Background: Studies from European and non-European countries have shown that migrants utilize cervical cancer screening less often than non-migrants. Findings from Germany are inconsistent. This can be explained by several limitations of existing investigations, comprising residual confounding and data which is restricted to only some regions of the country. Using data from a large-scale and nationwide population survey and applying the Andersen Model of Health Services Use as the theoretical framework, the aim of the present study was to examine the role that different predisposing, enabling and need factors have for the participation of migrant and non-migrant women in cervical cancer screening in Germany. Methods: We used data from the ‘German Health Update 2014/2015’ survey on n = 12,064 women ≥20 years of age. The outcome of interest was the participation in cancer screening (at least once in lifetime vs. no participation). The outcome was compared between the three population groups of non-migrants, migrants from EU countries and migrants from non-EU countries. We employed multivariable logistic regression to examine the role of predisposing, enabling and need factors. Results: Non-EU and EU migrant women reported a lower utilization of cervical cancer screening (50.1 and 52.7%, respectively) than non-migrant women (57.2%). The differences also remained evident after adjustment for predisposing, enabling and need factors. The respective adjusted odds ratios (OR) for non-EU and EU migrants were OR = 0.67 (95%-CI = 0.55–0.81) and OR = 0.80 (95%-CI = 0.66–0.97), respectively. Differences between migrants and non-migrants were particularly pronounced for younger age groups. Self-rated health was associated with participation in screening only in non-migrants, with a poorer health being indicative of a low participation in cancer screening. Conclusions: The disparities identified are in line with findings from studies conducted in other countries and are indicative of different obstacles this population group encounters in the health system. Implementing patient-oriented health care through diversity-sensitive health services is necessary to support informed decision-making.

Background: Antimicrobial resistance is considered one of the major threats to global health. The emergence of resistant microorganisms is a consequence of irrational use of antibiotics. In Turkey, the consumption of antibiotics is relatively high and antibiotics are among the most commonly used drugs. However, Turkey has adopted new, more restrictive policies and regulations on antibiotics. In addition, Turkish migrants to EU countries, such as Germany, the Netherlands and Sweden, may encounter health systems that promote a more restrictive and rational antibiotic use. The objective of this paper was to explore the variation in implemented policies related to rational antibiotic use that citizens in Turkey and Turkish migrants in Germany, the Netherlands and Sweden are subjected to and to discuss the implications for the promotion of rational antibiotic use. Data were collected through focus groups and individual interviews with citizens, physicians and pharmacists in the four countries. In total, 130 respondents were interviewed. Content analysis was used. Results: Three relevant themes were identified: Implementation of regulations and recommendations, Access to antibiotics and Need for health communication. Irrational use of antibiotics was reported mainly in Turkey. While it had become less likely to get antibiotics without a prescription, non-prescribed antibiotics remained a problem in Turkey. In the three EU countries, there were also alternative ways of getting antibiotics. Low levels of knowledge about the rational antibiotic use were reported in Turkey, while there were several sources of information on this in the EU countries. Communication with and trust in physicians were considered to be important. There were also system barriers, such as lacking opportunities for physicians to manage care in accordance with current evidence in Turkey and factors limiting access to care in EU countries. Conclusions: Several fields of importance for promoting rational antibiotic use were identified. There is a need for harmonisation of health-related regulations and policy programmes. Antibiotics should only be available with a prescription. Programmes for rational antibiotic use should be implemented on a broad scale, in medical care, at pharmacies and in the population. Methods for health communication and patient-centred care should be further developed and implemented in this field.

