Mike Mösko

The willingness to participate in health research studies of individuals with Turkish migration backgrounds: barriers and resources

BACKGROUND Lower participation rates of ethnic minorities in health research studies and potential participation barriers are commonly reported. METHODS Four semi-structured focus groups of individuals with Turkish migration backgrounds living in Germany were conducted to identify potential participation barriers. Documented statements and superscripted presentation cards by the participants were evaluated with a qualitative content analysis. RESULTS The following eight potential reasons for the lower participation rates were identified: role of women, lack of knowledge, lack of interest, German-Turkish interactions, mistrust, anxiety, data privacy protection and benefits of the study. Additionally, the following recruitment strategies to enhance participation rates were found: public relations, especially word-of-mouth promotion and contacting Turkish key figures, (non-) tangible incentives and trust building through transparent communication of the project and its conditions. DISCUSSION The findings provide a wide range of potential participation barriers and implications that should be considered to enhance the participation rates of minority populations. CONCLUSION The willingness to participate in health research studies can be increased through particular efforts, which should be tailored to the recruitment of the underrepresented target population.

Cross-cultural training in mental health care – challenges and experiences from Sweden and Germany

Globalization and cultural diversity challenge mental health care in Europe. Sensitivity to culture in mental health care benefits effective delivery of care to the individual patient and can be a contribution to the larger project of building a tolerant multicultural society. Pivotal for improving cultural sensitivity in mental health care is knowledge in cross-cultural psychiatry, psychology, nursing and related fields among professionals and accordingly training of students and mental health professionals. This paper will give an overview, and a critical examination, of current conceptualisation of cross-cultural mental health training. From German and Swedish experiences the need for crosscultural training and clinical research on evaluation will be presented.

When local poverty is more important than your income: Mental health in minorities in inner cities

Volkswagen Foundation and the German Federal Ministry for Education and Research . Grant Number: BMBF 01 EL0807

Der Stand der interkulturellen Öffnung in der psychosozialen Versorgung- Ergebnisse einer Studie in einem innerstädtischen Berliner Bezirk

The need for intercultural opening of supply facilities for improving access and treatment of people with migration background is acknowledged in Germany. The purpose of the survey was to determine the current state of intercultural opening of psychosocial services in one Berlin district. 127 representatives of institutions were interviewed using a semi-structured assessment tool. The response rate was very high. The cross-cultural opening was implemented on a small scale. Staff as well as users with migration background were underrepresented. Varying and missing standardized documentation as well as problems in assessing users with migration background might be responsible for their low utilization rates. The use of professional interpreters was often not implemented. To judge the low level of implementation of cross-cultural opening in the psychosocial supply system in general, a review of responsible causes is required.

Development and Psychometric Evaluation of an Instrument to Assess Cross-Cultural Competence of Healthcare Professionals (CCCHP)

Background Cultural competence of healthcare professionals (HCPs) is recognized as a strategy to reduce cultural disparities in healthcare. However, standardised, valid and reliable instruments to assess HCPs’ cultural competence are notably lacking. The present study aims to 1) identify the core components of cultural competence from a healthcare perspective, 2) to develop a self-report instrument to assess cultural competence of HCPs and 3) to evaluate the psychometric properties of the new instrument. Methods The conceptual model and initial item pool, which were applied to the cross-cultural competence instrument for the healthcare profession (CCCHP), were derived from an expert survey (n = 23), interviews with HCPs (n = 12), and a broad narrative review on assessment instruments and conceptual models of cultural competence. The item pool was reduced systematically, which resulted in a 59-item instrument. A sample of 336 psychologists, in advanced psychotherapeutic training, and 409 medical students participated, in order to evaluate the construct validity and reliability of the CCCHP. Results Construct validity was supported by principal component analysis, which led to a 32-item six-component solution with 50% of the total variance explained. The different dimensions of HCPs’ cultural competence are: Cross-Cultural Motivation/Curiosity, Cross-Cultural Attitudes, Cross-Cultural Skills, Cross-Cultural Knowledge/Awareness and Cross-Cultural Emotions/Empathy. For the total instrument, the internal consistency reliability was .87 and the dimension’s Cronbach’s α ranged from .54 to .84. The discriminating power of the CCCHP was indicated by statistically significant mean differences in CCCHP subscale scores between predefined groups. Conclusions The 32-item CCCHP exhibits acceptable psychometric properties, particularly content and construct validity to examine HCPs’ cultural competence. The CCCHP with its five dimensions offers a comprehensive assessment of HCPs’ cultural competence, and has the ability to distinguish between groups that are expected to differ in cultural competence. This instrument can foster professional development through systematic self-assessment and thus contributes to improve the quality of patient care.

