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  • 1. Abdillahi, Hamda A
    et al.
    Hassan, Khadra A
    Kiruja, Jonah
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Egal, Jama A
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    A mixed-methods study of maternal near miss and death after emergency cesarean delivery at a referral hospital in Somaliland2017In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 138, no 1, p. 119-124Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent.

    METHODS: A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015).

    RESULTS: Of the 138 maternal near misses and deaths recorded, 50 (36%) were associated with emergency cesarean delivery. The most frequent maternal complication was severe pre-eclampsia (n=17; 34%), and the most frequent underlying causes were hypertensive disorders (n=31; 62%) and obstetric hemorrhage (n=15; 30%). Healthcare providers were often prevented from performing emergency cesarean delivery until the required consent had been received from the woman's extended family.

    CONCLUSION: Maternity care in Somaliland must be improved, and the issue of legal authority for consent examined, to ensure both safe and timely provision of emergency cesarean delivery. This article is protected by copyright. All rights reserved.

  • 2. Dalmar, Abdirisak Ahmed
    et al.
    Hussein, Abdullahi Sheik
    Walhad, Said Ahmed
    Ibrahim, Abdirashid Omer
    Abdi, Abshir Ali
    Ali, Mohamed Khalid
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wall, Stig
    Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348693Article in journal (Refereed)
    Abstract [en]

    This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.

  • 3. Egeh, Abdi-Aziz
    et al.
    Dugsieh, Osman
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    The views of Somali religious leaders on birth spacing: A qualitative study2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 27-31Article in journal (Refereed)
    Abstract [en]

    Background

    Birth spacing is an important health intervention for women to attain good physical and mental health. In Somalia, religious leaders play a decisive role in approving or rejecting the use of family planning.

    Objective

    The study aimed to investigate Somali Islamic religious leaders’ views on birth spacing.

    Method

    Qualitative individual interviews were conducted with 17 Somali Islamic religious leaders aged 28–59 years and analysed through content analysis.

    Results

    The main category that emerged from the analysis was that the concept “birth spacing should be used and nor family planning to be in accordance with the Islamic religion. Two perspectives of views of birth spacing were identified: accepted ways and unaccepted ways. The accepted ways include breastfeeding, use of contraceptives causing no harm to the women’s health, and coitus interruptus. The preferred method should be determined by a joint agreement between the husband and wife, and that Muslim doctors should play a key role while the couples investigate their preferred method. Using contraceptives with the intention to limit the number of children was against Islamic values and practice. In addition, it was believed that using condoms promoted the temptation to engage in sex outside the marriage and was therefore prohibited.

    Conclusion

    According to the religious Islamic leaders, selected practice recommendations for contraceptive use is permitted in relation to birth spacing to promote the health of the mother and child. When providing professional contraceptive counselling to Muslim women, the word “birth spacing” is recommended to be used instead of “family planning”.

  • 4.
    Erlandsson, Kerstin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hatakka, Mathias
    Dalarna University, School of Technology and Business Studies, Information Systems.
    Egal, Jama Ali
    Byrskog, Ulrika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Pedersen, Christina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty2017In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 25, p. 96-103Article in journal (Refereed)
    Abstract [en]

    To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.

  • 5.
    Faysal Badal, Naciima
    et al.
    Department of Nursing, Hargeisa University.
    Alo Yusuf, Ubax
    Department of Nursing, Hargeisa University.
    Egal, Jama
    Department of Nursing, Hargeisa University.
    Pedersen, Christina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Byrskog, Ulrika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    With knowledge and support women can attend antenatal care: the views of women in IDP camps in Somaliland2018In: African Journal of Midwifery and Womens' Health, ISSN 1759-7374, Vol. 12, no 3Article in journal (Refereed)
    Abstract [en]

    In Somaliland, women’s perceptions of barriers to accessing antenatal care is sparsely described, particularly with regard to marginalized women. The aim was to investigate perceptions of barriers to accessing antenatal care from the perspective of pregnant women living in Internal Displaced Persons camps. Individual semi-structured interviews with fifteen women were conducted and analysed using content analysis. The overriding theme was “With knowledge and support, women can attend antenatal care”.  The findings highlighted that to obtain antenatal care, it is crucial for women to have knowledge and trust regarding antenatal services, a supporting environment, and ways to overcome practical barriers, such as patient fees and long waiting hours. If women and families received relevant information about the structure and benefits of ANC, they would probably prioritize ANC, given that the care is tailored to each woman’s needs. For this, community awareness and trust between women, families and ANC providers are central.

