Patrick Brzoska

Illness perceptions in Turkish migrants with diabetes: A qualitative study

Objectives Illness perceptions are usually conceptualized using the self-regulatory model of illness. Although a few examinations of illness perceptions among Turkish language populations exist, the validity of the self-regulatory model of illness has never been confirmed for this population group. The aim of our study was to explore the validity of the self-regulatory model of illness in chronically ill Turkish migrants residing in Germany using diabetes mellitus type 2 as an example. Methods Qualitative semi-structured interviews were conducted with 24 Turkish migrants with self-reported diabetes who were recruited through key persons. The core aspects of the qualitative data were extracted through a hermeneutic approach. Subsequently, a system of categories and sub-categories was developed by means of content analysis. Results Seven distinct core dimensions of illness perceptions, each with a different number of sub-domains, could be identified in the sample. They comprised the perceived timeline of diabetes, its consequences, its causes, its controllability as well as the identity/coherence and the emotional response with respect to the condition. Discussion As regards the conceptualization of illness perceptions, the dimensions identified are in line with the self-regulatory model of illness. Addressing illness perceptions through tailored interventions may contribute to improving health care and health outcomes in Turkish migrants.

Reviewing the topic of migration and health as a new national health target for Germany

AbstractObjectivesTo review migration and health as a potential new national health target for Germany.MethodsThe theme was evaluated along 13 standardized criteria preset by the Health Targets Network. For each of the criteria an expert opinion based on an extensive (but nonsystematic) review of literature is presented.ResultsMigrants differ in many health-related aspects from the majority population in Germany. Despite having some health advantages, their health status, on average, is lower than that of non-migrants. They also experience barriers in health care and cannot participate in the society on equal terms with the majority population. Different measures to improve the health situation of migrants are available, but their current implementation in the health system is limited in several ways. Present data on the health of migrants is inadequate and limits migrant-sensitive health reporting.ConclusionThe evaluation of potential health targets based on standardized criteria is a valuable tool for health policy formulation. The present documentation can assist other countries in evaluating migration and health as a national health target. It may also contribute to similar activities at the European level.

Erreichbarkeit und Ergebnisqualität rehabilitativer Versorgung bei Menschen mit Migrationshintergrund

