Self-reported health and social alienation in Swedish adolescents: A cross-sectional study among high-school students in Stockholm

Background: Adolescents' health-damaging behaviors and social alienation of young people are recognized as public-health problems. One of the hypotheses that is emerging and evolving in the sociology, physiology, and health fields is that individuals with a great feeling of alienation are at risk of mental health problems and present negative health-risk behaviors. Objectives: This thesis aims to investigate the relationship between the feeling of social alienation and selfreported health. The first sub-study aims to provide an appropriate social alienation scale for use in the Swedish context and among adolescents. The second and third sub-studies aim to explore social alienation and the selfreported health status of Stockholm’s high-school students by examining the role of age, sex, and immigration background. The fourth sub-study investigates the relationship between self-reported health and the feeling of social alienation. The final sub-study investigates the relationship between the feeling of alienation and mental health by examining the role of socio-economic factors. Materials: The thesis is built around five articles through the analysis of data gathered with the Nottingham health profile (NHP) and the Jessor and Jessor social alienation scale. The data were collected from eight high schools in Stockholm, and the number of participants was 446 (age = 15–19; SD = 1.01; mean = 17). Results: The Jessor and Jessor alienation scale translated to Swedish and several validity methods such as translation and back-translation and face, content, and construct validity were used. A stability and interconsistency test was also performed to examine the reliability of the scale. The overall result of the abovementioned tests indicated that the Swedish version of the alienation scale is an adequate and valid questionnaire to use among adolescents (Article I). Age was found to be associated with the feeling of alienation and mental health, and students aged 17 demonstrated fewer mental-health problems and a lower feeling of alienation (Article II and V). Sex was shown to be one of the main significant variables in regard to self-reported health and contributes to a larger number of self-reported problems; also, female students reported more health problems than male students (Article III and V). These differences were much larger amongst immigrant students. Native Swedish females reported significantly more health problems about two aspects of health (energy level and emotional reaction) than native Swedish males, whereas the female students from an immigrant background reported significantly higher self-reported problems on other dimensions as well (isolation, physical mobility, and pain).The immigration background was found to be a significant variable in self-reported health and feeling of alienation (Article II, III, & V). Students with an immigrant background reported significantly more self-reported problems with sleep, pain, emotional reaction, and energy level (Article III). They also have larger health problems, in particular mental health problems (Article V). Students from non-Swedish parents (in particular from a Middle-Eastern origin) reported significantly more health problems in comparison with native Swedish students (Article V). Students with an immigrant background also significantly reported a stronger feeling of social alienation than Swedish natives, and the level of feeling of alienation was much higher among the first generation of immigrants (Article II). Neighborhood characteristics, such as home area and home type, were also found to be a significant variable on self-reported mental health. No significant differences about feeling of alienation and self-reported health were observed with respect to parents’ educational level (Article II &V). Finally, alienation was found as a mediating variable between selfreported mental health and self-reported physical health (Article IV & V). The more severe mental health problems are associated with a higher feeling of alienation, and the feeling of alienation is associated with selfreported physical health problems (Article IV & V). Conclusion: The results described in this thesis highlight that, in general, female students report more health problems than male students, and the contrast is larger among the students with an immigrant background. The finding shows that the feeling of alienation and self-reported health problems are higher among students with immigrant background, regardless of the country of origin, and self-reported health problems are higher among students from the Middle East. The results also indicate a strong association between the feeling of alienation and having more self-reported mental health problems; this suggests the mediating role of the feeling of alienation between mental health and physical health

Nursing students’ perceptions of their verbal and social interaction skills in Sweden and China during their first semester