  • 6. Kiruja, J.
    et al.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Egal, J. A.
    Essén, B.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Maternal near-miss and death incidences – Frequencies, causes and the referral chain in Somaliland: A pilot study using the WHO near-miss approach2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 12, p. 30-36Article in journal (Refereed)
    Abstract [en]

    Background Somaliland is a self-declared country with a population of 3.5 million. Most of its population reside in rural areas. The objective of this pilot near-miss study was to monitor the frequency and causes of maternal near-miss and deaths and the referral chain for women to access Skilled Birth Attendants (SBA). Method: A facility-based study of all maternal near-miss and mortality cases over 5 months using the WHO near-miss tool in a main referral hospital. Reasons for bypassing the Antenatal Care facility (ANC) and late arrival to the referral hospital were investigated through verbal autopsy. Results: One hundred and thirty-eight (138) women with severe maternal complications were identified: 120 maternal near-miss, 18 maternal deaths. There were more near-miss cases on arrival (74.2%) compared with events that developed inside the hospital (25.8%). Likewise, there were more maternal deaths (77.8%) on arrival than was the case during hospitalization (22.2%). The most common mode of referral among maternal near-miss events was family referrals (66.7%). Of 18 maternal deaths, 15 were family referrals. Reasons for bypassing ANC were as follows: lack of confidence in the service provided; lack of financial resources; and lack of time to visit ANC. Reasons for late arrival to the referral hospital were as follows: lack of knowledge and transportation; and poor communication. Conclusion and clinical implication: To increase the utilization of ANC might indirectly lower the number of near-miss and death events. Collaboration between ANC staff and referral hospital staff and a more comprehensive near-miss project are proposed. © 2017 Elsevier B.V.

  • 7.
    Kiruja, Jonah
    et al.
    College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jama, Ali
    College of Health Science and Medicine, Faculty of Nursing and Midwifery, Hargeisa University, Somaliland.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Malm, Mari-Cristin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Risk factors for stillbirth and beliefs: Findings from a pilot near miss questionnaire study in Somaliland focusing the mother-baby dyad2017In: MOJ Women’s Health, ISSN 2475-5494, Vol. 5, no 3, article id 00123Article in journal (Refereed)
    Abstract [en]

    Background: Somalia is one of 13 countries in Africa with stillbirth rates of more than 30 per 1000 total birth. To our knowledge no study in Somaliland has focused on the mother-baby dyad regarding risk factors for stillbirth. The objective of this study was to identify frequency, causes and beliefs for stillbirth in mothers with life threatening conditions as a pilot for a potential nationwide near-miss study with full coverage in the Somaliland health care system.Method: A prospective cross sectional study using the WHO near-miss questionnaire in a tertiary level hospital with 1.385 deliveries during a five months period in 2015.Results: Out of 138 near miss and death events 22% (n=30) had a stillbirth. Seventy-seven percent (77%) of the mothers (n=23) with stillborn babies survived and 23% died (n=7). They were diagnosed with life threatening conditions, possible to prevent, on arrival at the tertiary hospital. None of them developed the maternal complication/s during the hospital stay. Cesarean sections (43%) were performed within three hours after arrival. Beliefs regarding the stillbirth for the near miss women were that holding the baby born death helps them cope with the loss (74%) and that religious believes helps them cope faster with the loss (91%).Conclusion and clinical implications: The near miss women, their families, TBAs and SBAs might need better information of what causes a stillbirth, how they could prevent it and about the near miss women’s beliefs surrounding stillbirth to enable them to communicate this to pregnant women and prevent delay in admission to the tertiary level hospital. Furthermore, this pilot study suggest that the “Near Miss Questionnaire” could be used in low-and middle income settings to detect a full picture of the situation with stillbirth in a country.

  • 8.
    Klingberg-Allvin, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hatakka, Mathias
    Dalarna University, School of Technology and Business Studies, Information Systems.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Byrskog, Ulrika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Egal, Jama
    "Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, p. 135-142Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to explore midwifery educators’ expected outcomes in the net-based master's programme, the programmes’ realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.

