Germans' awareness of refugees' information barriers regarding health care access: a cross-sectional study.

BACKGROUND: In light of their experiences on the refuge and upon their arrival in the receiving society, refugees may have differentiated needs regarding health care. However, negative attitudes of the members of the receiving society and a lack of information pose as barriers for refugees when trying to access health care services. In that sense, it is largely unknown, which antecedents positively affect Germans' perception of information barriers that refugees face. Based on an extended version of the Empathy-Attitude-Action model, this study examined selected predictors of problem awareness in the form of perceived information barriers that refugees face, emphasizing the role of positive intercultural contact experiences. METHODS: A sample of members of the receiving society, here: Germans (N = 910) completed a cross-sectional online survey with validated self-report measures. From the perspective of Germans, assessments covered positive intercultural contact, attitudes on refugees' rights, the recognition of refugees' socio-emotional support needs as a form of cognitive empathy, and the perception of refugees' information barriers when accessing health care. We conducted structural equation modeling to examine hypothesized latent associations and specified three different models with unidirectional paths between the study variables, each allowing another direct path from intercultural contact to the variables. We determined the best model using the chi-square-difference test and tested for indirect effects along the paths through bias-corrected bootstrapping. RESULTS: Our results show consistency with the Empathy-Attitude-Action model. We found Germans' cognitive empathy toward refugees to be associated with more positive attitudes and a greater awareness of refugees' information barriers. We further found more positive intercultural contact to be associated with greater cognitive empathy toward refugees and with more positive attitudes. While these contact experiences showed a slightly direct negative effect on Germans' perception of refugees' information barriers to accessing health care, the indirect effects via cognitive empathy and positive attitudes were positive. CONCLUSION: Previous positive intercultural contact may be directly and indirectly linked to greater awareness for refugees, helping Germans as the receiving community (1) to become more empathetic toward refugees, (2) to improve their attitudes toward refugees' rights and to (3) raise consciousness for information barriers that refugees face when trying to access health care services.

An ecosystemic view on refugee mental health care: on caring environments and their interaction.

Despite the burden of mental health problems among refugees, knowledge about mental health care for this group is limited. In this context, the comprehensive discussion is important because care is more than professional care, but takes place in everyday situations and between different groups of people. In this study, we look at expert views (based on profession and lived experience) on caring environments concerning refugees' mental health on different system levels. These levels include the individual level, family level, community level and the society. Additionally, we aimed to understand how these system levels interact. We conducted interviews with 11 psychotherapists from Germany and 12 participants who fled from Arabic-speaking countries to Germany. We analyzed transcripts following Braun and Clarke's reflexive thematic analysis. Interviewees shared ideas on how society in general (e.g. increase acceptance), professional actors (e.g. be sensitive about cultural differences), other refugees (e.g. exchange information), family/friends (e.g. provide emotional help) and refugees with mental health problems themselves (e.g. be open to involve others) could provide care. Participants provided examples of how system levels interacted, for example when legal norms made care among family members harder. The interactions between different system levels point to a multidisciplinary approach towards mental health care for refugees and call for building expert networks instead of viewing refugee mental health as a medical, psychiatric issue alone. To improve the mental health of refugees, different societal actors should keep in mind the interactions across different system levels and exchange their respective expert knowledge.

[Development and Validation of the Revenge Fantasy Inventory for Adolescents (RFI-J)]. / Das Rachefantasieinventar für Jugendliche (RFI-J): Entwicklung und Validierung.

