Facilitating an encounter with a new sexuality discourse: the role of civic communicators in building sexual health literacy among newly arrived migrants

Abstract

Language and different sexual health discourses constitute barriers to the uptake of information on sexual and reproductive health and rights among migrants. Challenges remain with regards to the design and implementation of culturally appropriate programmes and interventions. This study explored the role of civic communicators in increasing access to sexual health information among migrants resettling in Sweden. Twenty in-depth interviews were conducted and analysed using qualitative content analysis. Findings illustrate the potential role of civic communicators in identifying sexual health needs, deconstructing misinformation and providing a space for reflective dialogue. Training in adult pedagogy, leadership, cultural competence and subject knowledge, and allocating sufficient time to cover themes that are culturally different, sensitive and politicised, are essential for good quality implementation and promoting rights-based sexual health.

Keywords:

• Sexual health literacy
• migrant health
• health communication
• cultural mediation
• Sweden

Introduction

By mid-2020, global forced displacement surpassed 80 million people. About 4.2 million persons were asylum seekers (UNHCR 2020). Almost 20 percent of Sweden’s total population of 10.2 million are foreign born (SCB 2020a). Around one million come from countries outside of Europe (SCB 2020b), in recent years mainly from Syria, Iraq, Iran, Somalia, Afghanistan and Eritrea (Swedish Migration Agency 2020). Migrants and refugees are at risk of poor sexual and reproductive health (SRH) due to lower utilisation of health services and poorer access to preventive activities. Thus, a key public health concern is to address structural and cultural barriers with respect to access to sexual health information, prevention and care by a linguistically and culturally diverse population (Rechel et al. 2013; Keygnaert et al. 2014; Mason-Jones and Nicholson 2018).

Sexual and Reproductive Health and Rights (SRHR) involves physical, emotional, mental and social wellbeing as well as freedom of coercion, discrimination and violence. SRHR includes the right to education and information (Starrs et al. 2018). In Sweden, the SRHR of migrants is supported by health care legislation (SFS 2017:30), non-discrimination legislation (SFS 2008:567), gender equality frameworks (Skr 2016/17:10), national SRHR policies (Public Health Agency of Sweden 2020) and Sweden’s work towards the implementation of the sustainable development goals (SDG) (Prop. 2019/20:188). The WorldValueSurvey fecently indicated that the largest value gaps between migrants and the Swedish population more generally concern sexuality and gender norms (Puranen 2019). Women who migrate from countries with strong patriarchal gender norms may be particularly vulnerable due to limited access to sex education and cultural taboos that shape misconceptions, beliefs and practice. Studies suggest that migration to, and subsequent acculturation within, a country with policies that promote rights-based SRH can provide women with the opportunity to gain knowledge and adjust to new sexuality norms (Ussher et al. 2017; Quelopana and Alcalde 2014; Metusela et al. 2017; Kaneoka and Spence 2020; Svensson, Carlzén, and Agardh 2017; Röder and Mühlau 2014).

Challenges remain however as to how best to design and implement culturally appropriate SRHR-interventions (Kreuter et al. 2003). Cultural mediation by bilingual and culturally competent professionals has been recognised as a tool to bridge socio-cultural norms and facilitate intercultural communication about sensitive issues. Evaluations show successful outcomes such as the increased uptake of interventions, increased service utilisation, and increased understanding and compliance with health advice and instruction (Henderson, Kendall, and See 2011; Botfield, Newman, and Zwi 2017; Marques et al. 2020; Verrept 2019). Olsson et al.’s (2014) study showed that using doulas with skills in cultural and linguistic interpretation, contributed to increased participation in cervical cancer screening in an area with a large number of foreign-born residents. Another Swedish study found that intercultural mediators trained in disseminating SRHR information improved sexual health literacy among refugee women (Svensson, Carlzén, and Agardh 2017). Typically, cultural mediators share the language and cultural background of the target group. However, the literature indicates large variations with regards to role definition, training and professionalisation (Verrept 2019). Research specifically draws attention to the need for pedagogic training and support in dealing with role conflict (Khamphakdy-Brown et al. 2006; Valero-Garcés and Martin 2008; Botfield, Newman, and Zwi 2017).