Aim: This study aimed to investigate the similarities and differences related to verbal and social interaction skills between nursing students attending universities in Sweden and China, two countries with different educational systems, during the students’ first semester. Background: Nurses need a high level of interaction skills in order to interact effectively with patients and their families. Thus, practical nursing education focusing on clinical skills is essential. Method: Students at one university in Sweden and two universities in China completed the Verbal and Social Interactions for Nursing Students (VSI-NS) questionnaire. Results: The students perceived ‘Building a caring relationship’ and ‘Caring towards health and well-being’ as the most frequently occurring and important types of caring interactions. The students perceived that talking with a patient about his/her feelings and thoughts was the least frequently occurring and least important type of caring interaction. Conclusion: The students appear to understand from the initial phase of their education that the caring relationship and the patients’ health and well-being will be the major focus of their role as nurses. Résumé But : Cette étude visait à étudier les similitudes et les différences liées aux habiletés d’interaction verbale et sociale entre des étudiantes en sciences infirmières d’universités en Suède et en Chine, deux pays avec des systèmes d’enseignement différents, au cours du premier semestre des étudiantes. Contexte : Les infirmières ont besoin d’un niveau élevé d’habiletés interactionnelles afin d’interagir avec les patients et leurs familles. Ainsi, il est essentiel qu’elles puissent bénéficier d’une formation en sciences infirmières axée sur les habiletés cliniques. Méthode : Des étudiantes d’une université en Suède et de deux universités en Chine ont rempli le questionnaire Verbal and Social Interactions for Nursing Students (Interactions verbales et sociales pour les étudiantes en sciences infirmières; VSI-NS). Résultats : Les étudiantes percevaient qu’« Établir une relation de caring » et « Se soucier de la santé et du bien-être » étaient les formes d’interactions caring les plus fréquentes et les plus importantes. Les étudiantes ont perçu que parler avec un patient de ses sentiments et de ses pensées était le type d’interaction de caring le moins fréquent et le moins important. Conclusion : Les étudiantes semblent comprendre dès le début de leur formation que la relation de caring ainsi que la santé et le bien-être des patients se trouveront au centre de leur rôle d’infirmière

Immigrant women’s food choices in pregnancy: perspectives from women of Chinese origin in Canada

Objective: Following migration, pregnant immigrant women may encounter social, cultural, and economic challenges that negatively affect their food choices and subsequent health outcomes. Culturally appropriate health care is crucial during the perinatal period to ensure the health of immigrant mothers and their children. This project aims to explore and understand how the health beliefs and practices of Chinese immigrant women affect their food choices during the perinatal period. Design: This qualitative study used the methodology of focused ethnography. Women participated in one semi-structured interview, followed by a second photo-assisted, semi-structured interview which incorporated photographs taken by the women themselves. Results: The food choices and health behaviors of immigrant women were influenced by their general health beliefs, cultural knowledge concerning particular types of foods, traditional Chinese medical beliefs, social advice and information, and socio-economic factors. Conclusion: The provision of culturally appropriate health care is crucial during the perinatal period, as it is not only a vulnerable life stage for women and their children but also a sensitive period of interaction with the Canadian health-care system. Understanding these intersecting factors can help to ensure culturally appropriate care and optimized health outcomes for Chinese immigrant women during the perinatal period

An ethnographic investigation of maternity healthcare experience of immigrants in rural and urban Alberta, Canada

Background: Canada is among the top immigrant-receiving nations in the world. Immigrant populations may face structural and individual barriers in the access to and navigation of healthcare services in a new country. The aims of the study were to (1) generate new understanding of the processes that perpetuate immigrant disadvantages in maternity healthcare, and (2) devise potential interventions that might improve maternity experiences and outcomes for immigrant women in Canada. Methods: The study utilized a qualitative research approach that focused on ethnographic research design and data analysis contextualized within theories of organizational behaviour and critical realism. Data were collected over 2.5 years using focus groups and in-depth semistructured interviews with immigrant women (n = 34), healthcare providers (n = 29), and social service providers (n = 23) in a Canadian province. Purposive samples of each subgroup were generated, and recruitment and data collection – including interpretation and verification of translations – were facilitated through the hiring of community researchers and collaborations with key informants. Results: The findings indicate that (a) communication difficulties, (b) lack of information, (c) lack of social support (isolation), (d) cultural beliefs, e) inadequate healthcare services, and (f) cost of medicine/services represent potential barriers to the access to and navigation of maternity services by immigrant women in Canada. Having successfully accessed and navigated services, immigrant women often face additional challenges that influence their level of satisfaction and quality of care, such as lack of understanding of the informed consent process, lack of regard by professionals for confidential patient information, short consultation times, short hospital stays, perceived discrimination/stereotyping, and culture shock. Conclusions: Although health service organizations and policies strive for universality and equality in service provision, personal and organizational barriers can limit care access, adequacy, and acceptability for immigrant women. A holistic healthcare approach must include health informational packages available in different languages/media. Health care professionals who care for diverse populations must be provided with training in cultural competence, and monitoring and evaluation programs to ameliorate personal and systemic discrimination

