Oral health behaviour in migrant and non-migrant adults in Germany: the utilization of regular dental check-ups

Background Migrants in many European countries including Germany tend to utilize preventive measures less frequently than the majority population. Little is known about the dental health of migrants as well as about their oral health behaviour, particularly in the adult population. The aim of this study was to examine differences in the uptake of annual dental check-ups in adult migrants and non-migrants in Germany. Methods We used data from the cross-sectional survey ‘German Health Update 2010’ conducted by the Robert Koch Institute (n = 22,050). Data from 21,741 German-speaking respondents with information on the use of dental check-ups was available, of which 3404 (15.7%) were migrants. Multiple logistic regression models were applied to adjust for demographic and socioeconomic confounders, including the place of residence as well as type of health insurance. Results Migrants were generally younger, had a lower socioeconomic status and showed a lower utilization of dental check-ups. The unadjusted odds ratio (OR) for utilization was 0.67 (95%-CI = 0.61–0.73). After adjusting for demographic and socioeconomic confounders the chance only increased slightly (adjusted OR = 0.71; 95%-CI = 0.65–0.77). Conclusions The analysis shows that migration status is associated with a reduced chance of attending dental check-ups, independently of demographic and socioeconomic factors. The influence of other factors, such as type of health insurance and place of residence had also no influence on the association. Migrants are exposed to different barriers in the health care system, comprising the patient, provider and system level. Further studies need to examine the relevant barriers for the uptake of preventive dental services in order to devise appropriate migrant- sensitive measures of dental prevention

Is exposure to secondhand smoke associated with current depression (PHQ-8) among never-smokers? Results from a survey among German adults

Background!#!Findings on the association between exposure to secondhand smoke (SHS) and depression are contradictory. Comparability of existing research is limited due to varied methods and measures. This study examines the potential association between exposure to SHS and depression and a potential moderation by sex using representative data from Germany.!##!Methods!#!For our study, we used data from the German Health Update (GEDA) 2014/2015 on n = 10,274 never-smokers. We calculated a logistic regression model with an interaction term for potential sex-exposure interactions. We used the self-reported duration of exposure to predict current depression of any type as defined by the Patient Health Questionnaire PHQ-8 (score ≥ 10), accounting for a large number of confounders.!##!Results!#!In our sample, prevalence of depression was 8.8% in women and 5.3% in men. 90.4% were never or almost never exposed to SHS, while 7.1% were exposed < 1 h per day and around 2.5% reported being exposed for ≥1 h per day. While SHS exposure for < 1 h per day was not associated with current depression (OR = 1.54; 95%-CI: 0.93-1.61), SHS exposure for at least 1 h per day was associated with increased odds for current depression (OR = 1.59; 95%-CI: 1.08-2.35). No sex-specific differences were found.!##!Conclusions!#!Higher levels of SHS exposure are associated with current depression, although the nature and direction of the association are still unclear. We identified no differences in the association between men and women. More studies, particularly using longitudinal data, are needed to determine the nature of the association

Enabling and Predisposing Factors for the Utilization of Preventive Dental Health Care in Migrants and Non-Migrants in Germany

Background: In many European countries including Germany, migrants utilize preventive services less frequently than the majority population. This is also true for the utilization of dental checkups. Little is known about which demographic, social, behavioral, and health-related factors influence the decision of migrants to seek preventive dental health care and how these factors differ from those in non-migrants. The aim of the present study was to examine the role of these factors among migrants and non-migrants residing in Germany. Methods: Data from cross-sectional national health surveys are used, providing information on preventive dental health behavior from n = 41,220 individuals, of which 15.0% are migrants. Andersen’s Behavioral Model of Health Services Use is the conceptual framework of the investigation. Multiple logistic regression models were applied to examine the role of different predisposing and enabling factors. Interaction terms were included in order to examine whether determinants differ between migrants and non-migrants. Average marginal effects (AMEs) are reported in addition to odds ratios (ORs) as measures of effect size which are robust against bias arising from unobserved heterogeneity. Results: Migrants are at an about 36% lower chance of utilizing regular dental checkups than non-migrants [OR = 0.64 (95% confidence interval, 95% CI: 0.61, 0.68); AME = −0.081 (95% CI = −0.093, −0.069)]. Differences are partly explained by the influence of demographic, social, behavioral, and health-related factors [adjusted OR = 0.69 (95% CI: 0.64, 0.73); AME = −0.065 (95% CI = −0.076, −0.053)]. Younger age, being male, lower socioeconomic status, a non-statutory health insurance, not living in a relationship, living in the Western part of Germany and in an urban setting, and poor limited social support were associated with a lower chance of utilizing regular dental checkups. Interaction effects could be observed for age and for the type of health insurance. Discussion: The study identifies different enabling and predisposing factors that are relevant for the utilization of dental checkups among the population in Germany, some of which differ between migrants and non-migrants. Differences are particularly pronounced for younger ages. This differs from findings on other preventive services where older migrants tend to be more disadvantaged. Additional explanatory factors such as barriers that migrants experience in the dental health care system need to be considered in order to implement patient-oriented services and to reduce disparities in access to dental prevention

