Prevalence and factors associated with healthcare avoidance during the COVID-19 pandemic among the Sámi in Sweden: the SámiHET study

ABSTRACT

The aim of this population-based cross-sectional study was to assess the prevalence of healthcare avoidance during the COVID-19 pandemic and its associated factors among the Sámi population in Sweden. Data from the “Sámi Health on Equal Terms” (SámiHET) survey conducted in 2021 were used. Overall, 3,658 individuals constituted the analytical sample. Analysis was framed using the social determinants of health framework. The association between healthcare avoidance and several sociodemographic, material, and cultural factors was explored through log-binomial regression analyses. Sampling weights were applied in all analyses. Thirty percent of the Sámi in Sweden avoided healthcare during the COVID-19 pandemic. Sámi women (PR: 1.52, 95% CI: 1.36–1.70), young adults (PR: 1.22, 95% CI:1.05–1.47), Sámi living outside Sápmi (PR: 1.17, 95% CI: 1.03–1.34), and those having low income (PR: 1.42, 95% CI:1.19–1.68) and experiencing economic stress (PR: 1.48, 95% CI: 1.31–1.67) had a higher prevalence of healthcare avoidance. The pattern shown in this study can be useful for planning future pandemic responses, which should address healthcare avoidance, particularly among the identified vulnerable groups, including the active participation of the Sámi themselves.

KEYWORDS:

• Sámi
• Indigenous
• COVID-19
• healthcare avoidance
• fears
• economic stress
• Sweden

Acknowledgments

We are grateful to the Sámi parliament in Sweden and the Public Health Agency of Sweden who funded the SámiHET study. The authors also would like to thank the participants for their valuable contributions to the SámiHET study. Ollu giitu!

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The raw/processed dataset analysed in this study cannot be shared publicly due to legal and ethical reasons.

Author contributions

MTD conceived the topic, analysed and interpreted the data, and drafted the manuscript. JPS and MSS conceived the original SámiHET study and collected the data, read and commented the article draft. LMN supervised MTD and oversaw the analysis, reviewed the interpretation and findings. All authors approved the final version of article.

Abbreviations and acronyms

WHO: World Health Organization, COVID-19: Coronavirus Disease 2019, USA: United States of America, RMR: Reindeer Mark Register, SER: Sámi Electoral Roll, HET: Health on Equal Terms, RHC: Reindeer Herding Community, VIF: Variance Inflation Factor.

Study design

Cross-sectional population-based study.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/22423982.2023.2213909.

Footnote

Overview of education level classification as characterised by statistics Sweden [22].

Low level education (codes 100–206) includes primary education shorter than 9 years [10].

Medium level education (codes 310–527) includes secondary education and post-secondary education shorter than 2 years.

High level education (codes 530–640) includes 3 years post-secondary education up to the level of doctoral education.

Additional information

Funding

The Sámi parliament in Sweden and the Public Health Agency of Sweden funded the data collection for the SámiHET study; Sámediggi (the Sámi Parliament in Sweden) [DNR 2020-1074]; Public Health Agency of Sweden [01401-2021.2.3.2]. The author(s) report no additional funding associated with the work featured in this article.