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Developing health promotion through community-based participatory research with women having experience of migration
Malmö University, Faculty of Health and Society (HS), Department of Care Science (VV).
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis was conducted within a community-based participatory research (CBPR) program, initiated as a response to preceding health inequity commissions, and aiming to find innovative forms for health promotion. The overall aim of the thesis was to develop health promotion through CBPR, together with women with experience of migration in a socioeconomically disadvantaged neighborhood in Sweden. The CBPR approach guided the process, focusing on reflective dialogues and both qualitative and quantitative data collection methods were used. As a point of departure for the process, an identification of conditions for health and of actions to promote it, was made together with participants. The actions were developed in collaboration into various activities, and the participants pointed out contributors that made them engage in health-promoting activities: lay health promoters, having a place to meet, and social cohesion. The knowledge brought forward about health issues and health promotion within the community was used in the development of a CBPR intervention addressing type 2 diabetes. The intervention was a collaboration between the community and other actors and included reflective dialogues and workshops, conducted as group activities. In the mixed-method evaluation, it was found that stress and waist circumference were reduced, and that social support was crucial throughout the process, in providing motivation to engage in the activities and in promoting health. 

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2025. , p. 117
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383, E-ISSN 2004-9277 ; 2025:8
Keywords [en]
community-based participatory research, health literacy, health promotion, migrant women
Keywords [sv]
Samhällsbaserad deltagande forskning, hälsolitteracitet, hälsofrämjande arbete, utsatta områden
National Category
Public Health, Global Health and Social Medicine
Identifiers
URN: urn:nbn:se:mau:diva-75772DOI: 10.24834/isbn.9789178776368ISBN: 978-91-7877-635-1 (print)ISBN: 978-91-7877-636-8 (electronic)OAI: oai:DiVA.org:mau-75772DiVA, id: diva2:1956917
Public defence
2025-06-05, HS aula AS:E002, Allmänna sjukhuset, Malmö, 13:00 (English)
Opponent
Supervisors
Note

Paper IV in dissertation as manuscript, not included in the full text online.

Available from: 2025-05-09 Created: 2025-05-07 Last updated: 2025-05-28Bibliographically approved
List of papers
1. Health promotion focusing on migrant women through a community based participatory research approach
Open this publication in new window or tab >>Health promotion focusing on migrant women through a community based participatory research approach
2021 (English)In: BMC Women's Health, E-ISSN 1472-6874, Vol. 21, article id 365Article in journal (Refereed) Published
Abstract [en]

Background Migrants are often more vulnerable to health issues compared to host populations, and particularly the women. Therefore, migrant women's health is important in promoting health equity in society. Participation and empowerment are central concepts in health promotion and in community-based participatory research aimed at enhancing health. The aim of this study was to identify conditions for health promotion together with women migrants through a community-based participatory research approach. Methods A community-based participatory research approach was applied in the programme Collaborative Innovations for Health Promotion in a socially disadvantaged area in Malmo, Sweden, where this study was conducted. Residents in the area were invited to participate in the research process on health promotion. Health promoters were recruited to the programme to encourage participation and a group of 21 migrant women participating in the programme were included in this study. A qualitative method was used for the data collection, namely, the story-dialogue method, where a process involving issue, reflections and actions guided the dialogues. The material was partly analysed together with the women, inspired by the second-level synthesis. Results Two main health issues, mental health and long-term pain, were reflected upon during the dialogues, and two main themes were elaborated in the process of analysis: Prioritising spare time to promote mental health and Collaboration to address healthcare dissatisfaction related to long-term pain. The women shared that they wanted to learn more about the healthcare system, and how to complain about it, and they also saw the togetherness as a strategy along the way. A decision was made to start a health circle in the community to continue collaboration on health promotion. Conclusions The community-based participatory research approach and the story dialogues constituted an essential foundation for the empowerment process. The health circle provides a forum for further work on conditions for health promotion, as a tool to support migrant women's health.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Story-dialogue method, Health promoter, Empowerment, Health literacy, Social determinants of health
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:mau:diva-46709 (URN)10.1186/s12905-021-01506-y (DOI)000707701100001 ()34656089 (PubMedID)2-s2.0-85117360112 (Scopus ID)
Available from: 2021-11-08 Created: 2021-11-08 Last updated: 2025-05-07Bibliographically approved
2. Migrant women's engagement in health-promotive activities through a women's health collaboration
Open this publication in new window or tab >>Migrant women's engagement in health-promotive activities through a women's health collaboration
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2023 (English)In: Frontiers in Public Health, E-ISSN 2296-2565, Vol. 11, article id 1106972Article in journal (Refereed) Published
Abstract [en]

Introduction: Social determinants of health impact health, and migrants are exposed to an inequitable distribution of resources that may impact their health negatively, leading to health inequality and social injustice. Migrant women are difficult to engage in health-promotional activities because of language barriers, socioeconomic circumstances, and other social determinants. Based on the framework of Paulo Freire, a community health promotion program was established in a community-academic partnership with a community-based participatory research approach.

