmly established well ahead of future health crises. Our results emphasise the importance of culturally and linguistically adapted communication as an integral part of inclusive crisis communication. These findings position CSOs as community-engagement actors in inclusive emergency preparedness.

Background: Migrants living in socioeconomically disadvantaged neighborhoods in Sweden were overrepresented among the infected and deceased in coronavirus disease 2019 (COVID-19) and vaccination coverage was substantially lower, despite being free of charge. The overarching aim of this study was to analyze the experiences of operating a multilingual telephone service for public health crisis communication targeting migrant communities in Sweden during COVID-19. A secondary objectives was to identify specific opportunities and challenges in delivering culturally appropriate health information during a pandemic crisis. Methods: A qualitative design based on in-depth interviews with 12 health communicators staffing the telephone service was used. Additional quantitative descriptive data on the use of the telephone service are provided for context. Results: The quantitative data revealed that relatively few callers requested basic information about the virus or asked about topics such as where to turn in case of illness. The most common topic was testing for current infection. The thematic analysis identified seven major themes: The rationale behind a multilingual telephone service; the convergence of language, culture, and professional competence in trust building; dialogical dissemination of knowledge; cooperation with other actors and organizations; responding to misinformation and myths; managing emotions, existential concerns, and mental distress; and lessons for future health crisis response. Conclusions: For dissemination of information about COVID-19 and vaccination to migrants during the pandemic, experiences from the multilingual telephone service point to the value of communication that includes the possibility of dialogue with health professionals in a culturally safe mode using one’s native language. For future health crises, our findings emphasize the importance of having a communication strategy targeting vulnerable groups in place as a part of a comprehensive pandemic plan when the need emerges. Trial registration: The study protocol has been preregistered on the Open Science Framework (osf.io/rt47j).

The COVID-19 pandemic highlighted the communication challenges faced by public authorities in reaching all groups in society. The overall aim of this study is to gain an in-depth understanding of the experiences of non-native Swedish speaking residents in two multicultural municipalities in metropolitan Stockholm regarding the reception and understanding of COVID-19 and vaccination information from authorities. In addition, the aim is to identify sustainable communication approaches for culturally appropriate linguistic translation of health messages. Between May 2022 and December 2023, interviews were conducted with residents (n = 76) in two areas of Stockholm, Sweden. We used qualitative thematic analysis to develop themes. We developed five themes: Understanding and learning about COVID-19 and the vaccine; Conflicting knowledge bases; Whom to trust; Views on official communication and actions; and Preparing the local community for a future health crisis. For the non-native Swedish speaking residents in this study, understanding the authorities’ information about COVID-19 and vaccination was complicated, and receiving information in their own mother tongue was important to facilitate understanding. Deciding what sources and information to trust was a multifaceted and difficult task. For authorities to communicate trustworthy information in a public health crisis, such as the COVID-19 pandemic, the findings point to the importance of language, community engagement, authorities working with local health facilities, community actors, trusted leaders and religious organisations, and the value of verbal and culturally adapted information. We suggest that Antonovsky’s concept of Sense of Coherence should be considered for successful health crisis communication aimed at behaviour change and the importance of local community preparedness for future health crises. The results suggest that culturally and linguistically sensitive messages that consider people’s social realities, not least those most vulnerable in society, can support their sense of purpose in changing their behaviour in a crisis, but also inform policy guidance in health care. Trial registration The study protocol has been preregistered on the Open Science Framework (osf.io/rt47j)

Objective: Existing evidence on eating disorders (EDs) among migrant groups across the Global North is sparse and mixed, possibly reflecting the heterogeneity of these populations. This qualitative study explored experiences among patients with a migration background in Swedish specialist ED treatment, with a focus on barriers to treatment, resources, and needs. Method: Semi‐structured interviews were conducted with 17 adult patients self‐identifying as having a migration background, that is, being a first‐generation migrant or a child of migrants. Thematic analysis was used to identify key themes in the data. The study protocol was preregistered at osf.io/acfdy. Results: Thirteen themes were identified, describing various ways in which cultural and structural aspects of food and eating, body ideals, and treatment seeking affect participants' health. These include experiences of food as community and food insecurity, negotiations of body ideals as persons of color and within a family honor context, ways of relating to mental illness in migrant communities, and a prevailing view of EDs as a White concern within a racially and ethnically homogenous treatment setting. Suggestions for treatment adaptation and community outreach were also made. Discussion: This qualitative study points to numerous barriers that limit access to adequate treatment for migrant patients in Sweden. Participants called for culturally and structurally informed approaches that recognize the constraints that typically affect migrant communities. There is a need for community outreach efforts that engage in active dialogue with underserved populations.

