Background and aims: Posttraumatic stress disorder (PTSD) is highly prevalent among forced migrant populations and is often accompanied by comorbid mental and physical health problems, and low levels of physical activity (PA). This study evaluated a multi-component, trauma-informed PA intervention for refugees on symptoms of PTSD, depression, anxiety, and subjective wellbeing. Additional process outcomes included levels of PA, sedentary time, and intervention adherence. Methods: A randomized controlled trial with two arms: intervention group (IG) receiving a 10-week traumainformed PA intervention and a waitlist control group (CG). Assessments occurred pre- and post-intervention and at 6-month follow-up. PTSD symptoms (primary outcome) were assessed using the PTSD Checklist for DSM-5 (PCL-5). Intervention effects were evaluated using mixed-effects linear regression models. Results: The sample comprised 183 participants (age 22-67, 41 % women), with 92 in the IG and 91 in the CG. The IG showed significant reductions in PTSD symptoms from baseline to post-intervention and 6-month followup (p < .001), with estimated PCL-5 scores of 52.3, 40.9, and 37.6. The between-group difference in PTSD symptoms at post-intervention (MD =10.0, 95 % CI [6.2, 13.7], p < .001) reflected a large effect size (d = 0.81), with similarly large effects for depression and anxiety (d = 0.83) and subjective wellbeing (d = 0.98). IG participants shifted from below to above the cutoff for sufficient PA, and all improvements persisted or further increased at 6-month follow-up. Conclusion: The findings provide important evidence supporting PA in the treatment of PTSD and associated comorbidities among trauma-affected refugees.

Worldwide, too many sexuality and gender minority individuals face significant danger due to their identity(ies), compelling them to seek refuge in another country. This qualitative study explored the pre-migration trauma and post-migration health burdens of sexuality and gender minority forced migrants in Sweden. Between April and June 2023, 34 participants were recruited using convenience, purposive, and snowball sampling and interviewed individually using semi-structured interviews. Inductive qualitative content analysis was conducted collaboratively by two researchers and two sexuality and gender minority forced migrants. The findings reveal the deep impact of societal oppression and violence in participants' home countries, where they endured physical violence, torture, conversion attempts, and death threats, often from both community members and family. Escaping these dangers was filled with further risks. During resettlement, participants continued to face significant challenges, experiencing both mental and physical health issues, as well as profound loneliness.

BackgroundIn many settings, sexual and gender minorities experience severe persecution and are left with the only option to flee to another country. The aim of this study was to explore perspectives on what constitutes post-migration quality health services and health research tailored for sexual and gender minority forced migrants, according to the views of migrants with lived experience and health service providers.MethodsThis was a qualitative exploratory study with embedded public contribution through close collaboration with migrants representing the target population. Study participants were recruited through purposeful and snowball sampling (forced migrants n = 17, service providers n = 20). Semi-structured interviews were transcribed verbatim and analyzed with systematic text condensation.ResultsOpen doors and open minds in health services were identified as overarching cornerstones for quality health services. Participants consistently emphasized the need for accessible and welcoming health services, highlighting specific concerns about language barriers and fear of discrimination. A key element was the significance of sufficient awareness and reflection among health professionals who foster client comfort through affirming and individualized care. The importance of upholding confidentiality and privacy was underscored, considering the internalized shame and traumatic experiences represented within the population. High degrees of representation and in-depth considerations of intersectional nuances were identified as overarching cornerstones for health research. A high degree of embedded representation and inclusive approaches in research was highlighted. A need for research that will uncover intersectional mental health burdens and living conditions was articulated, alongside a need for research focusing on interventions that will promote equitable and tailored health services.ConclusionsThis study highlights the urgent need for health services to adapt to the complex and intersecting needs of underserved populations such as sexual and gender minority forced migrants. For quality health services to be achieved, it needs to be grounded in equitable access, intersectional awareness, affirming relationships, and safeguards for safety and confidentiality. Future research needs to prioritize inclusionary and participatory approaches, investigate specific subgroup needs, address multidimensional burdens, and focus on effective and pragmatic support interventions.

Aims: To explore the components that influence health and wellbeing of gender minority forced migrants residing in Sweden.Methods: Qualitative exploratory study based on semi-structured interviews with gender minority forced migrants recruited through a combination of convenience, purposeful and snowball sampling. Guided by the levels in the social ecological model, transcripts were analysed with systematic text condensation in a collaborative process between experts by lived experience, researchers and clinical psychologist.Results: Participants expressed resilience and hope about their future. Loneliness was a major issue contributing to health burdens and peer support was highly appreciated. Barriers hindering access to health services and judgemental behaviours among health professionals were described. Affirming support through empathy, trust, safety, confidentiality, continuity and respect was highlighted as essential in health services. While societal openness and safety for gender minority individuals was appreciated, participants faced an uncertain asylum process and unmet basic needs.Conclusions: Gender minority forced migrants show resilience and appreciate the newfound societal safety. However, they find themselves in the margins of society and encounter various multi-layered challenges. Loneliness is a public health concern that could be addressed through peer support, which is highly desired and valued. Ensuring access to affirming health services should be a prioritized area for researchers, professionals, stakeholders and policy-makers.