Background: Antimicrobial resistance may result from inappropriate use of antibiotics in health care. Turkey is one of the countries with the highest antibiotic consumption in the world. Considering the role of transnational ties between Turkish migrants and their social contacts in Turkey, the attitudes and behaviors relating to rational antibiotic use in Turkey can also affect the use of antibiotics by Turkish migrants residing abroad. This study explores physicians’ and pharmacists’ experiences and perspectives on rational antibiotic use among Turkish adults in Turkey and among Turkish migrants in Germany, Sweden, and the Netherlands, three European countries with large populations of Turkish migrants. Methods: Following a qualitative study design using convenience and snowball sampling, in-depth interviews with 21 family physicians and 24 pharmacists were conducted in the aforementioned countries. We transcribed all interviews verbatim and performed content analysis separately in the countries, followed by translation, pooling and joint interpretation of the findings. Results: Physicians and pharmacists encountered irrational use of antibiotics among their patients in Turkey. Physicians interviewed in the three European countries explained that Turkish migrants differ from non-migrants with respect to their attitudes towards antibiotics, for example by more often expecting to be prescribed antibiotics. All physicians and pharmacists in the selected countries reported to inform their patients on how to use antibiotics upon prescription; however, Turkish migrants’ poor language proficiency was considered as a substantial communication barrier by the physicians and pharmacists interviewed in the European countries. Conclusions: The study illustrated some aspects of irrational antibiotic use among the population in Turkey and Turkish migrants in selected European countries. It emphasized the need for closer community participation, adequate information campaigns, as well as in-service training of health care providers in Turkey. The strategies and interventions on rational antibiotic use should also be supported and encouraged by health care providers, who need to reach out to people with various cultural backgrounds.

The aim of the present study was to develop a pictorial questionnaire for the assessment of health-related quality of life (PictoQOL) and to examine its content validity and usability across three exemplary population groups of different origin residing in Germany (non-migrants, Turkish migrants and Arabic-speaking migrants). A mixed-methods design combining qualitative and quantitative methods was used, comprising 6 focus group discussions with a total of 17 participants, 37 cognitive interviews and a quantitative pretest with 15 individuals. The PictoQOL consists of a pictorial representation of a total of 15 different situations. Using a visual Likert scale, respondents indicate how much each situation applies to them. Some representations proved to be culturally sensitive and were adapted. Respondents found the use of an additional graphic layer in the form of symbols in addition to pictures helpful for interpretation. The PictoQOL is considered to allow a more accessible assessment and better comparability of HRQOL across different population groups regardless of their literacy level. It is therefore considered to be superior to existing instruments for routine use in health research and practice. Future studies need to examine its convergent and factorial validity.

Zusammenfassung: Hintergrund Verschiedene Diversitätsmerkmale, wie beispielsweise eine Behinderung, das Geschlecht, das Alter oder ein Migrationshintergrund, gehen mit unterschiedlichen Versorgungserwartungen und -bedürfnissen einher. Werden diese in der Gesundheitsversorgung, einschließlich der Rehabilitation, nicht berücksichtigt, kann das die Versorgungszufriedenheit und den Behandlungserfolg negativ beeinflussen. Diversitätssensibilität kann die Nutzerorientierung in der Versorgung erhöhen und somit helfen, den vielfältigen Versorgungsbedürfnissen und -erwartungen Rechnung zu tragen. Ziel der vorliegenden Studie ist es zu untersuchen, welche Maßnahmen Rehabilitationseinrichtungen in Deutschland nutzen, um eine diversitätssensible Versorgung anzubieten und welche möglichen Hindernisse bei der Umsetzung entsprechender Maßnahmen wahrgenommen werden. Methodik Zwischen Mai und August 2019 wurden Verwaltungsleitungen aller stationären Rehabilitationseinrichtungen zur Teilnahme an einer bundesweiten postalischen Fragebogenerhebung eingeladen (n=1233). Der Fragebogen umfasste Fragen zum Umgang mit den Diversitätsmerkmalen von Mitarbeitenden und Rehabilitand*innen. Es lagen Antworten von insgesamt 223 stationären Rehabilitationseinrichtungen vor (Rücklaufquote: 18,9%). Die Daten wurden deskriptiv ausgewertet. Ergebnisse Die Einrichtungsbefragung zeigt auf, dass Diversitätssensibilität für viele Rehabilitationseinrichtungen ein relevantes Thema ist. Diversitätssensibilität sei besonders von Bedeutung für die Zufriedenheit der Versorgungsnutzer*innen, die Zufriedenheit der Mitarbeitenden und den Behandlungserfolg von Rehabilitand*innen. Hindernisse bei der Umsetzung einer diversitätssensiblen Versorgung seien fehlende Anreize der Versorgungsträger, fehlende finanzielle Ressourcen und organisatorische Schwierigkeiten. Diskussion Die Mehrheit der befragten Verwaltungsleitungen erkennt die Relevanz einer diversitätssensiblen Versorgung an, Instrumente zur Umsetzung dieser kommen allerdings nur selten und unsystematisch zum Einsatz. Zur Förderung von Diversitätssensibilität benötigen Gesundheitseinrichtungen Unterstützung bei der Kompetenzbildung und bei der Auswahl und Implementierung geeigneter Maßnahmen. Eine Handreichung mit praxisnahen Anleitungen zur Umsetzung einer diversitätssensiblen Versorgung kann hierfür eine Grundlage bieten.

