ABSTRACT
Capacity building in migration and health in higher education is key to better, sustainable, and equitable health care provision. However, developments so far have been patchy, non-structural, and often unsustainable. While training programs have been evaluated and competency standards developed, perspectives from individual teachers are hardly accessible. We present expert perspectives from five European countries to illustrate good examples in higher education and identify gaps to further the advancement of capacity building in migration and health. Based on these perspectives, we have identified thematic areas at four levels: conceptual evolution, policy and implementation, organization at the academic level and teaching materials and pedagogies. Finally, we propose creating spaces to share concrete educational practices and experiences for adaptation and replication. We summarize key recommendations for the advancement of capacity building in migration and health.
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Family caregivers can be overwhelmed by the care they provide within the family without external support. The development of self-management skills and the associated ability to actively and responsibly manage one's own health or illness situation therefore plays a vital role in the home care of people living with dementia. As part of an individualized intervention for family caregivers of people of Turkish origin with dementia, existing self-management skills were examined through qualitative interviews to gain insight into health literacy and empowerment in caregiving and in interviewees' own practices to maintain their health. Ten caregivers of Turkish origin who were responsible for family members living with dementia were interviewed using problem-centered interviews. We found that the target group has very heterogeneous self-management competencies, which are based, on the one hand, on existing supportive resources and, on the other hand, on diverse care-specific, psychosocial and life-world challenges in intrafamily care that have not been overcome. Self-management skills in family caregivers are influenced by a complex interplay of both available resources that support these skills and challenging caregiving situations. This dynamic combination of resources and challenges results in varying levels of self-management ability among family caregivers. Strengthening resources can help caregivers to meet the challenges resulting from caregiving and to expand their self-management competencies. There is great need for action in promoting self-management skills among Turkish caregivers of people living with dementia in home care. Interventions to promote self-management skills must take into account the individual resources of those affected as well as their social and cultural diversity.
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Due to the coronavirus pandemic, telerehabilitation has become increasingly important worldwide. While the effectiveness of telerehabilitation is considered proven for many indications, there is comparatively little knowledge about the implementation conditions. Therefore, this scoping review summarises the current state of facilitating and inhibiting factors that may influence the uptake of telerehabilitation. The review follows the JBI methodology for scoping reviews. The article search was carried out in five databases (MEDLINE, EMBASE, Web of Science, Cochrane and Psyndex) in May 2022, with an update in October 2023. Two independent researchers identified relevant studies according to the inclusion and exclusion criteria. The Consolidated Framework for Implementation Research served as the theoretical basis for the categorisation of the facilitating and inhibiting criteria in the organisational context. A total of 28 studies (timespan 2012 to 2023) have been included. The most relevant barriers identified are technical issues and a lack of technical skills. The factors considered most favourable for implementation are patients' motivation and the involvement of high-level leaders. The results provide clear indications of factors that inhibit and facilitate implementation, but also show that further research is needed.
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BACKGROUND: During the Coronavirus Disease 2019 (COVID-19) pandemic, immunization programmes struggled to reach all population groups equally. While migrant groups face multiple barriers to health systems, including vaccination, little is known about their vaccine uptake. METHODS: We conducted a cross-sectional telephone survey on adults with and without migration history in Germany to investigate barriers and drivers to COVID-19 vaccination (11 April 2021 to 18 December 2021). Interviews were conducted in six languages. We used logistic regression models and a mediation model to analyze the association between migration history and vaccine uptake. Furthermore, we determined the effect of psychological determinants (5C model) on vaccine uptake. RESULTS: The survey comprised 2039 individuals, including 1015 with migration history. Of these, 448 were interviews conducted in languages other than German. Individuals with migration history had a significantly lower vaccine uptake but, while still unvaccinated, had a higher intention to get vaccinated (P = 0.015) compared with those without migration history. The association between migration history and vaccine uptake was no longer significant when other factors were included in the regression model (odds ratio = 0.9; 95% confidence interval: 0.57-1.47). Socio-economic index, language skills and discrimination experience fully mediated this association. Among the psychological determinants, 'higher confidence' and 'higher collective responsibility' increased the chance of individuals with migration history to be vaccinated. CONCLUSION: Migration history alone cannot explain vaccine uptake; socio-economic index, language skills and discrimination experiences need to be considered. To achieve vaccine equity, future public health policy should aim to reduce relevant barriers through tailored interventions.
Subject(s)
COVID-19 Vaccines , COVID-19 , SARS-CoV-2 , Transients and Migrants , Vaccination , Humans , Germany , Cross-Sectional Studies , COVID-19/prevention & control , Female , Male , Adult , COVID-19 Vaccines/administration & dosage , Transients and Migrants/statistics & numerical data , Transients and Migrants/psychology , Middle Aged , Vaccination/statistics & numerical data , Vaccination/psychology , Aged , Young Adult , Surveys and Questionnaires , Adolescent , Health Services Accessibility/statistics & numerical dataABSTRACT
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.
