Knowledge of the healthcare system is necessary for optimal healthcare-seeking behaviour. The results may form the basis of national and international changes in immigrant reception and optimise immigrants' contact with the healthcare system.

Objective: In most European countries, immigrants do not systematically learn about the host countries’ healthcare system when arriving. This study investigated how newly arrived immigrants perceived the information they received about the Danish healthcare system. Methods: Immigrants attending a language school in Copenhagen in 2012 received either a course or written information on the Danish healthcare system and subsequently evaluated this quantitatively. Results: The evaluation revealed a positive appraisal of the course/information provided. Conclusion: In times of austerity, incorporating healthcare information into an already existing language programme may be pertinent for providing immigrants with knowledge on the healthcare system.

Purpose The purpose of this paper is to examine any unanticipated effects of an educational intervention among newly arrived adult immigrants attending a language school in Denmark. Design/methodology/approach A qualitative case study was conducted including interviews with nine informants, observations of two complete intervention courses and an analysis of the official intervention documents. Findings This case study exemplifies how the basic normative assumptions behind an immigrant-oriented intervention and the intrinsic power relations therein may be challenged and negotiated by the participants. In particular, the assumed (power) relations inherent in immigrant-oriented educational health interventions, in which immigrants are in a novice position, are challenged, as the immigrants are experienced adults (and parents) in regard to healthcare. The paper proposes that such unexpected conditions for the implementation – different from the assumed conditions – not only challenge the implementation of the intervention but also potentially produce unanticipated yet valuable effects. Research limitations/implications Newly arrived immigrants represent a hugely diverse and heterogeneous group of people with differing values and belief systems regarding health and healthcare. A more detailed study is necessary to fully understand their health seeking behaviours in the Danish context. Originality/value Offering newly arrived immigrants a course on health and the healthcare system as part of the mandatory language courses is a new and underexplored means of providing and improving newly arrived immigrants knowledge and use of the Danish healthcare system.

BackgroundImmigrants may face problems with accessing the Danish healthcare system due to, for example, lack of knowledge of how to navigate it, which may cause inappropriate healthcare-seeking. Danish municipalities provide a mandatory introduction and language programme for newly arrived immigrants, but no information on the healthcare system is offered. This study investigated what effects information about the Danish healthcare system may have on the hypothetical healthcare-seeking behaviour of newly arrived immigrants and their actual healthcare use.MethodsA prospective intervention study of 1572 adult immigrants attending two language schools in Copenhagen was carried out. Two intervention groups received either a course or written information on the Danish healthcare system, respectively, while the control group received neither. Survey data included three case vignettes on healthcare-seeking behaviour (flu-like symptoms, chest pain and depression) and were linked to registry data on sociodemographic characteristics and healthcare use in the year to follow. Logistic regression and binomial regression analyses were performed.ResultsAppropriate hypothetical healthcare-seeking behaviour was reported by 61.8–78.8% depending on the vignette. Written information showed no effect on immigrants’ hypothetical healthcare-seeking behaviour, while the course showed a positive effect on hypothetical healthcare-seeking behaviour for flu-like symptoms (adjusted odds ratio [AOR] = 1.71, 95% confidence interval [CI] = 1.01–2.91, p-value = 0.0467), but not on chest pain or depression. The interventions did not affect immigrants’ actual healthcare use; all groups made lower use of health care services in the following year compared with the year where the study took place, except for the use of dental care which remained stable.ConclusionsInformation on the healthcare system embedded in the language school programme has the potential to facilitate immigrants’ access to healthcare. Yet, the results underscore the need for further refinement and development of educational interventions, as well as ensuring adequate utilisation of healthcare services by other means. Multi-dimensional and multi-sectional efforts are important for integration issues within healthcare in Europe.Trial registrationHealth-seeking behaviour among newly arrived immigrants in Denmark ISRCTN24905314, May 1, 2015 (Retrospectively registered).

Reporting on an interview and observation-based study in Danish municipalities, this article deals with local policy workers and takes it's departure in the great variation we observed in implementation of centrally issued health promotion guidelines. We present five types of local policy workers, each of whom we found typified a specific way of reasoning and implementing the guidelines. This typology illustrates the diversity found within a group of local policy workers and helps explain the variability reported in most studies on policy/guideline implementation. On the level of individuals, variation in implementation is often explained by the implementers’ perceptions of need for, and potential benefits of the policy, self-efficacy and skill proficiency. We add ‘professionally related experiences’ as another explanation. We introduce the concepts of translation and hinterland to understand how and why people in the same positions receiving the same set of guidelines implement them differently and suggest that local policy workers’ professionally related experiences affect the frames in which they translate the guidelines and decide upon the strategies of implementation. As such, this article illustrates a residual order of implementation practice: the unruly and elusive part of public policy implementation, ordered only partly by the centrally issued policies.