BACKGROUND Migrants comprise a large proportion of the population in Germany. As compared to non-migrants they are at a higher risk with respect tor occupational accidents, occupational diseases and early retirement due to disability. Tertiary preventive services such as rehabilitation, consequently, are of high relevance for this population group. OBJECTIVES We provide an overview of the accessibility and quality of preventive services among migrants residing in Germany using medical rehabilitation (tertiary prevention) as an example. We also present strategies which aim to improve health care for this population group. MATERIALS AND METHODS Summary of quantitative routine data analyses and of qualitative interviews with patients and health care professionals in rehabilitative care. RESULTS Migrants utilize rehabilitative health care services less often than non-migrants. Those who undergo medical rehabilitation report a lower satisfaction with health care and show less favorable health outcomes than non-migrants. This, for instance, becomes evident in the occupational performance and subjective treatment outcome after rehabilitation. Socioeconomic, sociodemographic and health factors only partially explain these associations. In addition, there is evidence that migrants face various barriers which affect the accessibility and quality of health care services. CONCLUSIONS Health care institutions have to provide services which are more sensitive to the heterogeneity of the population in order to reduce barriers in health care. Diversity management can contribute to this goal.Menschen mit Migrationshintergrund machen einen großen Teil der Bevölkerung in Deutschland aus. Im Vergleich zu Nichtmigranten/innen sind sie häufiger von Arbeitsunfällen, Berufskrankheiten und Erwerbsminderung betroffen. Die rehabilitative Versorgung spielt für sie daher eine wichtige Rolle. Es werden ein Überblick über die Erreichbarkeit und die Qualität präventiver Angebote bei Menschen mit Migrationshintergrund am Beispiel der medizinischen Rehabilitation (Tertiärprävention) gegeben und Schlussfolgerungen für eine Optimierung der Versorgungsgestaltung abgeleitet. Eine Zusammenfassung quantitativer Auswertungen von Reha-Routinedaten sowie qualitativer Auswertungen von Interviews mit Rehabilitanden/innen und Gesundheitspersonal. Menschen mit Migrationshintergrund nehmen rehabilitative Versorgungsangebote seltener in Anspruch als Nichtmigranten/innen. Gleichzeitig weisen diejenigen, die die Rehabilitation nutzen, eine geringere Versorgungszufriedenheit und ungünstigere rehabilitative Ergebnisse auf. Das spiegelt sich beispielsweise in der beruflichen Leistungsfähigkeit nach der Rehabilitation sowie im subjektiv wahrgenommenen Behandlungsergebnis wider. Sozioökonomische, demografische und gesundheitliche Faktoren erklären diese Zusammenhänge nur teilweise. Zusätzlich gibt es Hinweise darauf, dass Zugangs- und Wirksamkeitsbarrieren, denen Menschen mit Migrationshintergrund in der Versorgung begegnen, die Erreichbarkeit und die Qualität von Angeboten beeinträchtigen können. Die Institutionen der Gesundheitsversorgung müssen Angebote sensibel für die Heterogenität ihrer jeweiligen Nutzer/innen gestalten, um Barrieren in der Versorgung zu vermeiden. Diversity Management kann hierzu einen großen Beitrag leisten. Migrants comprise a large proportion of the population in Germany. As compared to non-migrants they are at a higher risk with respect tor occupational accidents, occupational diseases and early retirement due to disability. Tertiary preventive services such as rehabilitation, consequently, are of high relevance for this population group. We provide an overview of the accessibility and quality of preventive services among migrants residing in Germany using medical rehabilitation (tertiary prevention) as an example. We also present strategies which aim to improve health care for this population group. Summary of quantitative routine data analyses and of qualitative interviews with patients and health care professionals in rehabilitative care. Migrants utilize rehabilitative health care services less often than non-migrants. Those who undergo medical rehabilitation report a lower satisfaction with health care and show less favorable health outcomes than non-migrants. This, for instance, becomes evident in the occupational performance and subjective treatment outcome after rehabilitation. Socioeconomic, sociodemographic and health factors only partially explain these associations. In addition, there is evidence that migrants face various barriers which affect the accessibility and quality of health care services. Health care institutions have to provide services which are more sensitive to the heterogeneity of the population in order to reduce barriers in health care. Diversity management can contribute to this goal.

Does language matter? A case study of epidemiological and public health journals, databases and professional education in French, German and Italian

Epidemiology and public health are usually context-specific. Journals published in different languages and countries play a role both as sources of data and as channels through which evidence is incorporated into local public health practice. Databases in these languages facilitate access to relevant journals, and professional education in these languages facilitates the growth of native expertise in epidemiology and public health. However, as English has become the lingua franca of scientific communication in the era of globalisation, many journals published in non-English languages face the difficult dilemma of either switching to English and competing internationally, or sticking to the native tongue and having a restricted circulation among a local readership. This paper discusses the historical development of epidemiology and the current scene of epidemiological and public health journals, databases and professional education in three Western European languages: French, German and Italian, and examines the dynamics and struggles they have today.

Die Nutzung von Routinedaten in der rehabilitationswissenschaftlichen Versorgungsforschung bei Menschen mit Migrationshintergrund: Möglichkeiten und Grenzen

OBJECTIVE Little is known about the rehabilitative care of populations with a migrational background. Using the assessment of rehabilitation effectiveness as an example, we outline the potentials and limitations routine data from social security carriers has for this research field. METHODS We draw on an 80% random sample of all completed medical rehabilitations in the year 2006 funded by the German Statutory Pension Insurance Scheme (n=634 529). The assessment of rehabilitation effectiveness was based on the occupational performance at the time the rehabilitation was completed. Migrational background was defined by nationality. By means of logistic regression adjusted for socio-economic/-demographic and health-related variables, we examine whether rehabilitation effectiveness differs between German and non-German nationals. RESULTS AND DISCUSSION Non-German nationals have a higher chance of completing medical rehabilitation with a lower occupational performance - irrespective of differences in socio-economic/-demographic and health-related variables. Odds ratios for a lower rehabilitation effectiveness were 1.23 [95%-CI=1.16;1.30] for Turkish nationals and 1.47 [95%-CI=1.38;1.56] for persons from the former Yugoslavia. Different aspects limit the validity of the analysis. (1) By using nationality, only a selection of all persons with a migrational background can be identified. (2) Important covariates cannot be considered. (3) The assessment of rehabilitation effectiveness is inaccurate, because valid data on occupational performance prior to rehabilitation is missing. CONCLUSION Similar to routine data from other social security carriers, data from the German Statutory Pension Insurance Scheme has limitations for health services research on populations with a migrational background. Solutions comprise the application of computer-aided procedures for an accurate operationalisation of migrational background and the use of survey data for a valid assessment of rehabilitation effectiveness.

