Health promotion for the unemployed: the evaluation of the JOBS Program Germany from the trainers' perspective.

BACKGROUND: The JOBS Program Germany is a labor market integrative and health promotion intervention for unemployed people. This study examines JOBS Program Germany trainers' view of (1) the theoretical concept of the JOBS Program, (2) its practical implementation in Germany on-site, (3) its acceptance by participants, and (4) the training effects. The study aimed at identifying potential for adaption allowing adjustments to improve the practical implementation and the training effectiveness. METHODS: JOBS Program Germany trainers (two for each training) were interviewed via voluntary survey (computer-assisted web interviews) after each training. RESULTS: Fourteen JOBS Program trainings have been conducted and all trainers responded resulting in 28 interviews. 78.5% and 85.7% of the respondents were rather or very satisfied with the theoretical contents and its practical implementation, respectively. Almost all trainers (96.4-100.0%) were satisfied with the on-site coordination, the cooperation with the organizer's employees, the room equipment, the training room size, and the environmental conditions in the training rooms. In 89.3% of all responses the trainers rated the last training a success. However, the trainers also provided valuable suggestions for further improvement in Germany. This concerns the revision of the training manual, the adjustment of the trainer training and the preparation of participants. CONCLUSION: Besides the trainers' positive view on the different dimensions of the training content and implementation, their suggestions can help ensure that many unemployed people in Germany could benefit from a continued regular implementation of the JOBS Program Germany in the future. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00022388. Registered on 20 July, 2020.

Results from a Nationwide Evaluation Study of Labor Market-Integrative Health Promotion for the Unemployed: Impact of the JOBS Program Germany.

Compared to the employed, the unemployed suffer from poorer health, especially in terms of mental health. At the same time, health promotion rarely reaches unemployed people. The "JOBS Program" is an intervention to promote health and labor market integration and has shown positive effects in the USA and Finland. In this confirmatory study, we investigated whether the JOBS Program achieves similar effects in Germany. We applied a randomized controlled trial to compare an intervention group (IVG) with a waiting control group (WCG) before (T0; N = 94) and shortly after (T1; n = 65) the intervention. Concerning our primary outcomes, the JOBS Program Germany was beneficial: Compared to the WCG, the regression estimated that the IVG had (1) a 2.736 scale point higher level of life satisfaction (p = 0.049), (2) a 0.337 scale point higher level of general health (p = 0.025), and (3) a 14.524 scale point higher level of mental well-being (p = 0.004). Although not statistically significant, job search-specific self-efficacy also appeared to be positively associated with the intervention. This study provides evidence of the effectiveness of JOBS Program on the abovementioned outcomes, including for older and long-term unemployed people, supporting the benefits of regular implementation of this program for a wide range of unemployed people in Germany.

The Effectiveness of Health-Oriented Interventions and Health Promotion for Unemployed People-A Meta-Analysis.

Background: Unemployment is known to have negative effects on mental and physical health. Yet, the effectiveness of interventions aimed at improving the health of unemployed people is unclear. Methods: We conducted a random-effects meta-analysis of extant intervention studies with at least two measurement points and a control group. A literature search in PubMed, Scopus, and PsycINFO in December 2021 identified 34 eligible primary studies with 36 independent samples. Results: For mental health, the average meta-analytic effect sizes for the comparison of the intervention group and the control group were significant and of small size after the intervention, d = 0.22; 95% CI [0.08, 0.36], as well as at follow-up, d = 0.11; 95% CI [0.07, 0.16]. Effects on self-assessed physical health status were small and marginally significant (p = 0.10) after the intervention: d = 0.09; 95% CI [-0.02, 0.20], and insignificant at follow-up. However, when job search training was not part of the intervention program (i.e., all available resources were used solely for health promotion), the average effect size for physical health was significant after the intervention, d = 0.17; 95% CI [0.07, 0.27]. Furthermore, the effects of physical activity promotion were significant and of small-to-medium size after the intervention, leading to increased levels of activity, d = 0.30; 95% CI [0.13, 0.47]. Conclusions: Population-based health promotion programs are recommended because even measures with small effect sizes can actually improve the health of a large group of unemployed people.

