3 Months without the car in Bielefeld, Germany- a mixed-method study exploring individual motivation to participate in a municipal intervention.

BACKGROUND: Climate change is a major public health issue worldwide. To achieve climate targets and reduce morbidity, a paradigm shift in individual behavior e.g., in mobility, is needed. Municipal interventions can motivate individuals to engage in climate-friendly behavior through different psychological mechanisms. In order for successful interventions, it is necessary to gain better insight from study participants and their reasons for participating in mobility projects (e.g., motivational aspects). MATERIALS AND METHODS: A mixed-methods design was used to evaluate reasons and characteristics of people for participating in an municipal mobility intervention. The quantitative sub-study assesses socioeconomic characteristics, environmental awareness and perceived stress. The qualitative sub-study explores motivation for participation and change, perspectives on car replacement and reasons for car use. RESULTS: Results show that participants (n = 42) are rather high educated and show medium environmental awareness. Participants of the qualitative study part (n = 15) were motiviated to reduce car use already before the intervention and used the intervention as starting point or trial phase. CONCLUSIONS: Urban intervention projects with fitted recruitment strategies and better insights from study participants with the aim to motivate individuals to engage in climate-friendly behavior can help to strengthen sustainability and public health.

Exploring the Significance of Legal Status on Refugees' and Asylum Seekers' Access to Health Care in Germany-A Mixed-Method Study.

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.

Associations between postmigration living situation and symptoms of common mental disorders in adult refugees in Europe: updating systematic review from 2015 onwards.

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.

[Experiences of people with refugee backgrounds in utilising healthcare in Germany-findings from a qualitative study]. / Erfahrungen von Menschen mit Fluchtgeschichte bei der Inanspruchnahme der Gesundheitsversorgung in Deutschland ­ Erkenntnisse einer qualitativen Studie.

BACKGROUND: Refugees and asylum seekers face a variety of legal, structural, administrative, cultural and linguistic barriers in accessing healthcare. However, there is currently a lack of available data on the health needs of refugees and asylum seekers. In particular, their subjective experience in accessing healthcare has not been considered sufficiently. AIM OF THE STUDY: This paper explores the subjective experiences of refugees and asylum seekers in accessing and using healthcare. Strategies for dealing with potential challenges are presented. METHODS: The recruitment of interview partners was based on a quantitative cross-sectional study collected as part of a study on the health of refugees (FlüGe health study). Persons who agreed to be contacted again were contacted by telephone. A heterogeneous sub-sample (n = 18) with regard to age, gender, nationality, health status and utilisation behaviour was interviewed using interpreter-supported problem-centred interviews. Data were analysed using a deductive-inductive approach. RESULTS AND DISCUSSION: The migration-insensitive healthcare for refugees and asylum seekers is characterised by language barriers, disorientation, experiences of rejection, mistreatment and structural barriers. Experiences of foreignness in the healthcare system can lead to delayed care seeking or underusage of healthcare systems. At the same time, individual strategies by refugees, asylum seekers and healthcare providers are used in order to meet these challenges.

Health Care for Refugees in Europe: A Scoping Review.

BACKGROUND: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. METHODS: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. RESULTS: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. CONCLUSIONS: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care.

Maternal health care for refugee women - A qualitative review.