    Design

    In this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.

    Setting and participants

    Data was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.

    Findings

    Findings show that many of the graduates’ expectations were met, while some were more difficult to fulfil. While the midwives’ choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.

    Conclusion

    The flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.

  • 9. Mohamoud Osman, Hodan
    et al.
    Ali Egal, Jama
    Kiruja, Jonah
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Byrskog, Ulrika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Women’s experiences of stillbirth in Somaliland: A phenomenological description2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, no 1, p. 107-111Article in journal (Refereed)
    Abstract [en]

    Background: Low- and middle-income countries in Africa have the highest rates of stillbirths in the world today: as such, the stories of the grief of these women who have had a stillbirth in these settings need to be told and the silence on stillbirth needs to be broken. In an attempt to fill this gap, the aim of this study was to describe the experiences of Muslim Somali mothers who have lost their babies at birth.

    Method: Qualitative interviews with ten Somali women one to six months after they experienced a stillbirth. Data were analyzed using Giorgi's method of phenomenological description.

    Results: In the analysis, four descriptive structures emerged: “a feeling of alienation”; “altered stability in life”; “immediate pain when the sight of the dead baby turns into a precious memory”; and “a wave of despair eases”. Together, these supported the essence: “Balancing feelings of anxiety, fear and worries for one's own health and life by accepting Allah's will and putting one's trust in him”.

    Conclusions: This study makes an important contribution to our knowledge about how stillbirth is experienced by women in Somaliland. This information can be useful when health care providers communicate the experiences of stillbirth to women of Muslim faith who have experienced an intrauterine fatal death (IUFD) resulting in a stillbirth. 

  • 10.
    Omer, Mohammed
    et al.
    Stockholm University.
    Klomsri, Tina
    Stockholm University.
    Tedre, Matti
    Stockholm University.
    Popova, Iskra
    Stockholm University.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Dalarna University, School of Education, Health and Social Studies, Medical Science.
    E-learning opens the door to the global community. Novice users experiences of e-learning in a Somali University2015In: Journal of Online Learning and Teaching, ISSN 1558-9528, E-ISSN 1558-9528, Vol. 11, no 2Article in journal (Refereed)
    Abstract [en]

    E-learning has become one of the primary ways of delivering education around the globe. In Somalia, which is a country torn within and from the global community by a prolonged civil war, University of Hargeisa has in collaboration with Dalarna University in Sweden adopted, for the first time, e-learning. This study explores barriers and facilitators to e-learning usage, experienced by students in Somalia’s higher education, using the University of Hargeisa as case study. Interviews were conducted with students to explore how University of Hargeisa’s novice users perceived elearning, and what factors positively and negatively affected their e-learning experiences. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was used as a framework for interpreting the results. The findings show that, in general, the students have a very positive attitude towards e-learning, and they perceived that e-learning enhanced their educational experience. The communication aspect was found to be especially important for Somali students, as it facilitated a feeling of belonging to the global community of students and scholars and alleviated the war-torn country’s isolation. However, some socio-cultural aspects of students’ communities negatively affected their e-learning experience. This study ends with recommendations based on the empirical findings to promote the use and enhance the experience of e-learning in post conflict Somali educational institutions

  • 11.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Ladnaan : evaluation of a culturally tailored parenting support program to Somali-born parents2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Research shows that immigrant families encounter different complexities and challenges in a new host country, such as acculturation, isolation and lack of social support. These challenges have been shown to have negative impacts on immigrant families’ mental and emotional health, family function, parenting practices and parents’ sense of competence. Parental support programmes have been shown to positively affect parental skills, strengthen the parent-child relationship, and promote the mental health of parents and children. However, universal parenting support programmes face challenges in reaching and retaining immigrant parents. In addition, there is limited knowledge on the effectiveness of parenting support programmes among immigrant Somali-born parents and their children.

    Aim: The overall aim of this thesis was to develop and evaluate the effectiveness of a culturally tailored parenting support programme (Ladnaan intervention) on the mental health of Somali-born parents and their children. A further aim was to explore the parents’ experience of such a support programme on their parenting practises.

