Cumulative navigation burden in health and social care among First-Generation immigrants aged 41–67 in Finland, Sweden and Norway

Purpose This study aims to examine how first-generation immigrants aged 41–67 manage the routine demands of using health and social care in Finland, Sweden and Norway, and how repeated demands shape practical access from midlife into the early stages of later life. Design/methodology/approach The study draws on 29 individual semistructured interviews conducted in successive waves between 2021 and 2024. Reflexive thematic analysis combined inductive coding with theoretically informed interpretation. The three-country design is contextual rather than comparative. Findings Participants described access as continuing work: interpreting official communication, monitoring digital channels, arranging appointments, explaining needs, following referrals and deciding whether further contact justified the effort. Repetition generated fatigue and uncertainty. Family assistance enabled contact but could reduce privacy, while postponement and silence conserved effort yet could delay care. Practical implications Health and social care organisations should record users’ preferred spoken and written languages, arrange qualified interpreters when needed without defaulting to relatives, and maintain telephone and face-to-face routes alongside digital channels. Health and social care professionals should provide a clear written next-step plan after appointments, referrals and transitions between services. Originality/value The study develops cumulative navigation burden as a study-derived concept describing how informational, administrative and communicative work can build up across repeated service encounters. It connects processual access, everyday information practices, administrative burden, treatment workload and cumulative inequality.