Review Reports - Highly Educated Migrants in Norway: Identity and Well-Being During Delayed Workforce Entry—A Qualitative Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review.

Reviewer reflexivity: I reviewed this manuscript primarily from a public health and qualitative reporting perspective, using COREQ as the reporting framework. I am not a specialist in Norwegian migration policy, so comments on policy context are limited to clarity, relevance, and alignment with the study findings.

Review:

This manuscript explores how highly educated migrants in Norway experience delayed entry into professionally relevant employment and how this affects identity, well-being, belonging, and integration. The authors conducted semi-structured interviews with eight migrants enrolled in the introductory program and analyzed the data using reflexive thematic analysis informed by Social Identity Theory. The study identifies three themes: the importance of professional employment, the emotional toll of credential or residential limbo, and social isolation from Norwegian society. For reporting quality, the COREQ checklist was used and comments are below. The comments are meant to strengthen an already strong paper. The topic is relevant to migration health and public policy.

A summary of the recommendations are as follows:

Clarify researcher reflexivity and interviewer role. The authors mention that the team included Norwegian and migrant-background scholars and that reflexivity was practiced during the research process, but the manuscript does not clearly identify who conducted the interviews, the interviewer’s credentials, occupation, gender, prior relationship with the participants (if any), or assumptions related to the topic. A short reflexivity subsection or additional information in section 2 would satisfy COREQ.
Provide the interviewer guide or more detail about it. The manuscript states that an interview guide was used, but the guide itself is not included. Since the study relies on semi-structured interviews, the authors should provide the interview guide at least as a supplementary file or include the main questions in the manuscript. It would be helpful to know if this was piloted (COREQ item). This corresponds to lines 248-251.
Clarify the coding and analysis process. The analysis section would be stronger with more detail about how the coding was conducted. The manuscript states that the material was coded manually, that codes were refined into themes and subthemes, and that peer debriefing was used. However, it is unclear how many researchers coded the data, whether coding was conducted independently or collaboratively, how disagreements or alternative interpretations were handled, and how Social Identity Theory shaped the coding process. A coding tree or table showing the movement from codes to themes would improve analytic transparency and would serve as a quick reference to the reader. Lines 256-263.
Consultative: Consider adding “qualitative study” (or similar) in the title to signal the design.

Reporting Guideline Checklist:

COREQ Citation: Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042

COREQ item	COREQ Question	Where found in manuscript	Reviewer note
1. Interviewer/facilitator	Which author or authors conducted the interview or focus group?	Methods state that interviews were conducted, with two through an interpreter, but the manuscript does not identify which author or researcher conducted them. See data collection description at lines 242–254.	The authors should state who conducted the interviews. Suggestion: identify the interviewers by their initials.
2. Credentials	What were the researcher’s credentials? For example: PhD, MD, RN, MPH.	Author affiliations are listed at lines 4–8, but the manuscript does not report the researchers’ credentials.	Per COREQ item #2, it would be helpful to indicate the credentials of the researchers somewhere in the manuscript.
3. Occupation	What was the researcher’s occupation at the time of the study?	The manuscript states that the research team included Norwegian and migrant-background scholars with experience in qualitative research and migration studies at lines 264–266, but it does not specify the interviewer’s occupation. From 615-616 it appears to include graduate students.	The authors could add the interviewer’s role or occupation at the time of the interviews, such as master’s student, PhD candidate, postdoctoral researcher, faculty member, or clinician. This is partially found in the IRB statement circa lines 615-616.
4. Gender	Was the researcher male, female, or another gender identity, where relevant?	Participant gender is reported at lines 222–226, but the gender of the interviewer or facilitator is not reported.	Per COREQ #4, suggested to include the gender of the research team. Suggest to include this within the 2.4 data analysis section where reflexivity is discussed.
5. Experience and training	What experience or training did the researcher have in qualitative research?	The manuscript states that the research team had experience in qualitative research and migration studies at lines 264–266.	Satisfied
6. Relationship established	Was a relationship established with participants before study commencement?	Recruitment is described at lines 214–220, including a presentation at the program site and later email contact	Partially Satisfied. Recruitment is described, but the authors should clarify whether the interviewer had any prior relationship with participants or the introductory program.
7. Participant knowledge of the interviewer	What did participants know about the researcher? For example: personal goals, reasons for doing the research.	Participants received information about the study and provided consent at lines 217–220. Reflexivity is discussed 265-269 that included their position to the participants.	Partially Satisfied. Participants received study information, but it is not fully clear what they knew specifically about the interviewer.
8. Interviewer characteristics	What characteristics were reported about the interviewer or facilitator? For example: bias, assumptions, reasons and interests in the research topic.	Reflexivity and positionality are mentioned generally at lines 264–268.	Partially Satisfied. Reflexivity is mentioned, but the authors should provide more detail on interviewer assumptions, positionality and interests.
9. Methodological orientation and theory	What methodological orientation was stated to underpin the study? For example: grounded theory, discourse analysis, ethnography, phenomenology, content analysis.	The manuscript describes a qualitative approach grounded in a hermeneutic phenomenological paradigm, informed by Social Identity Theory, at lines 236–241. Reflexive thematic analysis is described at lines 256–258. Additionally, the SIT is further described in 191-203.	Satisfied.
10. Sampling	How were participants selected? For example: purposive, convenience, consecutive, snowball.	The manuscript states that a purposive sample of eight highly educated adult migrants was recruited from a larger group of approximately 60 participants at lines 214–216.	Satisfied.
11. Method of approach	How were participants approached? For example: face-to-face, telephone, mail, email.	Participants were approached through a brief presentation in English and Norwegian at the program site, and interested individuals were later contacted by email at lines 216–219.	Satisfied.
12. Sample size	How many participants were in the study?	The manuscript reports eight participants at lines 214–215 and describes them further at lines 222–234.	Satisfied.
13. Non-participation	How many people refused to participate or dropped out? What were the reasons?	The manuscript describes the recruitment pool and approach at lines 214–220, but does not report how many people declined, dropped out, or were excluded. In lines 245-246 the authors explain why some may have been hesitant to participate (language barriers).	Partially Satisfied. The authors could describe how many (or if any) people declined, did not respond, or were excluded, if available.
14. Setting of data collection	Where was the data collected? For example: home, clinic, workplace.	Interviews were conducted in October and December 2023 at the site of the Introductory Program for migrants in Kristiansand, Norway, at lines 242–244.	Satisfied.
15. Presence of non-participants	Was anyone else present besides the participants and researchers?	The manuscript states that two interviews were supported by interpreters at lines 246–248.	Satisfied. However, if others were present, that should be made known.
16. Description of sample	What are the important characteristics of the sample? For example: demographic data, date.	Participant characteristics are reported at lines 222–234, including age range, countries of origin, migration reasons, length of stay, gender, education/profession, accreditation status, and program participation.	Satisfied.
17. Interview guide	Were questions, prompts, or guides provided by the authors? Was the interview guide pilot tested?	The manuscript states that interview questions were outlined in an interview guide and covered belonging, professional continuity or loss, and work- or education-related activities at lines 248–251.	The interview guide is mentioned but not included. The authors should provide it as a supplement and say whether it was pilot tested.
18. Repeat interviews	Were repeat interviews carried out? If yes, how many?	The manuscript describes the interview procedure at lines 242–254; no repeat interviews mentioned. In line 264 “no additional interviews” were necessary.	Satisfied. (It is understood no repeat interviews were conducted)
19. Audio/visual recording	Did the research use audio or visual recording to collect the data?	All interviews were digitally recorded with participant consent at lines 253-254.	Satisfied.
20. Field notes	Were field notes made during or after the interview or focus group?	The manuscript describes data collection at lines 242–254, but does not report whether field notes were made. As written it is understood the sole source of data collection are the recorded transcripts and the demographics of the informants.	Satisfied.
21. Duration	What was the duration of the interviews or focus groups?	Most interviews lasted approximately one hour at lines 246–247.	Satisfied.
22. Data saturation	Was data saturation discussed?	The team discussed data saturation and concluded that no additional interviews were necessary because no major new insights or themes emerged in the last interviews at lines 260–264.	Satisfied.
23. Transcripts returned	Were transcripts returned to participants for comment or correction?	The manuscript states that interviews were transcribed verbatim at lines 251–254, but does not say whether transcripts were returned to participants.	The authors should state whether transcripts were returned to participants for review. If they were not, that is fine, but it should be stated per COREQ.
24. Number of data coders	How many data coders coded the data?	The manuscript states that all interviews were reviewed, the full material was coded manually, and peer debriefing was used at lines 256–263, but it does not say how many coders were involved. Line 609 appears that AB did the work, but it is unclear who else.	The authors should say how many people coded the data and identify them by initials.
25. Description of the coding tree	Did the authors provide a description of the coding tree?	Initial codes were refined into themes and subthemes through iterative review and reorganization at lines 258–262, but no coding tree is provided.	A coding tree, codebook excerpt, or theme-development table would make the analysis easier to follow.
26. Derivation of themes	Were themes identified in advance or derived from the data?	Themes and subthemes were developed from initial codes through iterative review and reorganization at lines 258–262.	Satisfied.
27. Software	What software, if applicable, was used to manage the data?	The manuscript states that the full material was coded manually at lines 258–260.	Satisfied.
28. Participant checking	Did participants provide feedback on the findings?	The analysis process is described at lines 256–269, but the manuscript does not report whether participants gave feedback on the findings.	The authors should state whether participant checking was done. If not, they can simply say it was not conducted. This goes with item #23.
29. Quotations presented	Were participant quotations presented to illustrate the themes or findings? Was each quotation identified? For example: participant number.	Participant quotations are presented throughout the Findings section and identified by participant number. Examples appear at lines 291–307, 312–324, 349–360, and 398–410.	This is well done.
30. Data and findings consistent	Was there consistency between the data presented and the findings?	The three themes are introduced at lines 282–285 and supported with quotations in the Findings section: work identity at lines 291–307, usefulness/contribution at lines 308–324, limbo/distress at lines 325–390, and social isolation at lines 393–428.	Satisfied. The authors could strengthen this further by adding a theme table with sample quotations. This recommendation goes with item #25.
31. Clarity of major themes	Were major themes clearly presented in the findings?	Three major themes are clearly named at lines 282–285: professional employment, credential/residential limbo, and social isolation from Norwegian society.	Satisfied.
32. Clarity of minor themes	Was there a description of diverse cases or discussion of minor themes?	Subthemes are presented under Theme 1 at lines 286–290. A contrasting example of relief after receiving a positive residency decision appears at lines 382–390.	Satisfied.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear editor and dear authors!
Thank you for the opportunity to review the manuscript “Highly Educated Migrants in Norway: Identity and Well-Being During Delayed Workforce Entry”. The manuscript deals with the important and timely topic of how migrants’ delayed integration into labour market impacts their mental health.