A richer understanding of the experiences of cultural mediators or persons playing a similar role in SRHR promotion will yield information that can inform and streamline the development of interventions targeting migrants and other capacity building activities. The aim of this study was to explore the role of civic communicators in increasing access to SRHR information among resettling migrants in Sweden and furthermore, examine the competencies and conditions needed for such activities to be effective.

Methods

Study setting

Civic orientation for newly arrived migrants was introduced in Sweden in 2010, with the goal of accelerating their settlement in the country. Since 2013, civic orientation is offered by the state to migrants granted residency due to asylum or family reunification (SFS 2010:197; SFS 2017:584). In addition to civic orientation, the programme includes information about the Swedish health system. Some municipalities include additional information, such as SRHR, including information on Swedish laws and norms related to sexually transmitted infections (STI), female gender mutilation (FGM), interpersonal violence, and the psychosocial aspects of sexual relationships. Elsewhere, SRHR issues are addressed briefly in relation to gender equality and discrimination or upon request (Länsstyrelsen 2020). The approach aims to be culturally sensitive and dialogue-based, and the information is provided by civic communicators (samhällskommunikatörer), preferably in the migrant’s mother tongue. There is no accredited training for civic communicators. They are usually recruited for their language skills, shared migration experience and assumed cultural competence. In 2020, civic orientation activities were scaledup from 60 to 100 hours (Swedish Government 2019), creating windows for capacity development. A model for an integrated civic and health communication has been promoted nationally (2018 − 2020) through a web-based education platform reaching 180 enrolled civic communicators (World Health Organisation (WHO)) 2018).

Sampling and data collection

Study participants were purposively sampled based on the criteria of being employed as a civic communicator, being enrolled in the aforementioned web-based education platform and having experience teaching SRHR (Dahlgren et al. 2019). Eligible study participants (n = 121) were contacted via email retrieved from a list of enrolled communicators, out of which twenty volunteered to participate.

Data were collected through in-depth interviews using a semi-structured interview guide with thematic areas focusing on experiences, challenges, self-perceived role and preparedness regarding the dissemination of SRHR information within the civic orientation programme. Eight interviews were conducted through videocall (https://zoom.us) and seven in person, as preferred by the study participant. A further five interviews took place by telephone. Digital interviews were deemed appropriate since they facilitate participation from a wide geographic area (Janghorban, Roudsari, and Taghipour 2014), reaching individuals who might otherwise not participate (Weller 2017; Krouwel, Jolly, and Greenfield 2019). All the interviews were conducted in Swedish.

Prior to the interviews, the guide was piloted to assess the clarity of the questions. The duration of the recorded interviews ranged between 35 to 70 min, and interviews were transcribed verbatim. Data collection took place between January and March 2019 until saturation was reached (Dahlgren et al. 2019).

Analysis

The procedures for qualitative content analysis (QCA) were followed, by which manifest and latent messages in the interviews were identified and interpreted, and underlying meanings explored. The transcripts were bracketed into meaning units, condensed and assigned codes. Five main content areas were identified: strengths and limitations, strategies, challenges, resources, and potential. Codes were refined and aggregated into categories, and sub-themes, themes and an overall theme were identified. Interviewing, transcribing and initial coding were undertaken by the first author. The analytic process was developed and the themes were elaborated together with the co-authors. Member checking was undertaken by back-checking transcripts and preliminary results with two randomly selected study participants (Dahlgren et al. 2019). Analysis was facilitated by the use of Excel (version 16.38) and Nvivo 12 (version 12.6.0).

Ethical considerations

Prior to interview, all study participants were given written and oral information about the study, their right to withdraw, and the fact that confidentiality would be ensured by replacing any identifiers with a number code. They were invited to ask for any clarification, after which oral informed consent was obtained (Creswell and Poth 2018). The study was approved by the regional Ethical Review Board at Lund University.

Results

Twenty civic communicators operating across Sweden participated in the study. They consisted of twelve men and eight women who ranged in age from 24 to 63 years. The majority of the study participants represented the Arabic language group, followed by Somali, Tigrinya and Dari/Pashto. Length of time working as a communicator ranged from seven months and thirteen years. Four of the study participants had received specific training in teaching SRHR (Table 1).

