Psykosocialt stöd motsvarande behoven bland migranter som tvingats fly identifierande som HBTQ+: utmaningar och möjligheter i utbildning, klinisk vård och forskning
Svensk sammanfattning
Det övergripande syftet är att generera kunskap hur vårdutbildning, klinisk vård och forskning kan tillgodose behov av psykosocialt stöd bland immigranter som identifierar sig som HBTQ+. Projektet kommer genom främst kvalitativ metod utforska perspektiv och upplevelser bland studenter och lärare vid sjuksköterskeprogram, vårdpersonal vid Röda Korsets behandlingscenter för krigsskadade och torterade, samt immigranter som tvingats fly till sverige och som identifierar sig som HBTQ+.
Purpose
The overarching aim of the project is to generate knowledge how nursing education, clinical care and future research agenda can meet the psychosocial support needs of forced migrants identifying as LGBTQ+. The project seeks to determine important aspects needed to provide culturally competent care for persons identifying within this population. The included studies will concern the perspectives of nursing students, nursing teachers, health professionals, and forced migrants identifying as LGBTQ+. A significant focus will be placed on how to support persons with experience of trauma linked to war, torture or severe migration, considering the significant impact these experiences may have on their psychological health. Through exploratory studies and co-production with representatives of the population under study, the findings will identify prioritized research questions and future interventions that promote high-quality education and inclusive care.
Specific aims of the included studies are to explore:
Study 1. Cultural competence among nursing students, and further, identify learning activities in nursing programmes that promote preparedness to communicate with and support migrants identifying as LBGTQ+
Study 2. Clinical challenges and essential aspects of care needed to provide culturally competent psychosocial support for forced migrants identifying as LBGTQ+ with trauma linked to war, torture or severe migration
Study 3. Experiences of post-migration psychosocial health, psychosocial support, cultural competence in health care services, and suggestions for relevant psychosocial interventions among forced migrants identifying as LGBTQ+
Study 4. The lived experiences of post-migration psychosocial health and support among migrants identifying as LBGTQ+ with experience of trauma linked to war, torture or severe migration
Study 5. Consensus regarding essential aspects of culturally competent care for forced migrants identifying as LGBTQ+, and further, set a prioritization for future research within this population
Overall study design
The project will utilize qualitative and mixed methods, primarily drawing on the strengths of qualitative approaches as methods to explore the perspectives and lived experiences as expressed by research participants. Data will be collected through semi-structured focus groups, individual interviews and questionnaires. To remain as grounded in the experiences described by the study participants as possible, an inductive approach will be applied when analyzing qualitative data.
Study 1
The study will utilize an exploratory mixed methods design, consisting of two phases. In the first qualitative phase involving focus group discussions, recruitment will be conducted via e-mails/ads distributed to final-year nursing students at Swedish nursing institutions for higher education and nursing teachers. Approximately 20 nursing students and 20 nursing teachers will take part in separate online focus group discussions. One moderator will lead semi-structured discussions, while one researcher will take notes and observe. The discussions will be transcribed verbatim and analyzed with inductive qualitative content analysis.
In the second quantitative phase, final-year nursing students at two Swedish nursing institutions for higher education will be consecutively recruited and answer a questionnaire (n=200 students). The questionnaire will contain the following self-reported variables: (i) age, gender and country of birth; (ii) experience in providing care/support for immigrants and persons identifying as LGBTQ+ in their clinical placements; (iii) cultural competence; and (iv) development of Lesbian, Gay, Bisexual, and Transgender Clinical Skills. The questionnaire will contain Likert-scale questions asking participants to rate their agreement with the categories identified in the focus groups and open-ended questions.
Study 2
This qualitative study will recruit health professionals (e.g. psychologists, psychotherapists, nurses and physiotherapists) working at the six Swedish Red Cross Treatment Centers for Persons Affected by War and Torture. Potential participants will be informed about the study and those expressing an interest in participating will be invited to a semi-structured face-to-face or online focus group discussion. Approximately 35 - 45 health professionals will participate in focus groups. One moderator will lead the semi-structured discussions/interviews, while one researcher will take notes and observe. The discussions/interviews will be audio recorded, transcribed verbatim and analyzed with inductive qualitative content analysis. Co-production and joint analysis will be performed in collaboration with health professionals in the advisory group.
Study 3
This qualitative study will recruit persons identifying as LGBTQ+, with experience of forced migration through convenience and snowball sampling. Approximately 30 semi-structured individual interviews will be conducted, determined through thematic saturation. Data will be transcribed verbatim and analyzed with systematic text condensation. Co-production and joint analysis will be performed in collaboration with immigrants and health professionals in the advisory group.
Study 4
This qualitative study will purposefully recruit forced migrants identifying as LBGTQ+ and who have experience of trauma linked to war, torture, or severe migration. An open-ended interview about the lived post-migration psychosocial experience when identifying as LBGTQ+ and having experience of trauma linked to war, torture, or severe migration will be conducted. Approximately 15 - 20 persons will be interviewed. The interviews will be audio recorded, transcribed verbatim and analyzed with systematic text condensation. Co-production and joint analysis will be performed in collaboration with health professionals in the advisory group.
Study 5
The study will utilize the Delphi technique to determine consensus regarding essential aspects of culturally competent psychosocial support, and prioritize research questions regarding the health and life situation of immigrants identifying as LGBTQ+. The study will be based on two separate Delphi panels, consisting of health professionals and forced migrants identifying as LGBTQ+. Panel 1 will consist of 20 health professionals, while panel 2 will consist of 20 forced migrants identifying as LGBTQ+. Both panels will be purposefully recruited. The first Delphi round will involve semi-structured individual telephone interviews, focusing on essential aspects of culturally competent psychosocial support and relevant future research. The interviews will be transcribed verbatim and analyzed with inductive qualitative content analysis. In consecutive rounds, questionnaires will be distributed in which members will be asked to rate the importance of the identified categories on a Likert scale. In open-ended questions, members will be given the opportunity to add additional comments. The ratings will be analyzed with descriptive statistics and consensus will be considered achieved at 75% agreement.