BackgroundSeeking refuge in another country is a significant life event associated with health burdens and unmet health needs. However, the diversity within the migrant population necessitates a multidimensional framework acknowledging intersectional perspectives, and there is a notable lack of studies about the health and support of sexual minority forced migrant women. The aim of this study was to explore psychosocial health and wellbeing among lesbian forced migrants in Sweden.MethodsExploratory qualitative study consisting of semi-structured interviews with lesbian forced migrants recruited via purposeful, convenience, and snowball sampling. All participants originated from Africa. Data were analyzed with systematic text condensation through a collaborative approach involving researchers, experts by lived experience, and a clinical psychologist.ResultsParticipants experienced a challenging journey involving intersectional disadvantages and an unsafe living situation. They struggled to meet basic needs, experienced painful memories during asylum interviews, feared potential deportation, and faced loneliness in a new and unfamiliar society. A newfound freedom and social support empowered them to keep pursuing happiness in the face of struggles. They found strength in welcoming spaces, found belonging and comfort among peers, and were aided through informational and instrumental support. When trying to access health services, participants suffered in silence because of barriers hindering their access. While the importance of sensitivity and respect in clinical settings was emphasized, non-affirming behaviors were sometimes encountered when interacting with health professionals. Interpreters' discretion and safety were considered essential aspects when they are utilized in health services.ConclusionsLesbian forced migrants face a range of challenges impacting their health and wellbeing. Loneliness is a pressing concern, while social support among peers is highly desired and appreciated. Lesbian forced migrants emphasize the importance of accessible and affirming health services, including respectful behaviors and appropriate utilization of interpreters promoting client safety. Peer support has the potential to offer comfort and belonging, but more research is needed.

The health of underserved populations, including sexual and gender minority forced migrants, is a pressing global concern. Public contribution in research has the potential to enhance prioritisation and aid in intervention development, but has been criticised due to a lack of sufficient diversity and engagement with underserved populations.

The core research team conducted eight workshops together with eight experts by lived experience to prioritise and guide future peer support intervention research. Activities included brainstorming, pathway mappings, ranking procedures, storytelling exercises, photovoice sessions and individual open-ended writing sessions. Open-ended reflective meetings and manifest content analysis of material, as well as documentation, guided the progress towards final results.

Peer support was identified as an intervention with the potential to reduce mental health burdens, enhance the capacity to integrate into society and provide access to basic needs. Peer support interventions aiming to reduce health inequities by promoting language proficiency and employment attainment were identified as prioritised areas. A range of considerations and barriers regarding the modality of interventions, the training of peer supporters and recruitment strategies needs further examination in research.

Our findings illustrate the importance of public contribution when planning research addressing support for underserved and marginalised populations. Public contribution efforts targeting underserved populations such as ours will help researchers gain an in-depth understanding of prioritised research questions and pragmatic study procedures. In regard to research for sexual and gender minority forced migrants, we recommend prioritisation of intervention development that promotes mental health and reduces loneliness through support from peers in group settings and from peer mentors, informational support and capacity-building.Patient or Public ContributionRepresentatives acting as experts by lived experience contributed as research partners throughout the procedures and workshops.

Aim: To explore experiences of social and health professional support among sexual minority forced migrant men.

Design: Exploratory qualitative study.MethodsIndividual semi-structured interviews were conducted in 2023 with 15 participants recruited through convenience, purposive and snowball sampling. Interviews were audio recorded, transcribed and analysed with systematic text condensation in a collaborative process between researchers and experts by lived experience.

Results: The first category was 'desiring support along a road with challenging intersections'. Participants encountered a harsh reality and dangers in the host country. They sought social connections and communicated with others whilst in a social labyrinth within a new and reserved society. Although social support was desired and highly appreciated, the process involved a spectrum of both belonging and exclusion. The second category was 'navigating uncharted waters when seeking affirming health services'. A range of barriers to health services were encountered in a complex health system. Participants emphasized the importance of safe and affirming spaces that accommodate the vulnerability of disclosure.

Conclusion: Ensuring respectful and affirming support for sexual minority forced migrants is essential. Barriers in accessing health services need to be addressed, including informing about rights and ensuring safety.Implication for the Professional and Patient CareNurses and other health professionals can consider social support as a potentially valuable resource for health promotion. However, there is a need for more research investigating its mental health effects.ImpactThe intersectional disadvantages and discrimination encountered by sexual minority forced migrants call attention to the need for further advancements in inclusion health and affirming care.Reporting MethodThis study adhered to the Consolidated Criteria for Reporting Qualitative Research.