Background: Alcohol use disorder (AUD) is a major clinical problem in Uganda. Explanatory models (EMs) of illness are important as they have consequences for treatment. Clinicians´ knowledge about patients´ EMs can improve understanding of the latter´s perspectives and adapting treatments. There is a lack of African studies about EMs of AUD. The aim of this study was to explore EMs for AUD among hospitalized patients and their relatives at the alcohol and drug unit (ADU) at Butabika hospital in Uganda. Methods: An adapted version of the Explanatory Model Interview Catalogue (EMIC) was used for interviews with ten patients and five relatives to investigate how both hospitalized patients with AUD and their relatives understand the disease. Data were analysed for themes with a qualitative content analysis and support of the software program, OpenCode 4.03. Results: Five major themes were identified from the patient interviews: “Context promotes AUD”; “Alcohol is part of culture”; “Spiritual causes of AUD in the community”; “Help through Western medicine and religious sources is preferred” and “Social problems and stigmatization”. Six major themes identified from the interviews with relatives were: “Numerous causes of drinking alcohol”; “Devastating consequences of drinking alcohol”; “Exploiting persons with AUD”; “Others’ suffering”; “Relatives struggling for help” and “Suggested solutions”. Conclusions: Patients’ EMs of AUD included social and spiritual explanations. Alcohol is seen as an important part of the Ugandan culture among both patients and their relatives. The results indicate it is important in clinical contexts to investigate the EMs of the patients and relatives to individually tailor treatment interventions.

Objective: To investigate outcomes in patients with chronic pain after participation in an interdisciplinary pain rehabilitation programme with language interpreters, and to investigate the outcomes in women and men separately. Design: Prospective multi-centre cohort study. Patients: Ninety-five patients in Sweden with chronic pain who have insufficient knowledge of the Swedish language. Methods: Duration and intensity of pain, anxiety and depression, health-related quality of life and fear of movement were evaluated before and after the programme. Patients were compared with a reference group comprising Swedish-speaking patients participating in an ordinary interdisciplinary pain rehabilitation programme. Results: Before the interdisciplinary pain rehabilitation programme with language interpreters, all variables except pain duration differed significantly to the detriment of the studied group. The studied group showed significant improvements after the interdisciplinary pain rehabilitation programme with language interpreters, with regards to pain intensity, depression and fear of movement. The reference group improved significantly for all variables. The women in the studied group showed significant improvements for the same variables as the whole group, while the men in the studied group did not improve in any of the variables. Conclusion: This study indicates that patients with chronic pain, and especially women, who have insufficient knowledge of Swedish seem to benefit from participating in an interdisciplinary pain rehabilitation programme with language interpreters. The result may be of value for the further development of rehabilitation programmes with language interpreters.

Indigenous people globally suffer from poorer health than majority populations. For the Sami, the indigenous people living in the north of Norway, Sweden, Finland and Russia, physical health conditions seem to be comparable to the population in general, but there are concerns about mental health. Studies have shown a higher risk of suicide, especially for young men active in traditional reindeer herding in the north. There is less knowledge about the mental health of Samis that have migrated to the cities. In this study, we interviewed 25 Samis, recruited through convenience sampling in the Stockholm area, about their perceptions of health and well-being, the importance of the Sami background and culture, their views of mental health services and the need of adapting them to Sami needs. Throughout the process, the researchers collaborated closely with the Stockholm Sami Association, in an approach of participatory research. The interviews were analysed with thematic analysis. For the participants, a secure Sami identity and being treated with respect for their identity was seen as essential for mental health and well-being. Informants' emphasis on respect for their Sami identity and belonging can be seen as a call for restoration of basic human rights. Historical experiences, current harassments and political decisions affected their health. The informants wished caregivers to increase their knowledge of Sami history and traditions.

