Norwegian "dugnad" as a rhetorical device in public health communication during the COVID-19 pandemic. A qualitative study from immigrant's perspectives.

BACKGROUND: During the COVID-19 pandemic, the Norwegian government appealed to the term "national dugnad" in the communication of containment measures as a call for collective action to fight the spread of infection. "Dugnad" is traditionally associated with solidarity, social responsibility, and a communal spirit in the form of volunteer work carried out by a local community. Although the word "dugnad" is difficult to translate to other languages, it was used as a rhetorical device by the government to communicate health-related information during the pandemic. This study aims to explore how immigrants understood and related to the term "dugnad" as used in the context of the COVID-19 pandemic in Norway. METHODS: We conducted 55 semi-structured interviews in 2020 with immigrants from Poland (10), Syria (15), Somalia (10), Sri Lanka (10), and Chile (10). Interviews were conducted in participants' mother-tongues. We used systematic text condensation following Malterud's four steps to analyze the data. RESULTS: The results are organized into three themes corresponding to: (1) meaning making of the term "dugnad"; (2) attitudes towards the term "dugnad"; and (3) reactions to the use of "dugnad" in a public health context. Overall, participants were familiar with the term "dugnad" and positively associated it with volunteering, unity, and a sense of community. However, we found a variety of reactions towards using this term in a public health context, ranging from agreement to disagreement and irritation. CONCLUSION: Health communication during pandemics is crucial for maximizing compliance and gaining control of disease spread. In multicultural societies, governments and authorities should be aware of the linguistic and cultural barriers to public health communication if they are to effectively reach the entire population. The use of culturally specific concepts in this context, specially as rhetorical devices, may hinder effective health communication and increase health inequalities.

'Who is telling the truth?' Migrants' experiences with COVID-19 related information in Norway: a qualitative study.

AIMS: The over-representation of migrants among those infected by COVID-19 in high-income countries has spurred questions about insufficient distribution of health information to society's subgroups. Our study aimed to shed light on migrants' experiences with information relating to COVID-19 in Norway. METHODS: We conducted 55 semi-structured interviews with migrants from five different countries living in Norway: Somalia (10), Syria (15), Sri Lanka (10), Chile (10), and Poland (10). The interviews were performed by bilingual researchers with a migrant background, audio-recorded, transcribed and thematically analysed. RESULTS: We identified the four key themes of multiple and contradictory information sources, language barriers, conspiracy theories/speculations, strategies for information provision and ways ahead. Participants accessed and combined several often transnational sources of information. Information was perceived as confusing and contradictory and there was a wish for more translated information. CONCLUSIONS: It is important to recognise the specific factors affecting migrants' ability to receive, trust and use health-related information during pandemics and other health crises.

The evolvement of trust in response to the COVID-19 pandemic among migrants in Norway.

BACKGROUND: The COVID-19 pandemic has had profound consequences for the world's population, particularly for vulnerable groups like migrants who face barriers to healthcare access. Trust in authorities is crucial to any crisis management strategy implemented by a government. However, trust in authorities is linked to trust in other areas of life and it evolves during a crisis. This study explores migrants' trust in the Norwegian government's response to the COVID-19 pandemic. METHODS: We conducted semi-structured interviews from April to May 2020 with migrants from Somalia (10), Syria (15), Sri Lanka (10), Chile (10) and Poland (10) who were living in Norway. Interviews were conducted via telephone and in participants' mother tongue. Data were analysed thematically using the systematic text condensation method. RESULTS: Trust was established at four levels: (i) in the personal sphere, (ii) in Norwegian society in general, (iii) in the Norwegian authorities' management of the pandemic, and (iv) in the transnational sphere. Trust was deeply rooted in relationships with individuals, groups and entities, across countries. High trust in authorities emerged in the accounts of participants who felt they were taken care of in the diverse relationships they established in Norway, particularly during the crisis. CONCLUSION: Pandemics create more vulnerability but also opportunities for trust-building. Trust-building can be fostered through relationships in the host country that provide the foundation for migrants to feel included. Healthcare providers are in a position from which they can nurture trust as they can build relationships with migrants over time.

Maternity care through the eyes of Southern European immigrant parents in Norway / Experiencias de padres y madres inmigrantes del sur de Europa con los servicios noruegos de salud reproductiva

Objective: To explore Southern European immigrant mothers and fathers' experiences of reproductive health services in Norway, and their perceptions of health providers' beliefs and attitudes regarding pregnancy and childbirth. Method: We employed a qualitative research methodology with two focus group discussions and 11 in-depth interviews with 4 fathers and 11 mothers from Italy, Spain, Portugal, and Greece, whose children were born in Norway. Thematic Analysis was conducted to identify and analyze patterns across the data. Results: We identified three themes as key elements in parents' experiences: experiences with the coverage and organization of the Reproductive Health Services; relational experiences with health providers; and pregnancy and delivery as a culturally-shaped event. The immigrant parents experienced a clash between their expectations and the procedures and health facility environment encountered in Norway regarding check-ups, diagnosis tests, childbirth preparation courses, and health facilities. Informants perceived that the maternity care practices of the host country were underpinned by the health care providers' cultural understandings of labor and pregnancy. Particularly, they experienced a less interventionist approach towards pregnancy and childbirth. Conclusions: The experiences of immigrant parents provide relevant information to improve reproductive health services in a cross-cultural context. Inmigration brings new challenges that must be addressed from a perspective of cultural competence. These services should acknowledge diversity in cultural beliefs around childrearing and involve both fathers and mothers in decision-making. (AU)