On the use of theories in study of personal health behavior during epidemics/pandemics

Communicable diseases pass all the geographical and political boundaries as a result of globalization, population movement, and international trade regime. Every year, the WHO publishes a long list of new disease outbreaks. Thus, Covid-19 is not the last and the only disease that requires adjustment in health behavior and public participation. During an epidemic/pandemic, different countries design new and different public health measures to protect their own population. However, people may choose to follow these new policies or ignore them. Choosing to ignore them jeopardizes the effect of new public health policies and counteracts all the efforts of healthcare providers. This theoretical paper attempts to provide a theoretical foundation for personal health behaviors during an epidemic/pandemic by providing evidence from the current Covid-19 outbreak. This paper covers the main theoretical aspects from the epidemiological transition decision-making process, health belief model, optimism bias, conspiracy theory and trust, stigmatization and super-spreader, and social determinates of health in three levels (from individual level to social and contextual level), which can allow us to understand personal health behavior during epidemics/pandemics.

Access to Primary Health Care by New and Established Immigrants in Canada

Aim: To investigate barriers related to access to primary health care by new andestablished immigrants in a western Canadian province. Background: The immigrant population continues to rise in Canada; butimpediments to the access of immigrants to primary health care may be threateningtheir health and well-being. Methods: In total, 12 new and established immigrants participated in our focusedethnographic study. Data obtained from semi-structured interviews was analysed usingthe framework of Roper and Shapira assisted by the use of ATLAS.ti the qualitativeanalysis software package. Findings: We identified four main factors that create barriers to access ofprimary health care services: (1) information barriers that impede navigation of thehealth care system by immigrants; (2) communication barriers arising from languagedifficulties and cultural differences; (3) socioeconomic barriers that make medicalexpenses unaffordable and the provision of services inequitable; and (4) negativeprior experiences that discourage further use of services. We reveal that Canadianprimary health care, although universally available, does not necessarily provideequitable care to new and established immigrants because they face considerablebarriers in accessing and navigating these services

Experience of Education in the International Classroom : A Systematic Literature Review

In this essay, we investigate the learning and teaching experiences in the international classroom from both the teachers and the students’ perspectives. The findings of this study showed that language barriers are one of the difficulties, but academic cultural differences seem to play a more important role that can impact on the learning outcomes in the international classroom. This can also lead to negative experiences and the forming of stereotypical views of international students solely based on their educational background.

Measuring nursing students’ cultural awareness : a cross-sectional study among three universities in southern Sweden

Background/Objective: Cultural awareness refers to when someone is aware of his/her own and other people’s cultural values. Academic nursing education should promote students’ ability to analyze, understand, and respect people’s cultural backgrounds and their values to be able provide equitable care in a multicultural society. This essential competence for nursing students can be obtained through learning and practicing to prioritize people’s greatest needs. The aim of this study was to explore students’ cultural awareness related to their nursing education by considering their socio-demographic background. Methods: This quantitative study was conducted by means of a pre-designed Cultural Awareness Scale. In total, 215 students participated in this study. Descriptive statistics were used to report the distribution of the data, and regression analysis was carried out to assess the statistical significance of the association between the variables. Results: The results indicated moderately high cultural awareness among nursing students related to their general education, cognitive awareness, comfort with interaction, and clinical practice/patient care. Nevertheless, no statistically significant correlation was identified between the socio-demographic factors (sex, age, and experience of living abroad). However, being a first generation immigrant was significantly associated with better cultural awareness in terms of Patient Care/Clinical Issue. Conclusions: In Sweden, universities are free to design their educational programs since there is no universal curriculum that applies to all the universities; nonetheless, the relatively high level of cultural awareness remained the same for the universities under investigation. This finding suggests that the importance of cultural awareness in nursing education is recognized in this context