Healthcare Providers’ Perceptions of Mental and Sexual Health Needs of Young Males with Forced Migration Experiences in Stockholm Region, Sweden: A Patient-Centered Approach

Healthcare Providers’ Perceptions of Mental and Sexual Health Needs of Young Males with Forced Migration Experiences in Stockholm Region, Sweden: A Patient-Centered Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Healthcare Providers’ Perceptions of Mental and Sexual Health Needs of Young Males with Forced Migration Experiences in Stockholm Region, Sweden: A Patient-Centered Approach Fitri Karimah, Jordanos Tewelde McDonald, Maria Stålgren, Mariano Salazar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7554746/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Jan, 2026 Read the published version in BMC Health Services Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background Young males with forced migration experiences (YMFMEs) face numerous health challenges, particularly in terms of sexual and mental health. The disparity in health beliefs and knowledge between healthcare providers (HCPs) and vulnerable groups can exacerbate these challenges. Sexual health encompasses both physical and psychosocial aspects; however, the interplay between these two aspects is often overlooked in research and clinical practice. Additionally, existing research has focused predominantly on females, neglecting the specific needs of YMFMEs. Engaging HCPs provides expert insights into the unique healthcare challenges faced by YMFMEs, enabling the development of tailored, evidence-based interventions that address their specific needs. We believe that utilizing a patient-centered framework is crucial for effectively addressing these needs. Aim This study aims to explore HCPs’ perceptions of the sexual and mental health needs of YMFMEs and their perspectives on approaches to addressing these needs within a patient-centered framework in the Stockholm Region, Sweden. Methods This qualitative study was conducted in the Stockholm Region, Sweden, between May and June 2021 using semi-structured interviews. Nine health care providers were included in the study. The interview transcripts were analyzed using inductive content analysis. Results We identified three themes that describe HCPs’ perceptions of YMFMEs’ sexual and mental health needs in healthcare; 1) recognizing and incorporating the biopsychosocial interconnectedness of sexual and mental health into healthcare practices; 2) addressing gaps in health literacy, cultural norms, and expectations is crucial for fostering trust and promoting patient-centered care; and 3) the impact of forced migration and discrimination on YMFMEs' mental and sexual health and the need for targeted knowledge in healthcare practices. Conclusion This study highlights the importance of HCPs understanding the complex relationship between forced migration, mental health, and sexual health for YMFMEs and integrating this awareness into healthcare practices. Healthcare Providers Mental Health Sexual Health Young Males with Forced Migration Experiences Patient-Centered Framework Introduction In 2024, Sweden received 223,204 refugees under the UNHCR mandate, reflecting the country’s ongoing diversification ( 1 ). These individuals have experienced forced migration and fled their countries due to conflict, violence, or fear of persecution, seeking safety in another country ( 2 ). Upon crossing an international border in search of safety, individuals typically must apply for protection from another country, and during this process, they are referred to as asylum seekers ( 3 ). Sweden grants residence permits to asylum seekers recognized as refugees under Swedish legislation and EU regulations ( 4 ). This study explores both groups, asylum seekers and individuals with granted refugee status in Sweden, and we use the term young male with forced migration experiences throughout the study. Youths, particularly those between the ages of 15 and 24 with asylum-seeking and refugee backgrounds, face extreme and difficult forced migration experiences while transitioning from adolescence to adulthood ( 5 ). Globally, issues related to sexual health and mental health are significant within this group ( 6 , 7 ). In general, male youths have difficulty accessing mental health care due to stigma and cultural expectations, such as traditional gender norms, which hinder their ability to be vulnerable and express emotions ( 8 ). In particular, cultural and religious beliefs about mental and sexual concerns may further prevent open discussions among young males with forced migration experiences (YMFMEs) ( 8 – 10 ). Furthermore, the unique sociocultural challenges they face can limit their access to health resources and information, increasing their lack of understanding and risk of negative health outcomes ( 9 , 11 ). The current working definition of sexual health as described by the WHO is “…a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity ( 12 ).” Despite the integration of physical, emotional, and social well-being in sexual health as defined by the WHO, much youth sexual health research focuses only on physical aspects, such as sexually transmitted diseases (STDs) ( 13 ), often treating mental and sexual health as separate domains and overlooking the complex interplay between them ( 14 , 15 ). Engaging HCPs to explore their perspectives on the mental and sexual health needs of YMFMEs offers several advantages. First, HCPs bring their expertise and experience to the table, providing valuable insights into the healthcare challenges faced by this demographic ( 16 , 17 ). Moreover, by integrating HCPs’ insights, interventions can be tailored to better meet the specific needs and preferences of YMFMEs, promoting more personalized and evidence-based practices ( 18 ). For example, a study in the USA showed that differences in how patients and HCPs describe treatment goals may reflect varying perspectives on the underlying disease processes ( 18 ). While patients prioritize their immediate needs and concerns, HCPs provide expertise in understanding the broader context of diseases and their treatment implications ( 18 ). The sexual and mental health needs of male YMFMEs have often been overlooked, as most studies have focused on the needs of female YMFMEs ( 10 ). In our previous study, we reported that the sexual and mental health needs of YMFMEs followed a process of individual change over time in Sweden and were influenced by contextual factors such as social and cultural norms and health literacy ( 19 ). In this study, we aimed to explore HCPs’ perceptions of the sexual and mental health needs of YMFMEs and their perspectives on approaches to addressing these needs within a patient-centered framework in the Stockholm Region, Sweden. We believe that HCPs provide invaluable insights into the scientific and clinical aspects of these health concerns that may not be readily apparent to YMFMEs. Theoretical Framework The patient-centered framework serves as an exemplary model for delivering comprehensive care, especially in addressing the complex health needs of YMFMEs ( 20 ). The principles of the patient-centered framework are the essential characteristics of the clinician, the clinician-patient relationship, the patient as a unique person, and the biopsychosocial perspective ( 20 ). By prioritizing characteristics such as empathy, respect, and accountability, this framework fosters a trusting and collaborative relationship between HCPs and patients, which is essential for navigating sensitive topics ( 20 ). Moreover, by recognizing each patient as a unique individual with distinct needs and preferences, patient-centered care ensures that interventions are tailored to specific circumstances and experiences, promoting more effective and culturally sensitive healthcare delivery ( 20 ). Methods Study Setting Between 2013 and 2022, Sweden saw a predominance of refugees from Syria seeking protection, although Ukraine topped the list in 2022 ( 21 ). Other significant countries of origin include Afghanistan, Eritrea, Iraq, and Somalia ( 21 ). Asylum seekers in Sweden are entitled to emergency healthcare, dental care, and healthcare that cannot wait, as well as services under the Swedish Communicable Diseases Act, including childbirth, abortion care, contraception advice, and maternity care ( 22 ). Additionally, asylum seekers are entitled to an interpreter when accessing healthcare ( 22 ). Asylum seekers in Sweden undergo a health assessment upon arrival at the asylum reception, offering advice, tests, and information about healthcare services in Sweden ( 22 , 23 ). Asylum seekers with a granted permit will gain a new status as refugees and have the same healthcare rights as Swedish residents, with most services being free of charge ( 4 ) ( 22 ). Health services in Stockholm, Region Sweden, including sexual and reproductive health (SRH) services, are provided mainly through public health care organized by regions ( 24 ). The Youth Clinic and Men’s Clinic are examples of clinics organized by counties that provide SRH services along with mental health support ( 24 – 26 ). In addition to the Youth Clinic, there are non-governmental organization (NGO) clinics that focus on mental and sexual health, such as Riksförbundet, för sexuell upplysning; or the Swedish Association for Sexuality Education (RFSU); and the Origo Clinic, which offers counseling for youth ( 27 , 28 ). Despite efforts to improve care, concerns remain regarding entitlement to health care on the basis of migration status and the need for a more comprehensive approach to individual health needs ( 23 , 29 ). Study Design and Participants’ Selection HCPs were selected based on work experience in delivering mental and sexual health services to YMFMEs. A minimum of 3 years of work experience in a healthcare facility that provides both sexual and mental health services was required. Because of the specific criteria for working in healthcare that provide services related to both concerns, experiences in delivering services to YMFMEs, and the COVID-19 pandemic during the data collection, snowball sampling was used to recruit participants ( 30 ). This meant that the first HCP who met our specific characteristics helped us identify the others ( 30 ). Our research assistant (M)S and one of the investigators (JTM) initially approached potential participants via email, providing them with detailed information about the study, including its ethical considerations. Those who expressed interest were sent a written informed consent form, which they returned via email prior to data collection. The participants who consented to take part in the study received a store voucher as an appreciation. The sample size was guided by information power theory, where the size of the sample depended on the aim of the study, sample specificity, use of established theory, quality of dialogue, and analysis strategy ( 31 ). A sample of 6–10 participants with specific characteristics and diverse experiences provided adequate information power ( 31 ). Data Collection Semi-structured interviews were conducted from May-June 2021. Our research assistant (MS), a Swedish nurse, conducted the interviews in Swedish over Zoom and recorded them for analysis. On average, they lasted one hour. The interview guide explored HCPs’ experiences and perspectives on YMFMEs' mental and sexual health, focusing on HCPs’ health concerns, needs, knowledge, attitudes, misconceptions, relationships, consent, mental health coping strategies, and experiences with racism were included. Additionally, several questions probed barriers and potential improvements in healthcare services for this population group. The questions were primarily open-ended and exploratory, encouraging detailed responses. The study included nine HCPs with a range of specialties and years of experience, as summarized in Table 1 . Analysis The data were analyzed using inductive qualitative content analysis, as described by Graneheim ( 32 ). The first step of the analysis involved multiple thorough readings of the transcripts ( 32 , 33 ). JTM reviewed and transcribed the recordings in Swedish, whereas FK translated them into English by using the Word Translate feature. The translated transcripts were reviewed by JTM, a native Swedish speaker. The coding was initially performed by FK who looked at both the manifest and latent content of the text ( 32 , 33 ). The codes were later discussed with the other co-authors (MS and JTM). After the initial coding was performed, codes that had something in common were clustered into categories, which later evolved into themes representing the overall ideas running through the data. The categorization and themes formulation were developed through discussion and consensus agreement. The coding process was conducted in English, utilizing OpenCode 4.03. Table 1 Demographic Characteristics of the Participants Age Average 31–60 years old 43.8 years old Professions Nurse (including a school nurse) 3 Psychiatric nurse 1 Midwives 3 Psychologist 2 Years of Experience Average 3–22 years 8.8 years Gender Female 8 Male 1 Workplace Asylum Reception 3 High School Clinic 1 Youth Clinic 2 Men’s Clinic 1 NGO Clinic 2 Results We identified three themes and their corresponding categories describing HCPs’ perceptions of YMFMEs’ sexual and mental health needs related to healthcare (Table 1 ). Table 1 Themes and Categories Themes Theme 1: Recognizing and incorporating the biopsychosocial interconnectedness of sexual and mental health into healthcare practices Theme 2: Addressing gaps in health literacy, cultural norms, and expectations is crucial for fostering trust and promoting patient-centered care Theme 3: The impact of forced migration and discrimination on YMFMEs' mental and sexual health and the need for targeted knowledge in healthcare practices. Categories The link between sexual and mental health identified by HCPs and the need for a holistic approach Gaps in cultural norms and health literacy create misconceptions and barriers that prevent YMFMEs from seeking care. Traumatic experiences and discrimination as determinants of