Coverage of migrant and refugee data is incomplete and of insufficient quality in European health information systems. This is not because we lack the knowledge or technology. Rather, it is due to various political factors at local, national and European levels, which hinder the implementation of existing knowledge and guidelines. This reflects the low political priority given to the topic, and also complex governance challenges associated with migration and displacement. We review recent evidence, guidelines, and policies to propose four approaches that will advance science, policy, and practice. First, we call for strategies that ensure that data is collected, analyzed and disseminated systematically. Second, we propose methods to safeguard privacy while combining data from multiple sources. Third, we set out how to enable survey methods that take account of the groups’ diversity. Fourth, we emphasize the need to engage migrants and refugees in decisions about their own health data. Based on these approaches, we propose a change management approach that narrows the gap between knowledge and action to create healthcare policies and practices that are truly inclusive of migrants and refugees. We thereby offer an agenda that will better serve public health needs, including those of migrants and refugees and advance equity in European health systems. No specific funding received.

Quality of life among immigrants in Swedish immigration detention centres: a cross-sectional questionnaire study

There is a knowledge translation gap between policies promoting equitable access to healthcare and person-centred care, and the use of untrained interpreters in cross-cultural consultations leading to disparities in health outcomes. An 11 member inter-sectoral working group met at four workshops to discuss and agree on levers and barriers to the provision of trained interpreters in healthcare settings in Ireland. The process was informed by Participatory Learning and Action (PLA) research to support inter-stakeholder dialogue and learning. Normalisation Process Theory (NPT) was used as a conceptual framework to analyse levers and barriers. The NPT analysis explored sense-making, engagement and enactment and found challenges with sense-making and engagement in senior level service planners, managers and governmental offices. This had negative impacts on other key actors, including healthcare providers, medical students and interpreters. This also meant that the enactment of interpreted consultations in practice settings was replete with barriers, most notably a lack of resources, training and supportive organisational structures. The emergent action plan focused on improving sense-making and engagement through inter-sectoral awareness raising, designed to stimulate a series of complementary levers for implementation. Combining PLA and NPT provided new insights into macro level influences on implementation work at the level of a national healthcare system. The approaches used in this study are applicable in other fields.

‘‘It is a thin line to walk on’’: Challenges of staff working at Swedish immigration detention centres

Purpose: Unaccompanied asylum-seeking children (UASC) from Somalia are one of the largest groups of UASC in Europe and Sweden. The current study is a follow-up of a Swedish study conducted in 1999, where unaccompanied asylum-seeking girls (UASG) from Somalia were interviewed. In 2013, UASG from the 1999 study were interviewed again, as adults who have settled and found a new life in Sweden. The purpose of this paper is to explore how these women experienced their transition into the Swedish society.Design/methodology/approach: A qualitative research design using semi-structured interviews was adopted for this descriptive study. Thematic analysis was used to analyze the data.Findings: UASG need support from different groups of adults, ranging from the staff at the group homes to community members, including countrymen, to establish a good life in their new country. The UASG need understanding and knowledgeable staff that can support them through the initial period, when they do not have their parents close to them. All actors in the supporter network need more knowledge about the difficulties in war situations. Former UASC can assist newcomers as well as being informants to authorities in a new country. Both parties involved need to be open and willing to learn from each other.Research limitations/implications: UASG who consider themselves successful in being integrated into the Swedish society were interviewed and, therefore, the study mainly describes aspects that promote integration.Originality/value: There are limited follow-up studies on how UASG have experienced their life after almost two decades in the new country.

Myocardial infarction (MI) is one of the leading causes of mortality and disability worldwide. Emotional distress, such as anxiety and depression, are common among MI patients. The aim of this study was to investigate emotional reactions following MI and to explore how MI patients self-manage their emotional distress using the perspective of an explanatory behavioural model of depression and anxiety. Written testimonies from 92 MI patients starting an internet-based cognitive behavioural therapy (iCBT) were analysed using qualitative content analysis with a mixed deductive and inductive approach. Six themes were identified. The first three highlight the emotional reactions post-MI: Hypoarousal reactions and low mood; Hyperarousal reactions; and A changed sense of self and outlook on life. The following three themes describe strategies for managing emotional distress: Avoidance of potentially rewarding situations; Avoidance of heart relevant stimuli triggering anxiety; and Engaging in potentially positive activities and acceptance. The MI experience may trigger emotional reactions, with a particular emphasis on heart-focused anxiety, depression and a shift in the perception of one’s identity. Patients tend to manage emotional distress through social withdrawal and experiential avoidance which likely maintains the distress. Applying a behavioural model to the management of emotional distress following MI is suited.