Surveying migrant populations – methodological considerations: An example from Germany

Data available from the recruitment process for a population-based survey on psychological well-being in women of Turkish origin aged 18–75 years was subjected to post-hoc analysis to examine effects of different recruitment approaches and reasons for non-response. A random sample of 80,000 women was drawn from the Berlin population registry and 3884 women of Turkish origin identified by a name-based algorithm. The women were assigned randomly to three waves for further contact. The protocol consisted of an invitation letter, telephone contact and door-to-door visits. Door-to-door visits were only performed in one wave, to assess the effect of an intensified recruitment approach. Response rates were 11.9% (95% CI: 7.2–16.6) in the first wave, 3.9% (95% CI: 1.7–6.2) in the second wave and 1.3% (95% CI: 0.9–1.8) in the third wave. The contact rate was highest in the first wave (n=126; 68.1%), which included door-to-door visits. Participants were more often married, had more children, higher educational level, a higher net household income and more often a history of mental disorder. Participation was associated with door-to-door visits (OR=4.22; 95% CI: 1.89–9.45), age (for 35–54 years; OR=2.01; 95% CI: 1.03–3.91) and reply by telephone (OR=4.32; 95% CI: 2.18–8.60). Through the intensified recruitment approach the contact rate could be increased. Despite this we found a relatively low response rate in all recruitment waves.

Lifetime prevalence of mental disorders among first and second generation individuals with Turkish migration backgrounds in Germany

BackgroundThis paper focuses on the lifetime prevalence of mental disorders in individuals with Turkish migration backgrounds in Germany, as there is a lack of reliable epidemiological data on this subject.MethodsIn total, 662 adults with Turkish migration backgrounds were interviewed in Hamburg and Berlin by trained, bilingual interviewers using the computerized Composite International Diagnostic Interview (CIDI DIA-X Version 2.8) to assess diagnoses according to the DSM-IVTR.ResultsThe analyses showed a weighted lifetime prevalence of 78.8% for any mental disorder, 21.6% for more than one and 7.3% for five or more disorders. Any mood disorder (41.9%), any anxiety disorder (35.7%) and any somatoform disorder/syndrome (33.7%) had the highest prevalences. Despite the sociodemographic differences between the first and second generations, there were no significant differences in the lifetime prevalence between generations, with the exception of any bipolar disorder. Female gender, older age and no current partnership were significantly associated with the occurrence of any mood disorder.ConclusionsOverall, the results indicate a high lifetime prevalence in individuals with Turkish migration backgrounds in Germany. These initial data are highly relevant to the German clinical and psychosocial healthcare system; however, the methodological limitations and potential biases should be considered when interpreting the results.

Acculturation and other risk factors of depressive disorders in individuals with Turkish migration backgrounds

BackgroundAcculturation is a long-term, multi-dimensional process occurring when subjects of different cultures stay in continuous contact. Previous studies have suggested that elevated rates of depression among different migrant groups might be due to patterns of acculturation and migration related risk factors. This paper focused on prevalence rates of depressive disorders and related risk factors among individuals with Turkish migration backgrounds.MethodsA population-based sample of 662 individuals with Turkish migration backgrounds were interviewed by bilingual interviewers using a standardised diagnostic interview for DSM-IV-TR and ICD-10 diagnoses (CIDI DIA-X Version 2.8). Associations between 12-month prevalence rates of depressive disorders with potential risk factors were assessed, including gender, age, socioeconomic status, acculturation status and migration status.Results12-month prevalence rates of any depressive disorder were 29.0%, 14.4% of major depressive disorder (MDD) and 14.7% of dysthymia. Older age and low socioeconomic status were most consistently related to higher risks of depressive disorders. Acculturation status showed associations with subtypes of depressive disorder. Associations differed between men and women. Symptom severity of MDD was linked to gender, with females being more affected by severe symptoms.ConclusionThe prevalence of depressive disorders is high in individuals with Turkish migration backgrounds, which can be partly explained by older age, low socioeconomic status and acculturation pressures. Only a limited number of risk factors were assessed. Acculturation in particular is a complex process which might not be sufficiently represented by the applied measures. Further risk factors have to be identified in representative samples of this migrant group.

Leitlinien für Trainings inter-/transkultureller Kompetenz in der Aus-, Fort- und Weiterbildung von Psychotherapeuten

BACKGROUND The ongoing globalization leads to the fact that intercultural aspects are becoming more important in recent years. Unfortunately, the psychosocial sector in general as well as psychotherapists in particular are not sufficiently trained for those issues. In the German speaking countries so far there were no guidelines for the conceptualization of intercultural trainings for psychotherapists. In the present study guidelines for trainings of inter-/transcultural competence of medical and psychological psychotherapists have been developed. METHODS An extensive data base was collected including a systematic international literature research, qualitative expert interviews, a quantitative survey among therapists and 8 focus groups with clients as well as therapists from different cultural backgrounds. The guidelines for trainings were then extracted in a 2-step consensus procedure. RESULTS The guidelines define learning objectives which should be achieved in a training. They also describe the structural as well as substantive requirements which should be met in such a training. In addition to knowledge on cultural issues that should be acquired in a training the guidelines put high emphasis on the self reflection of training participants on their own cultural embededness as well as on the aquisition of culturally sensitive skills. DISCUSSION Regarding demographic trends in Germany trainings for intercultural competence should become an obligatory element in the training of psychotherapists. The guidelines represent a high-quality base for the conceptualization as well as the evaluation of such trainings. CONCLUSION The guidelines developed here represent an instrument for the improvement of the training of therapists in Germany in the field of transcultural psychology. In the long term they could contribute to the intercultural opening of the German mental health system and improve the quality of psychotherapeutical treatment of migrants in Germany.

Health situation of migrant and minority nurses: A systematic review

Introduction Globally, life expectancy together with multimorbidity and chronic diseases are increasing. This leads to a growing demand for care and hence for healthcare personnel and nurses. To meet this demand, healthcare workers from abroad are increasingly hired. The nurses’ workplace in general is characterized by physically and psychologically demanding tasks, while that of migrant and minority nurses is additionally characterized by discriminatory practices. The present knowledge about the health of migrant and minority nurses and the terminology in this context are diverse. Thus, the purpose of this review is to systematically identify and synthesize international publications that explicitly focus on migrant nurses’ health. Materials and methods A systematic review of relevant studies was undertaken using the databases Medline, PsycINFO, CINAHL and Web of Science. The screening process was conducted in several phases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines while the methodological quality assessment of the included papers was performed with the Mixed Method Appraisal Tool (MMAT). Results Out of 11,599 citations initially obtained, 14 empirical studies were included in the final synthesis. The methodological quality of the empirical studies and reviews was diverse. The majority of the studies were conducted in the US and the nurses under study migrated from countries like the Philippines, India, Europe, and Africa. Among migrant nurses of different origins, there are differences in their physiological responses to stress. Migrant nurses and native nurses differ in reporting work-related injuries. Discussion Migrant and minority nurses are at high risk of work-related injuries and discrimination than native or majority nurses. However, mixed results were obtained, namely that the reported health of migrant nurses either improves over time or it decreases. This review revealed that discrimination is the leading cause of impaired health amongst migrant and minority nurses.