the mental and sexual health of YMFMEs HCPs’ limited scope in addressing the interconnectedness of sexual and mental health among YMFMEs Negative experiences and different expectations cause YMFMEs’ lack of trust and underutilization of healthcare HCPs’ need for specific knowledge about forced migration’s burden on health Theme 1: Recognizing and incorporating the biopsychosocial interconnectedness of sexual and mental health into healthcare practices Category 1: The link between sexual and mental health identified by HCPs and the need for a holistic approach . The findings showed that sexual and mental health should not be separated because they often influence each other among YMFMEs. The participants in this study noted that psychological pressure or stress related to the forced migration experience can be a factor in sexual health complaints, or vice versa, where sexual health complaints can lead to mental distress. “You do an assessment call, and you understand that okay, this person has erection problems and needs help for that. It is not so strange that they experience sexual illness because there are so many more factors that contribute to, uh, that there is a general illness, a mental illness that you think is the primary thing to address.” (HCP E, Men Clinic) We noted that the HCPs mentioned that YMFMEs’ sexual health concerns are related to sexual dysfunctions such as erectile dysfunction, premature ejaculation, and low libido, as well as inner conflicts about masturbation and sexual activities before marriage, areas in which mental health concerns need to be assessed. The participants in this study also mentioned that misconceptions about sexual health can adversely affect the mental well-being of YMFMEs. For example, HCPs observed that this vulnerable group is particularly prone to feelings of guilt, shame, and fear around sexual health, as well as harsh norms related to it. Additionally, sexual assaults,which can be considered both mental and sexual issues, are prevalent among YMFMEs. Category 2: HCPs' limited scope in addressing the interconnectedness of sexual and mental health among YMFMEs. Although the relationship between sexual and mental health was frequently observed to be interconnected among YMFMEs, this study also revealed several limitations in providing holistic care for them. HCPs working at asylum receptions described that they tended to omit discussions about sexual health with YMFMEs despite discussing it with female asylum seekers. The midwives in this study described their difficulties in discussing mental illness with YMFMEs. The participants often found it difficult to discuss topics such as traumatic experiences, such as sexual assault, during their practice. The midwives mentioned that although it is part of their responsibility to refer sexual health patients with mental illness to psychiatrists, this is difficult because they do not routinely screen for mental health issues. “We do not talk so much about sexual health, I will say, and that is probably what, now when I started to get into this for this interview, I started to think about it, that we do not talk so much about it, more with women then because we talk about contraception and stuff.” (HCP A, asylum reception) Theme 2: Addressing gaps in cultural norms, health literacy, and expectations is crucial for fostering trust and promoting patient-centered care. Category 1: Gaps in cultural norms and health literacy create misconceptions and barriers that prevent YMFMEs from seeking care. HCPs recognized and highlighted that cultural norms, traditional gender roles, and a lack of proper education may influence how YMFMEs respond to and seek care for sexual and mental health issues. “Beliefs and regulations about sex where you have not been allowed to explore your sexuality on your own terms without it, and this may have limited you in your sexual health. What I'm also going to say is the lack of sex education. Ehm, you have not had the opportunity to uh, assimilate knowledge about the body, bodily and sexual functions. In addition, they talk about the greater emotional connection to sex and sexuality. Uh, so there's a lot that is, that is not verbalized even to oneself or like, what to say, made conscious to oneself.” (HCP E, Men Clinic) Furthermore, our participants revealed the complex beliefs and attitudes of YMFMEs regarding sexual health. The participants in this study reported that YMFMEs’ cultural and religious beliefs often dictate that sexual activities should occur only within the context of marriage, leading to feelings of guilt and inner conflict regarding what is considered right or wrong. According to HCPs’ experience in interacting with YMFMEs, many YMFMEs find it forbidden to discuss sexual health due to religious and cultural restrictions. “The common thread is low; there is low knowledge about sexuality and relationships. Or, a different kind of knowledge, and that is what we are not talking about. We often say that they do not have much knowledge about sexuality. They have relationships, but they have another. A very religiously influenced, traditional, conservative, very similar to what we had in Sweden a hundred years ago.” (HCP C, psychologist) HCP C also observed that YMFMEs often approach sexual health issues from philosophical and moral standpoints, making discussions about some areas of some aspects of sexual health easier. HCP C observed that YMFMEs tend to absorb information about STDs more easily, as it is more about anatomy and health education, and provides less room for moralizing, making it the easiest area to educate on. However, discussing sexual health in terms of morals and values becomes challenging, as many YMFMEs believe that sexual activities should occur only within heterosexual marriage and that homosexuality is often seen as a foreign concept. “In some areas, it is easier. STDs, anatomy, uh, and so on. However, in some areas, it is much more difficult, when it comes to morality, and when it comes to values.” (HCP C, psychologist) In addition to cultural and religious values, deeply ingrained gender norms also make some areas challenging to discuss, particularly consent and contraception. The midwives in this study perceived that YMFMEs may lack an understanding of consent for sexual relations or may even be unaware that consent exists. The midwives in this study observed that many YMFMEs come from patriarchal societies where women are subordinate and men are seen as decision-makers. “ So... it is because they often come from patriarchal societies. Uh, so, so it is like this stereotypical image of relationships. Who's going to do what, and then consent can sometimes be quite difficult to understand, because of that.” (HCP G, a midwife) Our participants argued that contraceptive use is another area that is influenced by traditional gender norms. YMFMEs’ lack of knowledge and misconceptions regarding contraception are often caused by shifting contraceptive responsibility to women. In many cases, HCPs observed that YMFMEs believed that contraception is solely the responsibility of women, as they leave decisions to women and may even hold easy attitudes towards abortion if pregnancy occurs. “Yes, it can, it can be for example… they said ‘Uh, do not have to, do not need to wear a condom because... No, on the one hand, maybe it is the girl's responsibility” (HCP G, a midwife) Importantly, we found that traditional gender norms were also noted among HCPs, who often shifted the responsibility of contraception and pregnancy prevention to women. While female asylum seekers and refugees often receive information about contraception, discussions about sexual health with their male counterparts are less common. The lack of discussion in this area is due to HCPs’ omission of sexual health topics during health screening. “Uh, and even though I see myself as a very conscious person, I obviously also put that responsibility (contraception) on the woman as well.” (HCP B, asylum reception) Additionally, traditional gender norms harm YMFMEs’ ability to discuss and seek mental health care. The psychologist and psychotherapist in this study noted that it was not easy for YMFMEs to express themselves and verbalize their mental concerns to seek support. From HCPs' experience, many YMFMEs feel stigmatized when referred to psychiatrists, and it is considered taboo in tradition to ask YMFMEs about their mental well-being. According to the HCPs’ experiences in this study, YMFMEs often mention stereotypical gender roles where men should be “macho” and not subjected to oppression, making it difficult for them to acknowledge or address their mental health struggles. “There are extremely stereotypical gender roles. In addition, the man is the one who is supposed to be like, what can I say, macho, uh, should deliver eh... Finances and money; he should have a good status in his working life and should not be subjected to violence and oppression. So... It is very difficult for the self-image to, to kind of define it (mental health struggles) right from the start.” (HCP G, a midwife) A lack of proper education may influence how YMFMEs respond to and seek care related to sexual and mental health. The HCPs in this study reported that YMFMEs are generally not accustomed to psychotherapy and may refuse to attend counseling. “Therefore,they have been really, really hesitant about, to... Uh, medications. I feel that many people are very skeptical about psychotropic drugs. And, so, and you do not want it to change your brain.” (HCP D, a school nurse) Our study participants also implied that the lack of reliable sources of sexual health education in YMFMEs’ home countries was a factor influencing misconceptions about sexual health issues. “Um, there's no one, uh, who's talked about being taught or given information about sexual health. Eh, many people have not been to school, but even those who have been to school have never had information. So what you have heard is based on what other people have said. Um, so very limited knowledge about sexual health.” (HCP I, asylum reception) Category 2: Negative experiences and different expectations cause YMFMEs’ lack of trust and underutilization of healthcare. This study revealed a significant challenge as perceived by HCPs from the language barrier, as interpreters are not available at every clinic, and there is uncertainty about the accuracy of interpretation. The participants who worked at asylum reception expressed concerns about the interpreter's potential biases, which could affect the quality of the information conveyed. “Actually, first of all, those of us who are with an interpreter. It is very difficult because you never know what they're interpreting, how much information will get through and how much information will get through. And, if it is the right information or not, you still try to confirm by always asking the question again, have you understood? Can you explain to me again? Uh, then it confirms by repeating, then I know aha but then it has got the right information.” (HCP I, asylum reception) In their interviews, HCP D highlighted that negative experiences with healthcare can occur due to HCPs' lack of understanding of YMFMEs’ experiences. “And quite a few people have pretty bad experiences of health care because they have met sometimes like that, uh, maybe at the health center who maybe does not understand your migration experience at all.” (HCP D, a school nurse) Theme 3: The impact of forced migration and discrimination on YMFMEs' mental and sexual health and the need for targeted knowledge in healthcare practices . Category 1: Traumatic experiences and discrimination as determinants of the mental and sexual health of YMFMEs Our study participants described how the traumatic experiences of YMFMEs in their home countries and during their migration journeys significantly shaped their psychological well-being. The participants in this study often mentioned the uncertainty and threats faced during their journey, along with the possibility of becoming slaves or going without food, exacerbating YMFMEs’ mental health concerns, with PTSD, depression, and integration difficulties being major issues upon arrival in their host countries. Uncertainty of residence status and socioeconomic factors were also often mentioned by HCPs in this study, further contributing to YMFMEs' mental health concerns. In addition to mental health struggles, YMFMEs face difficulties in finding partners because of eputational issues and discrimination. “Yes... I mean, it is..... There is a picture of uh... It is a kind of stereotype. Partners' parents, absolutely. They are bad guys; dangerous; they come from dangerous countries. Uh, they have a dangerous religion. Without even meeting the person.” (HCP G, a midwife) Category 2: HCPs’ need for specific knowledge about forced migration’s burden on health HCPs in this study mentioned that they require specific knowledge about the burden of forced migration on health and migration in general to effectively care for YMFMEs. For example, training is needed to understand the needs of different groups with refugee backgrounds and the unique experiences and challenges that YMFMEs face. Another reflection was that knowledge of the above factors can help HCPs recognize their biases and beliefs which might influence their interactions with YMFMEs. “I also think that these health centers there....uh, that, that you should have a specific, maybe a little specific competence as well. Those who work should have slightly more knowledge and understanding of what... The patients we meet, what have they been through in the past, where do they come from, and why do they expect this? Perhaps you should be a little sharper, more trained, or have specific experience. At the asylum reception, we have that. However,at the health centers in general, it does not seem like that.” (HCP A, asylum reception) Discussion Our main findings are reflected in the following themes: 1) recognizing and incorporating the biopsychosocial interconnectedness of sexual and mental health into healthcare practices; 2) addressing gaps in health literacy, cultural norms, and expectations is crucial for fostering trust and promoting patient-centered healthcare; and 3) the impact of forced migration and discrimination on YMFMEs’ mental and sexual health and the need for targeted knowledge in healthcare practices. Recognizing and Incorporating the Biopsychosocial Interconnectedness of Sexual and Mental Health into Healthcare Practices Our research highlights the biopsychosocial interconnectedness of sexual and mental health among YMFMEs in Stockholm, Region, Sweden, and emphasizes the importance of incorporating these aspects into healthcare practices. The HCPs in this study perceived that misconceptions and stigma surrounding sexual health can exacerbate mental health issues among YMFMEs. This includes feelings of guilt, shame, and fear, as well as inner conflicts regarding sexual activities and sexuality. This finding aligns with a study conducted in Sweden that highlighted how cultural and religious beliefs lead to fear and shame around sexual activities, although they did not mention its correlation with mental health ( 34 ). Another important finding is that healthcare providers do not effectively address mental and sexual health issues among YMFMEs. The nurses working at the asylum reception in this study may choose not to discuss sexual health concerns with YMFMEs despite consistently doing so with females during asylum seekers' health assessments upon arrival. A study in Sweden proposed doubt and thought that it is another HCP’s responsibility as a reason for nurses’ hesitancy in discussing sexual health concerns, which may also apply to the nurses in this study.