Background Studies of the relationship between diverse populations, healthcare access and health ... more Background Studies of the relationship between diverse populations, healthcare access and health outcomes have been dominated by approaches focusing on ethno-national groups or specific healthcare sectors. Healthcare bricolage conceptualises the processes by which individuals use multiple resources to address health concerns. It is relevant in superdiverse neighbourhoods with complex populations. This paper is original in its application of mixed methods to examine the extent to which, and the reasons why, individuals engage in healthcare bricolage. Methods The study utilized a parallel sequential methodology. Eight superdiverse neighbourhoods were selected, two in each of Bremen, Birmingham, Lisbon and Uppsala. Ethnographic research scoping the nature of each healthcare ecosystem was followed by 160 interviews (20 each neighbourhood) with a maximum variation sample of residents undertaken October 2015 to December 2016. Interviewees were asked to recall a health concern and describe...
IRiS Working Paper Series The Institute for Research into Superdiversity (IRiS) Working Paper Ser... more IRiS Working Paper Series The Institute for Research into Superdiversity (IRiS) Working Paper Series is intended to aid the rapid distribution of work in progress, research findings and special lectures by researchers and associates of the Institute. Papers aim to stimulate discussion among scholars, policymakers and practitioners and will address a range of topics including issues surrounding population dynamics, security, cohesion and integration, identity, global networks, rights and citizenship, diasporic and transnational activities, service delivery, wellbeing, social exclusion and the opportunities which superdiverse societies offer to support economic recovery.
This paper presents an analysis of press coverage of the General Medical Council Professional Con... more This paper presents an analysis of press coverage of the General Medical Council Professional Conduct Committee (PCC) during 1990 and 1991. All tabloid press coverage during this period was compared with PCC minutes to establish what kinds of cases were reported. The analysis reveals that the press gave undue attention to hearings involving sexual misconduct by General Practitioners and that the majority of patients reported as suffering from such misconduct were young women. The paper goes on to document the ideological assumptions underpinning this coverage and considers the consequences for the doctor-patient relationship.
An educational intervention, based on qualitative evidence of racism in healthcare, is described.... more An educational intervention, based on qualitative evidence of racism in healthcare, is described. Using vignettes from a previous project, interviews were conducted to gather qualitative evidence of racism in healthcare settings from a wide range of healthcare staff in Sweden. From this interview material, case studies were devised that were subsequently presented to trainee healthcare professionals, in a seminar discussion. After the seminar, trainees responded to reflective questions. The order of work, as well as the materials used, are described. This intervention was successful in facilitating discussion about racism in an educational context, despite the difficult nature of these conversations for some participants.
Healthcare has long been a gendered enterprise, with women taking responsibility for maintaining ... more Healthcare has long been a gendered enterprise, with women taking responsibility for maintaining health and engaging with service providers. Universal healthcare provision notwithstanding, women nonetheless undertake a range of healthcare work, on their own account and on behalf of others, which remains largely invisible. As part of a multi-method comparative European study that looked at access to healthcare in diverse neighbourhoods from the point of view of people’s own health priorities, the concept of ‘healthcare bricolage’ describes the process of mobilizing resources and overcoming constraints to meet particular health needs. Bricolage mediates between different kinds of resources to meet particular challenges and describing these processes makes visible that work which has been unseen, over-looked and naturalised, as part of a gendered caring role. Drawing on 160 semi-structured interviews and a survey with 1,755 residents of highly diverse neighbourhoods in Germany, UK, Swe...
... Millie Hill (1994) put forward a similar argument in relation to disabled people&... more ... Millie Hill (1994) put forward a similar argument in relation to disabled people's movement and the need for 'black' disabled people to build alliances with the black communities in order to fight racism. ... Finally, minority ethnic groups, disabled people and carers, as distinct ...