Unemployment and Job Search Behavior among People with Disabilities during the First Year of the COVID-19 Pandemic in Germany.

Not much is known about how the COVID-19 pandemic affected the labor market experiences of people with disabilities. Since they constitute a generally disadvantaged group in the labor market, it is important to scrutinize whether their position has worsened during these difficult times and how they reacted with regard to their job search behavior. We therefore used data for the year 2020 from a large German panel (Panel Arbeitsmarkt und Soziale Sicherung, PASS), in order to scrutinize the prevalence of unemployment among people with disabilities (N = 739) during the first year of the COVID-19 pandemic. The factors that affected their unemployment status were also analyzed. The study found that people with legally recognized disabilities were more often unemployed than non-disabled people, even when controlling for possible confounding factors such as age, gender, or education. This effect was significant for severe disabilities and marginally significant for minor disabilities. Additionally, the type of disability affected the probability of being unemployed, with cardiovascular diseases, mental illnesses, and musculoskeletal disorders carrying a higher risk. In terms of job-seeking behavior, unemployed people with disabilities reported using some job search methods more frequently than their non-disabled counterparts. However, the intensity of the job search did not differ significantly between the two groups. Further differences were found when analyzing the reasons for abstinence from searching for a job, with unemployed people with disabilities primarily citing health-related factors (with a frequency of over 90%). In summary, health played a pivotal role in determining disabled people's labor market experiences during the COVID-19 pandemic.

[Workplace Health Promotion in Germany for All? Results of the 2018 BIBB/BAuA survey of Employed People]. / Betriebliche Gesundheitsförderung in Deutschland für alle? Ergebnisse der BIBB-/BAuA-Erwerbstätigenbefragung 2018.

AIM OF THE STUDY: This secondary analysis aims to investigate the prevalence and uptake of workplace health promotion (WHP) in Germany. METHODS: Our data base was the 2018 BIBB-/BAuA Survey in Germany, which is a randomized representative CATI survey of 20,012 employed persons aged 15 and older. Proportions were compared among different groups and a binary logistic regression model was estimated. RESULTS: 47% of the employees reported that WHP interventions had been implemented in their company in the last two years. 25% of the employees had taken up the offer of WHP. The proportion of employees who confirmed that WHP was offered in their company increased sharply with the company size, but the take-up rates decreased. Employees in companies with a works/staff council stated a disproportionately high rate of implementation of WHP. However, employees with a low socioeconomic status reported WHP offer to a relatively small extent. In particular, employees without a vocational qualification, in a fixed-term employment, at risk of dismissal and temporary agency workers reported a relatively low implementation of WHP in their company. Logistic regression analyses aimed to identify predictors for the WHP offer. Compared to small companies, workers in medium-sized companies were more than twice as likely (OR=2.17) to have a WHP offer in their company and more than five times as likely (OR=5.64) in large companies. In the public sector, the chances of employees having WHP in their company were significantly better than in industry, crafts, trade or other sectors. Compared to German employees, employees with a foreign citizenship had a significantly lower chance of WHP being offered in their company (OR=0.78). A very good or excellent health status was associated with a slightly increased OR of 1.15 for WHP in the company. In companies in which employees were very satisfied with their work overall, the probability of a WHP offer was significantly increased (OR=1.70). CONCLUSION: The analysis reveals large disparities in the WHP. There is a need for WHP strategies for targeting the small companies and the employees with a low socioeconomic status within the companies.

[Necessity and Ways to Develop Care Goals for the Health System in Germany - a Position Paper of the DNVF]. / Notwendigkeit und Wege zur Entwicklung von Versorgungszielen für das Gesundheitssystem in Deutschland ­ ein Positionspapier des DNVF.