( 35 ). On the other hand, HCPs working at sexual health-focused clinics may struggle with mental health screening and addressing traumatic events, despite their acknowledgment of referring patients with mental health issues as their role. Many healthcare facilities in Sweden already incorporate both mental and sexual health in one clinic, indicating that the interconnectedness of both concerns is well recognized ( 25 – 28 ). However, in our study, some nurses who work in asylum reception do not discuss sexual health concerns with men, and midwives in youth clinics do not screen for mental health effectively in practice. A study in Sweden emphasized that mental health concerns, especially violence, are difficult topics for midwives and that they do not feel well-equipped to screen for them ( 36 ). The study also mentioned that the existing mental health screening guide was not implemented by midwives, which is similar to the finding of our study ( 36 ). Recognizing and incorporating the interconnectedness of sexual and mental health into healthcare practices aligns with the biopsychosocial perspective principle within the patient-centered framework, which emphasizes understanding health issues within the broader context of patients' biological, psychological, and social factors ( 20 ). From this perspective, we suggest that mental and sexual health are interconnected aspects of YMFME’s overall well-being. This may involve screening for both mental and sexual health concerns during assessments and providing integrated interventions that address both aspects simultaneously. Addressing gaps in health literacy, cultural norms, and expectations is crucial for fostering trust and promoting patient-centered care. This study also highlights how cultural and religious beliefs, as well as traditional gender norms, significantly impact YMFMEs’ perceptions and practices related to sexual and mental health. Struggles with feelings of guilt and taboos surrounding sexual health, particularly due to the belief that sexual activities should occur only within heterosexual marriage, were also observed in a study conducted to map sexual health values among Jordanian and Syrian youth ( 37 ). In this study, HCPs highlighted how these beliefs shape YMFMEs’ perceptions of healthcare services and affect their comfort level when discussing sensitive topics. Additionally, the HCPs in our study often mentioned that traditional gender roles make discussions about consent, contraception, and mental health challenging, as men are often expected to be dominant decision-makers, and that pregnancy prevention is the sole responsibility of women. This finding aligns with another study that mentioned that consent as a concept is difficult to digest in patriarchal societies ( 38 ). We found that traditional gender norms are particularly concerning because they are observed not only among YMFMEs but also among some HCPs. For example, an HCP working in asylum reception tends to discuss sexual health only with female asylum seekers. The participants in this study also reported that traditional gender norms harm YMFMEs’ ability to seek and accept support for their mental health issues. Many HCPs in our study perceived that the notion that men should be “macho” and not oppressed hinders YMRs’ willingness to express their vulnerabilities. This finding aligns with a study conducted in Australia, which revealed that traditional masculine ideals discourage emotional expression and cause many stigmas around men and vulnerabilities, with people perceiving seeking help as a weakness. ( 39 ) The core concept of the patient-centered framework is to encourage collaboration between HCPs and patients ( 20 ). Involving patients in treatment decisions and asking for their opinions about their health concerns may help empower patients from vulnerable populations and make them feel understood ( 20 , 29 ). A lack of understanding of how to provide health services can impact low levels of patient satisfaction and non-compliance with recommended treatment, especially among patients with diverse ethnic and racial backgrounds ( 29 ). The impact of forced migration and discrimination on YMFMEs' mental and sexual health and the need for targeted knowledge in healthcare practices . This research also highlights the important role of forced migration and integration in the mental and sexual health needs of YMFMEs and emphasizes the need for HCPs to consider these factors in providing better care for this population. All the participants in this study highlighted the need for specialized training to equip them with the competence to address the mental and sexual health concerns of YMFMEs effectively. In the Stockholm Region, Sweden, only HCPs working in asylum reception and some HCPs in mental health care have the opportunity to receive training specifically to care for asylum seekers and refugees ( 40 ). The training has a good outcome and increases empathy for vulnerable groups ( 40 ). Unfortunately, we found that other HCPs who also meet and provide services for individuals with asylum-seeking backgrounds, for example, those who work at the Youth Clinics, are not as well equipped to care for YMFMEs. Another principle from the patient-centered framework is seeing the patient as a unique person, which means providing care that is tailored based on individuals' needs and values ( 20 ), as well as taking forced migration burden into account, is essential for better care. In Region Stockholm, such training is already available and offered free of charge by Transkulturellt Centrum. One example is the course “Transkulturell hälsa och dess betydelse för ditt kliniska arbete” (Transcultural Health and Its Relevance to Your Clinical Practice), which addresses how forced migration affects physical and mental health and how to navigate challenges in cross-cultural clinical encounters ( 41 ). We recommend that access to training in transcultural health be expanded beyond specialized units. Strengths and Limitations The qualitative approach allowed for an in-depth exploration of HCPs’ perspectives and experiences. Additionally, including multiple HCPs from different backgrounds and settings enhanced the credibility and richness of the findings. While this study provides valuable insights into the complex interplay between mental health, sexual health, and forced migration, several limitations should be acknowledged. The study focused specifically on HCPs’ perspectives and experiences, which may not fully represent the perspectives of YMFMEs themselves regarding their sexual and mental health needs. While the qualitative approach offers an in-depth understanding of unique needs, it also has limitations, such as the potential for subjective interpretation and difficulty in generalizing findings to a larger population. This study only offers HCPs subjective perspectives on their experiences managing and observing YMFMEs. Additionally, there are notable disadvantages to relying solely on HCPs’ perspectives. One concern is the risk of stereotyping, where the diverse needs and individual differences among YMFMEs may be overlooked, perpetuating biases based on cultural or demographic factors. Moreover, there is a limitation in the depth of understanding when exclusively relying on HCP perspectives. HCPs’ views, influenced by personal experiences and professional biases, may not fully capture the backgrounds and diverse needs of YMFMEs. Therefore, while valuable, HCPs’ perspectives should be complemented by direct engagement with YMFMEs to ensure the development of patient-centered interventions. Conclusions and recommendations In conclusion, this study highlights the need for HCPs to address the complex interplay among forced migration, integration, mental health, and sexual health among YMFMEs. Adopting a holistic approach that considers cultural dynamics, gender norms, and education and incorporating a patient-centered framework can significantly improve care. Encouraging collaboration between HCPs and YMFMEs can empower YMFMEs by involving them in treatment decisions and respecting their unique cultural backgrounds, which enhances their satisfaction and compliance. Additionally, structured multidisciplinary training for HCPs can equip them with the necessary knowledge and sensitivity to better address the health needs of YMFMEs. The lack of direct input from YMFMEs themselves is a critical drawback, as it may result in interventions that do not align with YMFMEs’ unique needs and preferences. Therefore, while valuable, HCP perspectives should be complemented by direct engagement with YMFMEs to ensure the development of patient-centered interventions. Declarations Ethics approval and consent to participate Ethical approval was obtained from the Swedish Ethical Review Authority, Dnr: 2019-01159. This study was conducted in accordance with The Helsinki Declaration. Before participation, our team approached the participants via email and sent them information about the study, including ethical considerations. When the participants agreed to participate, both verbal and written informed consent were obtained. The participants were fully informed about the purpose of the study, emphasizing the voluntary nature of their involvement. To ensure anonymity, pseudonymization of the data was used to protect the participants’ identities. Consent for publication Not applicable Availability of data and materials Relevant data and information is provided in the manuscript and supplementary materials. Complete transcripts and personal data are not publicly available due to these contained information that could compromise research participant privacy. Deidentified dataset may be requested to the corresponding author ( [email protected] ) upon reasonable request. Competing interests None declared Funding This study was supported by Region Stockholm (Stockholm County Council) (Grant number 232100-0016). Open access funding was provided by Karolinska Institutet. Authors’ Contribution FK analyzed the interview data and wrote original draft of the manuscript. JTM wrote the interview guidelines, recruited the participants, reviewed the language translation, and participated in theme formulation. JTM also reviewed and edited the manuscript. M.Stålgren recruited the participants and did the interviews. M.Salazar conceptualized the study, wrote the interview guidelines and participated in theme formulation. M.Salazar also reviewed and edited the manuscript. Acknowledgements We thank to the study participants who have participated in the interviews, the professionals at RFSU ( Riksförbundet för Sexuell Upplysning / Swedish Association for Sexuality Education) and the Knowledge Centre for Sexual Health at Region Stockholm for providing feedback in terms of the interview guide. We are also grateful for the non-governmental organization and youth associations for helping with recruiting participants. References The UN Refugee Agency (UNHCR). 2024. Refugee Data Finder. The UN. Refugee Agency. Refugees. 2024. UNCHR. https://www.unhcr.org/asylum-seekers . Who is an ‘asylum-seeker’?. The Swedish Migration Agency. https://www.migrationsverket.se/English/Private-individuals/Protection-and-asylum-in-Sweden/Applying-for-asylum/Asylum-regulations.html . 2023. Asylum regulations. Pfarrwaller E, Suris JC. Determinants of health in recently arrived young migrants and refugees: A review of the literature. 9, Italian J Public Health. 2012. Global Refugee Youth Consultations. We Believe in Youth. 2016. Edwards WM, Div M, Coleman E. Defining Sexual Health: A Descriptive Overview. Volume 33. Archives of Sexual Behavior; 2004. Satinsky E, Fuhr DC, Woodward A, Sondorp E, Roberts B. Mental health care utilization and access among refugees and asylum seekers in Europe: A systematic review. Health Policy (New York). 2019;123(9):851–63. Kaczkowski W, Swartout KM. Exploring gender differences in sexual and reproductive health literacy among young people from refugee backgrounds. Cult Health Sex. 2020;22(4):369–84. Mason-Jones AJ, Nicholson P. Structural violence and marginalization. The sexual and reproductive health experiences of separated young people on the move. A rapid review with relevance to the European humanitarian crisis. Public Health. 2018;158:156–62. Morris MD, Popper ST, Rodwell TC, Brodine SK, Brouwer KC. Healthcare barriers of refugees postresettlement. J Community Health. 