Challenged assumptions and invisible effects: an explorative case study of a health education intervention addressing immigrants

Abstract

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.

Know where to go: evidence from a controlled trial of a healthcare system information intervention among immigrants

“…Limitations of this study were that the intervention was not delivered within a standardised prototype which we were able to control. Findings of the explorative qualitative process evaluation of this study elucidated how the participants’ sharing of experiences, opinions and interests modified the content in the educational course from the planned content [ 3 ]. This contributes to explaining the weak effect of the intervention.…”

“…This study should be used as a stepping-stone towards testing different designs of improving more appropriate healthcare-seeking behaviour and utilisation of services. Lessons learnt from the process evaluation underscored the importance of participants’ existing health beliefs which challenged the underlying assumption of the intervention that increased knowledge on the structure of and access to the Danish healthcare system would lead to changed healthcare-seeking behaviour and healthcare use [ 3 ]. In support of this, a recent Australian PhD study elucidated that immigrants have a range of unrecognised health literacy skills that are not adequately understood or addressed within the healthcare system [ 35 ].…”

“…Hitherto, in relation to the present study, we investigated how healthcare education was unfolded in the language school, and whether systematic healthcare education affected immigrants’ knowledge of the Danish healthcare system. An explorative qualitative process evaluation elucidated how the participants’ understanding of health and their risks perception overruled the normative information they learned on the healthcare education course [ 3 ]. Nevertheless, we found that healthcare education improved knowledge of the Danish healthcare system in terms of who to contact in the event of an accident but not in the event of illness and further, it positively affected correct answers for 9 out of 11 true or false questions on access to and use of the healthcare system [ 4 ].…”

Ignorance is not bliss: The effect of systematic information on immigrants’ knowledge of and satisfaction with the Danish healthcare system

“…Therefore, neither of these variables was very reliable and their influence on the effect of the interventions on the immigrants should be interpreted with caution. A qualitative explorative process evaluation of the study underscored that the course intervention did not fully unfold as intended, as immigrants questioned the normative information on how and when to access the different healthcare services that they were given [25]. Additionally, the participants were overtly interested in the topic of health and healthcare, and thus very engaged in the class/course, thereby actively constructing the content of the intervention [25].…”

Recruitment of ethnic minorities for public health research: An interpretive synthesis of experiences from six interlinked Danish studies

“…In addition, the integration of data collection procedures into the institution’s everyday activities (e.g. in discussions during the lectures or in written assignments) encouraged some teachers to regard the research activities as a positive contribution to the participants’ education (study 4) and to the teacher–student relationship (study 6) [23].…”