Healthcare providers' perceptions of immigrant patients' values about sexual and reproductive rights: a cross-sectional comparison with immigrants' self-reported values.

BACKGROUND: Stereotypes about immigrant patients in healthcare can hinder effective communication, erode trust, and contribute to discrimination and poorer health outcomes. Culturally competent healthcare aims to improve communication and build trust by acknowledging patients' cultural backgrounds, but it also risks overemphasising cultural differences and reinforcing stereotypes. To address this tension, this study examines how healthcare providers in Sweden perceive the values of immigrant patients regarding sexual and reproductive rights and compares these perceptions with the actual values held by newly arrived immigrants. METHODS: The study draws on two large-scale surveys conducted in 2020-2021. The first survey was conducted among newly arrived immigrants in Sweden and included eighteen questions on moral issues related to sexual and reproductive rights, such as abortion, contraception, and sex before marriage. Responses from newly arrived immigrants originating from the Middle East, North Africa, and the Horn of Africa (N = 992) were used in this study. The second survey was conducted among healthcare providers working in sexual and reproductive healthcare (N = 1,041) and asked how they believed immigrant patients from corresponding regions would respond on the same set of issues. Results from the two surveys were compared using three complementary approaches: examining the distribution of healthcare providers' perceptions, assessing their accuracy relative to immigrants' self-reported values, and testing for systematic biases in the direction of these perceptions. RESULTS: Of the eighteen included issues, healthcare providers' perceptions aligned with immigrants' self-reported issue positions in only six cases. The greater the proportion of immigrants holding liberal rather than conservative positions, the more often providers' perceptions were incorrect (Pearson's r = -0.73). Healthcare providers often erroneously assumed that immigrant patients hold very conservative values, a pattern most pronounced on issues where immigrants held the most liberal views. CONCLUSIONS: To avoid stereotypes and promote equitable, culturally competent healthcare, providers need to develop a better understanding of immigrants' values and how these are shaped. Our findings reveal a tendency to underestimate the liberal values of immigrant patients, particularly on issues related to sexual and reproductive rights, thereby reinforcing bias and contributing to essentialist thinking in clinical practice.