2009;34(6):529–38. World Health Organization. https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health . Defining Sexual Health. Moreau C, Kågesten AE, Blum RW. Sexual dysfunction among youth: an overlooked sexual health concern. BMC Public Health. 2016;16(1):1–10. Leiler A, Bjärtå A, Ekdahl J, Wasteson E. Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden. Soc Psychiatry Psychiatr Epidemiol. 2019;54(5):543–51. Åkerman E, Larsson EC, Essén B, Westerling R. A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden. Sex Reproductive Healthc. 2019;19:64–70. McKeary M, Newbold B. Barriers to care: The challenges for Canadian refugees and their health care providers. J Refug Stud. 2010;23(4):523–45. Kotovicz F, Getzin A, Vo T. Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists. J Patient Cent Res Rev. 2018;5(1):28–35. Col NF, Solomon AJ, Springmann V, Garbin CP, Ionete C, Pbert L, et al. Whose Preferences Matter? A Patient-Centered Approach for Eliciting Treatment Goals. Med Decis Making. 2018;38(1):44–55. Tewelde McDonald J, Fayzi B, Laktinah M, Ekström AM, Salazar M. Sweden has changed me: a qualitative study exploring the sexual health needs and associated mental health aspects of young male former unaccompanied minors, asylum seekers and refugees in Region Stockholm. Swed BMJ Open. 2024;14(12):e080514. Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of patient-centeredness-A systematic review and concept analysis. Volume 9. PLoS ONE. Public Library of Science; 2014. The Swedish Migration Agency. https://www.migrationsverket.se/English/About-the-Migration-Agency /Current-topics/The-Swedish-Migration-Agency-Answers/Migrationsverket-svarar/2023-10-20-The-Swedish-Migration-Agency-answers--Who-comes-to-Sweden---and-why.html. 2023. The Swedish Migration Agency answers: Who comes to Sweden – and why?. The Swedish Migration Agency. :~:text=Right%20to%20healthcare, of%20healthcare%20you%20can%20receive. Healthcare for Asylum Seekers; 2023. https://www.migrationsverket.se/English/Private-individuals/Protection-and-asylum-in-Sweden/While-you-are-waiting-for-a-decision/Health-care.html# . Pacheco LL, Jonzon R, Hurtig AK. Health assessment and the right to health in Sweden: Asylum seekers’ perspectives. PLoS ONE. 2016;11(9). Baroudi M. Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden. Glob Health Action 2023;16(1). Region Stockholm. https://www.ungdomsmottagningarna.se/other-languages/english/om-um/ . Youth Centre. Region Stockholm. https://www.stockholmsmansmottagning.se/en . Stockholms Manmottagning. Origo Region Stockholm. https://etjanster.stockholm.se/Origo/hur-kan-vi-hjalpa-dig . Hur kan vi hjälpa dig?. The Swedish Association for Sexuality Education (RSFU). https://www.rfsu.se/en/this-is-rfsu/in-english/about/ . The Swedish Association for Sexuality Education (RSFU). Tucker CM, Arthur TM, Roncoroni J, Wall W, Sanchez J, Patient-Centered. Culturally Sensitive Health Care. Vol. 9, American Journal of Lifestyle Medicine. SAGE Publications Inc.; 2015. pp. 63–77. Valerio MA, Rodriguez N, Winkler P, Lopez J, Dennison M, Liang Y, et al. Comparing two sampling methods to engage hard-to-reach communities in research priority setting. BMC Med Res Methodol. 2016;16(1):1–11. Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26(13):1753–60. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15. Amroussia N. Providing sexual and reproductive health services to migrants in Southern Sweden: a qualitative exploration of healthcare providers’ experiences. BMC Health Serv Res. 2022;22(1). Saunamäki N, Engström M. Registered nurses’ reflections on discussing sexuality with patients: Responsibilities, doubts and fears. J Clin Nurs. 2014;23(3–4):531–40. Henriksen L, Garnweidner-Holme LM, Thorsteinsen KK, Lukasse M. It is a difficult topic - A qualitative study of midwiveś experiences with routine antenatal enquiry for intimate partner violence. BMC Pregnancy Childbirth. 2017;17(1). Gausman J, Othman A, Daas I, Hamad I, Dabobe M, Langer A. How Jordanian and Syrian youth conceptualize their sexual and reproductive health needs: a visual exploration using concept mapping. Cult Health Sex. 2021;23(2):176–91. Hawkey AJ, Ussher JM, Perz J. Negotiating sexual agency in marriage: The experience of migrant and refugee women. Health Care Women Int. 2019;40(7–9):870–97. Rice SM, Purcell R, McGorry PD, Adolescent, Young Adult Male Mental Health. Transforming System Failures Into Proactive Models of Engagement. Journal of Adolescent Health. Volume 62. Elsevier USA; 2018. pp. S9–17. Bäärnhielm S, Edlund AS, Ioannou M, Dahlin M. Approaching the vulnerability of refugees: Evaluation of cross-cultural psychiatric training of staff in mental health care and refugee reception in Sweden. BMC Med Educ. 2014;14(1). Transkulturellt centrum RS. Transkulturell hälsa och dess betydelse för ditt kliniska arbete [Internet]. [cited 2025 Jul 13]. Available from: https://www.transkulturelltcentrum.se/utbildning-och-natverk/kalender2/transkulturell-halsa-och-dess-betydelse-for-ditt-kliniska-arbete/ Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Published Journal Publication published 10 Jan, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 23 Oct, 2025 Reviews received at journal 15 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviews received at journal 09 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviewers invited by journal 03 Oct, 2025 Editor invited by journal 12 Sep, 2025 Editor assigned by journal 11 Sep, 2025 Submission checks completed at journal 11 Sep, 2025 First submitted to journal 07 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7554746","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530005274,"identity":"b07f09fa-855b-4aa1-9859-3c1761430247","order_by":0,"name":"Fitri Karimah","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Fitri","middleName":"","lastName":"Karimah","suffix":""},{"id":530005275,"identity":"e381c278-e20b-407d-85ec-37cf5ccc3fb9","order_by":1,"name":"Jordanos Tewelde McDonald","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Jordanos","middleName":"Tewelde","lastName":"McDonald","suffix":""},{"id":530005276,"identity":"c4ac6734-aa5c-4adc-aa3a-f5086b206794","order_by":2,"name":"Maria Stålgren","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Stålgren","suffix":""},{"id":530005277,"identity":"d5251619-78ff-4c58-8e57-8b68a19406c2","order_by":3,"name":"Mariano Salazar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYJCCAxCKuQFEykkwE6+FEazFmCgtDMhaEmcQUqfbfvbhgZ87bBjk2w82fvxRcy99ZjsD84cPeLSYnUk3ONh7Jo3B4Exis4TEseLc2cwMbJL4rDI7kMZwgLftMIMBQ2KDhAFbQu48oBZmHnxazj9jOPgXqEW+/2Hzj4R/CelyzAzMn//g03IjjeEwyBaGG4ltEgfbEhKkgSEmjc/7ZjeeMRyWbUvjMbjxsM2ysS/BcGYzY5tkD16HpTF/fNtmIyffn3z45o9vCfIS5w8f/vADnzVQgOxfSASNglEwCkbBKKAAAAAu603+EzOwsAAAAABJRU5ErkJggg==","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":true,"prefix":"","firstName":"Mariano","middleName":"","lastName":"Salazar","suffix":""}],"badges":[],"createdAt":"2025-09-07 07:53:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7554746/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7554746/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-13991-0","type":"published","date":"2026-01-10T15:58:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93668701,"identity":"9ab46098-b86b-47e6-9450-e5158202469a","added_by":"auto","created_at":"2025-10-16 09:33:29","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":282069,"visible":true,"origin":"","legend":"","description":"","filename":"250910HealthcareProvidersPerceptionsofMentalandSexualHealthNeedsofYoungMaleswithForcedMigrationExperiencesinStockholmRegionSwedenAPatientCenteredApproach.docx","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/07c3ec2cd6bb878e7f40495a.docx"},{"id":93669612,"identity":"2640ff23-43ad-49e3-995a-6e47be9b3566","added_by":"auto","created_at":"2025-10-16 09:41:29","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7433,"visible":true,"origin":"","legend":"","description":"","filename":"094e30fb101f4e60bfea8858d0a061fe.json","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/4a04cd2c3d5bac3ec5e77400.json"},{"id":93668695,"identity":"90710436-3c7e-43e1-93df-593e0b8e7e6c","added_by":"auto","created_at":"2025-10-16 09:33:29","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16673,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/c79c8bcccd6e69e6fe599499.docx"},{"id":93668697,"identity":"0f59bc5d-0067-43dd-adf4-09681e246639","added_by":"auto","created_at":"2025-10-16 09:33:29","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103367,"visible":true,"origin":"","legend":"","description":"","filename":"094e30fb101f4e60bfea8858d0a061fe1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/cc7ef71ccb9e3a3545f139f5.xml"},{"id":93668699,"identity":"a6d82a0b-621c-48e9-bae1-f85d29140867","added_by":"auto","created_at":"2025-10-16 09:33:29","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":53291,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/1effe857a13ff0033f6ca3e0.jpeg"},{"id":93669613,"identity":"46a72099-777f-4a97-971e-3a702eb75e18","added_by":"auto","created_at":"2025-10-16 09:41:29","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6430,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/f5fa0bc698a45a3698cca512.png"},{"id":93668702,"identity":"1d5d4278-e610-45ad-99ae-1b8f70e5e502","added_by":"auto","created_at":"2025-10-16 09:33:29","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100686,"visible":true,"origin":"","legend":"","description":"","filename":"094e30fb101f4e60bfea8858d0a061fe1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/2eef80a1026ba9ea21996eb7.xml"},{"id":93668703,"identity":"7b567612-4d63-4d66-9484-8c3529c626cf","added_by":"auto","created_at":"2025-10-16 09:33:29","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":112220,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/8d29ffe5696e05413e2dcc88.html"},{"id":100070276,"identity":"94c59676-04f0-460a-b652-65a4f9c22f22","added_by":"auto","created_at":"2026-01-12 16:17:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1428096,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/c1dd5714-d548-4c86-b0a1-a0ea792ae34b.pdf"},{"id":93668698,"identity":"c19dc37c-36e3-4536-919b-a4d90804df53","added_by":"auto","created_at":"2025-10-16 09:33:29","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16673,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7554746/v1/210fc90c21402262f51f2fda.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eHealthcare Providers’ Perceptions of Mental and Sexual Health Needs of Young Males with Forced Migration Experiences in Stockholm Region, Sweden: A Patient-Centered Approach\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2024, Sweden received 223,204 refugees under the UNHCR mandate, reflecting the country\u0026rsquo;s ongoing diversification (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). These individuals have experienced forced migration and fled their countries due to conflict, violence, or fear of persecution, seeking safety in another country (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Upon crossing an international border in search of safety, individuals typically must apply for protection from another country, and during this process, they are referred to as asylum seekers (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Sweden grants residence permits to asylum seekers recognized as refugees under Swedish legislation and EU regulations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This study explores both groups, asylum seekers and individuals with granted refugee status in Sweden, and we use the term young male with forced migration experiences throughout the study.\u003c/p\u003e\u003cp\u003eYouths, particularly those between the ages of 15 and 24 with asylum-seeking and refugee backgrounds, face extreme and difficult forced migration experiences while transitioning from adolescence to adulthood (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Globally, issues related to sexual health and mental health are significant within this group (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In general, male youths have difficulty accessing mental health care due to stigma and cultural expectations, such as traditional gender norms, which hinder their ability to be vulnerable and express emotions (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In particular, cultural and religious beliefs about mental and sexual concerns may further prevent open discussions among young males with forced migration experiences (YMFMEs) (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Furthermore, the unique sociocultural challenges they face can limit their access to health resources and information, increasing their lack of understanding and risk of negative health outcomes (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe current working definition of sexual health as described by the WHO is \u0026ldquo;\u0026hellip;a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u0026rdquo; Despite the integration of physical, emotional, and social well-being in sexual health as defined by the WHO, much youth sexual health research focuses only on physical aspects, such as sexually transmitted diseases (STDs) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), often treating mental and sexual health as separate domains and overlooking the complex interplay between them (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEngaging HCPs to explore their perspectives on the mental and sexual health needs of YMFMEs offers several advantages. First, HCPs bring their expertise and experience to the table, providing valuable insights into the healthcare challenges faced by this demographic (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Moreover, by integrating HCPs\u0026rsquo; insights, interventions can be tailored to better meet the specific needs and preferences of YMFMEs, promoting more personalized and evidence-based practices (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). For example, a study in the USA showed that differences in how patients and HCPs describe treatment goals may reflect varying perspectives on the underlying disease processes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). While patients prioritize their immediate needs and concerns, HCPs provide expertise in understanding the broader context of diseases and their treatment implications (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe sexual and mental health needs of male YMFMEs have often been overlooked, as most studies have focused on the needs of female YMFMEs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In our previous study, we reported that the sexual and mental health needs of YMFMEs followed a process of individual change over time in Sweden and were influenced by contextual factors such as social and cultural norms and health literacy (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In this study, we aimed to explore HCPs\u0026rsquo; perceptions of the sexual and mental health needs of YMFMEs and their perspectives on approaches to addressing these needs within a patient-centered framework in the Stockholm Region, Sweden. We believe that HCPs provide invaluable insights into the scientific and clinical aspects of these health concerns that may not be readily apparent to YMFMEs.