The factor structure of the Turkish version of the Revised Illness Perception Questionnaire (IPQ-R) in patients with diabetes and cardiovascular disease.

BackgroundThe Revised Illness Perception Questionnaire (IPQ-R) has been used extensively in the study of illness perceptions across different populations. Only few confirmatory factor analytic (CFA) studies of the questionnaire are available. This study examines the construct and discriminant validity of the Turkish IPQ-R in patients with diabetes and cardiovascular disease focusing on the hypothesized seven dimensions of personal controllability, treatment controllability, timeline acute/chronic, timeline cyclical, coherence, consequences and emotional representations.Methods302 patients (60.6% women) with a medically confirmed diagnosis of diabetes or cardiovascular disease and a mean age of 53.9 years were recruited from out-patient clinics in Turkey and surveyed by means of standardized interviews. Direct maximum likelihood confirmatory factor analysis was conducted.ResultsSeveral areas of ill-fit were identified in the original measurement model of the IPQ-R. Four items (items 17, 19, 20, and 31) were deleted because of poor factor loadings. Also, two error covariances (between items 33 and 34 and between items 7 and 8) were added and item 6 respecified to obtain a good model fit. The modified 34-item model showed good reliability and discriminant validity.ConclusionIn accordance with studies on other language adaptations of the questionnaire, we identified certain items of the IPQ-R as potential sources of poor model fit. Their inclusion should be reconsidered in future applications of the questionnaire and researchers should examine whether our reduced set of items is stable across different populations. Our modified 34-item model showed a good reliability and discriminant validity and hence could be a valuable instrument in the assessment of illness perceptions in the Turkish health care setting, provided that the model is confirmed in subsequent research.

Migration and occupational health: high work-related burden

Abstract Migrants are at a higher risk for occupational accidents, occupational diseases, short-term disability and early retirement than employees of the majority population. This is particularly the case for individuals of Turkish origin. Measures of prevention and health promotion that are sensitive to the needs of migrants need to be implemented in companies and the health care system to improve occupational health and to address consequences resulting from a higher work-related burden in this population group.

Arbeit, Migration und Gesundheit

Deutschland ist ein bevorzugtes Ziel von internationaler Mobilitat und Zuwanderung. Insgesamt haben rund 15,4 Millionen Menschen in Deutschland einen Migrationshintergrund und machen damit fast ein Funftel der Gesamtbevolkerung aus. Daten des Mikrozensus 2007 und des Sozio-oekonomischen Panels (SOEP) zeigen, dass Migranten im Hinblick auf unterschiedliche soziookonomische Faktoren im Vergleich zur einheimischen Mehrheitsbevolkerung benachteiligt sind. Sie haben geringere schulische und berufliche Abschlusse und arbeiten in Berufen, die ein geringeres Qualifikationsniveau erfordern. In der Folge ist ihre wirtschaftliche Situation durchschnittlich ungunstiger. Daruber hinaus sind sie groseren berufsbedingten Gesundheitsrisiken ausgesetzt und haben einen schlechteren Gesundheitszustand. Das geht aus Statistiken der Sozialversicherungstrager zu Arbeitsunfallen, Berufskrankheiten, Arbeitsunfahigkeitszeiten und gesundheitlicher Fruhberentung hervor. Es ist daher die Aufgabe der Akteure im Sozial- und Gesundheitswesen dafur zu sorgen, dass Arbeitsbedingungen fur Migranten verbessert, ihr Zugang zum Arbeitsmarkt durch Reduzierung von Bildungsungleichheit erleichtert und bereits eingetretene berufsbedingte gesundheitliche Beeintrachtigungen bedarfs- und bedurfnisgerecht adressiert werden.