OBJECTIVE: The number of forced migrants increased worldwide, while pregnant refugee women are considered a vulnerable group, concerning their physical and mental health. How do maternal health care professionals manage their maternal health care? The aim is to review the current evidence regarding the interaction between migrant refugee women and professionals in maternal health care provision after resettlement and in high-income host countries. DESIGN: We conducted a systematic qualitative review and searched the databases PubMed (MEDLINE); CINAHL; PSYNDEX, PsycINFO and Cochrane Library. Studies were judged for eligibility: a study had to address maternal health care provision for asylum seeking refugee (and migrant) women. FINDINGS: 16 primary studies were included. Heterogeneity of the included studies exists regarding e.g. origin of the women, reasons for migration and receiving country. Nevertheless, synthesis provides valuable information on challenges and chances within interactions in maternal health care for asylum seeking refugee (and migrant) women: Finding one's way in the unknown health care system is a barrier for women, which professionals meet by informing the women and coordinating their care. The perceived diversity of women may lead to conflicts in care. While some studies recommend "cultural recipes", others emphasize the individuality of women and prefer holistic care approaches. KEY CONCLUSIONS: Maternal health care professionals face different barriers when providing maternal health care to refugee (and migrant) women such as communication barriers, coordinating care and handling women's diversity. IMPLICATIONS FOR PRACTICE: Initiating and enhancing public health activities such as training courses for professionals that convey general principles such as woman-centered care or communication techniques are valuable opportunities to improve asylum seeking refugee (and migrant) women's maternal health care.

Gender differences in the mental health of unaccompanied refugee minors in Europe: a systematic review.

OBJECTIVES: Our aim was to summarise the current evidence regarding gender differences in the mental health of unaccompanied refugee minors (URM) and to identify gaps in research. SETTING: We focused on quantitative studies presenting primary data from Organisation for Economic Co-Operation and Development(OECD)countries. Language was restricted to English or German. PARTICIPANTS: To be eligible, a study had to involve (former) URM who immigrated to an OECD country. DESIGN: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases MEDLINE, CINAHL, LIVIVO, PSYNDEX and PsycINFO were searched from 1990 to 2017. Studies were judged for eligibility by two independent reviewers each. We narratively summarised our results. RESULTS: 9 primary studies, all from Europe, examined gender differences in the mental health of URM. The majority of the included studies found female URM to be more often affected by post-traumatic or depressive symptoms than their male counterparts. There is only weak evidence regarding other mental health outcomes. Two studies each conducted gender-specific analyses on anxiety and externalising behaviour, but no statistically significant differences between female and male URM were detected. CONCLUSIONS: Female gender is associated with a higher vulnerability towards certain mental health problems among URM residing in Europe. However, the lack of representative studies using reliable diagnostic methods indicates that the findings so far should be treated with caution. Further research is needed to clarify the role of gender for mental health in URM and to examine underlying mechanisms.

Interprofessional practice in health care: an educational project with four learning sequences for students from six study programs.

INTRODUCTION: In response to demographic changes and the growing complexity of healthcare demands, national and international organizations are requiring greater cooperation among the health professions. Implementation of interprofessional learning programs within study programs in medicine, midwifery, nursing, and therapy is still rare. The first projects are currently underway in Germany. This paper presents the experience gathered by the organizers as interprofessional courses for six study programs were implemented. PROJECT DESCRIPTION: As part of the collaborative project "Interprofessional Practice in Health Care" between the Medical School at the Ruhr University in Bochum and the Department for Applied Health Sciences at the Hochschule für Gesundheit, interprofessional curricular units were developed, taught and evaluated with the aim of establishing permanent and joint curricular structures at the two German universities. Imparting communication skills, knowledge of and appreciation for the work performed by the other health professions, as well as having students reflect on their own professional roles and responsibilities, were the focus of four curricular units. Students worked together in small interprofessional groups. RESULTS: A total of 220 students enrolled in occupational therapy, midwifery, speech therapy, medicine, nursing, and physiotherapy participated in small-group seminars. When conducting and implementing the seminars, administrative and methodological challenges became apparent, and this should be taken into consideration in regard to any future development of interprofessional courses. Integration into existing curricula, along with finding time in the various schedules and appropriate classroom space for small groups, were among the challenges faced. For over 86% of the students it was important that students from all six of the degree programs involved participated in the project. A detailed analysis of the content and evaluation will follow. CONCLUSION: The value of the project's aim to include as many study programs in the health professions and medicine as possible was confirmed by the participating students. However, accomplishing this requires a substantial amount of organizational effort in terms of scheduling, finding classroom space and integration into existing curricula. Careful attention must be given specifically to the coordination of monoprofessional and interprofessional teaching units.