Table 1. Characteristics of study participants: sex, age, language group, time in Sweden and how long they have worked as civic communicators.

Characteristic	Study participants (n = 20)
Sex	n
Male	12
Female	8
Age	Range = 24-63 years Median= 45 years
24–35	4
36–45	7
46–55	7
56+	2
Language group
Arabic	11
Somali	4
Dari	2
Tigrinya	3
Time in Sweden	Range = 6-28 years Median = 11 years
6 − 10 years	7
11-15 years	5
16-20 years	2
≥ 21 years	6
Work experience	Range = 7 months-13 years Mean = 4.7 years
≤2 years	7
3-5 years	6
6-10 years	7
≥ 11 years	2

The findings are presented through one overarching theme: facilitating an encounter with a new sexuality discourse, which was synthesised from four themes, themselves informed by nine subthemes (Figure 1). Together these illustrate the self-perceived preparedness of civic communicators in terms of knowledge, pedagogic skills, and competence to facilitate intercultural communication about SRHR, as well as to identify/create a safe space for dialogue concerning sensitive topics.

Figure 1. Overall theme, themes and sub-themes illustrating civic communicators’ experiences and self-perceived role with regards to disseminating sexual health information to newly arrived migrants in Sweden.

Deconstructing barriers

The struggle of being new

Communicators emphasised the importance of their role in creating links between institutions and newly arrived migrants. Essential tasks were to break down communication barriers, correct misconceptions, build trust and bridge socio-cultural understandings. They had themselves gone through the process of learning the language, of navigating in a novel system and encountering different norms. Communicators described themselves as members of Swedish society. Being in-between in terms of structural and social integration enabled them to understand the system and norms from both perspectives. When communicating about SRHR within the civic orientation programme, they moved beyond individual risks to stress an understanding of the interrelationships between structural and contextual factors. Communicators’ own migration experience contributed to their ability to relate to the practical and emotional demands associated with resettlement. They emphasised the benefits of having access to accurate information early on in the resettlement process.

‘The important thing is to provide information to people who are new in this country, who needs this information that can help them in different areas of life, such as health, relationships, social life, jobs, everything. We can help them by showing the way’. (IP14, female, age 45)

Managing role conflict

Embedded in the role of the communicator was a strong compassion for the situation of migrants. Often, they became that one person that course participants relied upon. Communicators’ experiences revealed a blurred line between their private and professional roles. The distinction between job obligations and informal tasks, such as translating documents, booking medical appointments, or otherwise consulting on private matters, was often vague. Investing emotionally in the role without setting up boundaries often had consequences in terms of heavy workload and stress.

‘We are not only civic communicators, we are also curators, we do a lot of extra work’. (IP12, male, age 38)

As communicators’ interviewees were spokespersons for Swedish laws and norms, which in regard to SRHR could be perceived as controversial. If they pushed the agenda prematurely, they could be accused of being försvenskade (‘Swedified’) and risked losing the credibility that was built on shared cultural affinity. Communicators often felt that they were being ‘tested’ by course participants, who checked if they were still allied to their culture of heritage by confronting them with questions concerning private opinions or experiences.

‘I think a lot before I talk about it, because I don’t want to lose their trust…like, if I think like this “he is no longer one of us” ’. (IP4, male, age 27)

Building an ethos for reflection and learning

Balancing heterogeneous groups and needs

Building trust in the classroom was essential for conveying sensitive information. Based on communicators’ reports, several key components for trust were identified: representativeness (culture, gender, migrant); language and cultural competence (understanding meaning systems); and contextual understanding (migration experience). Trust was achieved through informal contact, by being attentive, competent and confident. By sharing their own migration history, communicators created a connection based on a common narrative. They believed they were regarded as role models, representing history, struggle and future prospects.

