title: Perspectives and experiences of new migrants on health screening in Sweden.
abstract: BACKGROUND
  In Sweden, migrants from countries considered to have a high burden of certain infectious diseases are offered health screening to prevent the spread of these diseases, but also identify their health needs. However, very little is known about their experiences and perceptions about the screening process. This study aimed at exploring these perceptions and experiences in order to inform policy and clinical practice.
  
  
  METHODS
  Using an interpretive description framework, 26 new migrants were interviewed between April and June 2013 in four Swedish counties. Thematic analysis was used to analyze data.
  
  
  RESULTS
  The three themes developed include: new country, new practices; new requirements in the new country; and unmet needs and expectations. Participants described what it meant for them to come to a new country with a foreign language, new ways of communicating with caregivers/authorities and being offered health screening without clarification. Participants perceived health screening as a requirement from the authorities to be fulfilled by all newcomers but conceded that it benefits equally the host society and themselves. However, they also expressed concern over the involvement of the Migration Board staff and feared possible collaboration with health service to their detriment. They further stated that the screening program fell short of their expectations as it mainly focused on identifying infectious diseases and overlooked their actual health needs. Finally, they expressed frustration over delay in screening, poor living conditions in reception centers and the restrictive entitlement to care.
  
  
  CONCLUSIONS
  Migrants are aware of their vulnerability and the need to undergo health screening though they view it as an official requirement. Thus, those who underwent the screening were more concerned about residency rather than the actual benefits of screening. The issues highlighted in this study may limit access to and uptake of the screening service, and compromise its effectiveness. To maximize the uptake: (1) linguistically and culturally adapted information is needed, (2) other screening approaches should be tried, (3) trained medical interpreters should be used, (4) a holistic and human right approach should be applied, (5) the involvement of migration staff should be reconsidered to avoid confusion and worries. Finally, to improve the effectiveness, (6) all migrants from targeted countries should be offered screening and efforts should be taken to improve the health literacy of migrants and the living conditions in reception centers.
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, SE- 901 87, Umeå, Sweden. faustine.nkulu@epiph.umu.se.
authors.forename: Faustine Kyungu
authors.initials: FK
authors.lastname: Nkulu Kalengayi
authors.affiliation: Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, SE- 901 87, Umeå, Sweden.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Hurtig
authors.affiliation: Norrbotten County Council, Public Health Center, SE-971 89, Luleå, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Nordstrand
authors.affiliation: Department of Clinical Microbiology, Division of Infectious Diseases, Umeå University, SE- 901 87, Umeå, Sweden.
authors.forename: Clas
authors.initials: C
authors.lastname: Ahlm
authors.affiliation: Department of Women's and Child Health, Uppsala University, SE- 751 85, Uppsala, Sweden.|Skaraborg Institute of Research and Development, SE-541 30, Skövde, Sweden.
authors.forename: Beth Maina
authors.initials: BM
authors.lastname: Ahlberg
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000208:ethnology / Q000523:psychology; D003299:Cooperative Behavior; D005060:Europe / Q000208:ethnology; D005260:Female; D006291:Health Policy; D006801:Humans; D007802:Language; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D010465:Perception; D011369:Professional-Patient Relations; D013548:Sweden; D014171:Transients and Migrants / Q000523:psychology*