Goals for health and health care are an indispensable basic requirement for a functioning health care system. The dilemma of the German health care system is that it has not been designed in a planned way, but that it has grown historically. In recent years, it has developed through the free play of forces into what it is today. The OECD characterizes the current state as follows: The costs of the German health system do not correspond to the often only average health outcomes for the population. To meet the legal requirements (especially SGB V §§ 12, 27 and 70), health care/the health system in Germany needs concrete goals. An orientation towards health care goals entails measures on all levels of health care: on the macro level (overall system/total population), on the meso level (subdivided according to regions, specific population groups, etc.) as well as on the micro level (patients and health care providers). Based on national and international experiences, this position paper of the DNVF e.V. (German Network for health services research) shows the potential of how operationalised health care targets can ensure effective, affordable and high-quality health care. The coalition agreement of the current government propagates a reorientation with patient-related health care goals. Now it is important to derive concrete and realisable goals from this declaration of intent and to involve all important groups in the process. In addition, values and ethical standards for implementation shall be agreed upon in this process. The Health Ministry (BMG) should facilitate and promote the process of societal will-building for the definition of national health care goals. This requires a clear political will. As a result, the National Health Care Goals are available at the end of the process, which are published and maintained together with evidence-based facts as well as valid and resilient data in a Manual "National Health Care Goals". The operational responsibility for implementation could lie with the newly to be founded Federal Institute of Public Health, as already announced in the agreement of the governing coalition. The DNVF is willing to actively participate in the development of health care targets.

What helps the unemployed to stay healthy? A qualitative study of coping with the negative effects of job loss.

BACKGROUND: A variety of empirical studies have shown the negative effects of unemployment on health. A research gap exists regarding salutogenic factors and successful coping strategies to master involuntary job loss and unemployment with the least damage to health. Hence, this study aims at generating a deeper understanding of coping with unemployment and maintaining health. DESIGN AND METHODS: We conducted problem-centered guideline interviews with 21 unemployed people. For the analysis of the interviews, we followed the qualitative content analysis. RESULTS: The study identified that five themes were particularly relevant in coping with unemployment: i) the financial situation, ii) social support and psychosocial strains due family obligations, iii) health problems, iv) time structure, and v) coping strategies. The respondents expressed their financial situation as a major strain in unemployment. They emphasized the importance of social support by their families, but reported also stressful psychosocial demands due to their family members. Further, our respondents mentioned their health problems as a barrier to reintegration into the labour market. In connection with social role demands, a rudimentary time structure was reported by the participants The common reported coping strategy in unemployment is seeking social support. CONCLUSIONS: In summary, our results show - besides health problems and a deteriorated financial situation in unemployment - the great importance of social support and time structure for maintaining mental health in unemployment. Consequently, health promotion approaches for the unemployed should especially target social support and time structure.

Prevalence and utilization of company integration management in Germany: Results of the 2018 BiBB/BAuA survey of employed persons.

OBJECTIVES: This secondary analysis aims to investigate the implementation of the legally required company integration management ("BEM") in case of an incapacity for work of at least six weeks and to identify predictors. METHODS: Database is the representative randomized 2018 BIBB/BAuA Employment Survey of 20 012 employed persons in Germany. RESULTS: Of the 1367 employees entitled to company integration management, 40% received an offer from their employer and 27% accepted it. In the public sector, half of those who were entitled reported an offer. Among those entitled to company integration management, employees under the age of 30, at risk of dismissal, or with fixed-term employment contract received an offer particularly rarely. Entitled employees with disabilities or in companies with works/staff councils received disproportionately often an offer of company integration management. Logistic regression analyses reveal strong associations between company integration management offer and the duration of incapacity to work. The probability of receiving an offer is almost halved for those entitled in medium-sized compared to small companies. The higher the level of educational qualification, the higher are odds ratios for an offer. In companies in which employees were less or not satisfied with their work overall, the chance of a company integration management offer is significantly reduced almost by half. The chance of an offer is more than three times higher in companies with workplace health promotion compared to those without. CONCLUSIONS: Only a minority of eligible employees received an offer that is closely associated with health-promoting corporate culture and job satisfaction.

JOBS Program Germany for health promotion among the unemployed in the community setting with institutions for employment promotion (JobsProgramDtl): study protocol for a randomized controlled trial.