Background: There is increasing attention paid to the arrival of migrants from outwith the EU reg... more Background: There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes. Methods: This review scoped 77 papers from nine European countries (Austria,
Background: Studies of factors associated with the use of Internet-based health information gener... more Background: Studies of factors associated with the use of Internet-based health information generally focus on general, rather than migrant populations. This study looked into the reasons why Internet-based health information is used and the effects of migration-related factors, other socio-demographic characteristics and health-related factors on the tendency to consult the Internet. Methods: In a cross-sectional survey conducted in eight superdiverse neighbourhoods-two each in Birmingham, United Kingdom; Bremen, Germany; Lisbon, Portugal and Uppsala, Sweden-participants were presented with six scenarios and asked to indicate the resources they most relied on when addressing a health concern from a given list. The scenarios included establishing the underlying causes of a health concern and seeking information about prescription drugs, treatments and services available as part of the public healthcare system. The list of resources included the public healthcare system, alternative medicine, family and friends, and the Internet. Frequencies for which the Internet was consulted for each different scenario were calculated and compared across the participating cities. The association between consulting Internetbased health information and migration-related factors, and further socio-demographic characteristics as well as healthrelated factors such as self-reported health and health literacy was assessed using multivariable logistic regressions. Results: Of the 2570 participants from all four cities who were included in the analyses, 47% had a migrant background and 35% originated from non-EU countries. About a third reported relying on Internet-based health information for at least one of the given scenarios. The two most frequently chosen scenarios were to find out about other possible treatments and prescription drugs. Generally, using Internet-based health information was negatively associated with being a first generation migrant (OR 0.65; 95% CI 0.46-0.93), having poor local language competency (OR 0.25; 95% CI 0.14-0.45), older age (≥60 years, OR 0.21; 95% CI 0.15-0.31), low education (OR 0.35; 95% CI 0.24-0.50) and positively associated with low trust in physicians (OR 2.13; 95% CI 1.47-3.10).
International Journal of Migration, Health and Social Care
Purpose Research has long focused on the notion of access and the trajectory towards a healthcare... more Purpose Research has long focused on the notion of access and the trajectory towards a healthcare encounter but has neglected what happens to patients after these initial encounters. This paper focuses attention on what happens after an initial healthcare encounter leading to a more nuanced understanding of how patients from a diverse range of backgrounds make sense of medical advice, how they mix this knowledge with other forms of information and how they make decisions about what to do next. Design/methodology/approach Drawing on 160 in-depth interviews across four European countries the paper problematizes the notion of access; expands the definition of “decision partners”; and reframes the medical encounter as a journey, where one encounter leads to and informs the next. Findings This approach reveals the significant unseen, unrecognised and unacknowledged work that patients undertake to solve their health concerns. Originality/value De-centring the professional from the healthc...
Freely available healthcare, universally accessible to the population of citizens, is a key ideal... more Freely available healthcare, universally accessible to the population of citizens, is a key ideal for European welfare systems. As labor migration of the twentieth century gave way to the globalized streams of the twenty-first century, new challenges to fulfilling these ideals have emerged. The principle of freedom of movement, together with large-scale forced migration have led to large scale movements of people, making new demands on European healthcare systems which had previously been largely focused on meeting sedentary local populations' needs. Drawing on interviews with service providers working for NGOs and public healthcare systems and with policy makers across 10 European countries, this paper considers how forced migrants' healthcare needs are addressed by national health systems, with factors hindering access at organizational and individual level in particular focus. The ways in which refugees' and migrants' healthcare access is prevented are considered in terms of claims based on citizenship and on the human right to health and healthcare. Where claims based on citizenship are denied and there is no means of asserting the human right to health, migrants are caught in a new form of inequality.
How people in community settings describe their experience of disappointing health care, and thei... more How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi-structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.
... dhamal (chaos): moral and ethical dilemmas of working in areas of violence, Rubina Jasani; Id... more ... dhamal (chaos): moral and ethical dilemmas of working in areas of violence, Rubina Jasani; Identifying the 'resilience factor': an emerging counter narrative to the traditional discourse of 'vulnerability' in 'social suffering', Astier M. Almedom, Evelyn A. Brensinger and Gordon M ...
Background Despite the removal of the term ’race’ from statutory documents in Sweden, after the S... more Background Despite the removal of the term ’race’ from statutory documents in Sweden, after the Second World War, racism continues to exist in various institutions including healthcare. Racism can persist in the absence of a biological notion of ’race’ but becomes harder to explain when there is no official recognition. There is evidence of discrimination by patients and healthcare professionals, although fragmented and under-researched. As healthcare should be built on equity and solidarity, accounts of racism constitute a serious breach. Our research focuses on conceptualising racism in healthcare in Sweden to develop means of improving equity in care for populations characterised by migration-driven diversity. Methods Data from 28 qualitative interviews with both patients and healthcare professionals in Sweden was collected. Results Preliminary results indicate that patients from minority ethnic groups report that healthcare providers deem their symptoms as insignificant, due to ...
