Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study.

BACKGROUND: In many European countries, foreign nationals experience, on average, less favorable treatment outcomes in rehabilitative care than the respective majority population. In Germany, this for example is reflected in a lower occupational performance and a higher risk of disability retirement after rehabilitation as analyses of routine data show. However, little is known about the perspective of health care users. The aim of the present study was to compare self-rated treatment outcomes between German and non-German nationals undergoing in-patient medical rehabilitation in Germany. METHODS: We analyzed data from a cross-sectional representative rehabilitation patient survey of 239,811 patients from 642 clinics in Germany who completed about 3 weeks of in-patient rehabilitative treatment. The self-rating of the treatment outcome was based on a dichotomized Likert scale consisting of three items. A multilevel logistic regression analysis adjusted for various demographic, socio-economic, health and other covariates was conducted to examine differences in the self-rated treatment outcome between German and non-German nationals. RESULTS: Of the 239,811 respondents 0.9% were nationals from Turkey, 0.8% had a nationality from a former Yugoslavian country, 0.9% held a nationality from the South European countries Portugal, Spain, Italy or Greece and 1.9% were nationals from other countries. Non-German nationals reported a less favorable self-rated outcome than Germans. Adjusted odds ratios [OR] for reporting a less favorable treatment outcome were 1.24 (95%-confidence interval [95%-CI]: 1.12-1.37) for nationals from the South European countries Portugal/Spain/Italy/Greece, 1.62 (95%-CI: 1.45-1.80) for Turkish nationals and 1.68 (95%-CI: 1.52-1.85) for nationals from Former Yugoslavia. CONCLUSIONS: Knowledge on health outcomes from the patients' point of view is important for the provision of patient-centered health care. Our study showed that non-German nationals report less favorable outcomes of rehabilitative care than Germans. This may be due to cultural and religious needs not sufficiently addressed by health care providers. In order to improve rehabilitative care for non-German nationals, rehabilitative services must become sensitive to the needs of this population group. Diversity management can contribute to this process.

Determinants of mammography screening participation among Turkish immigrant women in Germany--a qualitative study reflecting key informants' and women's perspectives.

Mammography screening programmes aiming to reduce mortality from breast cancer are implemented in most European countries. Immigrant women are less likely to participate than women of the respective autochthonous populations in several European countries but not in Germany. Qualitative, semi-structured interviews were conducted with 16 key informants and 10 Turkish immigrant women aged 50-69 years to analyse the factors influencing their screening participation in Germany. Interviews were analysed using summarising content analysis. The Theory of Planned Behaviour was used for structuring the results. Key informants stated poor German language skills and insufficient knowledge about breast cancer and screening as factors influencing screening participation. Immigrant women demonstrated basic knowledge about screening, but their attitudes towards screening varied. Information from the invitation letter of the screening programme was often filtered by family members. Key informants tended to emphasise barriers and system-related factors while the Turkish women focused more on factors on the individual level. Contrasting both perspectives is helpful for health professionals to critically assess their own views. Measures to improve screening participation need to address not only barriers but also take women's attitudes and norms into account, thus helping women to make an informed decision.

[Health care among older people with Turkish migration background: qualitative survey of health mediators]. / Gesundheitsversorgung älterer Menschen mit türkischem Migrationshintergrund: Qualitative Befragung von Gesundheitsmediatoren.

BACKGROUND: Older people with a Turkish migration background face various barriers in terms of access to and quality of health care. Providing health care according to their subjective and objective needs is of increasing importance considering demographic aging. The aim of this study was to illustrate challenges older migrants experience in the health care process from the viewpoint of health mediators. METHOD: Construct interviews were conducted with six health mediators and were analyzed by means of content analysis. RESULTS: The interviews showed three different challenges in health care for people with a Turkish migration background. These were the patients' coping with the disease, their health beliefs, and factors associated with the health care process and the doctor-patient relationship. CONCLUSION: The study highlights that it is important to make health care institutions aware of the culture specific characteristics of illness and therapy beliefs among people with a Turkish migrations background. Diversity management is an adequate strategy to adjust health care to the needs and requirements of an increasingly diverse population.

[Storytelling: an intervention to improve home care of Turkish migrants]. / Storytelling als Intervention: Verbesserung der häuslichen Pflege von türkischen Migranten in Deutschland.

The number of people in need of nursing care in Germany is continuously increasing. As a result of problems with the foreign language and a lack of information, there are obstacles especially for people with a migrational background toward the use of professional help and offers for people in need of care. This report describes the saba study. We used the method of storytelling as a self-help oriented intervention strategy within the group of Turkish persons in need of care and their relatives who provide care. Health mediators facilitated weekly group meetings of Turkish family caregivers. During these meetings, the family caregivers talked to each other about their experiences. By sharing their stories, they increased their knowledge and information. The intervention encourages empowerment and self-management of Turkish people in need of care and their family caregivers. The study helps Turkish persons in need of care and their family caregivers to obtain knowledge and lower the barriers for access to the German Healthcare System.