From Hell to Heaven? Lived experiences of LGBTQ migrants in relation to health and their reflections on the future

This paper explores the lived experiences of LGBTQ migrants participating in a civil society group in Sweden during the migration process and their reflections on the future. Eleven migrants who self-identified as LGBTQ (seven male/gay, one female/lesbian, one female/bi-sexual, and two transgender/gay persons) from three local support groups for LGBTQ migrants agreed to be interviewed. Participants came from Guinea, Iraq, Kurdistan, North Macedonia, Nigeria, Nicaragua, Pakistan, the Russian Federation, Syria, Uganda and Ukraine. Interpretative-phenomenological analysis resulted in three themes: Past: from daily stress to the fear of being killed; Present: safety, belonging and resources to support the transition to a new life; and Future: making a positive difference or being afraid of what's ahead. Participants' health-related journeys and reflections about the future were complex in terms of favourable and unfavourable lived experiences, which become resources and risks for personal development. Study findings offers an enhanced awareness of the complex landscape of, and interaction between, vulnerability and potentiality. Based on the findings, we suggest the adoption of a health promoting approach focusing on the LGBTQ migrants' strengths and personal resources.

"This Group is Like a Home to Me:" understandings of health of LGBTQ refugees in a Swedish health-related integration intervention: a qualitative study

BACKGROUND

When large numbers of asylum seekers immigrate to a country, civil society is encouraged to contribute to their integration. A subgroup of asylum seekers comprising lesbian, gay, bisexual, transgender, or queer (LGBTQ) refugees are specifically deemed vulnerable to developing health and integration problems due to the double stigma of being a sexual/gender minority and a refugee. The Swedish Federation for LGBTQ Rights (RFSL) is a civil societal organization that has established the support group "RFSL Newcomers," a health-related integration intervention that targets such refugees. The aim of the present study is reconstructing the subjective understanding of health of LGBTQ refugees.

METHODS

Eleven participants in Newcomers and eight organizers were interviewed about LGBTQ refugees' experiences of migrating and participating in RFSL Newcomers. Qualitative content analysis was used to reconstruct subjective understandings of health that were constructed in these narratives. As the data did not originally concentrate on exploring understandings of health, a broad theoretical approach was used as a heuristic for the analysis, which focused on the common everyday approach of conceptualizing health as wellbeing.

RESULTS

The narratives revealed three interconnected, interdependent categories of understanding health in which tensions occur between wellbeing and ill-being: belonging versus alienation, security and safety versus insecurity, and recognition versus denial. The categories contribute to an overarching theme of health as framed freedom - i.e., freedom framed by conditions of society.

CONCLUSIONS

For our participants, belonging, recognition, and security/safety are conceptual elements of understanding health, not its social determinants. Thus, these understandings emphasize relational and existential meanings of health (theoretical implication). As for practical implications, the understandings of health were connected to being either inside or outside the Newcomers group and a new society, depending on whether LGBTQ refugees comply with social requirements. As a significant actor that is representative of the cultural majority and a facilitator of LGBTQ refugees' resettlement process, RFSL provides LGBTQ refugees with crucial orientations for becoming a "good migrant" and a "good LGBTQ person," yet a "bad bio-citizen." Generally, organizers of interventions may enhance the effectiveness of their interventions when relational, existential, and biomedical understandings of health are all incorporated.

"It's nice to just be": A qualitative study on the meaning-imbued reality of waterpipe smoking among young adults in Sweden

Background and aims: Waterpipe smoking is regarded as a burgeoning public health problem due to its popularity among young adults. This study aims to understand the meaning-imbued reality of waterpipe smoking for young adults in Sweden. Method: Data from 18 individual interviews with ethnically diverse Swedish young adults were analysed using inductive latent-level qualitative content analysis. Results: The youth's experience of waterpipe smoking shows different dimensions (time, space, fun, community) that construct the practice of waterpipe smoking as a closed bubble characterised by harmlessness, cosiness and freedom to develop an adult self in the waterpipe group. The bubble provides a breathing space and timeout in everyday life, fuelled by an understanding of the hookah as hazard-free and liberating. A variety of control mechanisms are used to defend the bubble's constructed harmlessness, proving responsibility by applying practice-, communication- and Othering-oriented means. Conclusion: The study enhances the understanding of waterpipe smoking by highlighting its community- and self-forming meaning in a combined focus on ritualistic and symbolic qualities. For young adults, waterpipe smoking combines potentially beneficial and detrimental impacts on health. This complex situation requires a dialogical - rather than a traditional - approach to prevention that negotiates the risk landscape faced by young adults.