The study looks particularly at the group of highly educated migrants and their experiences with the Norwegian labour market. Workforce affiliation can reduce loneliness by fostering shared-identity and belonging. Less is known about how highly educated migrants experience the absence of professionally meaningful work and how prolonged exclusion from work-related activities shapes health, identity and well-being during the integration process. The study addresses this gap by looking at how highly educated migrants in Norway experience the relationship between identity and work-related activities during the integration process.

Methods

The study is a part of a work package in a larger research project Integration for Health. The current study is a sub-study of a work package exploring how work-related intervention affected health and integration among highly-educated migrants in Bergen, Norway, with a particular emphasis on migrants with health professional backgrounds. It is not common to reveal the exact locations where the intervention has taken place. In this manuscript, Bergen and Kristiansand – two larger Norwegian cities, are pointed out as the locations for the interventions and the following data collection. I wonder why providing this information was necessary and how exactly it will benefit the field?

Moreover, providing information that 8 highly educated migrants were recruited from a larger group of participants in the Introductory program in Kristiansand may jeopardize their anonymity especially when the sample is so small and their country of origin (Ukraine, Turkey, Zimbabwe and Mexico), age (29-55), gender, education and reason for migration are also included in the manuscript. This is way too detailed information that can easily jeopardize the anonymity of the participants. In the presentation of the findings, informants’ professions and gender are included in the quotations, see for example lines 299-301 and lines 319-324. I wonder if this has been sufficiently anonymized? Is teaching/teacher the informant’s real profession and if so, what measures have been taken in order to not identify whom of the 8 informants this quotation comes from?

The study has a qualitative design and is grounded in the hermeneutic phenomenological paradigm, which seems appropriate given the study’s aim of exploring migrants’ perceptions and experiences. The social identity theory informs the interview guide, data collection, and data analysis.

Line 254 states that translated segments were checked for accuracy to ensure fidelity to participants’ meaning. Does this mean that only part of the interview transcripts and not the full interviews have been transcribed? And if this was the case, how was the coding done?

