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  • 1.
    Akhavan, Sharareh
    University of Skövde, School of Life Sciences.
    Fermale immigrant' health and working conditions in Sweden2007In: International Journal of Diversity in Organisations, Communities and Nations, ISSN 1447-9532, E-ISSN 1447-9583, Vol. 7, no 2, p. 275-286Article in journal (Refereed)
    Abstract [en]

    Sweden is one of the European countries that has successively changed from a mainly ethnically homogeneous society into a multi-ethnic society. In 2001, almost 20 per cent of the Swedish population was classified as immigrants, i.e., they were either born abroad and naturalized, of foreign nationality or born in Sweden with at least one parent who had been born abroad. Reports, statistics and research have shown that the health of female immigrants is worse than that of the total population and that the incidence of long-term sickness absence and early retirement is higher in this group. The overall aim of this article is to describe, understand and analyze factors that contribute to poor health among female immigrants in Sweden from the perspective of class, gender and ethnicity. Being unemployed, on sick leave or working in occupation with low income and low status are examples that are related to class position, gender and ethnicity. The main three aspects based on class are wage, professional status and female immigrants position in the hierarchical work organisation. Other factors are discrimination due to ethnicity and gender, unfavourable physical and psychosocial work environment and absence of opportunities for skills upgrade training. Experiences of rape, domestic violence, unanswered emotional and sexual needs and patriarchal culture are examples that are related to gender. And experiencing traumatic events (in pre-migration periods such as experiences of war, prison, etc. and in post-migration periods such as experiences of discrimination and racism) are examples that are related to ethnicity.

  • 2.
    Akhavan, Sharareh
    University of Skövde, School of Life Sciences.
    Invandrade kvinnors hälsa och arbetsvillkor i Sverige2011In: Perspektiv på kvinnors hälsa i arbetslivet / [ed] Sandmark, Hélène, Lund: Studentlitteratur, 2011, 1, p. 135-142Chapter in book (Refereed)
  • 3.
    Akhavan, Sharareh
    University of Skövde, School of Life Sciences.
    Midwives' views on factors that contribute to health care inequalities among immigrants in Sweden: a qualitative study2012In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 11, p. 47-Article in journal (Refereed)
    Abstract [en]

    Introduction: Ethnic and socioeconomic inequalities in the Swedish health care system have increased. Most indicators suggest that immigrants have significantly poorer health than native Swedes. The purpose of this study was to explore the views of midwives on the factors that contribute to health care inequality among immigrants. Methods: Data were collected via semi-structured interviews with ten midwives. These were transcribed and related categories identified through content analysis. Results: The interview data were divided into three main categories and seven subcategories. The category "Communication" was divided into subcategories "The meeting", "Cultural diversity and language barriers" and "Trust and confidence". The category "Potential barriers to the use of health care services" contained two subcategories, "Seeking health care" and "Receiving equal treatment". Finally, the category "Transcultural health care" had subcategories "Education on transcultural health care" and "The concept". Conclusions: This study suggests that midwives believe that health care inequality among immigrants can be the result of miscommunication which may arise due to a shortage of meeting time, language barriers, different systems of cultural beliefs and practices and limited patient-caregiver trust. Midwives emphasized that education level, country of origin and length of stay in Sweden play a role when an immigrant seeks health care. Immigrants face more difficulties when seeking health care and in receiving adequate levels of care. However, different views among the midwives were also observed. Some midwives were sensitive to individual and intra-group differences, while some others viewed immigrants as a group of "others". Midwives' beliefs about subgroup-specific health services vs. integrating immigrants' health care into mainstream health care services should be investigated further. Patients' perspective should also be considered.

  • 4.
    Akhavan, Sharareh
    University of Skövde, School of Life Sciences.
    Utvärdering av projektet "utlandsfödda kvinnor som doulor och kulturtolkar"2009Report (Other (popular science, discussion, etc.))
  • 5.
    Akhavan, Sharareh
    et al.
    University of Skövde, School of Life Sciences.
    Edge, Dawn
    School of Nursing, Midwifery and Social Work , The University of Manchester , Manchester , UK.
    Foreign-Born Women's Experiences of Community-Based Doulas in Sweden - A Qualitative Study2012In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 33, no 9, p. 833-848Article in journal (Refereed)
    Abstract [en]

    In this study our aim was to explore the experiences of doula support among foreign-born women in Sweden in the context of a “Community-Based Doula” (CBD) intervention project. We conducted interviews with ten women and analyzed the data using content analysis. Participating women reported that, in addition to support during labor; doulas provided important information and continuity of care, which apparently increased their satisfaction with and trust in maternity health care. Training of CBDs therefore has implications for delivery of equitable maternity care, which apply not only to Sweden and other European countries but wherever there are increasingly diverse populations.