‘You need to build trust so they can open up to you…and trust between each other in the classroom… when you have reached a level of trust where they discuss without interruption and without conflicts, then we can discuss anything… that process takes time’. (IP1, male, age 24)

Within groups, there was variety in terms of socio-demographic characteristics, life situation, migration experiences and SRHR knowledge and needs. Communicators needed to find an appropriate approach to engage with these dissimilarities. They also needed to handle conversations on topics that were taboo and be attentive to expressions of asymmetric power dynamics. Based on their experience, it was impossible to apply a dialogue-based approach when course participants refused to interact, showed disinterest, or attacked others in the discussions. Groups containing persons who were elderly, deeply religious with low levels of education, and who came from rural areas and/or from the same family were considered particularly challenging.

‘There’s always someone leaving the classroom, who doesn’t want to listen, who finds it very unpleasant…it doesn’t matter how much you try to convince them to say something, it’s not possible, something is in the way’. (IP1, male, age 24)

Among the course participants were also persons who had been exposed to sexual violence, forced marriage, abusive relationships or who had been otherwise traumatised. The communicators had to be careful not to re-traumatise or provoke conflict. Most felt that they had a supportive workplace, but that they were not well equipped to encounter course participants with poor mental health. Access to suitable venues and sufficient time for teaching sensitive subjects were other factors highlighted as important for creating a safe classroom atmosphere. Communicators stressed the importance of communicators being aware of the potential reactions that SRHR information might give rise to, and the need for communicators to receive training in how to mitigate these risks.

‘I said that in the classroom, everyone is free to speak…but he said that she belongs to him […] in the end she said, “you don´t own me” and he went quiet…but it is what will happen when they come home that worries me”’. (IP17, male, age 55)

Communicators were aware of how efforts by older or male participants to exert social control hindered the ability to receive and internalise SRHR information, especially among female course participants. Same-sex groups were perceived as less stressful, but usually did not conform with programme policies or were unmanageable due to venue or staff limitations. Generally, couples were divided into different groups in recognition of how the presence of spouses affected women’s participation, learning and empowerment.

‘It’s only he who speaks, she doesn’t dare…. but we want them to speak, therefore we stopped having couples in the same group. This has been decided…. now everyone discusses’. (IP18, male, age 55)

Competence in meeting SRHR needs

Communicators stressed the need for SRHR information by newly arrived migrants to compensate for incomplete sex education, correct misconceptions and to introduce new understandings. They stressed an urgent need to discuss gender norms, relationships, sexual consent, violence and intergenerational conflict together with others in a similar situation moderated by someone like themselves, who understood the situation and culture. Civic orientation was considered a suitable setting for these dialogues.

‘… to correct information, they have received before they arrived, but also after, when they have lived in Sweden and have received incorrect information from neighbours or friends. It is important that they get the right information in the right place’. (IP7, male, age 60)

‘It is better to clash in the classroom first, where there is space for reflection, discussion and explanation’. (IP12, male, age 38)

Civic communicators were unsure how to initiate discussion about SRHR without offending people’s feelings. They highlighted the need for leadership skills and self-confidence to counteract resistance among some course participants. While some communicators had participated in training related to SRHR through the workplace, others had received only superficial training, if any.

‘It is possible to change…but we need the right words and the right education…I have nothing, I only have what I know and have learned through experience’. (IP17, male, age 55)

Based on experience, communicators felt that to prevent harm and ensure information uptake, lectures should be delivered strategically and accurately so as to stimulate reflection among the course participants. Over time they had developed their own techniques or learned from colleagues with more experience, using broad concepts that everyone could engage with such as human rights, legislation or science as a pathway to talking about sexual health. Reasoning based on scientific facts was more acceptable from a religious perspective and helped deconstruct myths.

‘I go around the subject, I want them to think for themselves and reach the conclusion. Finally, I explain what the law says… In this way I am not perceived as a threat’. (IP13, female, age 45)

It was important to demonstrate that the information being conveyed came from credible sources. Communicators expressed concern about the quality of the information disseminated by some less prepared colleagues. They feared that without accurate knowledge, understanding and skills there was a risk that important information would be missed, that incorrect information would be disseminated, and that messages would be misinterpreted.