Participatory development of a manual for the implementation of diversity-sensitive palliative and hospice care in Germany: a mixed-methods study protocol

Abstract Background The diversity of the population is associated with different needs and expectations towards palliative and hospice care. Current approaches available in Germany generally fall short in addressing the role of diversity and intersectionality in this health care setting and healthcare facilities struggle with organizational difficulties and missing information on how to implement corresponding diversity-sensitive measures. The present study aims to develop a hands-on manual that enables providers of hospice and palliative care to implement measures and strategies for diversity-sensitive care, while taking into account the perspective of healthcare users and explicitly including vulnerable and minority patient groups. Methods A participatory approach is used to co-create the aforementioned manual using an explanatory sequential mixed-methods design. First, based on a systematic analysis of existing measures, an initial draft of the manual will be developed. Subsequently, an online survey will be conducted among all hospice and palliative care providers in Germany (n = 2,823). Based on the results of the survey, 12 to 15 qualitative problem-centered interviews will be conducted with employees of selected providers who took part in the survey. Results of the survey and the qualitative interviews will be integrated and analyzed. In parallel to the development and research process, a comprehensive dissemination strategy will be developed. Discussion The manual will assist providers of palliative and hospice care in determining goals, needs, and available resources in order to utilize patient-centered and diversity-sensitive measures to meet a wide range of expectations. It can also be informative for providers in other countries. The participatory co-development approach ensures the practical relevance of the manual, while the mixed-methods design allows for targeted input on the manual’s usability, acceptance, and viability as a supportive tool

Expectations, concerns and experiences of rehabilitation patients during the COVID-19 pandemic in Germany: a qualitative analysis of online forum posts

Altinok K, Erdsiek F, Yilmaz-Aslan Y, Brzoska P. Expectations, concerns and experiences of rehabilitation patients during the COVID-19 pandemic in Germany: a qualitative analysis of online forum posts. BMC Health Services Research . 2021;21(1): 1344.BACKGROUND: The COVID-19 pandemic, as well as efforts to prevent its spread, have had a strong impact on the delivery of rehabilitative services in Germany. While several studies have addressed the impact of these developments on health service providers and COVID-19 patients, little is known about its impact on patients in need of rehabilitative treatmentbecause of other conditions. This study aims to identify expectations, concerns and experiences of rehabilitation patients related to service delivery in this situation.; METHODS: Using a qualitative study design, user posts from six German online forums between March and Mid-November 2020 were systematically searched with respect to experiences, concerns and expectations of health care users toward receiving rehabilitative treatment. We used qualitative content analysis with inductive coding as ourmethodological approach.; RESULTS: Users fearing physical or psychological impairment were concerned about not receiving timely or effective treatment due to closed hospitals, reduced treatments and limited admissions. In contrast, patients more concerned about getting infected with COVID-19 worried about the effectiveness of protective measures and being denied postponement oftreatment by the funding bodies. During their stay, some patients reported feeling isolated due to contact restrictions and did not feel their treatment was effective, while others reported being satisfied and praised hospitals for their efforts to ensure the safety of the patients. Many patients reported communication problems before and during their treatment, including concerns about the safety and effectiveness of their treatment, as well as financial concerns and worries about future treatments. Several users felt that their concerns were disregarded by the hospitals and the funding bodies, leaving them feeling distressed, insecure and dissatisfied.; CONCLUSIONS: While some users report only minor concerns related to the pandemic and its impact on rehabilitation, others report strong concerns relating not only to their own health and safety, but also to financial aspects and their ability to work. Many users feel ignored and disregarded, showing a strong need for more coordinated strategies and improved communication specifically with funding bodies like health insurance companies and the German pension funds. © 2021. The Author(s)

Assessing health-related quality of life through pictorial items. An overview of the state of the art

