Health of refugee migrants in the early post-migration phase in Sweden : The role of health resources and health promotion

Sammanfattning: In the early post-migration phase, the health and well-being of newly settled refugee migrants is negatively affected by structural factors such as restrictive immigration policies, hostile political discourse and limited housing and work opportunities. There is a need for a better understanding of how individual health resources and health promotion can mitigate the impact of these ongoing stressors.  The thesis aimed to explore, assess, and further the understanding of the role of health promotion and individual health resources for health and well-being of newly settled refugee migrants in Sweden.In Study I, six focus group discussions were conducted with 32 newly settled refugees, exploring their perceptions of a Swedish Civic Orientation (CO) course with added health communication. The results showed that the course inspired them to focus on their health, promoted independence and empowerment, and gave new social contacts. However, the course is needed earlier in the post-migration phase and should be adjusted to better fit refugee migrants’ varying pre-existing knowledge. Study II was a cross-sectional study, exploring how individual resources of newly settled refugee migrants (n=787) were associated with self-rated health and psychological well-being. Logistical regression analysis showed that limited health literacy, lack of emotional support, and low self-efficacy were consistently associated with poor health outcomes. In Study III, interviews with 10 civic communicators were performed to explore their perceptions of an in-depth training course on mental health in relation to observed psychological needs among newly settled refugee migrants. The overall result was that the attainment of new knowledge and new tools enabled them to lead reflective conversations about mental health with participants. Mental health needs were perceived to be related to pre- and post-migration experiences. Barriers included stigma and lack of arenas to address mental health needs of refugee migrants.In Study IV, the effectiveness of a regular and an extended CO course was compared in a quasi-experimental study design among newly settled refugee migrants (n=173 and 143 respectively). Linear mixed models and Chi-square analyses showed that the extended course led to a small, but significant increase in health literacy. No significant differences were observed regarding other outcomes (emotional and practical support, general self-rated health, or psychological well-being).The thesis illustrates the potential of early health promotion initiatives focusing on individual health resources to enhance health. However, overarching structural barriers related to living conditions, work opportunities and inclusion must also be addressed.