Skip to main content
Top
Published in: Journal of Immigrant and Minority Health 1/2013

01-02-2013 | Original Paper

Practitioner and Client Explanations for Disparities in Health Care Use Between Migrant and Non-migrant Groups in Sweden: A Qualitative Study

Authors: Sharareh Akhavan, Saffron Karlsen

Published in: Journal of Immigrant and Minority Health | Issue 1/2013

Login to get access

Abstract

To investigate variations in explanations given for disparities in health care use between migrant and non-migrant groups, by clients and care providers in Sweden. Qualitative evidence collected during in-depth interviews with five ‘migrant’ health service clients and five physicians. The interview data generated three categories which were perceived by respondents to produce ethnic differences in health service use: “Communication issues”, “Cultural differences in approaches to medical consultations” and “Effects of perceptions of inequalities in care quality and discrimination”. Explanations for disparities in health care use in Sweden can be categorized into those reflecting social/structural conditions and the presence/absence of power and those using cultural/behavioural explanations. The negative perceptions of ‘migrant’ clients held by some Swedish physicians place the onus for addressing their poor health with the clients themselves and risks perpetuating their health disadvantage. The power disparity between doctors and ‘migrant’ patients encourages a sense of powerlessness and mistreatment among patients.
Footnotes
1
‘Utlandsfödda’ is a term used both by statutory authorities and researchers in Sweden to refer people who were either born outside Sweden or were born in Sweden but have at least one parent who was born abroad [2]. ‘Infödda’are typically Swedish–born people with two Swedish- born parents. A strict translation of these terms into English may be ‘in-people’ and ‘otherland-people’, or ‘insiders’ and ‘outsiders’.
 