\u003c/p\u003e\n\u003ch3\u003eTheoretical Framework\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe patient-centered framework serves as an exemplary model for delivering comprehensive care, especially in addressing the complex health needs of YMFMEs (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The principles of the patient-centered framework are the essential characteristics of the clinician, the clinician-patient relationship, the patient as a unique person, and the biopsychosocial perspective (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). By prioritizing characteristics such as empathy, respect, and accountability, this framework fosters a trusting and collaborative relationship between HCPs and patients, which is essential for navigating sensitive topics (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Moreover, by recognizing each patient as a unique individual with distinct needs and preferences, patient-centered care ensures that interventions are tailored to specific circumstances and experiences, promoting more effective and culturally sensitive healthcare delivery (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003eStudy Setting\u003c/h2\u003e\u003cp\u003eBetween 2013 and 2022, Sweden saw a predominance of refugees from Syria seeking protection, although Ukraine topped the list in 2022 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Other significant countries of origin include Afghanistan, Eritrea, Iraq, and Somalia (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Asylum seekers in Sweden are entitled to emergency healthcare, dental care, and healthcare that cannot wait, as well as services under the Swedish Communicable Diseases Act, including childbirth, abortion care, contraception advice, and maternity care (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Additionally, asylum seekers are entitled to an interpreter when accessing healthcare (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Asylum seekers in Sweden undergo a health assessment upon arrival at the asylum reception, offering advice, tests, and information about healthcare services in Sweden (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Asylum seekers with a granted permit will gain a new status as refugees and have the same healthcare rights as Swedish residents, with most services being free of charge (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHealth services in Stockholm, Region Sweden, including sexual and reproductive health (SRH) services, are provided mainly through public health care organized by regions (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The Youth Clinic and Men\u0026rsquo;s Clinic are examples of clinics organized by counties that provide SRH services along with mental health support (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In addition to the Youth Clinic, there are non-governmental organization (NGO) clinics that focus on mental and sexual health, such as \u003cem\u003eRiksf\u0026ouml;rbundet, f\u0026ouml;r sexuell upplysning;\u003c/em\u003e or the Swedish Association for Sexuality Education (RFSU); and the Origo Clinic, which offers counseling for youth (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Despite efforts to improve care, concerns remain regarding entitlement to health care on the basis of migration status and the need for a more comprehensive approach to individual health needs (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design and Participants’ Selection\u003c/h3\u003e\n\u003cp\u003eHCPs were selected based on work experience in delivering mental and sexual health services to YMFMEs. A minimum of 3 years of work experience in a healthcare facility that provides both sexual and mental health services was required. Because of the specific criteria for working in healthcare that provide services related to both concerns, experiences in delivering services to YMFMEs, and the COVID-19 pandemic during the data collection, snowball sampling was used to recruit participants (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This meant that the first HCP who met our specific characteristics helped us identify the others (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur research assistant (M)S and one of the investigators (JTM) initially approached potential participants via email, providing them with detailed information about the study, including its ethical considerations. Those who expressed interest were sent a written informed consent form, which they returned via email prior to data collection. The participants who consented to take part in the study received a store voucher as an appreciation.\u003c/p\u003e\u003cp\u003eThe sample size was guided by information power theory, where the size of the sample depended on the aim of the study, sample specificity, use of established theory, quality of dialogue, and analysis strategy (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). A sample of 6\u0026ndash;10 participants with specific characteristics and diverse experiences provided adequate information power (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eSemi-structured interviews were conducted from May-June 2021. Our research assistant (MS), a Swedish nurse, conducted the interviews in Swedish over Zoom and recorded them for analysis. On average, they lasted one hour. The interview guide explored HCPs\u0026rsquo; experiences and perspectives on YMFMEs' mental and sexual health, focusing on HCPs\u0026rsquo; health concerns, needs, knowledge, attitudes, misconceptions, relationships, consent, mental health coping strategies, and experiences with racism were included. Additionally, several questions probed barriers and potential improvements in healthcare services for this population group. The questions were primarily open-ended and exploratory, encouraging detailed responses. The study included nine HCPs with a range of specialties and years of experience, as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eThe data were analyzed using inductive qualitative content analysis, as described by Graneheim (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The first step of the analysis involved multiple thorough readings of the transcripts (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). JTM reviewed and transcribed the recordings in Swedish, whereas FK translated them into English by using the Word Translate feature. The translated transcripts were reviewed by JTM, a native Swedish speaker.\u003c/p\u003e\u003cp\u003eThe coding was initially performed by FK who looked at both the manifest and latent content of the text (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The codes were later discussed with the other co-authors (MS and JTM). After the initial coding was performed, codes that had something in common were clustered into categories, which later evolved into themes representing the overall ideas running through the data. The categorization and themes formulation were developed through discussion and consensus agreement. The coding process was conducted in English, utilizing OpenCode 4.03.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics of the Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;60 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e43.8 years old\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfessions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNurse (including a school nurse)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePsychiatric nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMidwives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePsychologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYears of Experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eAverage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e3\u0026ndash;22 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.8 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWorkplace\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAsylum Reception\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHigh School Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eYouth Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMen\u0026rsquo;s Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNGO Clinic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe identified three themes and their corresponding categories describing HCPs\u0026rsquo; perceptions of YMFMEs\u0026rsquo; sexual and mental health needs related to healthcare (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThemes and Categories\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTheme 1: Recognizing and incorporating the biopsychosocial interconnectedness of sexual and mental health into healthcare practices\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTheme 2:\u003c/p\u003e\u003cp\u003eAddressing gaps in health literacy, cultural norms, and expectations is crucial for fostering trust and promoting patient-centered care\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTheme 3: The impact of forced migration and discrimination on YMFMEs' mental and sexual health and the need for targeted knowledge in healthcare practices.\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eCategories\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe link between sexual and mental health identified by HCPs and the need for a holistic approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGaps in cultural norms and health literacy create misconceptions and barriers that prevent YMFMEs from seeking care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTraumatic experiences and discrimination as determinants of the mental and sexual health of YMFMEs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHCPs\u0026rsquo; limited scope in addressing the interconnectedness of sexual and mental health among YMFMEs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNegative experiences and different expectations cause YMFMEs\u0026rsquo; lack of trust and underutilization of healthcare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHCPs\u0026rsquo; need for specific knowledge about forced migration\u0026rsquo;s burden on health\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 1: Recognizing and incorporating the biopsychosocial interconnectedness of sexual and mental health into healthcare practices\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCategory 1: The link between sexual and mental health identified by HCPs and the need for a holistic approach\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eThe findings showed that sexual and mental health should not be separated because they often influence each other among YMFMEs. The participants in this study noted that psychological pressure or stress related to the forced migration experience can be a factor in sexual health complaints, or vice versa, where sexual health complaints can lead to mental distress.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;You do an assessment call, and you understand that okay, this person has erection problems and needs help for that. It is not so strange that they experience sexual illness because there are so many more factors that contribute to, uh, that there is a general illness, a mental illness that you think is the primary thing to address.\u0026rdquo;\u003c/em\u003e (HCP E, Men Clinic)\u003c/p\u003e\u003cp\u003eWe noted that the HCPs mentioned that YMFMEs\u0026rsquo; sexual health concerns are related to sexual dysfunctions such as erectile dysfunction, premature ejaculation, and low libido, as well as inner conflicts about masturbation and sexual activities before marriage, areas in which mental health concerns need to be assessed. The participants in this study also mentioned that misconceptions about sexual health can adversely affect the mental well-being of YMFMEs. For example, HCPs observed that this vulnerable group is particularly prone to feelings of guilt, shame, and fear around sexual health, as well as harsh norms related to it. Additionally, sexual assaults,which can be considered both mental and sexual issues, are prevalent among YMFMEs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCategory 2: HCPs' limited scope in addressing the interconnectedness of sexual and mental health among YMFMEs.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAlthough the relationship between sexual and mental health was frequently observed to be interconnected among YMFMEs, this study also revealed several limitations in providing holistic care for them. HCPs working at asylum receptions described that they tended to omit discussions about sexual health with YMFMEs despite discussing it with female asylum seekers. The midwives in this study described their difficulties in discussing mental illness with YMFMEs. The participants often found it difficult to discuss topics such as traumatic experiences, such as sexual assault, during their practice. The midwives mentioned that although it is part of their responsibility to refer sexual health patients with mental illness to psychiatrists, this is difficult because they do not routinely screen for mental health issues.