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Delivery of Health Care , Rehabilitation Centers , Humans , Germany , Gender Identity , Surveys and QuestionnairesABSTRACT
Over the past decade, there has been growing evidence that women worldwide experience sub-standard care during facility-based childbirth. With this critical review, we synthesize concepts and measurement approaches used to assess maternity care conditions and provision, birth experiences and perceptions in epidemiological, quantitative research studies (e.g., obstetric violence, maternal satisfaction, disrespect or mistreatment during childbirth, person-centered care), aiming to propose an umbrella concept and framework under which the existing and future research strands can be situated. On the 82 studies included, we conduct a meta-ethnography (ME) using reciprocal translation, in-line argumentation, and higher-level synthesis to propose the birth integrity multilevel framework. We perform ME steps for the conceptual level and the measurement level. At the conceptual level, we organize the studies according to the similarity of approaches into clusters and derive key concepts (definitions). Then, we 'translate' the clusters into one another by elaborating each approach's specific angle and pointing out the affinities and differences between the clusters. Finally, we present an in-line argumentation that prepares ground for the synthesis. At the measurement level, we identify themes from items through content analysis, then organize themes into 14 categories and subthemes. Finally, we synthesize our result to the six-field, macro-to-micro level birth integrity framework that helps to analytically distinguish between the interwoven contributing factors that influence the birth situation as such and the integrity of those giving birth. The framework can guide survey development, interviews, or interventional studies.
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Maternal Health Services , Parturition , Pregnancy , Female , Humans , Quality of Health Care , Attitude of Health Personnel , Delivery, Obstetric , Anthropology, Cultural , Epidemiologic StudiesABSTRACT
INTRODUCTION: We analyzed whether there were differences between people with and without migration history in their implementation of self-help measures before they accessed the services of an emergency department and if there was an association between self-help measures and an appropriate utilization of emergency departments. METHODS: The data basis of this secondary analysis is the EUMaR study, which was conducted from July 2018 to July 2019 and aimed to identify causes contributing to inappropriate and frequent use of emergency departments by migrants. Our study aimed to analyze the differences in self-help measures carried out by the population groups using several multiple logistic regressions. The association between self-help measures implemented and appropriate emergency department utilization was quantified using a multiple logistic regression as well as interactions. RESULTS: The odds of first-generation migrants visiting an emergency department on their own initiative (OR=1.28; 95% CI, 1.01-1.61) was high compared to people without migrant history. Furthermore, the odds of their doing something by themselves against their complaints (OR=0.70; 95% CI, 0.56-0.86) were low. The odds of appropriate utilization of emergency services by respondents who self-initiated a visit to an emergency department were lower (OR=0.41; 95% CI, 0.34-0.50). The odds of appropriate utilization of emergency department services by respondents who had previously measured vital signs (e. g., blood pressure) were higher (OR=1.28; 95% CI, 1.02-1.59). CONCLUSION: Barriers to the health care system as well as to general practitioners, medicines or medical aids among first-generation migrants could explain the increased odds of their visiting an emergency department on their own and the lower odds of their doing something by themselves about their complaints. A hypothesis of our study is that measuring vital signs may help to better assess individual health status.
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From free choice to forced flight, there are many reasons for migration. Accordingly, the backgrounds and living conditions of migrating people are also diverse. The different associated exposures affect the health of migrants and their children. To capture such a complex phenomenon, an approach is required that takes specific living conditions during the life course of migrants into account.An established methodological approach that can accomplish this is life course epidemiology. When applied to migrating populations, it examines exposures before, during, and after migration. In epidemiological research on the health of migrant populations, it is desirable to consider all three phases. This is countered by the fact that reliable data on the entire life course is not always available.A valid, timely collection and data protection-compliant linkage of longitudinal data from different sources can improve life course-related research on the health of migrants in Germany. In the future, corresponding data should also be included from the countries of origin of migrants.
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Transients and Migrants , Child , Humans , Germany/epidemiology , Life Change Events , Epidemiologic StudiesABSTRACT
Objectives: Few studies have assessed whether refugees' health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on variables on the accommodation and its physical context before assessing its association with health in multivariate analyses. Methods: We performed a cluster analysis based on a hierarchal, agglomerative clustering algorithm using Euclidean Distance and Ward's method. We analysed accommodation clusters based on number of inhabitants, degree of housing deterioration, urbanity of location (urban/rural distinction), and remoteness (walking distance to shops, medical or administrative services). In total, we analysed health and accommodation data of 412 refugees and asylum seekers from 58 different accommodation facilities in the federal state of Baden-Württemberg in the south-west of Germany. Results: Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and generalized anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression. Conclusion: Our findings inform policymakers on layout and location of refugee collective accommodation centres.