BACKGROUND: Compared to the employed, the unemployed are characterized by a substantially worse health status, particularly with regards to mental health. At the same time, conventional offers of prevention and health promotion rarely reach the unemployed. The JOBS Program is a health promotion program that combines job application training with elements of social learning theory and self-efficacy. Randomized field studies in the USA and Finland found significant positive effects on reintegration into the labor market and health amongst the unemployed. In this confirmatory study, we analyze whether the JOBS Program produces similar positive effects for the unemployed in Germany. METHODS: This study is designed as a country-wide, multi-center, non-blinded, two-armed, parallel-group, randomized controlled trial over 6 months. A total of approximately 1500 unemployed, who are willing to participate, are randomly assigned either to an intervention group or a waiting control group with an allocation ratio of 1:1. Guided by a team of two trainers, the intervention group completes JOBS Program Germany in small groups of 8 to 15 unemployed for a period of 1 week in units of 5 h a day. Primary outcome measures are the reintegration into the labor market, self-efficacy, life satisfaction, subjective state of health, depressive symptoms, and psychological distress. Of secondary interest are moderating variables such as socio-demographic characteristics, the duration of unemployment, and the job-search intensity. Outcomes will be repeatedly assessed via computer-assisted telephone interviews at three points in time: immediately before the intervention (pre-test), immediately after the intervention (post-test), and 6 months after the intervention has ended (6-months follow-up). DISCUSSION: This confirmatory study will provide empirical evidence on the effectiveness of the JOBS Program on the reintegration and (mental) health of the unemployed in Germany. If our results from the randomized controlled trail in a country-wide field experiment confirm its effectiveness, the JOBS Program Germany could, perspectively, be implemented into the German employment promotion and social security system on a long-term basis. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00022388 . Registered on 20 July, 2020.

[Guarantee of illness assistance for people seeking asylum: Two-tiered medical system in Germany?] / Die Gewährleistung von Krankheitshilfen bei asylsuchenden Menschen: Zweiklassenmedizin in Deutschland?

PURPOSE: In the area of the Asylum Seeker Benefits Act (AsylbLG), there are two options for granting benefits that have practical relevance to health care (depending on the period of previous residence): minimum provision and benefits in special cases, analogous to the Social Code Book XII (SGB XII). METHOD: This secondary data analysis examines the performance of benefits in the case of illness among benefit recipients according to the AsylbLG at the Research Data Centre of the Federal and State Statistical Offices. The examined group of individuals have not yet been granted refugee status or asylum entitlement. RESULTS: As of 31 December 2018, 423,201 persons in Germany were receiving benefits according to the AsylbLG. A good third of these were women. The average age was 24 years, and more than half came from Asia. More than one-third of all benefit recipients were in outpatient (33.5%) or inpatient treatment (1.3%). Among the federal states, benefits for assistance in the case of illness as well as the health-related per capita gross expenditure varied considerably. The provision of illness benefits in reception facilities was relatively low. With the health card, the use of inpatient treatment was higher. The standard health-related provision of assistance in special cases (§2 AsylbLG analogous to SGB XII) reached a higher share of people entitled to benefits at the end of the year (42.7%) than the minimum provision according to §3 AsylbLG (29.0%). Nevertheless, it caused comparatively less gross expenditure. CONCLUSION: It is recommended to apply §2 AsylbLG for a prestay period of three months or longer in order to be able to grant assistance analogous to Chapters 5 to 9 SGB XII earlier. Nationwide introduction of an electronic health insurance card for asylum seekers would improve access.

[DNVF Memorandum Health Literacy (Part 1) - Background, Relevance, Research Topics and Questions in Health Services Research]. / DNVF Memorandum Gesundheitskompetenz (Teil 1) ­ Hintergrund, Relevanz, Gegenstand und Fragestellungen in der Versorgungsforschung.

More than half of the German population has difficulties in dealing with health information. It is an important task of health services research to examine how healthcare professionals and health care organizations can meet this challenge. The DNVF Memorandum Health Literacy (Part 1) defines the terms of individual and organizational health literacy, presents the national and international state of research and ethical aspects of health literacy research in health care settings. The relevance of health literacy research is worked out in different phases of life, for different target groups and in different healthcare contexts. Central research topics and future research desiderata are derived.

[DNVF Memorandum Health Literacy (Part 1) - Background, Relevance, Research Topics and Questions in Health Services Research: Short Version]. / DNVF Memorandum Gesundheitskompetenz (Teil 1) ­ Hintergrund, Relevanz, Gegenstand und Fragestellungen in der Versorgungsforschung: Kurzfassung.