Health-related integration interventions for migrants by civil society organizations: an integrative review

Purpose: Migrants are a vulnerable group concerning health and integration. Civil society organizations are deemed important for the integration and health of migrants and have been encouraged to help. This study explored health and acculturation, as expressed in research into health-related integration interventions for migrant groups provided by civil society organizations.

Methods: Databases, journal websites and reference lists were searched in an integrative review. Thirteen articles were found and analysed using concepts of health strategies/perspectives and of acculturation with regard to general and health culture.

Results: Studies were divided between two primary spectrums: 1) assimilation-integration and 2) integration-separation spectrum. Spectrum 1 interventions tend to promote assimilation into the present host culture and into a Western view of health. They are mostly driven by representatives of the host culture. Spectrum 2 interventions are characterized by a greater openness concerning the home-culture understandings of health, alongside an appreciation of the home culture in general. They are mostly migrant-driven.

Conclusions: The different acculturating approaches in migrant and native-driven civil society organizations call for an awareness of their guiding health and acculturation assumptions and their applied perspectives and strategies. This awareness is considered crucial in order to achieve desired health and acculturation outcomes.

Right by your side? - the relational scope of health and wellbeing as congruence, complement and coincidence

Purpose: Although the relation between health and well-being is deemed conceptually important, it is diverse and intractable. The aim of this small-scale study is to reveal different possible relations of the concepts of health and well-being, interrelation of these relations and consequences of implied normative expectations in the relations.

Method: Primary data originate from course literature in Swedish health education. Additional data included scientific articles and website content (collected from WHO and via Google) and were analysed with objective hermeneutics.

Results: Congruent, complementary and coincident relations were found. In congruence, health and well-being are synonyms. Complement relations contain: “quality” with well-being as overall aim, “plurality” with health as umbrella term, “well-being as positive health”, “enhancement” with health and well-being potentially boosting each other and “subjectivity/objectivity” with objective health complemented by subjective well-being. In coincidence, health and well-being are counter-intuitively regarded unlinked, which may challenge expectations concerning health promotive activities. Independent and affiliated relations were identified.

Conclusion: In congruence and complement, health and well-being are mostly aligned whereas in coincidence, their quality may be decoupled. In the discursive climate of second modernity, the relation of health and well-being tends to conflict and ambiguous coincidence, demanding ambiguity tolerance as key skill.

The good, the bad and the ugly - a Swedish qualitative interview study about the landscape of meaning-imbued, exercise-related physical pain, as experienced by 'normal' gym-users

BACKGROUND

The gym is a well-known place for health promoting or rehabilitating exercise whose availability to all is regarded significant for people's personal health work and the public's health. In this context, physical pain is usually discussed as something negative that people seek to dispose of. However, certain painful experiences appear to be an appreciated part of the gym experience. To investigate this seemingly contradictory landscape of meaning-imbued physical pain, the study aims to explore the different kinds of physical pain present at the gym and their significance for exercising, as experienced by 'normal' gym-users.

METHODS

24 semi-structured in-depth interviews with active, dedicated, reasonably healthy (= normal) adult gym-users have been analyzed using qualitative content analysis from a hermeneutical stance.

RESULTS

Participants differentiate between three kinds of physical pain: the good pain of enhancement (often connected to muscle soreness and effort burn), the bad pain of impediment (primarily related to acute damage) and the composite, neutral pain of acceptance (potentially linked to all pains).

CONCLUSION

When pursuing the goal of personal health development, normal gym-users argue that exercising at the gym means to expose yourself to pain and to do so willingly, even longingly. Refusing to share this understanding may diminish people's chances to occupy the gym space and, hence, reduce their chances to promote their health.

I am what I am?-An integrative review of understandings of 'health identity' and 'illness identity' in scientific literature

Health and illness identities have been presented as important for the experience of health and illness, and they are a widespread research interest. However, these identities are conceptualised in many different ways. This conceptual diversity calls for us to take stock of existing understandings of health and illness identities to provide conceptual clarity and reliability. The study performs an integrative review of these understandings in scientific articles identified through the databases PsychInfo, Pubmed and Scopus. The final sample consists of 64 articles, on which a thematic analysis has been performed. Health and illness identities are regarded as constructed and can be understood in terms of being, acting and judging, answering the questions 'Who are you, with regard to health/illness?', 'How do you deal with health/illness?' and 'How are people judged by their health/illness?', respectively. The terms health identity and illness identity are understood in varied, not necessarily compatible ways, and need to be applied carefully. Health identity concepts appear to be less well established and based upon a more varied theoretical background, while illness identity concepts appear to be more well established and usually relate to a (bio-)medical context. A potential understanding of health identity for medical sociology is suggested.