Abstract
BackgroundRefugees tend to have a higher risk of mental ill-health and use mental health services less than the native-born population during their first 10 years in Sweden. Intercultural interactions between refugees and mental health professionals have been described as challenging. Cross-cultural training is proposed as one way to improve care for refugees. Evaluations of such training outcomes are sparse. The overall aim of this study was to evaluate Comprehensive Cross-Cultural Training for mental health care professionals in Stockholm, and to assess training outcomes for participants’ perceived knowledge regarding mental health and care for newly arrived refugee patients, asylum seekers and undocumented refugees. In addition, we analysed the dimensionality of the pre- and post-training questionnaires used.MethodsAn embedded mixed-method design was applied. We used pre-and post-training questionnaires (n = 248) and conducted six focus group discussions (FGDs) with mental health professionals after training. Quantitative data was analysed by t-tests and factor analysis, qualitative data was analysed using thematic content analysis.ResultsParticipants experienced gained knowledge and new perspectives in all aspects covered in the training. Training led to participants restructuring their existing knowledge. Those who had reported experience of refugee patients and working with interpreters pre-training in the past month, had higher ratings of perceived knowledge. Post-training, there were no significant changes in perceived knowledge between those with, and those without, experience of refugee patients and working with interpreters. Factor analysis resulted in 3 factors for the pre-training questionnaire, explaining 71% of the covariance, and 4 factors for the post-training questionnaire, explaining 78% of the covariance. Findings from the post-training FGDs, revealed that refugee patients were described as challenging. Also, that training promoted empathy towards refugees and strengthened participants’ professional role.ConclusionsThis cross-cultural training contributed to knowledge development and attitude changes. It was valuable regarding care providers’ professional role. Additional outcomes of the training were that participants not only gained knowledge about refugee mental health care but also restructured their existing knowledge.
Highlights
Refugees tend to have a higher risk of mental ill-health and use mental health services less than the native-born population during their first 10 years in Sweden
The precise content of the Comprehensive Cross-cultural Training (CCCT) included lectures covering: regulations and authorities involved in refugee reception; rights and access to care for migrants with different types of civic status; how the migration process and trauma may affect refugee health; culture and psychopathology; working with interpreters and talking about trauma, torture and migration with patients
Other aspects expressed in the focus group discussions (FGD) were: self-reflection, awareness of refugees’ background and current situations, making sense of their suffering, and difficulties refugees go through in navigating the Swedish refugee reception system involving many different authorities
Summary
Refugees tend to have a higher risk of mental ill-health and use mental health services less than the native-born population during their first 10 years in Sweden. The overall aim of this study was to evaluate Comprehensive Cross-Cultural Training for mental health care professionals in Stockholm, and to assess training outcomes for participants’ perceived knowledge regarding mental health and care for newly arrived refugee patients, asylum seekers and undocumented refugees. Barriers to mental health care among migrants are seen both on the individual and structural level [1, 2, 5, 8, 11, 12, 14, 15, 17, 18] Barriers both from the perspective of refugees and asylum seekers, as well as from service providers, may contribute to the lower use of mental health care. Swedish mental health care professionals’ understanding of rights to care for asylum seekers’ and undocumented refugees may be additional barriers [19]
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