Theme 2 on page 7 seem way too long compared to theme 1, which has two clearly defined sub-themes. It seems that the analytical work with theme 2 is not complete. For example, line 349 presents a direct answer to one of the interview questions rather than a sub-theme developed through coding and categorization of the material. The overall impression of theme 2 is that it is unfinished and that too much personal information about the participants is revealed. The same is the situation with theme 3 where informants’ direct answers to the interview questions are presented rather than sub-themes developed through coding and categorization. The material is simply not thoroughly analysed and organized into meaningful analytical units.

Language

Some sentences are too long (see for example lines 81-85; 176-180) and difficult to read. To improve reader-friendliness, long sentences can be divided into shorter ones.

Conclusion

The study has the potential to make an important contribution to the field of public health and inform policy development. However, the manuscript needs to undergo major revisions before it is publishable. The interview material needs to be thoroughly analysed and better organized into meaningful analytical units, to better communicate nuances in themes 2 and 3. Moreover, the selected quotes need to be much better anonymized in order to protect the informants’ right to anonymity. The material presented in this manuscript contains way too much identifiable information about the participants’ age, gender, profession, education, civil status, country of origin, reason for migration etc. and not at least, location for the interviews and the intervention.

Comments on the Quality of English Language

See the full report.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The paper examines the relationship between professional identity loss and well-being outcomes among highly educated migrants in Norway. The research findings contribute to expanding the body of knowledge within the field of migration health research and suggest what policy makers should do within public health to improve public health-oriented integration strategies and connect them with labor market structures. The key question the author aims to answer is how highly educated migrants experience the absence of professionally meaningful work and how prolonged exclusion from work-related activities shapes health, identity, and well-being during the integration process.

Although the paper is methodologically sound, its main weakness is that only eight interviews were conducted, involving participants from four completely different countries located across four (or three) distinct continents. The respondents were educated in six different fields, and their migration trajectories and ways of obtaining legal status varied, which was not mentioned in the paper.

With such a heterogeneous sample (varying countries, migration statuses, and professions), all eight stories are completely unique, making it difficult to identify common patterns; thus, we can speak of seven isolated "case studies." Consequently, achieving data saturation is challenging, despite the authors' claims to have reached it.

Specifically, migration status, country of origin, and profession profoundly shape an individual's experience regarding identity, well-being/quality of life, and health. Therefore, alongside unemployment within one's profession as the key indicator, these other indicators should also be addressed.

Consequently, this study, which was conducted within the larger Int4Healtsh project, should be treated as an exploratory and pilot study aimed at mapping the field and generating hypotheses to be tested in future, thematically focused research.

Although the authors state on page 5 that „WP3 more concretely examines how a work-related intervention affected health and integration among highly educated migrants in Bergen, with a particular emphasis on migrants with health professional bacgrounds“, the Findings and Discussion chapters do not distinguish this category from others, nor is it emphasized.

In the Policy Recommendations chapter, the authors failed to mention that the recognition of prior qualifications is crucial for professional reintegration and identity continuity, which is later stated in the conclusion.

In the Conceptual Framework, the social identity theory should be elaborated in slightly more detail, and the authors on whose theoretical propositions the article relies should be specified.

It is also suggested that the authors move Bygnes’ concept of mobility dissonance and the concept of Ulysses Syndrome from the Discussion chapter to another section, such as State of the Art or Conceptual Framework.

For greater clarity, the authors should briefly (in a few sentences) outline the key reasons why the respondents left their home countries, where they had been highly satisfied with their jobs which served as a source of pride, purpose, and identity (p. 12). This implies that job satisfaction is not the only factor, and that an unfavorable social environment can be a source of stress, deep frustration, and a motive for migration.

Furthermore, it should be taken into account that individuals without migration experience can also experience anxiety, shaken self-confidence, and feelings of worthlessness when they lose their jobs or do not work in positions matching their qualifications. Therefore, the claim that the inability to access adequate employment in line with one's qualifications is responsible for the loss of identity should be placed within a broader context and elaborated more cautiously, attempting to explain the correlation between professional and personal identity

While this exploratory study is primarily limited by a small, diverse sample of eight participants representing different origins, legal statuses, and careers, its findings remain highly plausible. This is due to a strong, unifying theme: every participant is a highly educated individual sharing the common struggle of being unemployed or underemployed in the host country. Therefore, rather than aiming for broad generalization, this study serves as an illustrative inquiry into the subjective experiences of professional underutilization, examining its profound effects on the identity and well-being of highly qualified migrants while unemployed.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Thank you very much for the opportunity to review this interesting article.