‘We need training in how to teach…methods, what tools to use…we must be competent to provide this information. If we do not have the right sources, if we are not knowledgeable, we will not be trustworthy’. (IP14, female, age 45)

Reflecting on own acculturation and cultural competence

Being both – an essential part of intercultural communication

Communicators described integration as the ability to identify with both Swedish culture and the culture from their home countries. Based on their own acculturation experience, they promoted the ability to actively choose and benefit from new gender norms related to sexual health and rights.

‘I am from Somalia, I have my culture from there, I came to a new society and learned many good things, I have kept what I need to live here, that’s enough’. (IP5, female, age 43)

Reflecting on their own psychological and socio-cultural adaptation also enabled communicators to relate to course participants’ in a new cultural context. Their accounts showed that ‘being both’ in terms of identity, enabled them to encode cultural meanings. Such encoding was as an important component of the skills needed to facilitate intercultural communication, especially concerning sensitive subjects.

‘You know directly from their body language and codes […] because we know what box we have opened and what the reactions will be… you have to take it stepwise in the right order so that they can absorb it, and you need to have built trust before initiating such discussions’. (IP1, male, age 24)

Negotiating personal SRHR attitudes

Communicators were aware of how their own attitudes towards sexuality affected their preparedness to teach. Similar to course participants, they had been enculturated by a sexuality discourse strongly associated with haram (things that are forbidden). Communicators stated that to convince others about the relevance of new sexuality norms, it was critical that they themselves were convinced. Some had needed to search for information that could justify talking about sexual health explicitly. Discussion of issues related to homosexuality was described as particularly challenging.

‘How can I stand in front of the participants and talk about something that I didn’t believe in? I had to convince myself [first] ’. (IP13, female, age 45)

Communicators with lingering concerns about taboo topics struggled to overcome their own cultural barriers. Some declared to themselves and to course participants that they had to talk about these matters because doing so was part of their work obligations. Others argued that the need for information must come before their own discomfort or moral dilemmas.

‘We grew up not talking about it, it’s forbidden… I still have problems…I know it’s stupid, but it so deep seated… when we discuss sexual consent my face turns completely red…. but I do it because I think it’s important to talk about it’. (IP13, female, age 45)

Communicators believed that in order to change deep seated norms, migrants must be stimulated by experiences and dialogue which enables different perspectives to be shared. One strategy was to use their own experiences of internalising new understandings to demonstrate an awareness that change was a process that took time.

‘I explain that when a person migrates, that person will change from day one without even feeling it […] if you had asked me about this years ago, I would have responded just like you; that a woman cannot say no to her husband… but now I say that she decide over her own body, and I explain why…’. (IP10, male, age 46)

SRHR necessitates dialogue on gender and power

Mediating intergenerational conflict

It was common for course participants to turn to communicators for advice on how to engage with new parenting norms. The majority of study participants were parents themselves and could relate to the worries experienced by migrants. Sex education in school was a particularly sensitive topic, especially when provided to girls. Communicators needed to work hard to dispel misconceptions. They indicated that if individuals were not reached with preventive measures early during resettlement, there was a risk of further alienation and the perpetuation of traditional and perhaps harmful ways. Based on their own experience, they encouraged parents to prepare their children for life in Sweden by helping them adapt to Swedish traditions.

‘… this is a big problem until we explain, then they start to change…I tell them that it is better for a girl or a boy to get knowledge about sex from school instead of looking for it themselves and get the wrong information’. (IP10, male, age 46)

Working with empowerment

While communicators perceived that female course participants were empowered by learning about gender equality, communicators were often accused by male participants of encouraging women to challenge traditional family norms and assert their rights.

‘I have had some problems with the men when I talked about gender equality… but the women were very happy… [and} the next day they told me that their husbands had told them that “your teacher has changed you” because they start thinking and discussing things’. (IP3, female, age 50)

Opposition from male course participants was to be expected and to some extent accepted. Communicators understood that discussing women’s rights and gender norms could be perceived as threatening. However, they expressed disappointment when information about men’s violence, intra-marital rape and gender equality was denied by both female and male course participants.

