[Supporting rehabilitation facilities in implementing diversity-sensitive care: Development of the DiversityKAT manual]. / Unterstützung von Rehabilitationseinrichtungen bei der Umsetzung einer diversitätssensiblen Versorgung: Entwicklung der DiversityKAT-Handreichung.

BACKGROUND: Expectations regarding health care including rehabilitation differ depending on age, gender, and also the migration history of the patient population. To meet the diverse expectations, health care needs to be diversity-sensitive, which can have a positive effect on the utilization and outcomes of care. Diversity-sensitive care, however, should take into consideration not only the expectations of diverse patient groups but also the opportunities and challenges offered by diversity of staff. Managers of health care facilities and health care staff in Germany are well aware of the need for diversity-sensitive care, but corresponding measures, so far, have been applied rarely and only unsystematically. The aim of the study was to develop a manual consisting of a catalogue of instruments and a guideline that can support rehabilitation facilities in implementing diversity-sensitive care. METHODS: A mixed methods approach was used for the study. Based on a scoping review, suitable instruments (n=34) were identified that can be used for the implementation of diversity-sensitive health care. Consensus on a draft of the manual was then reached in seven focus group discussions with health care staff (n=44) and a discussion circle consisting of n=5 representatives of the rehabilitation providers. RESULTS: The DiversityKAT manual, which was developed in a participatory manner, presents diversity-sensitive tools, including instructions, questionnaires, checklists and concepts that can be used to take into account the diversity of needs and expectations in everyday health care. In line with the feedback from health care staff, the manual includes information that can be used as a step-by-step guide to select and implement appropriate tools. At the request of the staff and the rehabilitation providers, exemplary case descriptions were added to present the use of selected instruments in specific situations. A matrix was developed for purposes of quick orientation and pre-selection of suitable instruments. DISCUSSION: Through practice-oriented advice and low-threshold guidance, the DiversityKAT-manual can increase user orientation in rehabilitation but needs to be further examined in future evaluation studies.

[Implementation Strategies of Diversity-Sensitive Health Care and Administration - A Nationwide Postal Survey of Inpatient Rehabilitation Facilities]. / Umsetzungsstrategien einer diversitätssensiblen Gesundheitsversorgung und Unternehmensführung ­ Eine bundesweite postalische Befragung von Rehabilitationseinrichtungen.

BACKGROUND: Diversity characteristics such as disability, gender, age or migration background are associated with different expectations towards health care. If these are not sufficiently considered in rehabilitative care, this may have a negative impact on the satisfaction with and outcomes of health care. Sensitivity towards the diversity of patients can promote patient-centered health care by helping to address different needs and expectations. The aim of the present study was to examine what measures inpatient rehabilitation facilities in Germany use to provide diversity-sensitive health care and which barriers prevent their proper implementation. METHODS: Between May and August 2019, administrative managers of rehabilitation facilities were invited to participate in a nationwide postal questionnaire survey (n=1,233). The questionnaire included questions on addressing the diversity of employees and rehabilitation patients. Responses were received from a total of 223 inpatient rehabilitation facilities (response rate: 18.9%). Results were analyzed descriptively. RESULTS: The survey shows that diversity-sensitive health care is a relevant topic for many rehabilitation facilities. It is regarded particularly important for the satisfaction of rehabilitation patients, treatment outcomes and employee satisfaction. Obstacles to the implementation of diversity-sensitive care comprise a lack of incentives on the part of health care organization, a lack of financial resources and organizational difficulties. DISCUSSION: The majority of the administrative managers surveyed acknowledge the relevance of diversity-sensitive care. Instruments enabling it, however, are used only sparingly and unsystematically. To promote diversity-sensitive care, health care facilities need support in competence building and in selecting and implementing appropriate measures. A handbook with instructions on how diversity-sensitive care can be implemented can contribute to that goal.

Pictorial Assessment of Health-Related Quality of Life. Development and Pre-Test of the PictoQOL Questionnaire.

The aim of the present study was to develop a pictorial questionnaire for the assessment of health-related quality of life (PictoQOL) and to examine its content validity and usability across three exemplary population groups of different origin residing in Germany (non-migrants, Turkish migrants and Arabic-speaking migrants). A mixed-methods design combining qualitative and quantitative methods was used, comprising 6 focus group discussions with a total of 17 participants, 37 cognitive interviews and a quantitative pretest with 15 individuals. The PictoQOL consists of a pictorial representation of a total of 15 different situations. Using a visual Likert scale, respondents indicate how much each situation applies to them. Some representations proved to be culturally sensitive and were adapted. Respondents found the use of an additional graphic layer in the form of symbols in addition to pictures helpful for interpretation. The PictoQOL is considered to allow a more accessible assessment and better comparability of HRQOL across different population groups regardless of their literacy level. It is therefore considered to be superior to existing instruments for routine use in health research and practice. Future studies need to examine its convergent and factorial validity.