Literature
1.
go back to reference Social Department—The Governmental Office: the fact page. No. 14; 2007. Social Department—The Governmental Office: the fact page. No. 14; 2007.
2.
go back to reference National Board of Health and welfare: Hälso-och sjukvård - lägesrapporter 2007. Health and health care, Current report on year 2007; 2008. National Board of Health and welfare: Hälso-och sjukvård - lägesrapporter 2007. Health and health care, Current report on year 2007; 2008.
3.
go back to reference National Statistics Central Board: Ohälsa och sjukvård 1980–2005, Levnadsförhållandena Rapport nr. 113. Ill-health and health care between 1980 to 2005, Life conditions report no. 113; 2006. National Statistics Central Board: Ohälsa och sjukvård 1980–2005, Levnadsförhållandena Rapport nr. 113. Ill-health and health care between 1980 to 2005, Life conditions report no. 113; 2006.
4.
go back to reference Hedemalm A: Immigrants with heart failure—a descriptive comparative study of symptoms, self care, social support, care and treatment. Doctoral thesis. Gutenberg University: Sahlgrenska Academy; 2007. Hedemalm A: Immigrants with heart failure—a descriptive comparative study of symptoms, self care, social support, care and treatment. Doctoral thesis. Gutenberg University: Sahlgrenska Academy; 2007.
5.
go back to reference Wamala S, Boström G, Akhavan S, Bildt C. Does socioeconomic disadvantage explain why immigrants in Sweden refrain from seeking needed medical treatment? Ital J Public Health. 2007;4(3):227–34. Wamala S, Boström G, Akhavan S, Bildt C. Does socioeconomic disadvantage explain why immigrants in Sweden refrain from seeking needed medical treatment? Ital J Public Health. 2007;4(3):227–34.
6.
go back to reference Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic, disparities in health care. Washington, DC: Committee on Understanding and Eliminating Racial and Ethnic Disparities in health care; 2003. Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic, disparities in health care. Washington, DC: Committee on Understanding and Eliminating Racial and Ethnic Disparities in health care; 2003.
7.
go back to reference Abreu JM. Conscious and nonconscious African American stereotypes: Impact on first impression and diagnostic ratings by therapists. J Consult Clin Psychol. 1999;67(3):387–93.PubMedCrossRef Abreu JM. Conscious and nonconscious African American stereotypes: Impact on first impression and diagnostic ratings by therapists. J Consult Clin Psychol. 1999;67(3):387–93.PubMedCrossRef
8.
go back to reference Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dube R, Taleghani CK, Burke JE, Williams S, Eisenberg J, Escarce JJ, Ayers W. The effect of race and sex on physicians’ recommendations for cardiac catherization. N Engl J Med. 1999;340:618–26.PubMedCrossRef Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dube R, Taleghani CK, Burke JE, Williams S, Eisenberg J, Escarce JJ, Ayers W. The effect of race and sex on physicians’ recommendations for cardiac catherization. N Engl J Med. 1999;340:618–26.PubMedCrossRef
9.
go back to reference Van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813–28.PubMedCrossRef Van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813–28.PubMedCrossRef
10.
go back to reference Social Department: Hälso-och sjukvård inför 90-talet, Invandrarna i hälso-och sjukvården, HS 90 (Statens offentliga utredningar, nr. 45, SOU). Helath and health care in 90-century, Immigrants in health care, HS 90 (The governmental investigations, no 45, SOU); 1984. Social Department: Hälso-och sjukvård inför 90-talet, Invandrarna i hälso-och sjukvården, HS 90 (Statens offentliga utredningar, nr. 45, SOU). Helath and health care in 90-century, Immigrants in health care, HS 90 (The governmental investigations, no 45, SOU); 1984.
11.
go back to reference Sturgis P. Designing samples. In: Gilbert N, editor. Researching social life. 3rd ed. London: Sage Publications Ltd; 2008. p. 165–81. Sturgis P. Designing samples. In: Gilbert N, editor. Researching social life. 3rd ed. London: Sage Publications Ltd; 2008. p. 165–81.
12.
go back to reference Krippendorf K. Content analysis: An introduction to its methodology. Beverly Hills: Sage; 1980. Krippendorf K. Content analysis: An introduction to its methodology. Beverly Hills: Sage; 1980.
13.
go back to reference Patton MQ. Qualitative evaluation and research method. 2nd ed. Newbury Park: Sage; 1990. Patton MQ. Qualitative evaluation and research method. 2nd ed. Newbury Park: Sage; 1990.
14.
go back to reference Holme IM, Solvang BK. Forskningsmetodik—Om kvalitativa och kvantitativa metoder. Research methodology—about qualitative and quantitative methods. Lund: Studentlitteratur; 1991. Holme IM, Solvang BK. Forskningsmetodik—Om kvalitativa och kvantitativa metoder. Research methodology—about qualitative and quantitative methods. Lund: Studentlitteratur; 1991.
15.
go back to reference Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Edu Today. 2004;24(2):105–12.CrossRef Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Edu Today. 2004;24(2):105–12.CrossRef
16.
go back to reference Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity and language among the insured: finding from a national sample. Med Care. 2002;40:52–9.PubMedCrossRef Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity and language among the insured: finding from a national sample. Med Care. 2002;40:52–9.PubMedCrossRef
17.
go back to reference Etchason J, Armour B, Ofili E, Rust G, Mayberry R, Sanders L, Pitts MM. Racial and ethnic disparities in health care. JAMA. 2001;285(7):285–883.CrossRef Etchason J, Armour B, Ofili E, Rust G, Mayberry R, Sanders L, Pitts MM. Racial and ethnic disparities in health care. JAMA. 2001;285(7):285–883.CrossRef
18.
go back to reference Akhavan S: The health and working conditions of female immigrants in Sweden. Doctoral thesis. Stockholm: Karolinska Institute; 2006. Akhavan S: The health and working conditions of female immigrants in Sweden. Doctoral thesis. Stockholm: Karolinska Institute; 2006.
19.
go back to reference Ver Ploeg M, Perrin E. National research council (U.S.), Panel on DHHS collection of race and ethnicity data staff (contributor). Eliminating health disparities: Measurement and data needs. Washington: National Academic Press; 2004. Ver Ploeg M, Perrin E. National research council (U.S.), Panel on DHHS collection of race and ethnicity data staff (contributor). Eliminating health disparities: Measurement and data needs. Washington: National Academic Press; 2004.
20.
go back to reference Nazroo JY. The structuring of ethnic inequalities in health: economic position, racial discrimination and racism. Am J Public Health. 2003;93(2):277–84.PubMedCrossRef Nazroo JY. The structuring of ethnic inequalities in health: economic position, racial discrimination and racism. Am J Public Health. 2003;93(2):277–84.PubMedCrossRef
21.
go back to reference Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006;35:888–901.PubMedCrossRef Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006;35:888–901.PubMedCrossRef
22.
go back to reference Foucault M. “Body/power” and “truth and power”. In: Colin G, editor. Power/knowledge—selected interviews 1972–1977. UK: Harvester; 1980. p. 131. Foucault M. “Body/power” and “truth and power”. In: Colin G, editor. Power/knowledge—selected interviews 1972–1977. UK: Harvester; 1980. p. 131.
23.
go back to reference Ivory JM. Self-colonization, loneliness and racial identity in Ama Ata Aidoo’s our sister Killjoyor reflections form a black-eyed squint. In: Japtok M, editor. Postcolonial perspectives on women writers from Africa, the Caribbean, and the U.S. Trenton: Africa World Press; 2003. p. 249–74. Ivory JM. Self-colonization, loneliness and racial identity in Ama Ata Aidoo’s our sister Killjoyor reflections form a black-eyed squint. In: Japtok M, editor. Postcolonial perspectives on women writers from Africa, the Caribbean, and the U.S. Trenton: Africa World Press; 2003. p. 249–74.
24.
go back to reference Said EW. Orientalism. New York: Pantheon; 1978. Said EW. Orientalism. New York: Pantheon; 1978.
25.
go back to reference McLeod J. Beginning post-colonialism. Manchester: Manchester University Press; 2000. McLeod J. Beginning post-colonialism. Manchester: Manchester University Press; 2000.
26.
go back to reference Misztal B. Trust in modern societies. Cambridge: Polity Press; 1996. Misztal B. Trust in modern societies. Cambridge: Polity Press; 1996.
27.
go back to reference Kai J, Beavan J, Faull Ch, Dodson L, Gill P, Beighton A. Professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study. PLoS Med. 2007;4(11):1766–75.CrossRef Kai J, Beavan J, Faull Ch, Dodson L, Gill P, Beighton A. Professional uncertainty and disempowerment responding to ethnic diversity in health care: a qualitative study. PLoS Med. 2007;4(11):1766–75.CrossRef
28.
go back to reference Regmi K, Naidoo J, Pilkington P. Understanding the processes of translation and transliteration in qualitative research. Int J Qual Methods. 2010;9(1):16–26. Regmi K, Naidoo J, Pilkington P. Understanding the processes of translation and transliteration in qualitative research. Int J Qual Methods. 2010;9(1):16–26.
Metadata
Title
Practitioner and Client Explanations for Disparities in Health Care Use Between Migrant and Non-migrant Groups in Sweden: A Qualitative Study
Authors
Sharareh Akhavan
Saffron Karlsen
Publication date
01-02-2013
Publisher
Springer US
Published in
Journal of Immigrant and Minority Health / Issue 1/2013
Print ISSN: 1557-1912
Electronic ISSN: 1557-1920
DOI
https://doi.org/10.1007/s10903-012-9581-y

Other articles of this Issue 1/2013

Journal of Immigrant and Minority Health 1/2013 Go to the issue