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Adjusting and doing the same: school nurses’ descriptions of promoting participation in health visits with children of foreign origin
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0002-7828-6999
Jönköping University, Jönköping, Sweden.
Jönköping University, Jönköping, Sweden.
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala University, Uppsala, Sweden.ORCID iD: 0000-0002-4302-5529
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2021 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 111Article in journal (Refereed) Published
Abstract [en]

Background: School nurses in the school health services are assigned to promote health and participation among children when conducting health visits. Still, for children of foreign origin this promotion of participation might be hampered by challenges related to cultural diversity and language barriers. Therefore, knowledge needs to be developed regarding how these children’s participation can be promoted, to support them in sharing and describing matters important for their health. The aim was to investigate school nurses’ descriptions of promoting participation for children of foreign origin in health visits. Methods: A content analysis of 673 Swedish school nurses’ answers to eight open-ended questions regarding promotion of participation for children of foreign origin was conducted. The open-ended questions were part of a larger web-based cross-sectional survey distributed to school nurses in Sweden. Results: The results show that school nurses use three main approaches during the health visit: adjusting according to the child’s proficiency in Swedish and/or cultural or national background, adjusting according to the child’s individual needs, and doing the same for all children regardless of their origin. Yet, adjustments according to the child’s proficiency in Swedish and/or cultural or national background were the most common. Conclusions: By combining the approaches of adjusting, a child-centered care that contributes to children’s participation in health visits and equity in health could be provided. 

Place, publisher, year, edition, pages
BioMed Central Ltd , 2021. Vol. 21, no 1, article id 111
Keywords [en]
article, child, content analysis, cultural diversity, female, human, human experiment, male, school health nursing, Sweden
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-53013DOI: 10.1186/s12889-020-10144-2ISI: 000609437100008Scopus ID: 2-s2.0-85098992744OAI: oai:DiVA.org:mdh-53013DiVA, id: diva2:1518006
Available from: 2021-01-14 Created: 2021-01-14 Last updated: 2023-08-28Bibliographically approved
In thesis
1. The relevance of cultures: Perspectives on health visits with children with migration experiences
Open this publication in new window or tab >>The relevance of cultures: Perspectives on health visits with children with migration experiences
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Swedish school nurses invite school-aged children to health visits. These involve screening for risks of ill-health and a dialogue about the children’s health. For children with migration experiences, i.e., children who have migrated or whose parents have migrated, assessment of their health might need to include factors related to migration. Previous research suggests that encounters between health professionals and these children might involve challenges if languages or expectations are not shared and if the professionals lack competence. Still, research about health visits with children with migration experiences is limited. The overall aim of the thesis was to investigate health visits with children with migration experiences in the school health services, focusing on guidelines and health questionnaires used in health visits, school nurses’ cultural competence and promotion of participation in health visits for children with migration experiences as well as the children’s experiences of these health visits.

Study I showed that 687 guidelines and health questionnaires used in health visits in Swedish municipalities included content on most factors related to migration affecting children’s health. The document analysis also showed that the content did not include factors related to discrimination based on ethnicity and origin and might reflect an ethnocentric perspective on health. In study II, 816 school nurses self-assessed their cultural competence using a web survey. Multivariate analysis showed that cultural competence was predicted by education in cultural diversity and encountering children with migration experiences more often. Interpretation of these results is unclear, as cultural competence might relate to othering not culture. How the health visits were conducted was described by 673 school nurses (study III) in a web survey and 17 adolescents in individual interviews and focus groups (study IV). The results of content analysis (III) and reflexive thematic analysis (IV) described how school nurses balanced between the framework guiding health visits and the adjustments and individualisation based on the child. The adolescents’ interpretations in this interaction influenced their participation, and willingness to talk about health (IV). 

This thesis shows that health visits with children with migration experiences include a balance between universal actions and individualisation based on children’s needs, wants, and experiences (including those related to migration). The interaction between school nurses and children is also influenced by cultures, shaping how the health are conducted and the shared meaning-making process. Further improvement of health visits might require questioning relations between culture and migration and challenging how differences are constructed.

Place, publisher, year, edition, pages
Västerås: Mälardalens universitet, 2022
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 365
Keywords
Adolescents, Children, Culture, Health visits, Interaction, Migration, Participation, School health services, School nurse
National Category
Health Sciences
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:mdh:diva-59915 (URN)978-91-7485-561-6 (ISBN)
Public defence
2022-11-25, Gamma och digitalt via zoom, Mälardalens universitet, Västerås, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2022-09-13 Created: 2022-09-12 Last updated: 2022-11-04Bibliographically approved

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Wahlström, EmmieHolmström, IngerPeter, LarmHarder, Maria

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