Aim: The aim of this study was to describe how a collaborative women's health initiative contributed to migrant women's engagement in health promotion activities.

Materials and methods: This study was part of a larger program, carried out in a disadvantaged city area in Sweden. It had a qualitative design with a participatory approach, following up on actions taken to promote health. Health-promotional activities were developed in collaboration with a women's health group, facilitated by a lay health promoter. The study population was formed by 17 mainly Middle Eastern migrant women. Data was collected using the story-dialog method and the material was analyzed using thematic analysis.

Result: Three important contributors to engagement in health promotion were identified at an early stage of the analysis process, namely, the group forming a social network, the local facilitator from the community, and the use of social places close to home. Later in the analysis process, a connection was made between these contributors and the rationale behind their importance, that is, how they motivated and supported the women and how the dialog was conducted. This therefore became the designated themes and were connected to all contributors, forming three main themes and nine sub-themes.

Conclusion: The key implication was that the women made use of their health knowledge and put it into practice. Thus, a progression from functional health literacy to a level of critical health literacy may be said to have occurred.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
health equality, community-based participatory research, health literacy, health promotion, migrant women, social support, story-dialog method, lay health promoter
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:mau:diva-61929 (URN)10.3389/fpubh.2023.1106972 (DOI)001016086800001 ()37397757 (PubMedID)2-s2.0-85164209706 (Scopus ID)
Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2025-05-07Bibliographically approved
3. The development process of a type 2 diabetes health-promoting CBPR intervention
Open this publication in new window or tab >>The development process of a type 2 diabetes health-promoting CBPR intervention
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2025 (English)In: Frontiers in Public Health, E-ISSN 2296-2565, Vol. 13, article id 1486996Article in journal (Refereed) Published
Abstract [en]

Introduction: Participation is one of the core elements of health promotion, which means that approaches and methods should focus on involvement. The process of involving women with a migration background in health promotion needs to be further explored. Thus, the aim of this study was to explore the development process of a type 2 diabetes health-promotive community-based participatory research intervention among Middle Eastern women with a migration background, living in Sweden. Materials and methods: This study was performed within the context of a community-based participatory research program in Sweden. The design of this study followed the development process of a community-based participatory research conceptual model, including three of the original four dimensions, that is, the context, the partnership process, and the intervention and research dimension. Appropriate methods for data collection were used in the various dimensions. Participants from the community, active in the program, conducted dialogue cafés, together with the core partners of the program, to inventory existing needs as well as what actions were needed for promoting health and thereby prevent type 2 diabetes. Results: The two dialogue cafes resulted in one long term and three short term goals. The third short-term goal—create health circles around food and nutrition was decided to be in focus for this study together with cooperation with the local health care center. The partnership process made it possible to involve relevant collaborators, which resulted in a jointly developed nurse-led educational intervention. Participants and stakeholders were also involved in the process of modifying and elaborating evaluation tools appropriate for the intervention. Discussion/conclusions: The community-based participatory research approach enables the acknowledgement and use of the various kinds of knowledge of all stakeholders, including the community members. In this study, the community members’ knowledge was obtained through participation and dialogue, aimed at balancing power between stakeholders. This approach, that is, developing a community-based participatory research intervention, offers a possibility for the primary health care to engage with the community members and for other stakeholders to work in a health-promotive way.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2025
Keywords
community-based participatory research, health literacy, health promotion, migration, peer support, type 2 diabetes, women
National Category
Nursing
Identifiers
urn:nbn:se:mau:diva-74319 (URN)10.3389/fpubh.2025.1486996 (DOI)001420296400001 ()39957984 (PubMedID)2-s2.0-85217860699 (Scopus ID)
Available from: 2025-02-24 Created: 2025-02-24 Last updated: 2025-05-07Bibliographically approved
4. Evaluation of a CBPR intervention focusing on health promotion and type 2 diabetes, developed together with women in a socioeconomically disadvantaged neighborhood: A mixed method study
Open this publication in new window or tab >>Evaluation of a CBPR intervention focusing on health promotion and type 2 diabetes, developed together with women in a socioeconomically disadvantaged neighborhood: A mixed method study
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(English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Identifiers
urn:nbn:se:mau:diva-75771 (URN)
Available from: 2025-05-07 Created: 2025-05-07 Last updated: 2025-05-07Bibliographically approved

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Lindsjö, Cecilia

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