Background Alcohol use disorder (AUD) is a growing clinical problem in Uganda. The alcohol consumption is among the most voluminous worldwide. Explanatory models (EMs) of illness are important as they have consequences for treatment. Clinicians´ knowledge about patients´ EMs can improve understanding of the latter´s perspectives and adapting treatments. There is a lack of African studies about EMs of AUD. The aim of this study was to explore EMs for AUD among hospitalized patients and their relatives at the alcohol and drug unit (ADU) at Butabika hospital in Uganda. Methods An adapted version of the Explanatory Model Interview Catalogue (EMIC) was used for interviews with ten patients and five relatives to investigate how both hospitalized patients with AUD and their relatives understand the disease. Data were analysed for themes with a qualitative content analysis and support of the software program, OpenCode 4.03. Results Five major themes were identified from the patient interviews: “Context promotes AUD”; “Alcohol is part of culture”; “Spiritual causes of AUD in the community”; “Help through Western medicine and religious sources is preferred” and “Social problems and stigmatization”. Six major themes identified from the interviews with relatives were: “Numerous causes of drinking alcohol”; “Devastating consequences of drinking alcohol”; “Exploiting persons with AUD”; “Others’ suffering”; “Relatives struggling for help” and “Suggested solutions”. Conclusions Patients’ EMs of AUD included social and spiritual explanations. Alcohol is seen as an important part of the Ugandan culture among both patients and their relatives. The results indicate it is important in clinical contexts to investigate the EMs of the patients and relatives.

The Cultural Formulation Interview (CFI), included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, is a person-centered instrument for systematically appraising the impact of cultural factors in psychiatric assessment. A number of key areas in the future development of the CFI have been identified in order to ensure further clinical uptake. In this paper, we suggest that applying a Therapeutic Assessment (TA) approach in using the CFI—i.e., framing the interview in a way that gives primacy to its self-transformative potential by explicitly focusing on those issues that are seen as the most urgent, relevant, and meaningful by the patient—could prove helpful in alleviating patients’ suffering beyond what is achieved by merely collecting relevant cultural information that may inform diagnosis and subsequent treatment interventions. The TA methodology has been designed as a collaborative approach to psychological assessment in which the assessment procedure itself is meant to induce therapeutic change. This is achieved by explicitly focusing on the particular questions and queries that patients have about themselves with respect to their mental health problems or psychosocial well-being; these questions are then allowed to guide the assessment process and the interpretation of the findings. We suggest a number of potential modifications to the related Outline for Cultural Formulation and to the CFI content that could strengthen a TA-inspired focus. With this paper, we do not claim to offer a definitive integration of the TA approach in using the CFI but hope to further the discussion of a therapeutic potential of the instrument.

Purpose: To better understand underutilisation of psychiatric care among migrant children, we compared utilisation of psychiatric care among unaccompanied refugee minors and accompanied migrant minors, with Swedish-born minors. Methods: Using a large longitudinal database of linked national registers, we established a retrospective cohort of 1,328,397 people born 1984–1988 comparing minors born in Sweden to 2 Swedish-born parents (95.4%) to minors who had been arriving in Sweden between 2002 and 2011 with a permanent resident permit and were either unaccompanied refugee minors (0.4%), or accompanied migrant minors (4.0%). The outcome measures were different measures of psychiatric care including in- and outpatient care, and prescribed psychotropic medication. Result: Compared with the Swedish-born minors the unaccompanied refugee minors had a higher likelihood of utilisation of all psychiatric care except ADHD medication. However, compared with accompanied migrant minors, the Swedish-born minors had a higher likelihood of having utilised psychiatric care. Conclusion: Our study shows that during the first years of living in Sweden, there seems to be fewer barriers to psychiatric care for unaccompanied refugee minors compared to the accompanied migrant minors. There are a number of possible reasons for this including stronger ties with the Swedish society.