Objective: A community research model developed in the United Kingdom was adopted in a multi-coun... more Objective: A community research model developed in the United Kingdom was adopted in a multi-country study of health in diverse neighbourhoods in European cities, including Sweden. This paper describes the challenges and opportunities of using this model in Sweden. Results: In Sweden, five community researchers were recruited and trained to facilitate access to diverse groups in the two study neighbourhoods, including ethnic, religious, and linguistic minorities. Community researchers recruited participants from the neighbourhoods, and assisted during semi-structured interviews. Their local networks, and knowledge were invaluable for contextualising the study and finding participants. Various factors made it difficult to fully apply the model in Sweden. The study took place when an unprecedented number of asylum-seekers were arriving in Sweden, and potential collaborators' time was taken up in meeting their needs. Employment on shortterm, temporary contracts is difficult since Swedish Universities are public authorities. Strong expectations of stable full-time employment, make flexible part-time work undesirable. The community research model was only partly successful in embedding the research project as a collaboration between community members and the University. While there was interest and some involvement from neighbourhood residents, the research remained University-led with a limited sense of community ownership.
Background: Racism is difficult to discuss in the context of Swedish healthcare for various cultu... more Background: Racism is difficult to discuss in the context of Swedish healthcare for various cultural and administrative reasons. Herein, we interpret the fragmentary nature of the evidence of racialising processes and the difficulty of reporting racist discrimination in terms of structural violence. Methods: In response to the unspeakable nature of racism in Swedish healthcare, we propose a phased participatory process to build a common vocabulary and grammar through a consultative framework involving healthcare providers and service users as well as policy-makers. These stakeholders will be involved in an educational intervention to facilitate discussion around and avoidance of racism in service provision. Discussion: Both the participatory process and outcomes of the process, e.g. educational interventions, will contribute to the social and political conversation about racism in healthcare settings. Creating new ways of discussing sensitive topics allows ameliorative actions to be taken, benefitting healthcare providers and users. The urgency of the project is underlined.
Background Studies of the relationship between diverse populations, healthcare access and health ... more Background Studies of the relationship between diverse populations, healthcare access and health outcomes have been dominated by approaches focusing on ethno-national groups or specific healthcare sectors. Healthcare bricolage conceptualises the processes by which individuals use multiple resources to address health concerns. It is relevant in superdiverse neighbourhoods with complex populations. This paper is original in its application of mixed methods to examine the extent to which, and the reasons why, individuals engage in healthcare bricolage. Methods The study utilized a parallel sequential methodology. Eight superdiverse neighbourhoods were selected, two in each of Bremen, Birmingham, Lisbon and Uppsala. Ethnographic research scoping the nature of each healthcare ecosystem was followed by 160 interviews (20 each neighbourhood) with a maximum variation sample of residents undertaken October 2015 to December 2016. Interviewees were asked to recall a health concern and describe...
IRiS Working Paper Series The Institute for Research into Superdiversity (IRiS) Working Paper Ser... more IRiS Working Paper Series The Institute for Research into Superdiversity (IRiS) Working Paper Series is intended to aid the rapid distribution of work in progress, research findings and special lectures by researchers and associates of the Institute. Papers aim to stimulate discussion among scholars, policymakers and practitioners and will address a range of topics including issues surrounding population dynamics, security, cohesion and integration, identity, global networks, rights and citizenship, diasporic and transnational activities, service delivery, wellbeing, social exclusion and the opportunities which superdiverse societies offer to support economic recovery.
This paper presents an analysis of press coverage of the General Medical Council Professional Con... more This paper presents an analysis of press coverage of the General Medical Council Professional Conduct Committee (PCC) during 1990 and 1991. All tabloid press coverage during this period was compared with PCC minutes to establish what kinds of cases were reported. The analysis reveals that the press gave undue attention to hearings involving sexual misconduct by General Practitioners and that the majority of patients reported as suffering from such misconduct were young women. The paper goes on to document the ideological assumptions underpinning this coverage and considers the consequences for the doctor-patient relationship.