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We do not talk so much about sexual health, I will say, and that is probably what, now when I started to get into this for this interview, I started to think about it, that we do not talk so much about it, more with women then because we talk about contraception and stuff.\u0026rdquo;\u003c/em\u003e (HCP A, asylum reception)\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: Addressing gaps in cultural norms, health literacy, and expectations is crucial for fostering trust and promoting patient-centered care.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCategory 1: Gaps in cultural norms and health literacy create misconceptions and barriers that prevent YMFMEs from seeking care.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e HCPs recognized and highlighted that cultural norms, traditional gender roles, and a lack of proper education may influence how YMFMEs respond to and seek care for sexual and mental health issues.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Beliefs and regulations about sex where you have not been allowed to explore your sexuality on your own terms without it, and this may have limited you in your sexual health. What I'm also going to say is the lack of sex education. Ehm, you have not had the opportunity to uh, assimilate knowledge about the body, bodily and sexual functions. In addition, they talk about the greater emotional connection to sex and sexuality. Uh, so there's a lot that is, that is not verbalized even to oneself or like, what to say, made conscious to oneself.\u0026rdquo;\u003c/em\u003e (HCP E, Men Clinic)\u003c/p\u003e\u003cp\u003eFurthermore, our participants revealed the complex beliefs and attitudes of YMFMEs regarding sexual health. The participants in this study reported that YMFMEs\u0026rsquo; cultural and religious beliefs often dictate that sexual activities should occur only within the context of marriage, leading to feelings of guilt and inner conflict regarding what is considered right or wrong. According to HCPs\u0026rsquo; experience in interacting with YMFMEs, many YMFMEs find it forbidden to discuss sexual health due to religious and cultural restrictions.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The common thread is low; there is low knowledge about sexuality and relationships. Or, a different kind of knowledge, and that is what we are not talking about. We often say that they do not have much knowledge about sexuality. They have relationships, but they have another. A very religiously influenced, traditional, conservative, very similar to what we had in Sweden a hundred years ago.\u0026rdquo;\u003c/em\u003e (HCP C, psychologist)\u003c/p\u003e\u003cp\u003eHCP C also observed that YMFMEs often approach sexual health issues from philosophical and moral standpoints, making discussions about some areas of some aspects of sexual health easier. HCP C observed that YMFMEs tend to absorb information about STDs more easily, as it is more about anatomy and health education, and provides less room for moralizing, making it the easiest area to educate on. However, discussing sexual health in terms of morals and values becomes challenging, as many YMFMEs believe that sexual activities should occur only within heterosexual marriage and that homosexuality is often seen as a foreign concept.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;In some areas, it is easier. STDs, anatomy, uh, and so on. However, in some areas, it is much more difficult, when it comes to morality, and when it comes to values.\u0026rdquo;\u003c/em\u003e (HCP C, psychologist)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIn addition to cultural and religious values, deeply ingrained gender norms also make some areas challenging to discuss, particularly consent and contraception. The midwives in this study perceived that YMFMEs may lack an understanding of consent for sexual relations or may even be unaware that consent exists. The midwives in this study observed that many YMFMEs come from patriarchal societies where women are subordinate and men are seen as decision-makers.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eSo... it is because they often come from patriarchal societies. Uh, so, so it is like this stereotypical image of relationships. Who's going to do what, and then consent can sometimes be quite difficult to understand, because of that.\u0026rdquo;\u003c/em\u003e (HCP G, a midwife)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eOur participants argued that contraceptive use is another area that is influenced by traditional gender norms. YMFMEs\u0026rsquo; lack of knowledge and misconceptions regarding contraception are often caused by shifting contraceptive responsibility to women. In many cases, HCPs observed that YMFMEs believed that contraception is solely the responsibility of women, as they leave decisions to women and may even hold easy attitudes towards abortion if pregnancy occurs.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, it can, it can be for example\u0026hellip; they said \u0026lsquo;Uh, do not have to, do not need to wear a condom because... No, on the one hand, maybe it is the girl's responsibility\u0026rdquo;\u003c/em\u003e (HCP G, a midwife)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eImportantly, we found that traditional gender norms were also noted among HCPs, who often shifted the responsibility of contraception and pregnancy prevention to women. While female asylum seekers and refugees often receive information about contraception, discussions about sexual health with their male counterparts are less common. The lack of discussion in this area is due to HCPs\u0026rsquo; omission of sexual health topics during health screening.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Uh, and even though I see myself as a very conscious person, I obviously also put that responsibility (contraception) on the woman as well.\u0026rdquo;\u003c/em\u003e (HCP B, asylum reception)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAdditionally, traditional gender norms harm YMFMEs\u0026rsquo; ability to discuss and seek mental health care. The psychologist and psychotherapist in this study noted that it was not easy for YMFMEs to express themselves and verbalize their mental concerns to seek support. From HCPs' experience, many YMFMEs feel stigmatized when referred to psychiatrists, and it is considered taboo in tradition to ask YMFMEs about their mental well-being. According to the HCPs\u0026rsquo; experiences in this study, YMFMEs often mention stereotypical gender roles where men should be \u0026ldquo;macho\u0026rdquo; and not subjected to oppression, making it difficult for them to acknowledge or address their mental health struggles.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;There are extremely stereotypical gender roles. In addition, the man is the one who is supposed to be like, what can I say, macho, uh, should deliver eh... Finances and money; he should have a good status in his working life and should not be subjected to violence and oppression. So... It is very difficult for the self-image to, to kind of define it (mental health struggles) right from the start.\u0026rdquo;\u003c/em\u003e (HCP G, a midwife)\u003c/p\u003e\u003cp\u003eA lack of proper education may influence how YMFMEs respond to and seek care related to sexual and mental health. The HCPs in this study reported that YMFMEs are generally not accustomed to psychotherapy and may refuse to attend counseling.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Therefore,they have been really, really hesitant about, to... Uh, medications. I feel that many people are very skeptical about psychotropic drugs. And, so, and you do not want it to change your brain.\u0026rdquo;\u003c/em\u003e (HCP D, a school nurse)\u003c/p\u003e\u003cp\u003eOur study participants also implied that the lack of reliable sources of sexual health education in YMFMEs\u0026rsquo; home countries was a factor influencing misconceptions about sexual health issues.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Um, there's no one, uh, who's talked about being taught or given information about sexual health. Eh, many people have not been to school, but even those who have been to school have never had information. So what you have heard is based on what other people have said. Um, so very limited knowledge about sexual health.\u0026rdquo;\u003c/em\u003e (HCP I, asylum reception)\u003c/p\u003e\u003cp\u003e\u003cb\u003eCategory 2: Negative experiences and different expectations cause YMFMEs\u0026rsquo; lack of trust and underutilization of healthcare.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study revealed a significant challenge as perceived by HCPs from the language barrier, as interpreters are not available at every clinic, and there is uncertainty about the accuracy of interpretation. The participants who worked at asylum reception expressed concerns about the interpreter's potential biases, which could affect the quality of the information conveyed.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Actually, first of all, those of us who are with an interpreter. It is very difficult because you never know what they're interpreting, how much information will get through and how much information will get through. And, if it is the right information or not, you still try to confirm by always asking the question again, have you understood? Can you explain to me again? Uh, then it confirms by repeating, then I know aha but then it has got the right information.\u0026rdquo;\u003c/em\u003e (HCP I, asylum reception)\u003c/p\u003e\u003cp\u003eIn their interviews, HCP D highlighted that negative experiences with healthcare can occur due to HCPs' lack of understanding of YMFMEs\u0026rsquo; experiences.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;And quite a few people have pretty bad experiences of health care because they have met sometimes like that, uh, maybe at the health center who maybe does not understand your migration experience at all.\u0026rdquo;\u003c/em\u003e (HCP D, a school nurse)\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 3: The impact of forced migration and discrimination on YMFMEs' mental and sexual health and the need for targeted knowledge in healthcare practices\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCategory 1: Traumatic experiences and discrimination as determinants of the mental and sexual health of YMFMEs\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOur study participants described how the traumatic experiences of YMFMEs in their home countries and during their migration journeys significantly shaped their psychological well-being. The participants in this study often mentioned the uncertainty and threats faced during their journey, along with the possibility of becoming slaves or going without food, exacerbating YMFMEs\u0026rsquo; mental health concerns, with PTSD, depression, and integration difficulties being major issues upon arrival in their host countries. Uncertainty of residence status and socioeconomic factors were also often mentioned by HCPs in this study, further contributing to YMFMEs' mental health concerns. In addition to mental health struggles, YMFMEs face difficulties in finding partners because of eputational issues and discrimination.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes... I mean, it is..... There is a picture of uh... It is a kind of stereotype. Partners' parents, absolutely. They are bad guys; dangerous; they come from dangerous countries. Uh, they have a dangerous religion. Without even meeting the person.\u0026rdquo;\u003c/em\u003e (HCP G, a midwife)\u003c/p\u003e\n\u003ch3\u003eCategory 2: HCPs’ need for specific knowledge about forced migration’s burden on health\u003c/h3\u003e\n\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHCPs in this study mentioned that they require specific knowledge about the burden of forced migration on health and migration in general to effectively care for YMFMEs. For example, training is needed to understand the needs of different groups with refugee backgrounds and the unique experiences and challenges that YMFMEs face. Another reflection was that knowledge of the above factors can help HCPs recognize their biases and beliefs which might influence their interactions with YMFMEs.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I also think that these health centers there....uh, that, that you should have a specific, maybe a little specific competence as well. Those who work should have slightly more knowledge and understanding of what... The patients we meet, what have they been through in the past, where do they come from, and why do they expect this? Perhaps you should be a little sharper, more trained, or have specific experience. At the asylum reception, we have that. However,at the health centers in general, it does not seem like that.\u0026rdquo;\u003c/em\u003e (HCP A, asylum reception)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur main findings are reflected in the following themes: 1) recognizing and incorporating the biopsychosocial interconnectedness of sexual and mental health into healthcare practices; 2) addressing gaps in health literacy, cultural norms, and expectations is crucial for fostering trust and promoting patient-centered healthcare; and 3) the impact of forced migration and discrimination on YMFMEs\u0026rsquo; mental and sexual health and the need for targeted knowledge in healthcare practices.