For better than the current to published , some issues for improvement.

Abstract: Please show the study design of this study. This study only shown the tools or method to collected data (semi-structured interview it isn't the study design).
Introduction: Please show the data of migrants in Norway and the difference between each migrant from each country, each SDoHs.
Methods:
3.1 Please explain the study design; In topic Data Collection and Setting found that A qualitative approach grounded in the hermeneutic phenomenological paradigm, please explain this issue, Is this a kind of qualitative study?
3.2 How did you collected data from 60 to 8 participants. Why this study wasn't selected the participants who have lower education?
Data Analysis and results: This study used thematic Analysis, Theme 1: The Importance of Professional Employment, have two sub‑themes (developed in relation to the importance of professional employment, and revolved around a need to be involved with something that provided them with a sense of meaning in their lives) for the participants that not Professional, How did the results?
Discussion: Please discussion with your Policies and Norway's National system for accept migrants to work in each work that same with characteristics of participant and compare with many studies.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 5 Report

Comments and Suggestions for Authors

General Comments

This manuscript addresses a timely and relevant public health issue by examining how delayed entry into the labor market affects identity, social belonging, and well-being among highly educated migrants in Norway. The study is grounded in an appropriate theoretical framework, employs a qualitative methodology that is consistent with its objectives, and contributes to expanding the understanding of social determinants of health related to migration and labor market integration processes.
The manuscript is well structured, demonstrates argumentative coherence, and establishes a meaningful dialogue between the empirical findings and Social Identity Theory. Furthermore, it provides valuable implications for public policies aimed at migrant integration and health promotion.

Introduction

The introduction provides a solid contextualization of migration and its relationship with health, employment, and well-being. The research problem is clearly defined, and the rationale for the study is supported by relevant and up-to-date literature.

Suggestions for improvement:

Reduce repetitions concerning the concepts of professional identity, belonging, and integration.
More explicitly highlight the originality and specific contribution of the study to the existing literature.
Condense some sections of the literature review to improve readability and narrative flow.

Theoretical Framework

The theoretical framework is appropriately grounded in Social Identity Theory and offers a consistent basis for understanding and interpreting the findings.

Suggestions for improvement:

Expand the discussion on potential limitations of the theoretical framework adopted.
Incorporate complementary perspectives addressing structural factors related to migrants’ labor market and social integration.

Methodology

The methodology is consistent with the proposed objectives and provides a satisfactory description of the data collection and analysis procedures. Ethical considerations have also been appropriately addressed.

Suggestions for improvement:

Provide a more detailed explanation of the criteria used to determine theoretical saturation.
Further discuss the potential implications of the predominance of female participants in the sample.
Include additional reflection on the use of interpreters and its possible implications for data generation and interpretation.

Results

The findings are clearly presented, organized into coherent thematic categories, and supported by relevant participant quotations.

Suggestions for improvement:

Shorten some lengthy quotations to enhance readability.
Avoid excessive theoretical interpretation within the results section in order to maintain a clearer distinction between results and discussion.
Explore potential differences among participants according to length of residence in Norway or professional background.

Discussion

The discussion represents one of the manuscript’s main strengths, establishing a strong dialogue between the findings and contemporary scientific literature.

Suggestions for improvement:

Minimize the repetition of arguments already presented in the results section.
Further deepen the analysis of institutional and structural factors influencing migrants’ professional integration.
Discuss the potential applicability of the findings beyond the Norwegian context.

Limitations

The limitations section appropriately acknowledges the main constraints of the study and demonstrates a commitment to scientific transparency.

Suggestions for improvement:

Expand the discussion regarding the transferability of the findings.
Explore potential biases related to participant recruitment.
Further discuss the implications of the small sample size for the scope and interpretation of the findings.

Conclusions

The conclusion adequately revisits the study objectives and main findings, emphasizing their relevance to public health and migrant integration policies.

Suggestions for improvement:

Adopt more cautious language when making broader generalizations.
More clearly emphasize the original contributions of the study.
Highlight potential directions for future research arising from the findings.

Final Recommendation

The manuscript demonstrates scientific relevance, methodological consistency, and makes an important contribution to the field of Public Health, particularly regarding the social determinants of health among migrant populations. The suggestions provided are intended to strengthen specific aspects of the manuscript’s writing and analytical depth without compromising its overall quality.

Recommendation: Accept with revisions.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf