Alf Trojan

Benefits of self-help groups: A survey of 232 members from 65 disease-related groups

This paper gives a report on the benefits of self-help groups as depicted by 232 members from 65 different disease-related groups. Intensive interviews and participant observation enabled us to formulate a questionnaire with 125 mostly standardized questions. The questions referred mainly to motives for membership, working procedures within the groups, goals and effectiveness, outcome of participation and need for outside support. The focus of this paper will be on what the members reported about the changes and effects induced by their participation in self-help groups. The interviewed group members reported a wide variety of goals. These were classified into two categories according to their range. Goals directed towards the group or group members were achieved (at least partly) by more than 90%. Goals directed towards persons outside the group (e.g. to change opinions of the family or of the professional system) were mentioned by about two thirds of the interviewed members. About three quarters of them achieved these goals at least partly. The effects of participation were grouped into the following categories. 1--Impact on disease-related stress (positive health effects, general enlargement of competence, general social activation); 2--impact on the relationship with family and friends (relationship with partner, changes in personal network); 3--impact on patient behaviour and professional services (general enlargement of competence in relation to the professional care system, social activation in relation to the professional care system, utilization of professional services). Most of the members reported considerable positive changes in these dimensions. Negative impacts were mentioned by a very small minority (between 1 and 4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluating the implementation of the WHO Healthy Cities Programme across Germany (1999–2002)

The WHO Healthy Cities Project (1988) is a well-known example of the setting-based approach to health promotion. Developed as a framework for translating the key principles of the Ottawa Charter for Health Promotion (1986) into practice, it is best characterized as a process for successfully encouraging healthy public policy. In 2001, the German Healthy Cities Network (HCN) commissioned a survey of the 52 local Healthy Cities programme Coordinators (HCC) to monitor progress and identify strengths and weaknesses associated with its implementation. Most (90%; 47/52) HCC participated in the survey. Several positive aspects of the Health Cities Programmes (HCP) in Germany were identified: during the first 5 years, it expanded rapidly; project coordinators felt highly engaged, despite limited resources; a combination of traditional and innovative approaches was adopted and applauded; and almost 75% of HCC felt that their efforts had been beneficial. Nonetheless, the following shortcomings were identified: increased resources required; greater clarification of concepts and strategies at the local level; stronger commitment to the Nine-Point Programme of Action; greater integration within the national HCN and the local political administrative system (PAS); better programme documentation and evaluation. In conclusion, the HCN in Germany has expanded and developed since its inception 20 years ago. German HCP will only improve if professionalism and quality of local work are improved, particularly in terms of strengthening their influence on the local PAS and on public policies.

Self-help friendliness: A German approach for strengthening the cooperation between self-help groups and health care professionals

Public and patient involvement in social and health care has proceeded in many civil societies. Depending on the legislations on national and community levels, citizens and patients have a greater say in shaping social and health care. In Germany, the patient involvement by self-help organizations at the macro level (national level and level of federal states) has significantly developed over the last ten years. At the meso level, however, the patient involvement is neither such far nor such systematically developed. The concept of self-help friendliness (SHF) in health care is a patient centred model that allows the development and implementation of patient participation in different health care institutions: hospitals, ambulatory medical care, public health institutions, rehabilitation facilities etc. In a series of projects on SHF we have (1) analysed the needs and wishes of self-help groups for cooperation with health care professionals as well as their experience, (2) gathered facilitators and barriers concerning the cooperation between self-help groups and hospitals, (3) developed a framework concept for SHF in hospitals including eight quality criteria for measuring SHF, and (4) implemented the framework of SHF in about 40 health care institutions (www.selbsthilfefreundlichkeit.de). Further projects followed: development of an instrument for measuring SHF in hospitals, integration of SHF-criteria in quality management systems in inpatient care as well as in out-patient care, and transferring SHF to a) medical ambulatory care, b) public health departments, and c) rehabilitation facilities. Considering advantages and shortcomings of the approach, we can summarize that implementing SHF is feasible, transferable and a helpful measure for promoting patient centeredness in health care.

Integration von Selbsthilfezusammenschlüssen in das Qualitätsmanagement im ambulanten und stationären Versorgungsbereich