The Revenge Fantasy Inventory for Adolescents (RFI-J) is a paper-pencil-questionnaire that aims at assessing revenge fantasies of adolescents and facilitates an interpersonal comparison of revenge fantasies. The RFI-J assesses components concerning the subjective relevance of revenge fantasies, for example a coherence with emotion regulation and adolescent's attitudes towards revenge. In addition, the content of revenge fantasies is measured. The psychometric properties of revenge fantasies were analysed in two studies: In the first study an early concept of the instrument (consisting of two parts: assessment of subjective relevance of the fantasies and assessment of revenge fantasy content) was presented to 248 students (123 males) with an average age of 14.9 years (SD=0.89; Range=14-18 years). Using Principal Component Analysis (PCA) both parts of the instrument were dimensionalised. Subsequently, scales were built and a first version of the inventory was developed. In a second study with another sample consisting of 88 students (48 males) with an average age of 14.9 years (SD=0.72; Range=14-17 years) four of the factors which had been found in the first study were replicated. Furthermore, correlations were found between the RFI-J and measures of aggression, measures of pro-sociality, as well as measures of physical and psychological complaints. The developed test in its current version consist of two parts (18 and 6 Items).

Challenges in substance use treatment as perceived by professionals and Arabic-speaking refugees in Germany.

BACKGROUND: Substance use (SU) and substance use disorders (SUDs) have been recently documented among forcibly displaced populations as a coping mechanism to migration and postmigration stressors. Although the literature exploring substance use among refugees has grown recently, little is known about SU among Arabic-speaking refugees and, more specifically, on the challenges and experiences in regards to SU treatment. This study investigates this topic from the perspectives of Arabic-speaking refugees and professionals in Germany. METHODS: Design and participants To expand our knowledge on this topic, a qualitative approach was employed by conducting in-depth and semi-structured interviews among 26 participants (13 refugees and 13 professionals) in Germany during 2020-2021. Purposive sampling was used to recruit Arabic-speaking refugees in two rehabilitation centers in Berlin. Data and analysis Interviews were conducted with 26 participants of which 13 were refugees and 13 professionals. Refugees were interviewed individually in the rehabilitation centers, they ranged from 21 to 52 years of age, and their average time in Germany was 6.3 years. An open-ended survey was conducted among the professionals via the SoSci-survey platform, and they ranged from 22 to 66 years of age, with an average of 5 to 9 years of work experience. Data were analyzed using thematic analysis. RESULTS: Three themes resulted from the thematic analysis: (1) The treatment is facilitated by institutional and emotional support; (2) The affected refugees struggle with complex contextual barriers to access SUD treatment; and (3) Individual and community preventive strategies are needed. CONCLUSIONS: This study provides insight into the support and challenges of accessing effective SU treatment and prevention among Arabic-speaking refugees in Germany. Collaborative efforts by the community, professionals, and policymakers are needed to facilitate access to effective treatment and implement culturally and linguistically sensitive approaches for the treatment and prevention of SU among refugees.

A systematic review of qualitative research on substance use among refugees.

AIMS: To evaluate qualitative research on substance use and substance use disorders (SUDs) among refugees in terms of practitioners' and substance users' attitudes, beliefs and experiences. METHODS: Six medical, allied health and social sciences databases (EBSCO, PubMed, ScienceDirect, Web of Science, Scholar and the Cochrane Library) were systematically searched in a time frame between January and April 2021 to identify original peer-reviewed articles describing qualitative findings related to substance use among refugees (alcohol, illicit drugs, tobacco and prescription drugs). Study selection, critical appraisal and detailed extraction were performed via the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Systematic Reviews (PRISMA) (2018). Three independent reviewers selected the relevant abstracts and articles. Synthesis of the evidence identified prominent themes relating to the context and consequences of substance use. RESULTS: Twenty-six studies were included in this review. Twenty-three studies applied qualitative methods and three applied mixed methods. Synthesis of the evidence from the included studies resulted in four main findings: there is a considerable susceptibility of refugees to substance use and SUDs; the harmful consequences of substance use are complicated by the social insecurities of refugees; there are rather high barriers to treatment and health facilities for refugees in many host countries; and there is a strong need to improve effective access to treatment, interventions and prevention approaches. CONCLUSIONS: Refugees are at high risk for substance use and substance use disorders and often face high barriers to treatment and interventions in host countries.