Findings from a prospective cohort study evaluating the effects of International Health Advisors’ work on recently settled migrants’ health

Abstract

BackgroundSeveral interventions have been carried out to tackle health inequalities between migrant groups, especially refugees, and native-born European populations. These initiatives are often address language or cultural barriers. One of them is the International Health Advisors (IHA) in Sweden; a peer education intervention aimed at providing health information for recently settled migrants. It is known that social determinants, such as educational level and access to social capital, affect health. Social determinants may also affect how health information is received and transformed into practice. The aims of this study was to a) assess the impact of the IHA on recently settled migrants’ self-reported health status, and received health information; b) determine the moderating role of educational level and social capital; and c) critically discuss the outcomes and suggest implications for health promotion practice.MethodsThe study was designed as a prospective cohort study. A postal questionnaire translated to Arabic was sent to recently settled Iraqi migrants in eight counties in Sweden, in May 2008 and May 2010. Two of the counties were exposed to the intervention, and six were used as references.ResultsThe proportion of individuals who reported that they had received information on healthy diet and physical exercise was higher in the intervention group than in the non-intervention group (OR 2.31, 95% CI 1.02–5.22), after adjustments. Low social participation was negatively associated with deteriorated or unchanged health needs (OR 0.47, 95% CI 0.24–0.92). No other statistically significant differences in health outcomes could be observed between the groups. No signs of effect modification on this association by social capital or educational level could be found.ConclusionsHealth information provided by the IHA increased self-reported level of knowledge on healthy diet and physical exercise. The interpretation of the observed negative association between low social participation and deteriorated or unchanged health needs is that participation was limited to one’s own social group, and therefore had limited positive influence on health seeking behaviour. The lack of measurable improvements in health status could be explained by limitations in the study, in the theoretical assumptions underlying the intervention, and in the implementation of the intervention. Further research is needed to understand success factors in health promoting interventions among recently settled migrants better.

Poor health and refraining from seeking healthcare are associated with comprehensive health literacy among refugees: a Swedish cross-sectional study

“…The results are notable as they indicate that about 40% of the refugees are at increased risk of further health problems, as self-perceived health is associated with sick leave (Carneiro et al 2013 ), mortality, and morbidity (Chandola and Jenkinson 2000 ). The high proportion of refugees having reported that they have refrained from seeking healthcare is consistent with, as far as we know, the only previous study examining this among refugees (Lecerof et al 2017 ). However, as our study included refugees from other countries of origin than the previous study, the results imply validity for other groups of refugees as well.…”

“…Another limitation in the use of self-reporting measurements in the study is that views on health and healthcare can vary with the country of birth and its culture (Ingleby 2012 ; Suphanchaimat et al 2015 ) and thus could influence interpretations of and answers to health-related questions. However, the measures used for self-reported general health, psychological well-being, and long-term illness are all three established instruments and indicators used in research and public health surveys in many different countries and cultures (Eurostat Statistics Explained 2016 ; Goldberg et al 1997 ; Lecerof et al 2017 ; Nielsen and Krasnik 2010 ; Sorensen et al 2015 ). Different views of health and health-seeking behaviors could also have affected the interpretations of and answers to the question about having refrained from seeking healthcare.…”

“…Follow-up questions were asked about the reason for having refrained from seeking healthcare. The question has been used in the previous studies (Lecerof et al 2017 ; Wamala et al 2007 ) and in the Swedish public health survey, as an indicator for identifying possible needs for action in healthcare (The Public Health Agency of Sweden 2014 ).…”

“…Long-term illness was measured by the question “Do you have any long-term illnesses, problems after an accident, any functional difficulties, or other long-term health problems?” (yes; no). The question is included in the Minimum European Health Module (Eurostat Statistics Explained 2016 ) and is frequently used in research (Lecerof et al 2017 ; Sorensen et al 2015 ).…”

“…Many refugees have poor self-perceived general health (Lecerof et al 2017 ; Nielsen and Krasnik 2010 ) and psychological well-being (Lecerof et al 2017 ; Tinghög et al 2016 ; Yaser et al 2016 ), and refugees’ health status often deteriorates over time (Thomas 2016 ). In addition, many refugees refrain from seeking healthcare and from participating in health promoting and disease preventing activities (Ingleby 2012 ; Lecerof et al 2017 ).…”