‘I understand it when the men oppose a woman in hijab teaching about sexual health or gender equality… They are brought up with power… but when women refuse to accept it …[and when] the men say “look, women don´t want rights”, it’s a disaster and it will take me a long time to convince her step by step’. (IP9, female, age 48)

Similar attitudes were reflected in female communicators’ perception that they needed to struggle to receive the same respect as their male colleagues. They believed that it was not considered respectable for a woman to be divorced, to be a working mother, or to teach men. Male communicators on the other hand said that it was not seen as respectable for men to promote gender equality, to engage in housework, or to have adopted a more liberal parental style. However, by sharing the same culture, the communicators believed that they personified how it was possible to change attitudes about gender equality and that for many course participants they were perceived as role models for new gender norms.

‘Some women are really happy! I have heard several times that “we are so lucky that you are our teacher because you defend women”’. (IP10, male, age 46)

Promoting rights-based sexual health

Communicators stressed how women’s rights and gender equality were two of the most important topics addressed in civic orientation. Many were of the opinion that the focus should be on laws and rights rather than the clinical aspects of sexual health, and efforts should be made to encourage male involvement in discussion. They argued that discussion about women’s rights to their own body, choosing whom to marry, deciding when and whether to have children, and sexual consent, must be preceded by dialogue about the power embedded in political structures, culture, gender and human rights. The way communicators expressed themselves revealed differences in their understanding of the complexities of these issues.

‘In my opinion, there should be more about women’s rights, sexual health and gender equality. All three topics are interrelated. I have forwarded a suggestion for a lecture that is only for men too’. (IP17, male, age 55)

Communicators expressed the ambition to stimulate reflection among course participants regarding the influence of culture and tradition on access to information, attitudes and behaviour related to sexual and reproductive health. They hoped to trigger critical discussion about culture and traditions as constructed, learned and reproduced, and possible to re-learn.

‘There is nothing wrong with religion, it is traditions that are wrong… it doesn’t matter if I believe in God or not… but gender equality exists, and I myself must reflect on what is right and wrong’. (IP19, male, age 46)

Ultimately, communicators were of the belief that their work influenced course participants’ attitudes towards SRHR so that by the end of the civic orientation programme, discourse had changed in the classroom and the atmosphere had become less stressed. They were aware, however, that there were limits to what could be achieved and complementary initiatives were needed to reach migrants with lower levels of education and greater cultural distance. By increasing access to SRHR information among newly arrived migrants, communicators hoped they had contributed to change that could benefit future generations.

‘. I will give them information and I hope that their children will benefit from this…that is why we try…there is hope’. (IP16, female, age 41)

Discussion

To our knowledge, this is the first study to explore the self-perceived role of civic communicators in increasing access to SRHR among newly arrived migrants in Sweden. Findings suggest that in the right conditions, civic communicators have a strategic role to play in identifying SRHR needs and making available a space which dialogue concerning the influence of power, culture and gender on access to information, interpersonal relations and sexual agency can take place.

Providing support for migrants’ integration was an important role of the communicators. According to communicators, bridging differing socio-cultural understandings about SRHR and discussing gender equality and women’s and children’s rights were a critical part of this process. Findings indicated an understanding among communicators of the intersection between SRHR and other contextual factors related to migrants’ situation (Rechel et al. 2013; Keygnaert et al. 2014).

Dilemmas related to tensions embedded in the bridging function and in difficulties separating the private person from their professional role occasionally contributed to confusion and to a feeling of having to protect one’s personal integrity. Communicators’ will to help was not always compatible with the time they had to do this. Work-related stress could arise from unclear task assignments, lack of guidance when setting boundaries and dealing with dual cultural roles (Khamphakdy-Brown et al. 2006; Botfield, Newman, and Zwi 2017). To ensure the quality of the delivery there may be value in the increased professionalisation, accreditation and training of cultural mediators (Valero-Garcés and Martin 2008; Verrept 2019).

Communicators sometimes reported being positioned in the middle of clashes between value systems and had to be careful to avoid alienation (Berry 2005; Khamphakdy-Brown et al. 2006). Seeing communicators as too ‘Swedified’ was a way for course participants to reject what was being said. Similar processes of rejection have been documented elsewhere in the literature (Khamphakdy-Brown et al. 2006; Olsson et al. 2014) According to Kumagai and Lypson (2009), learning to be culturally competent is a complex skill that requires deep self-reflection and personal maturity.