Objetivo: Explorar cómo fueron las experiencias de padres y madres inmigrantes procedentes del sur de Europa al utilizar los servicios de salud reproductiva en Noruega, así como sus percepciones sobre las actitudes y las creencias del personal de salud con respecto al embarazo y el parto. Método: Estudio cualitativo, basado en dos grupos focales y 11 entrevistas en profundidad con 4 padres y 11 madres italianos, españoles, portugueses y griegos, quienes habían tenido algún/a hijo/a en Noruega. Los datos se analizaron usando análisis temático. Resultados: Emergieron tres temas: experiencias con la cobertura y la organización de los servicios de salud reproductiva; experiencias con profesionales de salud; y embarazo y parto como eventos culturales. Los padres y las madres inmigrantes experimentaron un choque entre sus expectativas y las prácticas de los servicios de salud reproductiva noruegos, especialmente en cuanto a consultas, procedimientos, pruebas diagnósticas, preparación para el parto e infraestructura sanitaria. Los informantes percibieron que las prácticas de los/las profesionales de los servicios de salud reproductiva están influenciadas por creencias culturales relacionadas con el embarazo y el parto en Noruega. En concreto, los informantes experimentaron un enfoque menos intervencionista al recibir los cuidados perinatales del personal de salud en Noruega. Conclusiones: Las experiencias de los padres y las madres inmigrantes ofrecen información relevante para contribuir a mejorar los servicios de salud reproductiva en un contexto intercultural. La inmigración supone nuevos retos que deben afrontarse desde una perspectiva de competencia cultural. Los servicios de salud reproductiva deben reconocer la diversidad cultural en el embarazo y el parto, e involucrar a ambos progenitores. (AU)

COVID-19: information access, trust and adherence to health advice among migrants in Norway.

BACKGROUND: Migrants in Norway bear a higher burden of COVID-19 infections and hospitalization as compared to non-migrants. The aim of our study was to understand how migrants perceive their own health risk, how they access information regarding the preventive measures, the degree of trust in this information, in the Norwegian authorities and the news media, and migrants' adherence to authorities' recommendations regarding the pandemic. METHODS: An online survey was performed between May and July 2020 among 529 Polish, Arabic, Somali, Tamil, and Spanish-speaking migrants in Norway. For each outcome presented in the aims, unweighted and weighted descriptive analyses were performed for all migrants together and for each language group. RESULTS: Sixty-one percent of migrants perceived their health as excellent or very good, with the lowest value (42%) in the Tamil group and the highest among Somalians (85%). The majority of respondents (82%) felt they had received sufficient information. Press conferences from the government, health authorities' websites, and Norwegian news media were the preferred channels of information for all groups. Most migrants reported a high level of adherence to preventive measures (88%) and trust in Norwegian authorities (79%). However, there were variations among groups regarding the importance of sources of information and level of trust, which was lowest for the Polish group. CONCLUSION: Migrants in Norway reported receiving sufficient information about COVID-19 and high adherence to preventive measures. However, the levels of trust in the information sources, the services and the authorities varied among the groups. Understanding how migrants are dealing with this pandemic is crucial to improve the dissemination of information and trust in the health authorities for the different groups.

Maternity care through the eyes of Southern European immigrant parents in Norway.

OBJECTIVE: To explore Southern European immigrant mothers and fathers' experiences of reproductive health services in Norway, and their perceptions of health providers' beliefs and attitudes regarding pregnancy and childbirth. METHOD: We employed a qualitative research methodology with two focus group discussions and 11 in-depth interviews with 4 fathers and 11 mothers from Italy, Spain, Portugal, and Greece, whose children were born in Norway. Thematic Analysis was conducted to identify and analyze patterns across the data. RESULTS: We identified three themes as key elements in parents' experiences: experiences with the coverage and organization of the Reproductive Health Services; relational experiences with health providers; and pregnancy and delivery as a culturally-shaped event. The immigrant parents experienced a clash between their expectations and the procedures and health facility environment encountered in Norway regarding check-ups, diagnosis tests, childbirth preparation courses, and health facilities. Informants perceived that the maternity care practices of the host country were underpinned by the health care providers' cultural understandings of labor and pregnancy. Particularly, they experienced a less interventionist approach towards pregnancy and childbirth. CONCLUSIONS: The experiences of immigrant parents provide relevant information to improve reproductive health services in a cross-cultural context. Inmigration brings new challenges that must be addressed from a perspective of cultural competence. These services should acknowledge diversity in cultural beliefs around childrearing and involve both fathers and mothers in decision-making.