Brzoska P, Aksakal T, Erdsiek F, Yilmaz-Aslan Y. Assessing health-related quality of life through pictorial items. An overview of the state of the art. In: QUALITY OF LIFE RESEARCH. QUALITY OF LIFE RESEARCH. Vol 28. Dordrecht: Springer; 2019: S168-S169

What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany

Fieselmann J, Annac K, Erdsiek F, Yilmaz-Aslan Y, Brzoska P. What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany. BMC Public Health . 2022;22(1): 846.BACKGROUND: Vaccination against COVID-19 has been available in Germany since December 2020. However, about 30% of the population report not wanting to be vaccinated. In order to increase the willingness of the population to get vaccinated, data on the acceptance of vaccination and its influencing factors are necessary. Little is known about why individuals refuse the COVID-19 vaccination. The aim of this study was to investigate the reasons leading to rejecting vaccination, based on posts from three social media sites.; METHODS: The German-language versions of Instagram, Twitter and YouTube were searched regarding negative attitudes towards COVID-19 vaccination. Data was extracted until a saturation effect could be observed. The data included posts created from January 20, 2020 to May 2, 2021. This time frame roughly covers the period from the first reports of the spread of SARS-CoV-2 up to the generalavailability of vaccines against COVID-19 in Germany. We used an interpretive thematic approach to analyze the data and to inductively generate codes, subcategories and categories.; RESULTS: Based on 333 posts written by 323 contributing users, we identified six main categories of reasons for refusing a COVID-19 vaccination: Low perceived benefit of vaccination, low perceived risk of contracting COVID-19, health concerns, lack of information, systemic mistrust and spiritual or religious reasons. The analysis reveals a lack of information among users and the spread of misinformation with regard to COVID-19 and vaccination. Users feel inadequately informed about vaccination or do not understand the information available. These information gaps may be related to information not being sufficiently sensitive to the needs of the target group. In addition to limited information for the general population, misinformation on the internet can also be an important reason for refusing vaccination.; CONCLUSIONS: The study emphasizes the relevance of providing trustworthy and quality-assured information on COVID-19 and COVID-19 vaccination to all population groups. In addition, vaccinations should be easily accessible in order to promote the population's willingness to be vaccinated. © 2022. The Author(s)

Perceived controllability of a SARS-CoV-2 infection: an investigation of intersectional differences

Neugebauer T, Wahidie D, Erdsiek F, Yilmaz-Aslan Y, Brzoska P. Perceived controllability of a SARS-CoV-2 infection: an investigation of intersectional differences. BMC Public Health . 2022;22(1): 2371.Background: The perceived ability to influence an infection with SARS-CoV-2 has an impact on compliance with protective measures. Factors influencing perceived controllability are not yet fully known. The aim of this study was to identify intersectional differences in perceived controllability. Insights into these intersectional differences could help to develop user-centered strategies to improve the acceptance of protective measures. Methods: Data from the seventh wave of the German Ageing Survey (DEAS) was used to investigate differences in the population regarding the perceived controllability. The role of socio-demographic and socio-economic predictors was investigated using multivariable linear regression modeling. Intersectional differences were examined using interaction terms. Results: Information on 4,823 respondents aged 46 to 100 years were available, of which 50.9% were female. Migration status (yes vs. no: beta = -0.27; 95%-CI = -0.48,-0.06), education level (high vs. low: beta = 0.31; 95%-CI: 0.08, 0.55) and employment status (retired vs. employed: beta = 0.33; 95%-CI: 0.19, 0.48) were found to be significantly influencing perceived controllability. Interaction effects were found with respect to sex and migration status, with migrant women rating their perceived controllability lower than non-migrant women (beta = -0.51; 95%-CI = -0.80, -0.21), while no differences were evident between migrant and non-migrant men (beta = -0.02; 95%-CI = -0.32, 0.28). Further intersectional differences were not observed. Conclusions: The results show that intersectional differences in perceived controllability occur especially between migrant and non-migrant women. Possible causes may lie in language barriers, which in connection with lower health literacy may affect perceived controllability. Dedicated efforts to improve controllability among older adults, those with lower educational attainment and migrant women are warranted

Language barriers in HRQOL assessment: development of a picture-based questionnaire (PictoQOL)

Erdsiek F, Aksakal T, Dyck M, Padberg D, Yilmaz-Aslan Y, Brzoska P. Language barriers in HRQOL assessment: development of a picture-based questionnaire (PictoQOL). In: 16th World Congress on Public Health 2020. Public Health for the future of humanity: analysis, advocacy and action. Europäische Diktaturen und ihre Überwindung. Vol 30. Oxford: Oxford Univ Press; 2020: V806