Strategies for a health promoting Introduction for newly-arrived refurgees and other immigrants

Sammanfattning: From 1980 to 2005 about 340,000 persons have been granted permanent residency in Sweden for refugee or similar reasons. Many countries, including Sweden, have implemented introduction programmes aimed at reducing inequality in critical living conditions between refugees and the host population. From a structural perspective on health promotion, the intended outcomes and the role as everyday environment make such programmes interesting settings for health. This thesis aims to identify the preconditions for and to develop strategies for strengthening the health promoting potential of the Introduction for newly-arrived refugees and other immigrants, and its environment in Sweden. The four papers in the thesis are designed to identify important risk and protective factors for mental health within the Introduction and to consider how structures, processes and practices of the Introduction may promote such protective factors and prevent risk factors both during programme delivery and as a result of it. In Paper I, 28 professionals with different roles in the Introduction are interviewed about health among the refugees in the programme. The study shows that the most immediate conceptualization of health among staff is that it concerns absence of illness and that the role of the Introduction is to refer those with such problems to treatment in healthcare. However, in narrated everyday episodes about the Introduction, health is something far richer. It includes two levels: personal capacities and qualities in the Introduction and the environment, and threats to each of these levels. Paper II presents path analyses for core post-traumatic stress symptoms (CPTS) and symptoms of common mental disorder (GHQ-s), including socio-demographic variables, preresettlement trauma, personal capacity to handle stress, exposures as asylum-seekers and a new instrument to measure resettlement stressors, obtained from 115 persons, mainly from Iraq. The final path models of CPTS and GHQ-s are similar in some respects, such as the importance of personal capacity to handle stress, while in other respects they differ: resettlement stressors are more important than pre-resettlement trauma for explaining GHQ-s, whereas the reverse applies to CPTS. Paper III and Paper IV use information about the structure, process and practice of the Introduction, reported by 83 Introduction unit managers in the same number of local authorities in Sweden. Both studies focus on which building blocks, in the inter-organizational network that provides the Introduction that can explain differences in critical setting qualities. Various combinations of the following five main building blocks affect setting qualities: active management on all levels, systematic evaluation, active network involvement by many organizations, group modes of interaction between managers and staff as well as between staff and participants from all organizations, and conditions in the local authority. The results are integrated in the Health Promoting Introduction Model, which includes: network building blocks, setting qualities, the health promoting spiral of personal capacities, outcomes and environmental facilitators and long-term health, social and economic outcomes at the individual, group and societal levels. The model should guide policy and the development of practice in this area. It can also provide opportunities for focused research on complex health promoting service delivery systems in general and settings for refugee resettlement support in particular.