    Methods: The thesis involved two explorative qualitative studies and one randomised controlled trial (RCT). Study I employed qualitative focus group discussions (FGDs) to explore Somali-born parents’ need for parenting support. Study II involved an RCT study in which 120 parents with children aged 11–16 years, and parents with self-perceived stress relating to their parenting were randomised to an intervention group or a wait-list control group. The Ladnaan intervention consisted of three components: societal information (two sessions), the Connect parenting programme (10 sessions), and a cultural sensitivity component. The Ladnaan intervention was delivered in the participants’ native language by group leaders of similar background and experience, and modifying the examples and role plays in the Connect programme. The primary outcome was a reduction in children’s emotional and behavioural problems as measured by the Child Behaviour Checklist 8-16. The secondary outcomes were improved mental health among parents, as assessed by the General Health Questionnaire (GHQ12); and greater sense ofparenting competence, as measured by the Parent Sense of Competence (PSOC) scale. Study III comprises a qualitative study using individual semi-structured interviews (conducted two months after the Ladnaan intervention) to explore parents’ experiences of participating in a culturally tailored parenting support programme.

    Results: The results in study I, shows that Somali-born parents encountered challenges in the host country, which impacted their confidence in parenting and the parent-child relationship. These challenges included insufficient knowledge of the parenting system and social obligations as a parent in the new host country. Other parental challenges in the host country included a stressful society, isolation, role changes, and parent-child power conflict. The Somali parents experienced opportunities to rethink and modify their parenting and strengthen their relationship with their children in the new country, but needed support from the local authority and others in these endeavours. In study II, the Ladnaan intervention showed that, according to the parents’ self-reports, children in the intervention group showed significantly decreased aggressive behaviour, social problems, attention problems, externalising ofbehavioural problems, and in total problems at the two-month follow-up. Moreover, parents in the intervention group showed significantly and clinically improved mental health and sense of competence in parenting at the two-month follow-up. The improved mental health of the parents could, in part, be explained by their satisfaction in parenting. In study III, parents who participated in the culturally tailored intervention programme reported that it enhanced their confidence in parenting and contributed to their ability to become emotionally aware and available for their children. The parents attributed this to the combination of societal information, the Connect programme, and the cultural sensitivity ofthe Ladnaan intervention, which were most supportive for their parenting. The culturally sensitive approach ofthe parenting programme (i.e., conducted in their native language by bicultural and bilingual group leaders) was viewed by the parents as valuable for their participation in the programme, as well as for modifying their parenting practices.

    Conclusion: The culturally tailored parenting support programme helped parents overcome transition challenges related to social obligation as parents in the host country, and to modify their parenting orientation and styles in the new country. Furthermore, it improved the parents’ mental health and sense of competence in parenting, as well as reduced their children’s behavioural problems. When tailoring and delivering a parenting support programme to immigrant parents it is crucial to consider their specific needs and preferences and to ensure that the programme is culturally sensitive. Such an approach is more likely to contribute to participants’ engagement, retention, and acceptance of the parenting programme; and also improve their parenting practices and strengthen parent-child relationship, leading to improvements in children’s behaviour and parents’ mental health.

  • 12.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Parenthood in transition – challenges and opportunities encountered in the host country2016Conference paper (Refereed)
  • 13.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Parenthood in transition – Somali-born parents’ experiences of and needs for parenting support programmes2015Conference paper (Refereed)
  • 14.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Somali-born parents’ experiences and needs for parenting support programmes2015Conference paper (Refereed)
    Abstract [en]

    Introduction: The struggle of being a parent is universal. However, the  struggle is even greater when parents have experienced  forced migration and  lack of community and social support in the host country. Parenting behaviour in a host country is affected by the social environment and how the host country receives the immigrant parents. The research that explores Somali-born parents’ experiences and their need for parenting support in a new context is limited. Our aim is to explore Somali-born parents’ experiences of parenting and needs in relation to parenthood in Sweden.

    Method: Data were collected using focus group discussions (FGDs). The sample consisted of 23 mothers and fathers living in a county in central Sweden. Data were analysed using qualitative content analysis.