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Refugees , Humans , Cross-Sectional Studies , Germany , Algorithms , Cluster AnalysisABSTRACT
'Migrants' and 'refugees' are often categorized as Other, in a process called Othering. Using the example of forced migration, we develop a definition of Othering to make it useful for the analysis of health inequalities. We consider Othering as a social process that constructs and classifies differences in such a way that certain groups become socially visible as essential Others. On one hand, the process of Othering operates through a discursive practice that constructs differences, thereby transforming individuals into visible Others. On the other hand, it is based on a power asymmetry that enables the categorization of people, thereby marking them as different.Othering is not solely based on negative attitudes of individuals or groups. Rather, Othering is the result of a broad and historically evolved system of beliefs that gain credibility through power relations. Thus, we understand Othering as a powerful process that goes substantially beyond concepts of discrimination based on mere categorization processes. The concept of Othering stands out from other concepts of inequality by including the epistemic level as a key factor for inequality. Othering not only produces the Other epistemologically, but at the same time establishes a discursive legitimation for the unequal treatment of the Other.Drawing upon our understanding of Othering, we present practice-related findings on the consequences of Othering for the healthcare of 'migrants' and 'refugees'.
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Transients and Migrants , Humans , GermanyABSTRACT
BACKGROUND: Measures to contain COVID-19 have created burdens that have widened health inequalities. We examine the extent to which risk groups for reduced subjective well-being can be identified after the 2020 lockdown. In doing so, we also consider possible interactions of different social grouping characteristics as part of an intersectional approach. METHOD: Socio-Economic Panel (SOEP) data from the years 2018-2020 were analyzed. A total of 16,000 cases with information on changes in well-being (SF-12 scores and individual indicators) were included in the analyses. We use the classification method "random forests" to identify groups with different trends in well-being. For the interpretation of the content, we also present results from a regression model with social and health aspects as predictors. RESULTS: Demographic and social characteristics explained only a very small part of the changes in subjective well-being (R2â¯= 0.007-0.012) and did not allow for the differentiation of homogeneous risk groups. Although some significant predictors were found in the regression models, the corresponding effects were mostly small. In addition to the initial state of well-being before the pandemic began, the presence of chronic illnesses and disabilities in particular contributed to the explanation of subjective well-being. DISCUSSION: The currently available data do not allow a clear identification of risk groups for losses in well-being in the first year of the COVID-19 pandemic. Health status before the onset of the pandemic appears to be more important for short-term changes in subjective well-being than socio-demographic and socio-economic categorization characteristics.
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COVID-19 , Humans , COVID-19/epidemiology , Pandemics/prevention & control , Communicable Disease Control , Germany/epidemiology , Health StatusABSTRACT
Gender-transformative health interventions that involve men and boys are gaining global reach, adaptability to specific geographical, population and epidemiological contexts, public endorsement, and conceptual sophistication. However, the ways in which masculinities are conceptualised and operationalised in theory and practice across these interventions remains unclear. The purpose of this scoping review is to map intervention studies that conceptually grapple with masculinities and analyse: a) how the concept of masculinities is adapted and operationalised in gender-transformative interventions, with respect to intervention population and context, b) what the relationship between the concept of masculinities and its wider theoretical embedding is, and c) on which levels transformation can be observed when working with 'masculinities'.We conducted a search in APA Psych Articles, APA PsycINFO, and CINAHL via EBSCO, MedLine, PubMed, and Web of Sciences (December 2021) looking for peer-reviewed studies on gender-transformative health interventions which engaged with masculinities conceptually. There were no restrictions regarding language, publication date, or geography. Forty-two articles were included in this review. Our abductive analysis finds that 'hegemonic masculinities' is a central concept in almost all included studies. This shows how the concept is adaptable to a range of different intervention contexts. The review further identifies five theoretical approaches, that help operationalise masculinities on an analytical level: feminist framework, affect theory, critical pedagogy, theories of social change, and ecological approaches. Lastly, this review draws out six levels on which transformation can be observed in the intervention outcomes: relational level, symbolic level, material level, affective level, cognitive-behavioural level, and community-structural level. The discussion underlines that processes and practices of (gender) transformation also require engagement with theories of transformation more widely and advocates for theoretical pluralism. Lastly, implications for practice, including preventative, ecological and community-based care models, are drawn out.
