Structuring for Culture: Exploring Organizational Preconditions for Culturally Appropriate Dementia Care in Sweden-a Thematic Analysis

Migration and demographic change have increased the number of people with dementia who live in secondary countries, intensifying the need for culturally attuned and person-centred dementia care. This study aimed to explore how staff and unit managers understand and enact cultural responsiveness in everyday care practices. 24 in-depth interviews were conducted with staff working in dementia care settings, and the data were analysed using reflexive thematic analysis. The results show a persistent organizational disconnect that limits the integration of cultural considerations into person-centred care. Participants described a common assumption that cultural identity becomes less relevant as dementia progresses, which contributed to cultural needs being overlooked in care planning and daily interactions. Staff reported lacking the knowledge, training, and structural support needed to work in culturally informed ways, despite expressing a desire to provide individualized care. Two overarching themes and four subthemes illustrate how organizational priorities, resource constraints, and implicit norms shape care practices. Staff highlighted challenges related to language barriers, unfamiliar traditions, and differing expectations around family involvement. They also described tensions between cultural adaptation and budget constraints, noting that efforts to personalize care were often overshadowed by the need to maintain “budget in balance.” Although some staff used their own cultural or linguistic knowledge to support residents, these efforts were informal and sometimes led to feelings of being overused as cultural intermediaries. Managers, in contrast, often viewed cultural matching based on ethnicity as a practical and cost-effective strategy, revealing differences in how cultural competence was understood across organizational levels. The findings demonstrate the need for stronger organizational structures to support culturally responsive dementia care, including targeted education, reflective spaces, and clearer guidelines. Strengthening institutional support may enable staff to better address cultural needs and uphold person-centred values in increasingly multicultural care environments.