title: "It is a challenge to do it the right way": an interpretive description of caregivers' experiences in caring for migrant patients in Northern Sweden.
abstract: BACKGROUND
  Experiences from nations with population diversity show extensive evidence on the need for cultural and linguistic competence in health care. In Sweden, despite the increasing diversity, only few studies have focused on challenges in cross-cultural care. The aim of this study was to explore the perspectives and experiences of caregivers in caring for migrant patients in Northern Sweden in order to understand the challenges they face and generate knowledge that could inform clinical practice.
  
  
  METHODS
  We used an interpretive description approach, combining semi-structured interviews with 10 caregivers purposively selected and participant observation of patient-provider interactions in caring encounters. The interviews were transcribed and analyzed using thematic analysis approach. Field notes were also used to orient data collection and confirm or challenge the analysis.
  
  
  RESULTS
  We found complex and intertwined challenges as indicated in the three themes we present including: the sociocultural diversity, the language barrier and the challenges migrants face in navigating through the Swedish health care system. The caregivers described migrants as a heterogeneous group coming from different geographical areas with varied social, cultural and religious affiliations, migration histories and statuses, all of which influenced the health care encounter, whether providing or receiving. Participants also described language as a major barrier to effective provision and use of health services. Meanwhile, they expressed concern over the use of interpreters in the triad communication and over the difficulties encountered by migrants in navigating through the Swedish health care system.
  
  
  CONCLUSIONS
  The study illuminates complex challenges facing health care providers caring for migrant populations and highlights the need for multifaceted approaches to improve the delivery and receipt of care. The policy implications of these challenges are discussed in relation to the need to (a) adapt care to the individual needs, (b) translate key documents and messages in formats and languages accessible and acceptable to migrants, (c) train interpreters and enhance caregivers' contextual understanding of migrant groups and their needs, (d) and improve migrants' health literacy through strategies such as community based educational outreach.
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, SE- 901 85, Umeå, Sweden. faustine.nkulu@epiph.umu.se
authors.forename: Faustine Kyungu
authors.initials: FK
authors.lastname: Nkulu Kalengayi
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Hurtig
authors.forename: Clas
authors.initials: C
authors.lastname: Ahlm
authors.forename: Beth Maina
authors.initials: BM
authors.lastname: Ahlberg
mesh_terms: D017028:Caregivers / Q000523:psychology*; D003144:Communication Barriers; D003466:Cultural Characteristics; D054521:Cultural Competency; D003695:Delivery of Health Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D036301:Qualitative Research; D013548:Sweden; D014171:Transients and Migrants