Hintergrund Menschen mit Migrationshintergrund nehmen trotz eines höheren Bedarfs rehabilitative Leistungen seltener in Anspruch und weisen ungünstigere Ergebnisse auf als Menschen ohne Migrationshintergrund. Migrationssensible Versorgungsstrategien können einen Beitrag leisten, Barrieren abzubauen, denen Menschen mit Migrationshintergrund im Gesundheitssystem begegnen. Ziel der vorliegenden Studie ist es, hindernde und fördernde Faktoren für die Implementierung solcher Strategien aus der Perspektive von Gesundheitspersonal zu ermitteln. Methodik Die Untersuchung basiert auf 8 qualitativen leitfadengestützten Fokusgruppeninterviews mit insgesamt 50 MitarbeiterInnen unterschiedlicher Berufsgruppen in orthopädischen Rehabilitationseinrichtungen in Nordrhein-Westfalen und Schleswig-Holstein. Ergebnisse Das Gesundheitspersonal erachtet eine migrationssensible Versorgung als notwendig und ist motiviert, entsprechende Maßnahmen umzusetzen. Als Hindernis für die Implementierung werden v. a. fehlende personelle und finanzielle Ressourcen genannt, u.a. für das Einstellen zusätzlicher mehrsprachiger MitarbeiterInnen. Optimierungspotenziale wurden im Hinblick auf die fehlende Migrationssensibilität von Versorgungsträgern gesehen. Schlussfolgerung Die aufgezeigten Barrieren müssen überwunden werden, um den Einsatz migrationssensibler Versorgungskonzepte zu fördern. Diese können der Ausgangspunkt für eine über Migrationssensibilität hinausgehende diversitätssensible Versorgung sein, die auch der Rolle weiterer Diversitätsmerkmale Rechnung trägt. Background Despite a higher need for rehabilitation, migrants are less likely to use rehabilitative care than non-migrants and have poorer rehabilitative care outcomes. Migrant-sensitive health care strategies, which consider migrants’ needs and expectations, can contribute to reducing barriers that migrants encounter in the health system. Currently, only few hospitals in Germany employ such strategies. The present study aims to explore factors promoting and deterring their implementation in medical rehabilitation from the perspective of health care staff. Methods Eight qualitative focus group discussions with a total of 50 employees from different professions have been conducted in orthopedic rehabilitation hospitals in the federal states of North Rhine-Westphalia and Schleswig-Holstein. Employees were interviewed with respect to barriers and promoting factors regarding the implementation of migrant-sensitive health care strategies. Results The health care staff considers migration-sensitive rehabilitative care to be necessary and is highly motivated to implement services accordingly. Factors deterring the implementation of migrant-sensitive services are considered to be the lack of financial and personnel resources, e.g., needed to employ additional multilingual staff. Further potential for improvement is reported with respect to a limited migrant-sensitivity among funders of health care. Conclusion Barriers identified need to be overcome in order to promote the implementation of migrant-sensitive health care services. They can be the starting point for a diversity-sensitive health care which also takes into account the role of other diversity characteristics.