Patient or Public Contribution: Three sexual minority forced migrants were members of the research team. They were involved in the data collection, analysis and reporting in close collaboration with researchers.

Aims: To describe and synthesise qualitative studies exploring sexual and gender minority migrants' experiences of health service access and utilisation.

Design: Systematic meta-synthesis of qualitative studies.

Data Sources: Systematic searches in four databases and citation screening were conducted in 2023 and 2024. English-language empirical qualitative studies published in scientific journals within 10 years were included. Of 1109 screened, 21 reports were included.

Methods: Included reports were appraised using CASP and JBI checklists. Extracted results were analysed with inductive content analysis in a collaborative process.

Results: All reports had acceptable quality, including 365 participants from 72 countries. A range of external and internal barriers to accessing health services were reported, including financial constraints and fears. Although migrants expressed an appreciation of health services, they also experienced non-affirming behaviours and discrimination related to their intersecting identities. Several essential components in health services necessary to cater to the needs of migrants were addressed, including the personality and manner of health professionals as well as adherence to confidentiality.

Conclusion: Barriers to health services, intersectional discrimination and non-affirming behaviours when interacting with health services are pressing issues that need further attention.

Implication for the Profession and/or Patient Care: Ensuring safety through affirming support is key to achieving high-quality and accessible health services for sexual and gender minority migrants. Nurses and other health professionals need to carefully consider intersectional layers related to sensitivity and safety when supporting sexual and gender minority migrants. Open, friendly, validating, respectful and encouraging communication is essential in clinical settings.

Impact: This review addressed experiences of health services amongst a marginalised population. The findings highlight the importance of affirming care and are relevant for health professionals, stakeholders and decision-makers.

Reporting Method: ENTREQ.

Patient or Public Contribution: Two persons with lived experience were involved in the meta-synthesis.

Aims: To explore the experiences of seeking asylum and its impact on mental health among sexual minority forced migrant cisgender men living in Sweden.

Methods: Exploratory qualitative study based on individual semi-structured interviews with 15 adult gay and bisexual cisgender men recruited via a combination of purposeful, convenience and snowball sampling. Data were analysed with systematic text condensation through a collaborative approach with three migrants with lived experience.

Results: Seeking asylum had been an emotionally challenging journey for the participants in this study, involving several procedures that negatively impacted mental health. Being expected to disclose intimate information during asylum interviews had been a significant challenge, alongside needing to wait through long periods in uncertainty with little information about the progress of their asylum case. The behaviours and attitudes of professionals involved in the legal procedures had been a central aspect, as participants encountered interpreters and caseworkers who acted disrespectful and homophobic during asylum interviews. Participants mentioned that the behaviours of interpreters and the accuracy of the interpretation could influence the outcome of asylum claims and how comfortable they felt in sharing information. Thus, participants emphasized the importance of adequate and accurate interpreter services.

Conclusions: Sexual minority men are faced with an unfamiliar and emotionally challenging position when seeking asylum and undergoing asylum interviews. The findings highlight the importance of adequate competence among professionals involved in asylum interviews, including interpreter utilization. Research is needed to determine effective methods to support these men throughout their asylum process.

Background: Childhood cancer treatment completion can be a period of vulnerability for parents and is associated with mental health difficulties such as depression and anxiety. We developed an internet-administered, guided, low-intensity cognitive behavioural therapy-based self-help intervention (EJDeR) for parents delivered on the U-CARE-portal (Portal). The acceptability and feasibility of EJDeR and study procedures were examined using a single-arm feasibility trial (ENGAGE). Results indicated that EJDeR and ENGAGE study procedures are acceptable and feasible, however, a need for clinical and technical modifications to EJDeR and refinements to ENGAGE study procedures was identified.

Objectives: This study aimed to explore the acceptability and feasibility of EJDeR and ENGAGE study procedures from the perspective of e-therapists to inform clinical and technical modifications to EJDeR and refinements to study procedures prior to progression to a superiority randomised controlled trial.

Methods: We conducted semi-structured interviews with 10 e-therapists. Data were analysed using manifest content analysis.

Results: We identified three categories relating to the acceptability and feasibility of EJDeR: (a) Support to e-therapists (subcategories: Clinical supervision and Technical difficulties); (b) Guidance to parents (subcategories: Support protocols and Synchronous communication); and (c) Content (subcategories: Relevancy of the intervention and Pacing of the intervention). We identified four categories relating to the acceptability and feasibility of study procedures: (a) Recruitment and training of e-therapists (subcategories: Definition of the role and Training program); (b) Retention of parents (subcategories: Parent suitability and screening and Frequency of weekly Portal assessments); (c) Retention of e-therapists (subcategories: Administrative requirements and Communication with the research team); and (d) The Portal.

Conclusions: EJDeR and study procedures were considered acceptable and feasible, however, clinical and technical modifications and refinements to study procedures were suggested to enhance acceptability and feasibility. Results may also inform implementation considerations for both EJDeR and other similar digital psychological interventions.