ZusammenfassungDie Idee, Einrichtungen der Gesundheitsversorgung als besonders selbsthilfefreundlich zu kennzeichnen, ist zuerst für Krankenhäuser aufgegriffen worden. Hieraus entstand ein vom Bundesverband der Betriebskrankenkassen (BKK BV) unterstütztes Projekt in Hamburg mit dem Titel „Selbsthilfefreundliches Krankenhaus“. Parallel dazu sind aus einem Kreis erfahrener Selbsthilfeunterstützer erste Überlegungen entwickelt worden, um Selbsthilfefreundlichkeit als Kernelement von Patientenorientierung auch in das Qualitätsmanagement von Arztpraxen zu implementieren. Die beiden in diesem Beitrag vorgestellten Modelle zeigen unseres Erachtens, dass die Hoffnung berechtigt ist, dass nicht nur professionelle, sondern auch nutzerorientierte Qualitätsstandards für Gesundheitsdienstleistungen in die Qualitätsentwicklung sowohl im stationären als auch im ambulanten Bereich einfließen und dass in den vergangenen Jahren weitere Fortschritte bei der gemeinsamen Qualitätsverbesserung erzielt wurden. Die neuen Entwicklungen könnten jedoch auch unerwünschte Nebenwirkungen im Sinne einer Überforderung der Selbsthilfe haben.AbstractThe idea of introducing a special label for “self-help-friendly“ institutions was first developed for hospitals. A demonstration project (BKK BV, the German Federal Association of Company Health Insurance Funds) was launched and organized by the local contact point for self-help groups in Hamburg. Shortly thereafter, a group of experienced self-help supporters started to implement self-help friendliness in quality management systems for ambulatory care. These endeavours, presented in this article, prove that not only professional but also user-based quality standards are becoming more and more common in quality development processes of health care services. The general legislative and political conditions for these developments have considerably improved over the past few years. This will be the foundation for a new quality of the doctor-patient relationship.

Kunden- beziehungsweise Patientenzufriedenheit

ZusammenfassungPatientenzufriedenheit konnte sich neben anderen Qualitätsfaktoren als fester Bestandteil von Qualitätsmanagement etablieren. Auch wenn das Konstrukt theoretisch noch nicht ausreichend fundiert scheint und zusätzlich methodische Diskurse die Literatur durchziehen, können Patientenbefragungen Aussagen über das subjektive Erleben eines Krankenhausaufenthaltes liefern und im Sinne einer Defizitanalyse zu Verbesserungen in den Kliniken beitragen. Kritisch zu diskutieren bleibt im Rahmen des vorliegenden Beitrags das Konzept der Kundenzufriedenheit für Patienten, die theoretische Einbettung der empirischen Befunde, die Minderung falsch-hoher Zufriedenheitsangaben und die Nutzung von risikoadjustiertem vs. naivem Benchmarking der Daten. Dieses soll den theoretischen Diskurs weiterführen und gleichzeitig Anhaltspunkte bieten für die Planung einer methodisch fundierten Patientenbefragung.AbstractRecently, the concept of patient satisfaction has been established as an essential part of the quality management of hospitals. Despite the concept’s lack of theoretical and methodological foundations, patient surveys on subjective hospital experiences contribute immensely to the improvement of hospitals. What needs to be considered critically in this context is the concept of customer satisfaction for patients, the theoretical integration of empirical results, the reduction of false satisfaction indications and the application of risk-adjusted versus naïve benchmarking of data. This paper aims to contribute to the theoretical discussion of the topic and to build a basis for planning methodologically sound patient surveys.Recently, the concept of patient satisfaction has been established as an essential part of the quality management of hospitals. Despite the concepts lack of theoretical and methodological foundations, patient surveys on subjective hospital experiences contribute immensely to the improvement of hospitals. What needs to be considered critically in this context is the concept of customer satisfaction for patients, the theoretical integration of empirical results, the reduction of false satisfaction indications and the application of risk-adjusted versus naïve benchmarking of data. This paper aims to contribute to the theoretical discussion of the topic and to build a basis for planning methodologically sound patient surveys.

Health Literacy und Selbstmanagement im Kontext von Kooperation und Integration

Kaum ein Begriff hat in den letzten Jahren eine so grose Verbreitung in den Gesundheitswissenschaften gefunden wie der der Health Literacy (im Folgenden: HL) (Nutbeam 2000; Kickbusch 2000; Nutbeam 2008). Der exact phrase term „health literacy“ fuhrt in PubMed zu 4.834 Treffern (4.2.2016) und ist uber die Jahre hinweg exponentiell steigend.

An integrated action plan as a structurally preventive approach in the social space: the socially oriented prevention programme Lenzgesund in a disadvantaged district in Hamburg-Eimsbüttel

AbstractAimDevelopment and evaluation of an integrated action plan on health promotion in a disadvantaged district by a public private partnership of the local health authority and a research project of the University Medical Center of Hamburg funded by the German Ministry of education and research (prevention research).Subject and methodsWith the research projects, two major goals have been formulated that refer to the well-known Public Health Action Cycle:Development of district-related small-scale health reports in view of benefits for process and outcome control, as well as situation analysis.Development and testing of an evaluation method for setting-related prevention/health promotion (“capacity building”). The “science practice project” consists of a considerable work plan that is structured by work packages. It is based on a mix of quantitative and qualitative methods (secondary statistical analyses, expert interviews, interviews with residents, etc.). Results have so far been published in two “district diagnosis” reports and other publications as well.ResultsAn “integrated concept for fields of action” for social areas can be defined as inter-sectoral or coordinated actions of departments—and dynamic management and action instrument for local actors. By implementing the strategic concept, aims of the integrated fields of action are to be met as well as new goals, which have developed during the course the programme. Core quality criteria and requirements for a sustainable integrated action are presented.ConclusionSuccessful courses of action to improve quality of life in disadvantaged districts ask for integrated action plans due to complex problems on the one hand, and manifold relations and constellations between involved actors on the other.

