Challenges and strategies in the multicultural sexual and reproductive healthcare encounter - a qualitative study on the perspectives of health professionals.

Abstract

Background: Sexual and reproductive health (SRH) in Sweden is shaped by strong equity and gender-equality ideals, yet migrant patients continue to experience disparities in SRH outcomes. Social, cultural, and structural factors can complicate clinical encounters, potentially posing obstacles to equitable access. This study explored how SRH professionals experience and manage challenges in multicultural clinical encounters.

Methods: Thirty‑one SRH professionals (midwives, nurses, physicians, social workers, sexologists, and nursing assistants) from youth and women's health clinics in Skåne were interviewed using semi‑structured interviews. The material was analysed with inductive thematic analysis to identify recurring patterns of challenges and strategies in encounters with patients of foreign background.

Results: Four interconnected themes were identified: (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. Providers described navigating individual preferences, family relationships, social and religious norms, and structural constraints. They reported using flexible, individualized strategies to support confidentiality, informed decision-making, patient autonomy, and access to care.

Conclusions: SRH professionals described multicultural clinical encounters as shaped by intersecting individual, familial, social, and structural factors. Their accounts suggest that equitable SRH care should not rely on individual clinicians adapting to structural barriers. Institutional support for confidential communication, appropriate interpretation, patient-centred decision-making, protection from coercion, accessible health information, and privacy-sensitive digital systems is needed.