A qualitative study on the experiences of southern European immigrant parents navigating the Norwegian healthcare system.

BACKGROUND: Patients' experiences with health providers and their diagnostic and treatment expectations are shaped by cultural health beliefs and previous experiences with healthcare services in home country. This study explores how Southern European immigrant parents navigate the Norwegian healthcare system, through its focus on how this group manage their expectations on diagnosis and treatment practices when these are unmet. METHODS: The study had a qualitative research design. Fourteen in-depth interviews and two focus group discussions with 20 Southern European immigrant parents were conducted in 2017 in three Norwegian municipalities. With the help of NVivo software, data were transcribed verbatim and coded. Following a thematic analysis approach to identify patterns in immigrants' experiences with the Norwegian healthcare services, the codes were organized into two themes. RESULTS: The first theme includes immigrants' expectations on diagnostic tests and medical treatment. Southern European immigrants expected more diagnostic tests and pharmacological treatment than what was deemed necessary by Norwegian health providers. Experiences with unmet expectations influenced how immigrants addressed their and their children's healthcare needs. The second theme comprises immigrants' experiences of seeking healthcare in Norway (attending medical consultations in the private sector, seeking immigrant healthcare providers, and navigating the healthcare through their Norwegian social networks). This category includes also the alternative solutions immigrants undertook when they were dissatisfied with the diagnosis and treatment practices they were offered in Norway (self-medication and seeking healthcare in home countries). CONCLUSIONS: Cultural health beliefs and previous experiences with healthcare services from home country shaped immigrants' expectations on diagnosis and treatment practices. This had great implications for their navigation through the healthcare system and interactions with health providers in the host country. The study suggests that successful inclusion of immigrants into the Norwegian healthcare system requires an acknowledgement of the cultural factors that influence access and use of healthcare services. Exploring immigrants' perspectives and experiences offers important information to understand the challenges of cross-cultural healthcare and to improve communication and equitable access.

The Position of the Child in the Life Experiences of Immigrant Survivors of Intimate Partner Violence: A Study of Service Providers' Perspectives in Spain.

Intimate partner violence (IPV) is a global public health concern that has serious effects on the well-being of women and their children. Being a mother and an immigrant are critical factors that prevent women from seeking to end an abusive relationship. Evidence suggests that immigrant women see their children's well-being and future as paramount while managing an abusive relationship. However, less is known about how women negotiate their children's needs and interests when deciding whether to stay with or leave an abusive partner. Drawing on interviews with IPV service providers in Spain, this study aims to explore providers' understandings of the position of the child in mothers' reflections regarding whether to end an abusive relationship and of the implications of such positioning for mothers' decision-making. The findings indicate that children hold two main positions in this process. In one, children are positioned as a trigger for mothers to stay with abusers. This occurs when women are economically dependent on their partner, when they think that their children need a father figure, or when the abuser plays a role in women's migratory status within Spain. Second, children are positioned as a trigger for mothers to leave abusers when mothers see children as victims of violence or children in need of a mother figure. Framed by positioning theory, we discuss how we can understand the consequences of such positioning for immigrant women who are survivors of IPV and for service provision in this context. The implications of the findings for research, policy making, and professional decision-making are discussed.

Keeping silent or running away. The voices of Vietnamese women survivors of Intimate Partner Violence.

Background: Legislative initiatives have been implemented to fight against Intimate Partner Violence (IPV) and offer protection to its survivors in Vietnam. However, this type of violence is relatively common in the country, where broader structural inequalities, like poverty and the system of male dominance, increase women's vulnerability to IPV. Objective: This study aimed to explore the strategies that Vietnamese IPV survivors take to cope with the abuse from their partners and maximize their safety and wellbeing. Methods: Qualitative in-depth interviews were conducted with eight women survivors of IPV who lived in one of the Peace House Shelter in Hanoi. Participants were recruited through the shelter. Data were collected using semi-structured interviews and analyzed using qualitative content framed by the theoretical concept of the patriarchal bargain. Results: The IPV survivors in our study took two main strategies to cope with IPV: keeping silent and/or leaving the abuser. Leaving was a challenging strategy because it required support from others, something that was difficult to find due to the social stigma associated with divorce and the normalization of violence in intimate relationships. This was specially the case for participants coming from rural areas who did not count on a social network in the city where the shelter is located. The women strategized within a complex set of structural constrains like poverty, cultures of honor, social stigma, and traditional gender roles. As active agents, they decided whether challenging the patriarchal system would optimize their life options. Motherhood also played a crucial role in women's decisions regarding IPV. Conclusion: A strategy of conformity like silence can be a tactic for women to cope with a system of male dominance while navigating complex structural inequalities. To better address IPV in Vietnam, interventions should be sensitive to the structural gender inequalities within family and societal contexts.