Satisfaction with rehabilitative health care services among German and non-German nationals residing in Germany: a cross-sectional study

Objectives Rehabilitation following medical conditions is largely offered as in-patient service in Germany. Foreign-national residents use rehabilitative services less often than Germans and attain less favourable treatment outcomes. These differences are independent of demographic, socioeconomic and health characteristics. Satisfaction with different aspects of rehabilitative care presumably affects the effectiveness of rehabilitative services. We compared the degree of satisfaction with different domains of the rehabilitative care process between Germans and non-German nationals residing in Germany. Methods We used data from a cross-sectional rehabilitation patient survey annually conducted by the German Statutory Pension Insurance Scheme. The sample comprises 274 513 individuals undergoing medical rehabilitation in 642 hospitals during the years 2007–2011. Participants rated their satisfaction with different domains of rehabilitation on multi-item scales. We dichotomised each scale to low/moderate and high satisfaction. For each domain, a multilevel adjusted logistic regression analysis was conducted to examine differences in the levels of satisfaction between German and non-German nationals. Average marginal effects (AMEs) and 99.5% CI were computed as effect estimates. AMEs represent differences in the probability for the occurrence of the outcome. Results Turkish nationals had a higher probability for being less satisfied with most aspects of their rehabilitation, with AMEs ranging between 0.05 (99.5% CI 0.00 to 0.09) for ‘satisfaction with psychological care’ and 0.11 (99.5% CI 0.08 to 0.14) for ‘satisfaction with treatments during rehabilitation’. Patients from former Yugoslavia and from Portugal/Spain/Italy/Greece were as satisfied as Germans with most aspects of their rehabilitation. Conclusions Turkish nationals are less satisfied with their rehabilitative care than other population groups. This may be attributable to the diversity of the population in terms of its expectations towards rehabilitation. Rehabilitative care institutions need to provide services that are sensitive to the needs of all clients. Diversity management can contribute to this process.

Participation in cancer screening among female migrants and non-migrants in Germany: A cross-sectional study on the role of demographic and socioeconomic factors

AbstractIn many European countries, migrants utilize cancer screening less often than non-migrants. In Germany, in contrast, higher rates of utilization among migrants as compared with non-migrants have been reported. The role of demographic and socioeconomic factors potentially confounding the association between migration status and participation in screening, however, could not be studied. The present study aims to investigate the utilization of cancer screening among migrant and nonmigrant women residing in Germany, adjusting for potential confounders.We used self-reported information from women surveyed on whether they have ever participated in screening for cancer (n = 11,709). The data was collected as part of a cross-sectional representative telephone survey conducted by the Robert Koch-Institute in 2010. We distinguished between three groups of women: (1) respondents of non-German nationality, those who had immigrated to Germany after their birth or those who have two foreign-born parents (“migrants with two-sided migration background”), (2) respondents who only have one foreign-born parent (“migrant with one-sided migration background”), and (3) all others (“non-migrants”).To account for confounders, logistic regression analysis was performed. Only individuals proficient in German were included in the survey, allowing to control for a bias arising from poor language proficiency.84.9% of nonmigrant women, 82.1% of women with a one-sided, and 70.5% of women with a two-sided migration background had utilized screening for cancer at least once in their lifetime before the survey. The adjusted odds ratios (OR) as compared with nonmigrant women were 0.99 (95% confidence interval [95% CI]: 0.77–1.27) and 0.55 (95% CI: 0.47–0.64), respectively.The study shows that migrant women with a two-sided migration background residing in Germany utilize screening for cancer less often than nonmigrant women—independently of demographic and socioeconomic factors. This is in line with findings from other countries. Likely, barriers that migrant women encounter limit them from taking informed choices. These barriers need to be identified and appropriate measures aiming to enhance informed decision making must be implemented.