Communicators’ identification with the migration experience created a narrative that represented the shared journey. An acknowledgement of collective history enhanced communicator’s credibility and created a sense of affinity with course participants. It also helped communicators approach the subject strategically. To be convincing, supportive and persuasive, cultural and contextual awareness must be integrated with subject knowledge, comprehension and rhetoric (Liu, Volcic, and Gallois 2015).

Findings indicated that power asymmetries in the classroom affected some women’s learning, particularly in groups where family members were together. As was evident in communicators’ accounts and confirmed in other qualitative research (Ussher et al. 2017), sexual health as taboo was embodied in course participants’ perceptions and attitudes. It was reflected in their limited knowledge and manifested through social control and self-policing of the intake of information. Breaking down communication barriers and counteracting resistance placed high demands on communicators’ leadership skills and conflict management skills. Using same-sex groups as a way to reduce these stressors was compromised by other policy frameworks and limited resources (Botfield, Newman, and Zwi 2017).

Overall, study findings illustrate the complexities embedded in cultural mediation. According to theory on intercultural communication, re-coding and communicating cultural meanings requires bilingual and bicultural skills. In this study communicators sometimes struggled to provide culturally appropriate ‘translations’ of SRHR unless they first confronted their own cultural barriers (Liu, Volcic, and Gallois 2015). Having reflected on one’s own psychological and sociocultural acculturation as it related to SRHR enabled this process. Crucially, work needed to go beyond understanding to mobilise change (Kumagai and Lypson 2009). The importance of dialogue about gender and power was recognised, with communicators aiming to stimulate a reconceptualisation of sexuality and rights through dialogue that could benefit future generations. Research has shown how encounters with new conceptualisations of sexuality post-migration motivated migrant women to adjust to rights-based norms (Ussher et al. 2017; Quelopana and Alcalde 2014; Metusela et al. 2017; Svensson, Carlzén, and Agardh 2017). Elsewhere, Röder and Mühlau (2014) have documented how, compared to men, migrant women adopt new gender norms more rapidly, partly explained by the empowering effects of the education provided to women. In this study, communicators experienced more resistance among male course participants, while women were motivated by the benefits that learning about SRHR and women’s rights provided.

Finally, this study suggests that certain structures and competences are needed for this form of educational intervention to be effective and meaningful, including role recognition, training, and supportive working conditions. Competence is needed in terms of SRHR knowledge and understanding of underlying determinants, pedagogy for adult education, intercultural communication and leadership skills. Cultural competence should not be assumed but provided in the form of training that included introspection and reflection on communicators’ own cultural biases (Kumagai and Lypson 2009).

Strengths and limitations

By including study participants from a variety of settings, this study captured differences of experience regarding the implementation of civic orientation. Sample composition reflected a relatively wide range of study participants regarding sex, age, length of time in Sweden and work experience. However, only two study participants came from the Dari language group.

To avoid bias in data collection only communicators who had not yet started their web-based education were recruited. Efforts were made to reduce social desirability bias due to the parallel assessment of communicators’ professional performance by providing clear information about the steps that would be taken to guarantee study participants’ confidentiality throughout the research process.

A further limitation related to variation in study participants’ Swedish language skills. The quality of data may have been affected by some questions not being understood as intended. In addition, the ability to express oneself freely when responding may have been reduced. Although interviews were conducted in person, through videocalls and by telephone, no differences were noted in regards to data quality. The lead researcher’s prior experience working with the target group should be considered a strength.

Conclusion

By equipping civic communicators with the educational resources and time to cover topics that are culturally different, sensitive and often politicised, we can take advantage of the potential embedded in their roles and civic orientation as an arena for promoting rights-based sexuality understandings and practices. Findings from this study have relevance to future SRHR policy development, professional capacity building, and the design of holistic SRHR interventions. Further research is needed, however, to explore the pedagogic aspects of cultural mediation, and their impact in terms of SRHR literacy, gender attitudes and sexual agency among migrant men and women alike.

Acknowledgements

We thank study participants for sharing their time and accounts with us. We also thank the administration of MILSA education platform for facilitating recruitment and data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.