    Results: The results illustrated that many newly emigrated Somalis living in Sweden experienced parenthood in transition based on the complex process parents experience when they leave their home country and settle in a new country. It was a process that includes challenges and opportunities. The challenges concerned leaving the home country and family behind and losing membership in their social network. New challenges arose on arriving and alienated in the new country, exacerbated by lack of knowledge about the country’s systems related to parenthood. In response to these challenges, role change and power conflicts sometimes arose between family members. Despite these challenges, participants experienced opportunities in the new country. With regard to parenting, the new country presented them with new ways to improve their parenting. Somali-born parents strove to renegotiate their parenting style.

    Conclusion: Immigrant and refugee parents have a need for support from the Social and Health Care Services and it appears that the existing support is not reaching these families. Thus this study shows that there is a need for culturally sensitive support. 

  • 15.
    Osman, Fatumo
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Schön, Ulla-Karin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Ladnaan - att må bra: En utvärdering av ett riktat stöd till somaliska föräldrar i Borlänge Kommun2015Report (Other academic)
    Abstract [sv]

    Folkhälsomyndigheten har finansierat ett samarbetsprojekt mellan Borlänge kommun och Högskolan Dalarna för att anpassa och implementera ett föräldrastödsprogram till somaliska föräldrar, samt att mäta effekten av denna intervention avseende föräldrars och barns psykiska hälsa. Studien började med en explorativ delstudie med syfte att samla kunskap om vad somaliska föräldrar upplever som utmanande i sitt föräldraskap i Sverige, vilket behov av föräldrastöd de behöver samt hur ett sådant stöd ska vara utformat. Studien genomfördes med hjälp av fokusgruppsintervjuer med 23 föräldrar (15 mammor och 8 pappor) boende i Borlänge. Resultatet visade att föräldrarna upplevde en rad utmaningar i sin nya livssituation och i sitt föräldraskap i nya landet. De beskrev skillnader i synsätt på barnuppfostran och föräldraskap mellan hemlandet och Sverige och eftersträvade därför att kulturanpassa sitt föräldraskap.

    Resultaten från denna studie samt en genomgång av forskning kring föräldrastöd låg till grund för valet av föräldrastödsprogram samt ett samhällsorienterande tillägg till programmet.

     

    Målgrupp för studien var föräldrar med barn i åldrarna 11-16 år och som upplevde stress i sitt föräldraskap. Föräldrarna erbjöds sammanlagt 16 timmars utbildning fördelat på 12 träffar (10 timmar Connect föräldrastöd + 6 timmar samhällsorienterande tillägg). Effekten av föräldrastödet undersöktes genom en randomiserad kontrollerad studie där totalt 120 föräldrar ingick. De preliminära resultaten visar att deltagande föräldrars barn har förbättrats signifikant i subskalorna ”socialt” och ”skola”. Dessutom minskade barnens oro, somatiska problem, sociala problem och brytande av regler.

     

    Föräldrarna var nöjda med interventionen. De upplevde att de fått en ökad kunskap om hur socialtjänstens arbete fungerar och fått förtroende för deras arbete kring barn och unga. Över hälften av föräldrarna upplevde sig mer säkra i sin föräldraroll och att deras relation med barnen hade förbättrats.

     

    Genom en processutvärdering av implementeringen av föräldrastödet har framgångsfaktorer för genomförandet avföräldrastödsprogrammet studerats. Resultatet visade att de olika strategier som vidtagits vid rekrytering av föräldrar och implementering av interventionen har varit lyckade. Exempel på sådana strategier har varit att projektmedarbetarna som rekryterat till föräldrastödet har varit av Somaliskt ursprung, kursen har getts på somaliska men framförallt att föräldrastödet utgick ifrån föräldrarnas upplevda behov.

  • 16.
    Osman, Fatumo
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Schön, Ulla-Karin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    A support program for Somali-born parents on children's behavioral problems2017In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 3Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objectives of this study were to evaluate a culturally tailored parenting support program (Ladnaan) for Somali-born parents and to determine its effectiveness on children’s emotional and behavioral problems.