An educational intervention, based on qualitative evidence of racism in healthcare, is described.... more An educational intervention, based on qualitative evidence of racism in healthcare, is described. Using vignettes from a previous project, interviews were conducted to gather qualitative evidence of racism in healthcare settings from a wide range of healthcare staff in Sweden. From this interview material, case studies were devised that were subsequently presented to trainee healthcare professionals, in a seminar discussion. After the seminar, trainees responded to reflective questions. The order of work, as well as the materials used, are described. This intervention was successful in facilitating discussion about racism in an educational context, despite the difficult nature of these conversations for some participants.
Healthcare has long been a gendered enterprise, with women taking responsibility for maintaining ... more Healthcare has long been a gendered enterprise, with women taking responsibility for maintaining health and engaging with service providers. Universal healthcare provision notwithstanding, women nonetheless undertake a range of healthcare work, on their own account and on behalf of others, which remains largely invisible. As part of a multi-method comparative European study that looked at access to healthcare in diverse neighbourhoods from the point of view of people’s own health priorities, the concept of ‘healthcare bricolage’ describes the process of mobilizing resources and overcoming constraints to meet particular health needs. Bricolage mediates between different kinds of resources to meet particular challenges and describing these processes makes visible that work which has been unseen, over-looked and naturalised, as part of a gendered caring role. Drawing on 160 semi-structured interviews and a survey with 1,755 residents of highly diverse neighbourhoods in Germany, UK, Swe...
... Millie Hill (1994) put forward a similar argument in relation to disabled people&... more ... Millie Hill (1994) put forward a similar argument in relation to disabled people's movement and the need for 'black' disabled people to build alliances with the black communities in order to fight racism. ... Finally, minority ethnic groups, disabled people and carers, as distinct ...
Background: There is increasing attention paid to the arrival of migrants from outwith the EU reg... more Background: There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes. Methods: This review scoped 77 papers from nine European countries (Austria,
Background: Studies of factors associated with the use of Internet-based health information gener... more Background: Studies of factors associated with the use of Internet-based health information generally focus on general, rather than migrant populations. This study looked into the reasons why Internet-based health information is used and the effects of migration-related factors, other socio-demographic characteristics and health-related factors on the tendency to consult the Internet. Methods: In a cross-sectional survey conducted in eight superdiverse neighbourhoods-two each in Birmingham, United Kingdom; Bremen, Germany; Lisbon, Portugal and Uppsala, Sweden-participants were presented with six scenarios and asked to indicate the resources they most relied on when addressing a health concern from a given list. The scenarios included establishing the underlying causes of a health concern and seeking information about prescription drugs, treatments and services available as part of the public healthcare system. The list of resources included the public healthcare system, alternative medicine, family and friends, and the Internet. Frequencies for which the Internet was consulted for each different scenario were calculated and compared across the participating cities. The association between consulting Internetbased health information and migration-related factors, and further socio-demographic characteristics as well as healthrelated factors such as self-reported health and health literacy was assessed using multivariable logistic regressions. Results: Of the 2570 participants from all four cities who were included in the analyses, 47% had a migrant background and 35% originated from non-EU countries. About a third reported relying on Internet-based health information for at least one of the given scenarios. The two most frequently chosen scenarios were to find out about other possible treatments and prescription drugs. Generally, using Internet-based health information was negatively associated with being a first generation migrant (OR 0.65; 95% CI 0.46-0.93), having poor local language competency (OR 0.25; 95% CI 0.14-0.45), older age (≥60 years, OR 0.21; 95% CI 0.15-0.31), low education (OR 0.35; 95% CI 0.24-0.50) and positively associated with low trust in physicians (OR 2.13; 95% CI 1.47-3.10).
International Journal of Migration, Health and Social Care
Purpose Research has long focused on the notion of access and the trajectory towards a healthcare... more Purpose Research has long focused on the notion of access and the trajectory towards a healthcare encounter but has neglected what happens to patients after these initial encounters. This paper focuses attention on what happens after an initial healthcare encounter leading to a more nuanced understanding of how patients from a diverse range of backgrounds make sense of medical advice, how they mix this knowledge with other forms of information and how they make decisions about what to do next. Design/methodology/approach Drawing on 160 in-depth interviews across four European countries the paper problematizes the notion of access; expands the definition of “decision partners”; and reframes the medical encounter as a journey, where one encounter leads to and informs the next. Findings This approach reveals the significant unseen, unrecognised and unacknowledged work that patients undertake to solve their health concerns. Originality/value De-centring the professional from the healthc...
