"The police came in white protective suits and with batons, it was pure disaster" - a multi-stakeholder perspective on infection control in reception centers for asylum seekers during the COVID-19 pandemic in Germany.

BACKGROUND: The COVID-19 pandemic presented unprecedented challenges, particularly for vulnerable populations residing in confined settings such as refugee shelters: Physical distancing measures were challenging to implement in shelters due to shared rooms or communal use of kitchens and sanitary facilities, which increased the risk of infections. Meanwhile, individuals' capabilities for individual protection strategies were severely impaired by the structure of the shelters. Consequently, shelters had the duty to develop and implement strategies for the prevention and handling of SARS-CoV-2 infections. The aim of this study was to explore the perspectives of refugees, NGO employees, and shelter directors regarding COVID-19-related measures in German refugee shelters. The study aimed to identify challenges and conflicts arising from implemented measures, as well as expectations for improved support during the pandemic. METHODS: Semi-structured and narrative interviews were conducted with 6 refugees, 6 facility managers, 12 NGO staff, and 2 social service agency staff from February to August 2022. Qualitative content analysis was employed to analyze the data, identifying overarching themes and codes. RESULTS: The study uncovered challenges and conflicts resulting from pandemic measures, particularly mass quarantine orders, within refugee shelters. Lack of transparency and ineffective communication worsened tensions, with refugees feeling distressed and anxious. The quarantine experience had a negative impact on refugees' mental health, which was exacerbated by limited social interaction and leisure-time activities. Shelter managers encountered administrative challenges when implementing measures due to facility constraints and limited resources, while NGO employees encountered obstacles in providing immediate assistance due to legal regulations and a lack of cooperation from shelter managers. CONCLUSIONS: The study highlights that shelters are problematic institutions from a public health perspective. It shows the importance of implementing customized pandemic interventions in refugee shelters that take account of the diverse needs and experiences of both refugee and staff. To achieve this, we recommend to establish an ethics committee and involve various stakeholders in decision-making processes. Additionally, enhancing information dissemination to promote transparency and public understanding of measures is crucial. These insights can help develop comprehensive and effective pandemic plans for refugee shelters, ensuring better preparedness for future public health crises.

[Management Of Covid-19 Pandemic In Shelters For Asylum Seekers: Results From A Mixed Methods Study.] / Pandemie-Management in Unterkünften für Geflüchtete ­ Ergebnisse einer mixed methods-Studie während der COVID-19-Pandemie.

BACKGROUND: Refugees in Germany are often housed in shelters, where their influence on the organization of everyday life is severely limited. During the COVID-19 pandemic, these shelters therefore had a special responsibility to take measures to protect the health of their residents. The aim of this research project was to examine how this task was managed and how the pandemic affected daily life in refugee shelters, with the aim to formulate recommendations for practice. METHODS: Using a mixed-methods study, the first step was a scoping review of the literature on the management of infectious disease outbreaks in refugee shelters. Building on the findings of the review, management of the pandemic was then explored in an online survey and in interviews with experts and residents of shelters. In a third step, the results of the preceding steps were summarized and discussed with a panel of experts. Recommendations for practice were developed with the expert panel in two discussion rounds two months apart. RESULTS: The refugee shelters included in the study were inadequately prepared for the pandemic and often did not develop contingency plans until the pandemic was underway. In many cases, the contingency plans included the establishment of crisis teams, but the interests and perspectives of facility residents were generally not represented by these teams. This subsequently led to problems: Pandemic measures were often not communicated in a timely or sufficiently understandable manner, gaps in care resulting from measures were not identified or addressed, and psychosocial stresses associated with the pandemic and quarantine measures were not adequately mitigated. CONCLUSION: • Refugee shelters should establish mechanisms to integrate residents' interests and perspectives into decision-making processes in a structured manner, regardless of the pandemic.• Depending on the type of shelter, this should be realized through resident involvement in decision-making bodies or other appropriate representation of interests. • Measures introduced during the pandemic that may have a negative impact on the psychosocial situation of residents should be terminated as soon as the epidemic justification for the measures no longer applies.

[Strategies and Measures to Strengthen the Health Literacy of Migrants: An Online Survey of Primary Care Providers in Hessen]. / Strategien und Maßnahmen zur Stärkung der Gesundheitskompetenz von Menschen mit Migrationsgeschichte ­ Eine Online-Befragung von Primärversorger*innen in Hessen.

BACKGROUND: Adequate health literacy is crucial for active participation in health-related decisions. Migrants are one of the population groups that can have more difficulties in finding and using relevant information to make their own decisions. Primary care providers in Germany are the main point of contact for health and disease-related questions and can therefore make an important contribution to strengthening the health literacy of this population group. It remains unclear which specific approaches they use for that purpose. OBJECTIVES: This study aimed to examine which strategies and measures primary care providers in Hessen, Germany, use to strengthen the health literacy of migrants and which additional measures of support they consider important for that purpose. MATERIALS AND METHODS: 2,784 primary care providers in Hessen were invited by email between August 1, 2023 and October 24, 2023 to take part in a quantitative online survey. The data were analyzed descriptively. RESULTS: The majority of respondents used multilingual information material, referred to reliable sources of information and contact persons and predominantly used native-speaking staff or digital translation tools to improve the health literacy of migrants. Resources to improve communication and information and an increase in staff were considered by healthcare providers to be helpful in promoting the health literacy of those affected. At the same time, it was emphasized that efforts should also be made on the part of migrant patients to acquire health literacy. CONCLUSION: Although primary care providers already use strategies to support migrants in communication and decision-making, there is still room for improvement by taking steps to improve access and navigation within the doctor's office, by increasing collaboration with other stakeholders, and by integrating health literacy into the organizational structures of the office.