The relevance of cultures : Perspectives on health visits with children with migration experiences

Sammanfattning: 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.

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