Freely available healthcare, universally accessible to the population of citizens, is a key ideal... more Freely available healthcare, universally accessible to the population of citizens, is a key ideal for European welfare systems. As labor migration of the twentieth century gave way to the globalized streams of the twenty-first century, new challenges to fulfilling these ideals have emerged. The principle of freedom of movement, together with large-scale forced migration have led to large scale movements of people, making new demands on European healthcare systems which had previously been largely focused on meeting sedentary local populations' needs. Drawing on interviews with service providers working for NGOs and public healthcare systems and with policy makers across 10 European countries, this paper considers how forced migrants' healthcare needs are addressed by national health systems, with factors hindering access at organizational and individual level in particular focus. The ways in which refugees' and migrants' healthcare access is prevented are considered in terms of claims based on citizenship and on the human right to health and healthcare. Where claims based on citizenship are denied and there is no means of asserting the human right to health, migrants are caught in a new form of inequality.
How people in community settings describe their experience of disappointing health care, and thei... more How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi-structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.
... dhamal (chaos): moral and ethical dilemmas of working in areas of violence, Rubina Jasani; Id... more ... dhamal (chaos): moral and ethical dilemmas of working in areas of violence, Rubina Jasani; Identifying the 'resilience factor': an emerging counter narrative to the traditional discourse of 'vulnerability' in 'social suffering', Astier M. Almedom, Evelyn A. Brensinger and Gordon M ...
Background Despite the removal of the term ’race’ from statutory documents in Sweden, after the S... more Background Despite the removal of the term ’race’ from statutory documents in Sweden, after the Second World War, racism continues to exist in various institutions including healthcare. Racism can persist in the absence of a biological notion of ’race’ but becomes harder to explain when there is no official recognition. There is evidence of discrimination by patients and healthcare professionals, although fragmented and under-researched. As healthcare should be built on equity and solidarity, accounts of racism constitute a serious breach. Our research focuses on conceptualising racism in healthcare in Sweden to develop means of improving equity in care for populations characterised by migration-driven diversity. Methods Data from 28 qualitative interviews with both patients and healthcare professionals in Sweden was collected. Results Preliminary results indicate that patients from minority ethnic groups report that healthcare providers deem their symptoms as insignificant, due to ...
Objective: A community research model developed in the United Kingdom was adopted in a multi-coun... more Objective: A community research model developed in the United Kingdom was adopted in a multi-country study of health in diverse neighbourhoods in European cities, including Sweden. This paper describes the challenges and opportunities of using this model in Sweden. Results: In Sweden, five community researchers were recruited and trained to facilitate access to diverse groups in the two study neighbourhoods, including ethnic, religious, and linguistic minorities. Community researchers recruited participants from the neighbourhoods, and assisted during semi-structured interviews. Their local networks, and knowledge were invaluable for contextualising the study and finding participants. Various factors made it difficult to fully apply the model in Sweden. The study took place when an unprecedented number of asylum-seekers were arriving in Sweden, and potential collaborators' time was taken up in meeting their needs. Employment on shortterm, temporary contracts is difficult since Swedish Universities are public authorities. Strong expectations of stable full-time employment, make flexible part-time work undesirable. The community research model was only partly successful in embedding the research project as a collaboration between community members and the University. While there was interest and some involvement from neighbourhood residents, the research remained University-led with a limited sense of community ownership.
Background: Racism is difficult to discuss in the context of Swedish healthcare for various cultu... more Background: Racism is difficult to discuss in the context of Swedish healthcare for various cultural and administrative reasons. Herein, we interpret the fragmentary nature of the evidence of racialising processes and the difficulty of reporting racist discrimination in terms of structural violence. Methods: In response to the unspeakable nature of racism in Swedish healthcare, we propose a phased participatory process to build a common vocabulary and grammar through a consultative framework involving healthcare providers and service users as well as policy-makers. These stakeholders will be involved in an educational intervention to facilitate discussion around and avoidance of racism in service provision. Discussion: Both the participatory process and outcomes of the process, e.g. educational interventions, will contribute to the social and political conversation about racism in healthcare settings. Creating new ways of discussing sensitive topics allows ameliorative actions to be taken, benefitting healthcare providers and users. The urgency of the project is underlined.
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Papers by Hannah Bradby