[Integration of self-help associations into the quality management of outpatient and inpatient health care].

ZusammenfassungDie Idee, Einrichtungen der Gesundheitsversorgung als besonders selbsthilfefreundlich zu kennzeichnen, ist zuerst für Krankenhäuser aufgegriffen worden. Hieraus entstand ein vom Bundesverband der Betriebskrankenkassen (BKK BV) unterstütztes Projekt in Hamburg mit dem Titel „Selbsthilfefreundliches Krankenhaus“. Parallel dazu sind aus einem Kreis erfahrener Selbsthilfeunterstützer erste Überlegungen entwickelt worden, um Selbsthilfefreundlichkeit als Kernelement von Patientenorientierung auch in das Qualitätsmanagement von Arztpraxen zu implementieren. Die beiden in diesem Beitrag vorgestellten Modelle zeigen unseres Erachtens, dass die Hoffnung berechtigt ist, dass nicht nur professionelle, sondern auch nutzerorientierte Qualitätsstandards für Gesundheitsdienstleistungen in die Qualitätsentwicklung sowohl im stationären als auch im ambulanten Bereich einfließen und dass in den vergangenen Jahren weitere Fortschritte bei der gemeinsamen Qualitätsverbesserung erzielt wurden. Die neuen Entwicklungen könnten jedoch auch unerwünschte Nebenwirkungen im Sinne einer Überforderung der Selbsthilfe haben.AbstractThe idea of introducing a special label for “self-help-friendly“ institutions was first developed for hospitals. A demonstration project (BKK BV, the German Federal Association of Company Health Insurance Funds) was launched and organized by the local contact point for self-help groups in Hamburg. Shortly thereafter, a group of experienced self-help supporters started to implement self-help friendliness in quality management systems for ambulatory care. These endeavours, presented in this article, prove that not only professional but also user-based quality standards are becoming more and more common in quality development processes of health care services. The general legislative and political conditions for these developments have considerably improved over the past few years. This will be the foundation for a new quality of the doctor-patient relationship.

Ansätze der Prävention und Gesundheitsförderung

Der Beitrag soll uberblicksartig die strategisch wichtigsten Ansatze der Pravention und Gesundheitsforderung charakterisieren. In einem vorgeschalteten ersten Abschnitt wird zunachst auf die Frage eingegangen, wie weit es moglich ist, zwischen “Pravention“und dem neueren Konzept der “Gesundheitsforderung“eindeutige Grenzen zu ziehen. Es wird die These vertreten, das sich trotz der eindeutig unterschiedlichen Grundorientierungen zwischen Pravention und Gesundheitsforderung keine klare Trennungslinie ziehen last. Der folgende zweite Abschnitt behandelt vier praventive Strategien, die sich aus dem Risikofaktoren-Modell heraus bis hin zur Gesundheitsforderung im weit verstandenen Sinne entwickelt haben. Unterscheiden lassen sich hiervon die im dritten Abschnitt dargestellten Ansatze der Praventiv-Medizin und pradiktiven Medizin, die der Kompetenz und Tragerschaft der Arzteschaft zugeordnet werden. Im vierten Abschnitt werden die Entwicklungstendenzen und Konkurrenzbeziehungen zwischen den biomedizinischen und sozialen Ansatzen polarisierend herausgearbeitet. Es wird festgestellt, das die Durchsetzungschancen des medizinischen Modells deutlich besser sind als die insbesondere von der neuen Public Health-Forschung gestutzten Ansatze der Gesundheitsforderung und Pravention.

Patient-Centered Medicine and Self-Help Groups in Germany: Self-Help Friendliness as an Approach for Patient Involvement in Healthcare Institutions

Collaboration between laypersons and professionals is closely linked to the concept of patient centeredness. Patient centeredness means meeting the needs of individual patients as well as reacting to patients’ demands on the collective level. The support of self-help groups and their integration into healthcare institutions represent a major policy approach to fulfilling this requirement. Here, we first deal with the concept of patient centeredness in general, and the understanding of concept and use in Germany. We also provide a short definition of self-help friendliness (SHF) and discuss the success achieved in implementing it in Germany so far. We then clarify the closely related concepts of patient centeredness, patient participation and patient involvement SHF is seen as a strategy for increasing both patient centeredness and patient participation in healthcare services. We subsequently describe the involvement of self-help groups and patient associations in a series of empirical studies and practice-oriented projects carried out between 2004 and 2013. The last section contains a general discussion of the SHF approach as a means of systematically increasing sustainable patient centeredness and patient participation in healthcare services. Finally, we address the chances for future development in Germany and the transferability of SHF to other countries.