  • 6.
    Akhavan, Sharareh
    et al.
    University of Skövde, School of Life Sciences.
    Karlsen, Saffron
    University College London.
    Practitioner and Client Explanations for Disparities in Health Care Use Between Migrant and Non-migrant Groups in Sweden: A Qualitative Study2013In: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 15, no 1, p. 188-197Article in journal (Refereed)
    Abstract [en]

    To investigate variations in explanations given for disparities in health care use between migrant and nonmigrant 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.

  • 7.
    Akhavan, Sharareh
    et al.
    University of Skövde, School of Life Sciences.
    Lundgren, Ingela
    Univ Gothenburg, Inst Hlth & Care Sci, S-40530 Gothenburg, Sweden.
    Midwives' experiences of doula support for immigrant women in Sweden: A qualitative study2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 1, p. 80-85Article in journal (Refereed)
    Abstract [en]

    Objective: to describe and analyse midwives’ experiences of doula support for immigrant women in Sweden. Design: qualitative study, analysed using content analysis. Data were collected via interviews. Setting: interviews were conducted at the midwives’ workplaces. One midwife was interviewed at a cafe. Participants: ten midwives, who participated voluntarily and worked in maternity health care in western Sweden. Findings: the interview data generated three main categories. (1) ‘A doula is a facilitator for the midwife’ has two subcategories, ‘In relation to the midwife’ and ‘In comparison with an interpreter’, (2) ‘Confident women giving support, ’has two subcategories, ‘Personal characteristics and attitudes’ and ‘Good support,’ (3) ‘Doulas cover shortcomings’ has two subcategories, ‘In relation to maternity care’ and ‘In relation to ethnicity’. Key conclusion and implications for practice: The findings of this study show that midwives experience that doulas are a facilitator for them. Doulas provide support by enhancing the degree of peace and security and improving communication with the women in childbirth. Doulas provide increased opportunities for transcultural care. They may increase childbearing women’s confidence and satisfaction, help meet the diverse needs of childbearing women and improve care quality.

  • 8.
    Wamala, Sarah
    et al.
    Centre for Public Health, Stockholms Läns Landsting and Karolinska Institutet, Stockholm, Sweden.
    Boström, Gunnel
    Swedish National Institute of Public Health, Stockholm, Sweden.
    Akhavan, Sharareh
    University of Skövde, School of Life Sciences.
    Bildt, Carina
    Gotland University College and Karolinska Institutet, Stockholm, Sweden.
    Does socioeconomic disadvantage explain why immigrants in Sweden refrain from seeking the needed medical treatment?2007In: Italian Journal of Public Health, ISSN 1723-7807, E-ISSN 1723-7815, Vol. 4, no 3, p. 227-233Article in journal (Refereed)
    Abstract [en]

    Background: For the last 20 years, Sweden has changed from a homogeneous to multicultural society with about 20% of immigrants born in other countries. The existing Swedish studies have not shown coherent results on how access to health care services varies by ethnicity. The aim of this paper was to analyze the association between country of birth and refraining from seeking medical treatment and whether socioeconomic disadvantage modifies this association.Methods: Cross-sectional Swedish National Survey of Public Health 2004. A population-based sample comprising of 14,732 men (1,382 immigrants) and 17,115 women (1,717 immigrants) aged 21 to 84 years. Country of birth was categorised as being born in Sweden, other OECD countries or other countries (non-OECD). The main outcome was the self-reporting of refraining from seeking medical treatment during the past three months. Data was collected within a three-month period during the spring of 2004 and was based on a postal self-administered questionnaire linked to registry data from Statistics Sweden. The nonresponse rate was 37%.Main results: In spite of the fact that immigrants reported poorer health status, they were more likely to refrain from seeking medical treatment as compared to Swedish-born residents (odds for immigrants from other OECD countries were ORmen = 2.2, 95% CI 1.8-2.6 and ORwomen = 1.8, 95% CI 1.5-2.1 and forimmigrants from other countries (ORmen = 3.1, 95% CI 2.4-3.4 and ORwomen = 2.3, 95% CI 1.8-2.9). Socioeconomic disadvantage (SDI) did not explain why immigrants fromother OECD countries had increased odds for refraining fromseekingmedical treatment. However SDI explained about 20%of the increased odds for refraining from seeking medical treatment among immigrants from other (non-OECD) countries.Conclusions: Socioeconomic disadvantage does not fully explain why immigrants refrain from seeking medical treatment. Public health strategies towards the goal “care on equal terms” cannot be achieved without addressing wider socioeconomic determinants including interactions between class and ethnicity.

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