title: Knowledge and utilization of sexual and reproductive healthcare services among Thai immigrant women in Sweden.
abstract: Migration from Thailand to Sweden has increased threefold over the last 10 years. Today Thailand is one of the most common countries of origin among immigrants in Sweden. Since the year 2000, new HIV cases are also more prevalent among Thai immigrants compared to other immigrant nationalities in Sweden. The purpose of this study was to investigate the association between knowledge and utilization of sexual and reproductive healthcare services, contraceptive knowledge and socio-demographic characteristics and social capital among Thai immigrant women in Sweden.
  
  
  
  This is a cross-sectional study using a postal questionnaire to all Thai women (18-64) in two Swedish regions, who immigrated to the country between 2006 and 2011. The questionnaire was answered by 804 women (response rate 62.3 %). Bivariate and multivariate logistic regression analyses were used.
  
  
  
  The majority (52.1 %) of Thai women had poor knowledge of where they should turn when they need sexual and reproductive healthcare services. After controlling for potential confounders, living without a partner (OR = 2.02, CI: 1.16-3.54), having low trust in others (OR = 1.61, CI: 1.10-2.35), having predominantly bonding social capital (OR = 1.50, CI: 1.02-2.23) and belonging to the oldest age group (OR = 2.65, CI: 1.32-5.29) were identified as risk factors for having poor knowledge. The majority (56.7 %) had never been in contact with healthcare services to get advice on contraception, and about 75 % had never been HIV/STI tested in Sweden. Low utilization of healthcare was associated with poor knowledge about healthcare services (OR = 6.07, CI: 3.94-9.34) and living without a partner (OR = 2.53, CI: 1.30-4.90). Most Thai women had knowledge of how to prevent an unwanted pregnancy (91.6 %) and infection with HIV/STI (91.1 %).
  
  
  
  The findings indicate that social capital factors such as high trust in others and predominantly bridging social capital promote access to knowledge about healthcare services. However, only one-fourth of the women had been HIV/STI tested, and due to the HIV prevalence among Thai immigrants in Sweden, policy makers and health professionals need to include Thai immigrants in planning health promotion efforts and healthcare interventions.
authors.affiliation: Division of Social Medicine, Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. eva.akerman@pubcare.uu.se.
authors.forename: Eva
authors.initials: E
authors.lastname: Åkerman
authors.affiliation: Division of Social Medicine and Global Health, Department of Clinical Sciences Malmo, Lund University, Jan Waldenströms gatan 35, Malmö, 205 02, Sweden.
authors.forename: Per-Olof
authors.initials: PO
authors.lastname: Östergren
authors.affiliation: Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Akademiska sjukhuset, Uppsala, 751 85, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Essén
authors.affiliation: Division of Social Medicine and Global Health, Department of Clinical Sciences Malmo, Lund University, Jan Waldenströms gatan 35, Malmö, 205 02, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fernbrant
authors.affiliation: Division of Social Medicine, Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
authors.forename: Ragnar
authors.initials: R
authors.lastname: Westerling
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003267:Contraception; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D012747:Sexual Partners; D066270:Social Capital; D013548:Sweden; D013785:Thailand; D035502:Trust; D055815:Young Adult
keywords: HIV/STI; Healthcare utilization; Immigration; Social capital; Thai women