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eRecognizing and Incorporating the Biopsychosocial Interconnectedness of Sexual and Mental Health into Healthcare Practices\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eOur research highlights the biopsychosocial interconnectedness of sexual and mental health among YMFMEs in Stockholm, Region, Sweden, and emphasizes the importance of incorporating these aspects into healthcare practices. The HCPs in this study perceived that misconceptions and stigma surrounding sexual health can exacerbate mental health issues among YMFMEs. This includes feelings of guilt, shame, and fear, as well as inner conflicts regarding sexual activities and sexuality. This finding aligns with a study conducted in Sweden that highlighted how cultural and religious beliefs lead to fear and shame around sexual activities, although they did not mention its correlation with mental health (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother important finding is that healthcare providers do not effectively address mental and sexual health issues among YMFMEs. The nurses working at the asylum reception in this study may choose not to discuss sexual health concerns with YMFMEs despite consistently doing so with females during asylum seekers' health assessments upon arrival. A study in Sweden proposed doubt and thought that it is another HCP\u0026rsquo;s responsibility as a reason for nurses\u0026rsquo; hesitancy in discussing sexual health concerns, which may also apply to the nurses in this study.(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOn the other hand, HCPs working at sexual health-focused clinics may struggle with mental health screening and addressing traumatic events, despite their acknowledgment of referring patients with mental health issues as their role. Many healthcare facilities in Sweden already incorporate both mental and sexual health in one clinic, indicating that the interconnectedness of both concerns is well recognized (\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, in our study, some nurses who work in asylum reception do not discuss sexual health concerns with men, and midwives in youth clinics do not screen for mental health effectively in practice. A study in Sweden emphasized that mental health concerns, especially violence, are difficult topics for midwives and that they do not feel well-equipped to screen for them (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The study also mentioned that the existing mental health screening guide was not implemented by midwives, which is similar to the finding of our study (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecognizing and incorporating the interconnectedness of sexual and mental health into healthcare practices aligns with the biopsychosocial perspective principle within the patient-centered framework, which emphasizes understanding health issues within the broader context of patients' biological, psychological, and social factors (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). From this perspective, we suggest that mental and sexual health are interconnected aspects of YMFME\u0026rsquo;s overall well-being. This may involve screening for both mental and sexual health concerns during assessments and providing integrated interventions that address both aspects simultaneously.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAddressing gaps in health literacy, cultural norms, and expectations is crucial for fostering trust and promoting patient-centered care.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study also highlights how cultural and religious beliefs, as well as traditional gender norms, significantly impact YMFMEs\u0026rsquo; perceptions and practices related to sexual and mental health. Struggles with feelings of guilt and taboos surrounding sexual health, particularly due to the belief that sexual activities should occur only within heterosexual marriage, were also observed in a study conducted to map sexual health values among Jordanian and Syrian youth (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). In this study, HCPs highlighted how these beliefs shape YMFMEs\u0026rsquo; perceptions of healthcare services and affect their comfort level when discussing sensitive topics.\u003c/p\u003e\u003cp\u003eAdditionally, the HCPs in our study often mentioned that traditional gender roles make discussions about consent, contraception, and mental health challenging, as men are often expected to be dominant decision-makers, and that pregnancy prevention is the sole responsibility of women. This finding aligns with another study that mentioned that consent as a concept is difficult to digest in patriarchal societies (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). We found that traditional gender norms are particularly concerning because they are observed not only among YMFMEs but also among some HCPs. For example, an HCP working in asylum reception tends to discuss sexual health only with female asylum seekers.\u003c/p\u003e\u003cp\u003eThe participants in this study also reported that traditional gender norms harm YMFMEs\u0026rsquo; ability to seek and accept support for their mental health issues. Many HCPs in our study perceived that the notion that men should be \u0026ldquo;macho\u0026rdquo; and not oppressed hinders YMRs\u0026rsquo; willingness to express their vulnerabilities. This finding aligns with a study conducted in Australia, which revealed that traditional masculine ideals discourage emotional expression and cause many stigmas around men and vulnerabilities, with people perceiving seeking help as a weakness. (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe core concept of the patient-centered framework is to encourage collaboration between HCPs and patients (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Involving patients in treatment decisions and asking for their opinions about their health concerns may help empower patients from vulnerable populations and make them feel understood (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). A lack of understanding of how to provide health services can impact low levels of patient satisfaction and non-compliance with recommended treatment, especially among patients with diverse ethnic and racial backgrounds (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe impact of forced migration and discrimination on YMFMEs' mental and sexual health and the need for targeted knowledge in healthcare practices\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eThis research also highlights the important role of forced migration and integration in the mental and sexual health needs of YMFMEs and emphasizes the need for HCPs to consider these factors in providing better care for this population. All the participants in this study highlighted the need for specialized training to equip them with the competence to address the mental and sexual health concerns of YMFMEs effectively.\u003c/p\u003e\u003cp\u003eIn the Stockholm Region, Sweden, only HCPs working in asylum reception and some HCPs in mental health care have the opportunity to receive training specifically to care for asylum seekers and refugees (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). The training has a good outcome and increases empathy for vulnerable groups (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Unfortunately, we found that other HCPs who also meet and provide services for individuals with asylum-seeking backgrounds, for example, those who work at the Youth Clinics, are not as well equipped to care for YMFMEs. Another principle from the patient-centered framework is seeing the patient as a unique person, which means providing care that is tailored based on individuals' needs and values (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), as well as taking forced migration burden into account, is essential for better care.\u003c/p\u003e\u003cp\u003eIn Region Stockholm, such training is already available and offered free of charge by Transkulturellt Centrum. One example is the course \u003cem\u003e\u0026ldquo;Transkulturell h\u0026auml;lsa och dess betydelse f\u0026ouml;r ditt kliniska arbete\u0026rdquo;\u003c/em\u003e (Transcultural Health and Its Relevance to Your Clinical Practice), which addresses how forced migration affects physical and mental health and how to navigate challenges in cross-cultural clinical encounters (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). We recommend that access to training in transcultural health be expanded beyond specialized units.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe qualitative approach allowed for an in-depth exploration of HCPs\u0026rsquo; perspectives and experiences. Additionally, including multiple HCPs from different backgrounds and settings enhanced the credibility and richness of the findings. While this study provides valuable insights into the complex interplay between mental health, sexual health, and forced migration, several limitations should be acknowledged. The study focused specifically on HCPs\u0026rsquo; perspectives and experiences, which may not fully represent the perspectives of YMFMEs themselves regarding their sexual and mental health needs.\u003c/p\u003e\u003cp\u003eWhile the qualitative approach offers an in-depth understanding of unique needs, it also has limitations, such as the potential for subjective interpretation and difficulty in generalizing findings to a larger population. This study only offers HCPs subjective perspectives on their experiences managing and observing YMFMEs. Additionally, there are notable disadvantages to relying solely on HCPs\u0026rsquo; perspectives. One concern is the risk of stereotyping, where the diverse needs and individual differences among YMFMEs may be overlooked, perpetuating biases based on cultural or demographic factors. Moreover, there is a limitation in the depth of understanding when exclusively relying on HCP perspectives. HCPs\u0026rsquo; views, influenced by personal experiences and professional biases, may not fully capture the backgrounds and diverse needs of YMFMEs. Therefore, while valuable, HCPs\u0026rsquo; perspectives should be complemented by direct engagement with YMFMEs to ensure the development of patient-centered interventions.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions and recommendations","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003cp\u003eIn conclusion, this study highlights the need for HCPs to address the complex interplay among forced migration, integration, mental health, and sexual health among YMFMEs. Adopting a holistic approach that considers cultural dynamics, gender norms, and education and incorporating a patient-centered framework can significantly improve care. Encouraging collaboration between HCPs and YMFMEs can empower YMFMEs by involving them in treatment decisions and respecting their unique cultural backgrounds, which enhances their satisfaction and compliance. Additionally, structured multidisciplinary training for HCPs can equip them with the necessary knowledge and sensitivity to better address the health needs of YMFMEs. The lack of direct input from YMFMEs themselves is a critical drawback, as it may result in interventions that do not align with YMFMEs\u0026rsquo; unique needs and preferences. Therefore, while valuable, HCP perspectives should be complemented by direct engagement with YMFMEs to ensure the development of patient-centered interventions.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the\u0026nbsp;Swedish Ethical Review Authority, Dnr: 2019-01159. This study was conducted in accordance with The Helsinki Declaration.\u0026nbsp;Before participation,\u0026nbsp;our team approached the participants via email and sent them information about the study,\u0026nbsp;including ethical considerations. When the participants agreed to participate, both verbal and written informed consent were obtained. The\u0026nbsp;participants were fully informed about the purpose of the study, emphasizing the voluntary nature of their involvement. To ensure anonymity, pseudonymization of the data was used to protect the participants\u0026rsquo; identities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRelevant data and information is provided in the manuscript and supplementary materials. Complete transcripts and personal data are not publicly available due to these contained information that could compromise research participant privacy. Deidentified dataset may be requested to the corresponding author ([email protected]) upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Region Stockholm (Stockholm County Council) (Grant number 232100-0016). Open access funding was provided by Karolinska Institutet.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFK analyzed the interview data and wrote original draft of the manuscript. JTM wrote the interview guidelines, recruited the participants, reviewed the language translation, and participated in theme formulation. JTM also reviewed and edited the manuscript. M.St\u0026aring;lgren recruited the participants and did the interviews. M.Salazar conceptualized the study, wrote the interview guidelines and participated in theme formulation. M.Salazar \u0026nbsp;also reviewed and edited the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank to the study participants who have participated in the interviews, the professionals at RFSU (\u003cem\u003eRiksf\u0026ouml;rbundet f\u0026ouml;r Sexuell Upplysning /\u0026nbsp;\u003c/em\u003eSwedish Association for Sexuality Education) and the Knowledge Centre for Sexual Health at Region Stockholm for providing feedback in terms of the interview guide. We are also grateful for the non-governmental organization and youth associations for helping with recruiting participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThe UN Refugee Agency (UNHCR). 2024. Refugee Data Finder.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe UN. Refugee Agency. Refugees. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUNCHR. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unhcr.org/asylum-seekers\u003c/span\u003e\u003cspan address=\"https://www.unhcr.org/asylum-seekers\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Who is an \u0026lsquo;asylum-seeker\u0026rsquo;?.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Swedish Migration Agency. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.migrationsverket.se/English/Private-individuals/Protection-and-asylum-in-Sweden/Applying-for-asylum/Asylum-regulations.html\u003c/span\u003e\u003cspan address=\"https://www.migrationsverket.se/English/Private-individuals/Protection-and-asylum-in-Sweden/Applying-for-asylum/Asylum-regulations.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2023. Asylum regulations.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePfarrwaller E, Suris JC. Determinants of health in recently arrived young migrants and refugees: A review of the literature. 9, Italian J Public Health. 2012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGlobal Refugee Youth Consultations. We Believe in Youth. 2016.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEdwards WM, Div M, Coleman E. Defining Sexual Health: A Descriptive Overview. Volume 33. Archives of Sexual Behavior; 2004.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSatinsky E, Fuhr DC, Woodward A, Sondorp E, Roberts B. Mental health care utilization and access among refugees and asylum seekers in Europe: A systematic review. Health Policy (New York). 2019;123(9):851\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaczkowski W, Swartout KM. Exploring gender differences in sexual and reproductive health literacy among young people from refugee backgrounds. Cult Health Sex. 2020;22(4):369\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMason-Jones AJ, Nicholson P. Structural violence and marginalization. The sexual and reproductive health experiences of separated young people on the move. A rapid review with relevance to the European humanitarian crisis. Public Health. 2018;158:156\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorris MD, Popper ST, Rodwell TC, Brodine SK, Brouwer KC. Healthcare barriers of refugees postresettlement. J Community Health. 2009;34(6):529\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Defining Sexual Health.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoreau C, K\u0026aring;gesten AE, Blum RW. Sexual dysfunction among youth: an overlooked sexual health concern. BMC Public Health. 2016;16(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeiler A, Bj\u0026auml;rt\u0026aring; A, Ekdahl J, Wasteson E. Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden. Soc Psychiatry Psychiatr Epidemiol. 2019;54(5):543\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Aring;kerman E, Larsson EC, Ess\u0026eacute;n B, Westerling R. A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden. Sex Reproductive Healthc. 2019;19:64\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcKeary M, Newbold B. Barriers to care: The challenges for Canadian refugees and their health care providers. J Refug Stud. 2010;23(4):523\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKotovicz F, Getzin A, Vo T. Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists. J Patient Cent Res Rev. 2018;5(1):28\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCol NF, Solomon AJ, Springmann V, Garbin CP, Ionete C, Pbert L, et al. Whose Preferences Matter? A Patient-Centered Approach for Eliciting Treatment Goals. Med Decis Making. 2018;38(1):44\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTewelde McDonald J, Fayzi B, Laktinah M, Ekstr\u0026ouml;m AM, Salazar M. Sweden has changed me: a qualitative study exploring the sexual health needs and associated mental health aspects of young male former unaccompanied minors, asylum seekers and refugees in Region Stockholm. Swed BMJ Open. 2024;14(12):e080514.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScholl I, Zill JM, H\u0026auml;rter M, Dirmaier J. An integrative model of patient-centeredness-A systematic review and concept analysis. Volume 9. PLoS ONE. Public Library of Science; 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Swedish Migration Agency. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.migrationsverket.se/English/About-the-Migration-Agency\u003c/span\u003e\u003cspan address=\"https://www.migrationsverket.se/English/About-the-Migration-Agency\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e/Current-topics/The-Swedish-Migration-Agency-Answers/Migrationsverket-svarar/2023-10-20-The-Swedish-Migration-Agency-answers--Who-comes-to-Sweden---and-why.html. 2023. The Swedish Migration Agency answers: Who comes to Sweden \u0026ndash; and why?.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Swedish Migration Agency. :~:text=Right%20to%20healthcare, of%20healthcare%20you%20can%20receive. Healthcare for Asylum Seekers; 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.migrationsverket.se/English/Private-individuals/Protection-and-asylum-in-Sweden/While-you-are-waiting-for-a-decision/Health-care.html#\u003c/span\u003e\u003cspan address=\"https://www.migrationsverket.se/English/Private-individuals/Protection-and-asylum-in-Sweden/While-you-are-waiting-for-a-decision/Health-care.html#\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePacheco LL, Jonzon R, Hurtig AK. Health assessment and the right to health in Sweden: Asylum seekers\u0026rsquo; perspectives. PLoS ONE. 2016;11(9).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaroudi M. Beyond supply and demand: a new ecological framework for understanding the access of young migrants to sexual and reproductive health services in Sweden. Glob Health Action 2023;16(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRegion Stockholm. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ungdomsmottagningarna.se/other-languages/english/om-um/\u003c/span\u003e\u003cspan address=\"https://www.ungdomsmottagningarna.se/other-languages/english/om-um/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Youth Centre.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRegion Stockholm. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.stockholmsmansmottagning.se/en\u003c/span\u003e\u003cspan address=\"https://www.stockholmsmansmottagning.se/en\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Stockholms Manmottagning.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrigo Region Stockholm. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://etjanster.stockholm.se/Origo/hur-kan-vi-hjalpa-dig\u003c/span\u003e\u003cspan address=\"https://etjanster.stockholm.se/Origo/hur-kan-vi-hjalpa-dig\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Hur kan vi hj\u0026auml;lpa dig?.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Swedish Association for Sexuality Education (RSFU). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rfsu.se/en/this-is-rfsu/in-english/about/\u003c/span\u003e\u003cspan address=\"https://www.rfsu.se/en/this-is-rfsu/in-english/about/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. The Swedish Association for Sexuality Education (RSFU).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTucker CM, Arthur TM, Roncoroni J, Wall W, Sanchez J, Patient-Centered. Culturally Sensitive Health Care. Vol. 9, American Journal of Lifestyle Medicine. SAGE Publications Inc.; 2015. pp. 63\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eValerio MA, Rodriguez N, Winkler P, Lopez J, Dennison M, Liang Y, et al. Comparing two sampling methods to engage hard-to-reach communities in research priority setting. BMC Med Res Methodol. 2016;16(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26(13):1753\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGraneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElo S, Kyng\u0026auml;s H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmroussia N. Providing sexual and reproductive health services to migrants in Southern Sweden: a qualitative exploration of healthcare providers\u0026rsquo; experiences. BMC Health Serv Res. 2022;22(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaunam\u0026auml;ki N, Engstr\u0026ouml;m M. Registered nurses\u0026rsquo; reflections on discussing sexuality with patients: Responsibilities, doubts and fears. J Clin Nurs. 2014;23(3\u0026ndash;4):531\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHenriksen L, Garnweidner-Holme LM, Thorsteinsen KK, Lukasse M. It is a difficult topic - A qualitative study of midwiveś experiences with routine antenatal enquiry for intimate partner violence. BMC Pregnancy Childbirth. 2017;17(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGausman J, Othman A, Daas I, Hamad I, Dabobe M, Langer A. How Jordanian and Syrian youth conceptualize their sexual and reproductive health needs: a visual exploration using concept mapping. Cult Health Sex. 2021;23(2):176\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHawkey AJ, Ussher JM, Perz J. Negotiating sexual agency in marriage: The experience of migrant and refugee women. Health Care Women Int. 2019;40(7\u0026ndash;9):870\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRice SM, Purcell R, McGorry PD, Adolescent, Young Adult Male Mental Health. Transforming System Failures Into Proactive Models of Engagement. Journal of Adolescent Health. Volume 62. Elsevier USA; 2018. pp. S9\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eB\u0026auml;\u0026auml;rnhielm S, Edlund AS, Ioannou M, Dahlin M. Approaching the vulnerability of refugees: Evaluation of cross-cultural psychiatric training of staff in mental health care and refugee reception in Sweden. BMC Med Educ. 2014;14(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTranskulturellt centrum RS. Transkulturell h\u0026auml;lsa och dess betydelse f\u0026ouml;r ditt kliniska arbete [Internet]. [cited 2025 Jul 13]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.transkulturelltcentrum.se/utbildning-och-natverk/kalender2/transkulturell-halsa-och-dess-betydelse-for-ditt-kliniska-arbete/\u003c/span\u003e\u003cspan address=\"https://www.transkulturelltcentrum.se/utbildning-och-natverk/kalender2/transkulturell-halsa-och-dess-betydelse-for-ditt-kliniska-arbete/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Healthcare Providers, Mental Health, Sexual Health, Young Males with Forced Migration Experiences, Patient-Centered Framework","lastPublishedDoi":"10.21203/rs.3.rs-7554746/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7554746/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eYoung males with forced migration experiences (YMFMEs) face numerous health challenges, particularly in terms of sexual and mental health. The disparity in health beliefs and knowledge between healthcare providers (HCPs) and vulnerable groups can exacerbate these challenges. Sexual health encompasses both physical and psychosocial aspects; however, the interplay between these two aspects is often overlooked in research and clinical practice. Additionally, existing research has focused predominantly on females, neglecting the specific needs of YMFMEs. Engaging HCPs provides expert insights into the unique healthcare challenges faced by YMFMEs, enabling the development of tailored, evidence-based interventions that address their specific needs. We believe that utilizing a patient-centered framework is crucial for effectively addressing these needs.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eThis study aims to explore HCPs\u0026rsquo; perceptions of the sexual and mental health needs of YMFMEs and their perspectives on approaches to addressing these needs within a patient-centered framework in the Stockholm Region, Sweden.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis qualitative study was conducted in the Stockholm Region, Sweden, between May and June 2021 using semi-structured interviews. Nine health care providers were included in the study. The interview transcripts were analyzed using inductive content analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003e We identified three themes that describe HCPs\u0026rsquo; perceptions of YMFMEs\u0026rsquo; sexual and mental health needs in healthcare; 1) recognizing and incorporating the biopsychosocial interconnectedness of sexual and mental health into healthcare practices; 2) addressing gaps in health literacy, cultural norms, and expectations is crucial for fostering trust and promoting patient-centered care; and 3) the impact of forced migration and discrimination on YMFMEs' mental and sexual health and the need for targeted knowledge in healthcare practices.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study highlights the importance of HCPs understanding the complex relationship between forced migration, mental health, and sexual health for YMFMEs and integrating this awareness into healthcare practices.\u003c/p\u003e","manuscriptTitle":"Healthcare Providers’ Perceptions of Mental and Sexual Health Needs of Young Males with Forced Migration Experiences in Stockholm Region, Sweden: A Patient-Centered Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-16 09:33:25","doi":"10.21203/rs.3.rs-7554746/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-23T04:53:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T10:46:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42918122044757131787184992322441100046","date":"2025-10-13T09:47:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-09T14:58:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230215955846920585278580806694552601697","date":"2025-10-09T10:54:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-03T14:46:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-12T21:52:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-11T11:33:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-11T11:32:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-09-07T07:40:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccb763ba-88ca-44b9-a32a-3579a98d656b","owner":[],"postedDate":"October 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:12:48+00:00","versionOfRecord":{"articleIdentity":"rs-7554746","link":"https://doi.org/10.1186/s12913-025-13991-0","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-01-10 15:58:32","publishedOnDateReadable":"January 10th, 2026"},"versionCreatedAt":"2025-10-16 09:33:25","video":"","vorDoi":"10.1186/s12913-025-13991-0","vorDoiUrl":"https://doi.org/10.1186/s12913-025-13991-0","workflowStages":[]},"version":"v1","identity":"rs-7554746","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7554746","identity":"rs-7554746","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}