Global trends suggest that more people have migrated than ever before. In 2020, about 281 million people were international migrants.1 Most of these people were in the age of 15–64 years and about 15 per cent of migrants were below the age of 19 years. To provide high-quality healthcare services to migrants, the WHO states that culture is an important factor in the service delivery of refugee- and migrant-sensitive health systems.2 What does this statement entail? To what does culture refer to and how can it be conceptualised?

In political and scientific discourse alike, culture is alternatively conceptualised as an individual background variable, a cognitive scheme, a discursive construction or as a contextual characteristic. In encounters between migrant children and professionals working within health services, culture can be understood in all these conceptions. There is ample research recognising the importance of culture in such interaction,3–5 yet in the health and welfare domain, the focus is primarily on culture as a background variable or cognitive scheme. Additionally, culture is sometimes highlighted in relation to challenges such as when the professionals and children lack a joint culture and/or common language.5 By the same token, professionals tend to view culture mainly as a characteristic of the child in the encounter, whereas the professionals are conceived to be ‘acultural’,4 or culture is considered as a background variable explaining various health outcomes and healthcare needs among the children.6

Moreover, the culture of a child and their family is also stressed as something to acknowledge in encounters. It is also stressed that culture of children and families should be considered when providing care and accounting for their needs.3 Such ‘cultural considerations’ encompass, for instance, ethnic traditions, cultural norms and values, or religious beliefs impacting on interaction in general and the provision of healthcare in particular. ‘Cultural considerations’ also include aspects related to limited resources available in low-income or rural areas, as well as language and communication ‘barriers’. In relation to the ‘cultural considerations’ of children, findings in the same review of healthcare for paediatric patients show that the education of healthcare professionals tends to be ethnocentric, Eurocentric and without cultural self-reflection, that is, what Stier describes as discursive blind spots or biases.7 Thus, rather than counteracting ‘problems’ or misunderstandings or merely focusing on the culture of children and parents, such biases in education or among professionals, for instance, in school healthcare services, may fuel constructions of other needs as ‘different’ leaving healthcare professionals without competence to encounter children with needs, values and cultures outside ‘the norm’.8

Against this background, there is a need for research addressing culture as a discourse, social construction and interactional accomplishment as well as a need to collate research on the culture(s) within the healthcare services targeting children’s health and well-being beyond the paediatric context. One such healthcare service devoted to promoting health and preventing disease among children is the school health services (SHS). In an international context, SHS is multiprofessional, although the most common profession is school nurses.9 Among other professions, it includes doctors, psychologists and social workers. In Sweden, SHS consists mainly of school nurses, school doctors/physicians, school social workers, school psychologists and special education teachers. Out of these, school nurses are the largest number of professionals working solely within SHS (2910 persons in year 2021) followed by school social workers (2830 persons in year 2021).10 These two professional groups often have an office at the school and are available for spontaneous drop-in meetings where the children can discuss issues relating to their health and/or well-being. School doctors and school psychologists mainly serve as consultants, often to several schools within a limited geographical area (municipality or region). Although the work content of each profession contains aspects unique to the Nordic and Swedish context, similarities have been found with professionals’ work internationally.9 11 12 School nurses and school doctors worldwide encounter children to assess and screen the children’s health and development, vaccinate children against diseases and provide health education.9 Similarly, school social workers worldwide encounter children facing similar problems, for example, physical and psychological health issues, poverty, issues concerning attendance, dropout and motivation as well as decaying neighbourhoods and racism.12 Also, school psychologists are available in many countries13 and work with similar activities.14 By being available in the school setting, these professionals can assist children with issues related to health and development in the children’s everyday life, making it interesting to scientifically investigate these professionals’ understanding of culture when interacting with children.

Previous studies have been conducted studying preschool teachers’, teachers’, school nurses’, school social workers’ and school psychologists’ encounters with children, and have highlighted culture as relevant, especially in encounters with children who have migrated15–20 and in relation to race or ethnicity.21 Yet there is a lack of reviews collating research regarding school health professionals’ (ie, school nurses, school social workers, school doctors and school psychologists) understanding of culture. A preliminary search for existing scoping reviews within this area of research has been conducted by the research group (SLS and CL) in the Cochrane Library, Epistemonikos, Internationa HTA database, Open Science Framework, Social Care Online and PROSPERO. The searches confirmed that no scoping reviews are or have been conducted previously on this topic.

This review aims to identify, describe and analyse existing research on school health professionals’ (ie, school nurses, school social workers, school doctors and school psychologists) understanding of culture.

What research has been conducted on school nurses’, school social workers’, school doctors’ and school psychologists’ understanding of culture?

What research has been conducted on school nurses’, school social workers’, school doctors’ and school psychologists’ cultural self-understanding?

What research has been conducted on intercultural interaction and communication in the context of school health professionals’ encounters with students and their families?

In what geographical contexts (ie, countries) have research concerning school nurses’, school social workers’, school doctors’ and school psychologists’ understanding of culture been conducted?

How has culture been conceptualised in research concerning school nurses’, school social workers’, school doctors’ and school psychologists’ understanding of culture?