Challenges and strategies in the multicultural sexual and reproductive healthcare encounter - a qualitative study on the perspectives of health professionals.
Appelbäck M, Wredle A, et al. • Reproductive health • 2026
SRH professionals described multicultural clinical encounters as shaped by intersecting individual, familial, social, and structural factors, suggesting that equitable SRH care should not rely on individual clinicians adapting to structural barriers but requires institutional support.
Key Findings
Results
Four interconnected themes characterizing challenges in multicultural SRH encounters were identified through inductive thematic analysis of interviews with 31 SRH professionals.
The four themes were: (1) Navigating Structural Barriers in SRH Care; (2) Family Involvement, Power Dynamics and Autonomy; (3) Person-Centred Care Beyond Cultural Competence; and (4) Structural Opportunities and Constraints in Care.
Participants included midwives, nurses, physicians, social workers, sexologists, and nursing assistants.
Participants were recruited from youth and women's health clinics in Skåne, Sweden.
Semi-structured interviews were used for data collection and material was analysed with inductive thematic analysis to identify recurring patterns.
Results
SRH professionals reported navigating structural barriers including challenges related to confidentiality, interpretation, and privacy-sensitive digital systems.
Providers described structural constraints that complicated equitable access to care for patients of foreign background.
Institutional support for confidential communication and appropriate interpretation was identified as a key unmet need.
Privacy-sensitive digital systems were highlighted as a structural concern requiring institutional-level solutions rather than individual clinician adaptation.
These structural barriers were described as intersecting with individual, familial, social, and religious factors.
Results
Family involvement, power dynamics, and threats to patient autonomy were identified as recurring challenges in multicultural SRH encounters.
Providers described navigating family relationships and social and religious norms alongside individual patient preferences.
Protection from coercion was identified as a key area requiring institutional support.
Professionals reported using flexible, individualized strategies to support patient autonomy and informed decision-making.
The theme of family involvement was described as interconnected with the other three identified themes.
Results
SRH professionals reported moving beyond generalized cultural competence toward person-centred, individualized approaches to care.
Providers described using flexible, individualized strategies rather than culturally generalized approaches.
The theme 'Person-Centred Care Beyond Cultural Competence' reflected professionals' accounts of tailoring care to individual patient circumstances.
Strategies reported included supporting confidentiality, informed decision-making, patient autonomy, and access to care.
This approach was framed as necessary given the diversity of individual, familial, and social factors encountered.
Background
Migrant patients in Sweden continue to experience disparities in sexual and reproductive health outcomes despite the country's strong equity and gender-equality ideals.
The study was conducted in the context of Sweden's SRH system, which is shaped by equity and gender-equality ideals.
Social, cultural, and structural factors were identified as potentially posing obstacles to equitable access for migrant patients.
The study focused specifically on patients described as being of 'foreign background.'
The gap between equity ideals and actual SRH outcomes for migrants provided the motivating context for the study.
Conclusions
SRH professionals indicated that equitable care requires institutional support rather than reliance on individual clinicians to adapt to structural barriers.
Providers' accounts suggested that the burden of navigating structural challenges currently falls disproportionately on individual clinicians.
Institutional needs identified included: support for confidential communication, appropriate interpretation, patient-centred decision-making, protection from coercion, accessible health information, and privacy-sensitive digital systems.
The study sample consisted of 31 professionals across multiple disciplines from youth and women's health clinics.
This finding was presented as a key implication derived from the four identified themes.
What This Means
This research explored how healthcare professionals working in sexual and reproductive health (SRH) clinics in Sweden experience and handle challenges when caring for patients from migrant or foreign backgrounds. Researchers interviewed 31 professionals — including midwives, nurses, doctors, social workers, and sexologists — from youth and women's health clinics in the Skåne region. Through analysis of these interviews, four main themes emerged describing the types of challenges encountered and the strategies professionals used to address them.
The study found that professionals regularly navigated a complex mix of factors including language barriers, family involvement in patient care, cultural and religious norms, and systemic issues like inadequate interpretation services and privacy concerns in digital health systems. Rather than applying broad cultural generalizations, professionals reported trying to tailor their approach to each individual patient's specific circumstances — supporting patient autonomy, confidentiality, and informed decision-making on a case-by-case basis. However, professionals described these adaptations as often requiring significant individual effort in the absence of adequate institutional support.
This research suggests that achieving equitable SRH care for migrant populations cannot rely solely on individual healthcare workers finding workarounds to structural problems. Instead, the findings point to a need for healthcare institutions to provide systemic solutions — such as access to professional interpreters, privacy-protective digital tools, clear policies supporting patient confidentiality, and protections against coercion — to reduce disparities in reproductive healthcare access and outcomes for migrant patients in Sweden and similar contexts.
Appelbäck M, Wredle A, Wickramasinghe A, Essén B, Carlbom A. (2026). Challenges and strategies in the multicultural sexual and reproductive healthcare encounter - a qualitative study on the perspectives of health professionals.. Reproductive health. https://doi.org/10.1186/s12978-026-02471-1