    METHODS: This randomized controlled trial included 120 Somali-born parents with children aged 11 to 16 years. The parents reported self-perceived stress in relation to parenting practices. The intervention consisted of culturally tailored societal information combined with the parenting program Connect. Parents received 12 weeks of intervention, 1 to 2 hours each week, in groups of 12 to 17 parents. Nine group leaders with a Somali background who received a standardized training program delivered the intervention. The primary outcome was a decrease in emotional and behavioral problems based on a Child Behavior Checklist. Parents were randomly allocated either to an intervention group or a wait-list control group. Covariance analyses were conducted according to intention-to-treat principles.

    RESULTS: The results showed significant improvement in the children in the intervention group for behavioral problems after a 2-month follow-up. The largest effect sizes according to Cohen’s d were in aggressive behavior (95% confidence interval [CI], 1.06 to 3.07), social problems (95% CI, 0.64 to 1.70), and externalizing problems (95% CI, 0.96 to 3.53).

    CONCLUSIONS: The large effect sizes in this study show that this 12-week culturally tailored parenting support program was associated with short-term improvements in children’s behavior. The study adds to the field of parenting interventions by demonstrating how to culturally tailor, engage, and retain parenting programs for immigrant parents.

  • 17.
    Osman, Fatumo
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Schön, Ulla-Karin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Effectiveness of parenting support to Somali parents on children’s mental health: A randomized controlled trial2016Conference paper (Refereed)
  • 18.
    Osman, Fatumo
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Schön, Ulla-Karin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    The impact of a culturally tailored parenting support for Somali-born parents’ and children’s mental health: A randomized controlled trial2017Conference paper (Refereed)
  • 19.
    Osman, Fatumo
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Schön, Ulla-Karin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Parenthood in transition: Somali-born parents' experiences of and needs for parenting support programmes2016In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 16, no 1, article id 82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pre- and post-migration trauma due to forced migration may impact negatively on parents' ability to care for their children. Little qualitative work has examined Somali-born refugees' experiences. The aim of this study is to explore Somali-born refugees' experiences and challenges of being parents in Sweden, and the support they need in their parenting.

    METHODS: A qualitative descriptive study was undertaken. Data were collected from four focus group discussions (FGDs) among 23 Somali-born mothers and fathers living in a county in central Sweden. Qualitative content analysis has been applied.

    RESULTS: A main category, Parenthood in Transition, emerged as a description of a process of parenthood in transition. Two generic categories were identified: Challenges, and Improved parenting. Challenges emerged from leaving the home country and being new and feeling alienated in the new country. In Improved parenting, an awareness of opportunities in the new country and ways to improve their parenting was described, which includes how to improve their communication and relationship with their children. The parents described a need for information on how to culturally adapt their parenting and obtain support from the authorities.

    CONCLUSIONS: Parents experienced a process of parenthood in transition. They were looking to the future and for ways to improve their parenting. Schools and social services can overcome barriers that prevent lack of knowledge about the new country's systems related to parenthood. Leaving the home country often means separation from the family and losing the social network. We suggest that staff in schools and social services offer parent training classes for these parents throughout their children's childhood, with benefits for the child and family.

  • 20.
    Osman, Fatumo
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Salari, Raziye
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Schön, Ulla-Karin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e017600Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents' mental health and sense of competence in parenting.

    DESIGN: Randomised controlled trial.

    SETTING: A city in the middle of Sweden.

    PARTICIPANTS: Somali-born parents (n=120) with children aged 11-16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60).

    INTERVENTION: Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1-2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background.

    OUTCOME: The General Health Questionnaire 12 was used to measure parents' mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles.

    RESULTS: The results indicated that parents in the intervention group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up: B=3.62, 95% CI 2.01 to 5.18, p<0.001. Further, significant improvement was found for efficacy (B=-6.72, 95% CI -8.15 to -5.28, p<0.001) and satisfaction (B=-4.48, 95% CI -6.27 to -2.69, p<0.001) for parents in the intervention group. Parents' satisfaction mediated the intervention effect on parental mental health (β=-0.88, 95% CI -1.84 to -0.16, p=0.047).

    CONCLUSION: The culturally tailored parenting support programme led to improved mental health of Somali-born parents and their sense of competence in parenting 2 months after the intervention. The study underlines the importance of acknowledging immigrant parents' need for societal information in parent support programmes and the importance of delivering these programmes in a culturally sensitive manner.

    CLINICAL TRIAL REGISTRATION: NCT02114593.

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