More than half of the German population has difficulties in dealing with health information. It is an important task of health services research to examine how healthcare professionals and health care organizations can meet this challenge. This short version of the DNVF Memorandum Health Literacy (Part 1) defines the terms of individual and organizational health literacy, presents the national and international state of research and ethical aspects of health literacy research in health care settings. Central research topics and future research desiderata are derived.

[DNVF-Memorandum III - Methods for Health Services Research, Part 4 - Concept and Methods for Organizational Health Services Research: Short Version]. / DNVF-Memorandum III ­ Methoden für die Versorgungsforschung, Teil 4 ­ Konzept und Methoden der organisationsbezogenen Versorgungsforschung: Kurzfassung.

Organizational health services research in Germany is of increasing relevance. Based on the guide on methods for organizational health services research of the Memorandum III, part 1 from the year 2009, the fundamentals and standards have now been refined. The memorandum captures the theoretical framework, basic methodological approaches and methods in health services research for the design, evaluation and implementation of complex interventions in healthcare organizations.

[DNVF-Memorandum III - Methods for Health Services Research, Part 4 - Concept and Methods for Organizational Health Services Research. Chapter 3 - Methodological Approaches for the Evaluation and Implementation of Complex Interventions in Healthcare Organizations]. / DNVF-Memorandum III ­ Methoden für die Versorgungsforschung, Teil 4 ­ Konzept und Methoden der organisationsbezogenen Versorgungsforschung. Kapitel 3 ­ Methodische Ansätze zur Evaluation und Implementierung komplexer Interventionen in Versorgungsorganisationen.

Organizational health services research is still a relatively young field of research in Germany which is of increasing interest. The German Network Health Services Research e.V. (DNVF e.V.) published in 2009 - supported by expert associations and individual members of the DNVF - a guide on "Methods for organizational health services research" of the Memorandum III, part 1 [1]. Originating from this publication and facilitated by the increasing relevance of the field, a necessity to refine the conceptual and methodological basis became evident. The update and extension of the publication from 2009 consists of three chapters: (1) Definition and concept of organizational health services research, (2) Methodological approaches in organizational health services research: indicators, data sources, data collection and data analysis, (3) Methodological approaches for the design, evaluation and implementation of complex interventions in health care organizations. The aim of the third chapter is to present methods for intervention design, evaluation of effectiveness and efficacy as well as implementation research with particular regard to the organizational context of interventions to improve health care.

[Unmet Medical Need in Germany: Analyses of EU-SILC-Survey from 2005 to 2014]. / Ungedeckter medizinischer Versorgungsbedarf in Deutschland: Ergebnisse im EU-SILC-Survey 2005 bis 2014.

INTRODUCTION: The unmet medical need is an important indicator for the quality assessment of a health system on an international level. METHODS: The EU-SILC-Survey was launched in 2005 and is performed yearly in Germany. In EU-SILC-2014, 22 695 people (over 17 years) in 12 744 households have been interviewed. RESULTS: In accordance to the EU-SILC-waves 2005 and 2014, the unmet medical or dental need has been decreased strongly in Germany. 8.5 % of the population (aged 16 and over) reported either an unmet need for medical (6.4 %) or dental care (3.8 %). The main causes for not making use of unmet dental need are financial and of unmet medical need are personal reasons. In the multivariate logistical regression models, a bad health state has the biggest influence on the likelihood of occurrence of an unmet medical or dental need. Higher disposable (net) income and educational levels are associated with lower probability for non-utilization. Unemployment and migration are accompanied by a higher unmet medical and dental need. Middle-aged people are especially affected. CONCLUSION: The analyses reveal improvements in unmet needs for medical and dental care over time in Germany but also large social disparities. There are action approaches in financial regulation in the health system and strengthening individual health literacy.

Health promotion and prevention among the unemployed: a systematic review.

