Page 1 of 57 Department of Public Health and Caring Science Migrants’ opinions about COVID-19 information in Region Uppsala - A quantitative study Author Supervisors Sagal Roble Georgina Warner Josefin Wångdahl Master thesis in Public Health 30 credits 2021 Examinator Karin Nordin Page 2 of 57 SAMMANFATTNING Bakgrund: Migration är en del av hälsansbestämningsfaktorer, att vara migrant kan leda till att individen är mer utsatt för negativa hälsoeffekter. Såsom i andra kriser är migranter även utsatta för både direkta och indirekta effekter av COVID-19. Syfte: Att undersöka migranter i Region Uppsala uppfattningar kring COVID-19 information med hänsyn till omfattning, viktighet och möjlighet att följa. Metod: En kvantitativ studie baserad på en sekundär data från Region Uppsala. Urvalet bestod av n=855 deltagare mellan åldrarna 15 och 70 år. Data samlades in mellan september och oktober 2020. Deskriptivanalys genomfördes för att analysera migranters uppfattningar och icke parametriska analyser användes för att undersöka samband mellan ålder och migranters uppfattningar gällande COVID-19 information. Resultat: Migranterna i studien använde olika källor för att få information om COVID-19. Majoriteten av migranterna rapporterade skola, TV och sociala medier som källor. Migranters uppfattningar kring COVID-19 med hänsyn till omfattning, viktighet och möjlighet att följa, skilde sig åt. De flesta av migranterna hade kännedom för var de kunde hitta information om COVID-19, däremot rapporterade nästan hälften av migranterna att rekommendationerna från myndigheter bör vara mer omfattande. Det förekom skillnader mellan åldersgrupperna gällande att COVID-19 information skulle vara mindre omfattande samt om de har nödvändig information om myndigheternas arbete hittills och läget i världen. Det förekommer skillnader mellan åldersgrupperna gällande vikten av att följa COVID-19 rekommendationer, där yngre gruppen indikerade lägre nivå av viktighet. Det förekom även skillnader mellan åldersgrupperna när det gällde möjligheten till att följa rekommendationen stanna hemma vid symtom och hålla avstånd, där den yngre åldersgruppen indikerade lägre möjlighet att följa rekommendationerna. Slutsats: Migranters uppfattningar kring COVID-19 information i Region Uppsala skilde sig åt. Resultatet visar att interventioner kan vara till fördel för att förbättra migranternas inhämtande av hälsoinformation och literacy, samtidigt finns det behov av en ålder anpassat intervention. Page 3 of 57 ABSTRACT Background: Migration adds particular dimensions to social determinants of health, as being a migrant can make a person more vulnerable to negative health effects. Like in other crises, migrants are vulnerable to both direct and indirect impacts of COVID-19. Aim: To examine migrants’ opinions about COVID-19 information in Region Uppsala, with regard to comprehensiveness, importance and possibility to follow. Method: A descriptive cross-sectional study was conducted based on secondary data obtained from Uppsala County Council. The sample consisted of n=855 participants aged between 15 and 70 years. Data were retrieved between September and October 2020. Descriptive analysis was used to explore migrants’ opinions, and non-parametric analysis was used to investigate the association between age and migrants’ opinions about COVID-19 information. Results: Migrants were using different sources for COVID-19 information, with the majority seeking information via school, TV and social media. The migrants’ opinions about the COVID-19 information with regard to comprehensiveness, importance and possibility to follow differed. Most of the migrants knew where to find information regarding COVID-19; however, nearly half of the migrants reported that the recommendations from the authorities should be more extensive. Age differences were detected when it came to wanting the information to be less extensive, and having the necessary information about the authorities work so far and the situation globally. Differences were found between the age groups when it came to the importance of the COVID-19 recommendations, with the younger group indicating a lower level of importance. There were also age differences when it came to the possibility of following the recommendations of staying at home if you are sick and keeping distance, with the younger group indicating a lower possibility to follow the recommendations. Conclusions: Migrants’ opinions about COVID-19 information in Region Uppsala differed. The results indicate that interventions can be of use, in order to improve migrants’ health information seeking and literacy and an approach tailored by age could be helpful. Page 4 of 57 Acknowledgements First and foremost, all praise is due to Allah (God). I would like to express my gratitude to my supervisors Georgina Warner and Josefin Wångdahl, for their guidance and inspiring discussions. I would like to thank the Region Uppsala for providing me with data. Special thanks to all the administrators and lecturers of the Uppsala University for giving me the opportunity to be part of this master’s program and also gain more comprehensive knowledge of public health sciences. I would like to thank my loved ones, who have supported me throughout the entire process, especially my mother and my father; despite being the Prime Minister of Somalia. They always made sure to support me, will be grateful forever for your love. Page 5 of 57 TABLE OF CONTENTS 1. BACKGROUND...................................................................................................................... 7 1.1 Migration and migrants ................................................................................................... 7 1.1.1 Migrants’ health ............................................................................................................... 7 1.2 Health information and health communication ............................................................. 8 1.2.1 Health and health promotion ........................................................................................... 8 1.2.2 Health information ........................................................................................................... 9 1.2.3 Health communication ..................................................................................................... 9 1.3 COVID-19........................................................................................................................ 11 1.3.1 Health communication and COVID-19 .......................................................................... 12 1.3.2 COVID-19 and vulnerable groups ................................................................................. 13 1.4 Problem explanation....................................................................................................... 14 1.5 Aim ................................................................................................................................... 15 2. METHOD ............................................................................................................................... 16 2.1 Design ............................................................................................................................... 16 2.1.1 Selection of participants ............................................................................................... 16 2.1.1.1 Inclusion criteria ................................................................................................... 16 2.1.1.2 Exclusion criteria .................................................................................................. 17 2.2 Data collection ................................................................................................................. 17 2.3 Ethical considerations .................................................................................................... 17 2.4 Procedure ........................................................................................................................ 18 2.4.1 Questionnaire ............................................................................................................ 18 2.4.2 Independent variables ............................................................................................... 19 2.4.3 Dependent variables .................................................................................................. 19 2.5 Data analysis ................................................................................................................... 20 3. RESULTS ............................................................................................................................... 22 3.1 Descriptive statistics ....................................................................................................... 22 3.1.1 Sample characteristics .............................................................................................. 22 3.1.2 Information sources about COVID-19 ...................................................................... 24 3.2 Migrants’ opinions towards COVID-19information .................................................. 25 3.2.1 Comprehensiveness of information ........................................................................... 25 3.2.2 Importance of recommendations ............................................................................... 26 3.2.3 Possibility to follow recommendations ....................................................................