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Masculinity , Men , Male , Humans , Social ChangeABSTRACT
Objectives: The study aims to investigate the significance of legal status for well-being and access to and use of needs-based health care by asylum seekers and refugees in Germany. Methods: Using a mixed-method-design, we first conducted a cross-sectional study to explore access to health care and unmet needs of refugees and asylum seekers and legal status. Data were analysed using descriptive statistics. For the qualitative study a heterogeneous sample was recruited from the quantitative data. Interviews were analysed using a deductive-inductive approach. Results: Quantitative results showed that health care utilisation was associated with an unsecure legal status but not with unmet care needs. The in-depth qualitative study revealed that the legal status determines experiences of structural violence that can negatively affect well-being and associated access to health care. Conclusion: An insecure legal status can affect access to health care for refugees and asylum seekers. In order to improve health, changes in living conditions and the removal of access barriers are necessary.
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Refugees , Humans , Health Services Accessibility , Cross-Sectional Studies , Health Facilities , GermanyABSTRACT
BACKGROUND: Refugees and asylum seekers have a high prevalence of psychiatric disorders such as post-traumatic stress disorder (PTSD), anxiety, and depression. The postmigration context inheres different risk and protective factors for mental health of refugees and asylum seekers in host countries. We conducted a systematic review to update knowledge on the association between characteristics of the postmigration living situation (PMLS) and mental health outcomes in Europe since 2015. METHODS: We searched in five databases according to the PRISMA statement. From a total of 5,579 relevant studies published in 2015-22, 3,839 were included for title and abstract screening, and 70 full texts screened for eligibility. Out of these, 19 studies on refugees and asylum seekers conducted in European countries after 2014 were included in this systematic review. The quality of studies was assessed by using the Mixed Methods Appraisal Tool (MMAT) - version 2018. We performed a narrative synthesis using the four layers of the social determinants of health framework. RESULTS: A wide range of risk and protective factors for mental health in the PMLS were identified as exposure measures, which included individual factors (e.g., language skills), social and community networks (e.g., family concerns, loneliness and social support, discrimination), living and working conditions (e.g., legal status, duration of residence, unemployment and financial hardship, housing) as well as general socio-economic, cultural and environmental factors (e.g., social status, acculturation). We found postmigration stressors are positively associated with symptoms of depression, anxiety, and PTSD, albeit not consistently so. Especially, the general socio-economic, cultural and environmental factors showed weak associations with mental health. CONCLUSIONS: Heterogenous study characteristics likely explain the inconsistent associations between characteristics of the PMLS and mental health outcomes. However, broken down in its component layers, most risk and protective factors of the PMLS were significantly associated with symptoms of mental disorders showing the same direction of association across the included studies, while the association between some stressors or resources of the PMLS and mental health turns out to be less homogeneous than expected. Characteristics of the PMLS contribute to the high prevalence of mental diseases of refugees and asylum seekers. Disadvantages in general socio-economic conditions, living and working conditions, in access to social and community networks need to be redressed, in addition to better access to health care.
Subject(s)
Mental Disorders , Refugees , Stress Disorders, Post-Traumatic , Adult , Humans , Refugees/psychology , Mental Disorders/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Anxiety/epidemiology , Mental Health , Europe/epidemiologyABSTRACT
Background and Aim: Polio eradication efforts including polio-philanthropy have been coordinated and sustained since 1988, with the introduction of the Global Polio Eradication Initiative (GPEI). The polio fight is sustained in the name of evidence-based benevolence or beneficent philanthropy from which Africa has benefited immensely. With the recorded polio cases as of 2023, more efforts and funds are required to eradicate polio. Hence, it is not yet "Uhuru." Using the Mertonian lens, this study examines polio-philanthropy in Africa, its unintended consequences, and crucial dilemmas, which could impact the polio fight and polio-philanthropy. Methods: This is a narrative review that relies on secondary sources obtained through a thorough literature search. Only studies published in English were utilized. The study synthesized relevant literature in line with the study objective. The following databases were consulted: PubMed, philosopher's index, web of knowledge, Google Scholar, and Sociological Abstracts. Both empirical and theoretical studies were utilized for the study. Results: Despite significant achievements, the global initiative has shortcomings when examined through the Mertonian lens of manifest and latent functions. The GPEI sets a unilinear goal within multiple challenges. The activities of the philanthropic giants manifest in disempowering rigor, multisectoral neglect, and parallel (health) systems, sometimes, inimical to the national health system. Most philanthropic giants often operate vertically. It is observed that, apart from funding, the last phase of polio-philanthropy will be defined by some crucial factors, the 4Cs: Communicable disease outbreaks, Conflict, Climate-related disasters, and Conspiracy theory, which could impact the prevalence or resurgence of polio. Conclusion: The polio fight will benefit from the persistent drive to reach the finish line as scheduled. The latent consequences or dysfunctions are general lessons for GPEI and other global health initiatives. Therefore, decision-makers should calculate the net balance of consequences within global health philanthropy for appropriate mitigation.