The interactions between unemployment and health create a need for specific interventions for health promotion and prevention. This overview provides information on how health promotion for the unemployed has been approached with an analysis of controlled intervention studies between 1996 and 2016. The literature search consulted 11 international databases in medicine, social sciences and psychology. A total of 30 health interventions for the unemployed were identified, with 43 articles that included the effects of intervention. A controlled-study design was used in 14 studies. The health promotion measures were generally based on individual counselling, case management, training or group services. The overview demonstrates the breadth of variation in target groups and types of measures. Their result indicators for health and integration into the labor market vary substantially, as do the employment promotion effects. There is evidence of improved health and labor market integration for established approaches like the JOBS Program and JobFit. Effects are rather moderate or low in magnitude and the effect mechanisms often remain unclear. Effects weaken over time. While success is more common in the areas of health, physical activity, nutrition and stress relief, there was no impact on smoking behavior. A significant evolution can be observed in the quality and quantity of health promotion for the unemployed over time. There is a need for further research on the effectiveness and sustainability of interventions. Intervention strategies should be developed that take account of the diversity of the unemployed and their different needs.

[Subjective Health and Unemployment in Germany: Analysis of 2005-2014 EU-SILC Data]. / Subjektive Gesundheit und Erwerbslosigkeit in Deutschland auf Basis der EU-SILC-Daten von 2005 bis 2014.

BACKGROUND: This study aims to analyze self-perceived health and chronic illness in the working population and to explore disparities between social groups. METHODS: The annual EU-SILC Survey has been conducted in Germany since 2005. The reference population is defined as all private households. In the EU-SILC 2014, a random sample of 22,695 persons aged 16 years and older was interviewed in Germany (860 unemployed and 11,390 employed). RESULTS: In accordance to the EU-SILC-Surveys 2005 until 2014, the self-perceived general health of the population has improved in Germany. 65.2% of the population (aged 16 years and older) in Germany assessed their health as very good or good in 2014 vs. 60.7% in 2005, despite an ageing population. However, there was an increase in health inequalities between employment status groups. In 2014, only 37.2% among unemployed persons vs. 77.1% of the employed perceived their general health as very good or good (53.8 vs. 73.2% in 2005). Multivariate logistic regression models revealed strong associations of subjective general health and chronic illness with age groups and social determinants on the EU-SILC-Survey 2014. Cross-sectional analysis showed unemployed persons to be much less likely to have very good or good self-perceived health (OR=0.26) and more likely to have chronic illness (OR=3.99) compared to employed people after adjustment for sociodemographic characteristics. The probabilities of better health and lower chronic illness rose with the increasing disposable (net) income as well as educational levels. 78.8% of the household members in the highest income quintile vs. 51.7% of the household members in the lowest income quintile said they had very good or good health (OR=2.53). In all investigated age groups, members of the households at risk of poverty were more likely to have poor health on average. High educational level (ISCED 5-8) was associated with higher positive self-rated health (OR=1.78). CONCLUSION: The EU-SILC-Survey shows distinct health developments and inequalities in Germany. EU-SILC is useful as an annual general population survey to monitor public health targets and reduce health inequalities.

[Compatibility of Work and Family Life of Employees in the Healthcare Sector: An Issue in Health Services Research]. / Vereinbarkeit von Familie und Beruf bei Beschäftigten im Gesundheitswesen als Handlungsfeld der Versorgungsforschung.

BACKGROUND: Healthcare professionals are confronted with specific work-related demands that influence work-family relations and might indirectly affect the quality of healthcare. This paper seeks to provide an overview of the current state of research on this topic of relevance to health services research. The overview may serve as a starting point for modifying structures in the healthcare system (especially in rural regions) with the aim of improving work-family compatibility. METHODS: A systematic national and international literature search was conducted in terms of a scoping review. The following criteria/contents to be covered in publications were defined: work-family compatibility; work-family interface and work-family conflict in employees working in healthcare; healthcare professions in rural areas and links with work-family issues; interventions to improve work-family compatibility. 145 publications were included in the overview. RESULTS: The available literature focuses on physicians and nursing staff while publications on other professions are largely lacking. The methodological quality of existing studies is mostly low, including a lack of meta-analyses. Several studies document dissatisfaction in physicians and nursing staff regarding reconciliation of work and family life. Only few intervention studies were found that seek to improve work-life compatibility; few of them focus on employees in healthcare. There are also deficits with respect to linking work-family issues with aspects of healthcare in rural areas. CONCLUSIONS: There is a shortage of systematic national and international research regarding work-family compatibility, especially when it comes to the evaluation of interventions. The overview provides starting points for improving work-family compatibility in healthcare.