Protective Behavior in Course of the COVID-19 Outbreak: Survey Results From Germany

Objective: The COVID-19 outbreak means far-reaching changes in the organization of daily lives. Disease-related literacy and factors such as age, gender, or education play a major role in shaping individual practices of protective behavior. This paper investigates different types and frequency of practicing protective behaviors, as well as socio-demographic factors that are associated with such behavioral change. Methods: Data stem from a cross-sectional survey in Germany. Three thousand seven hundred and sixty-five people were contacted, 3,186 participated in the survey. Information on behavior to lower the risk of becoming infected with COVID-19 was assessed by nine items (answer options yes/no). For each item, logistic regression models were used to estimate odds ratios (OR), using education, sex, and age as main predictors and adjusting for partnership status and household composition. Results: People with lower educational level were less likely to avoid gatherings (OR = 0.63; 95%CI = 0.48–0.83), adapt their work situation (OR = 0.66; 95%CI = 0.52–0.82), reduce personal contacts and meetings (OR = 0.71; 95%CI = 0.55–0.93), or increase hand hygiene (OR = 0.53; 95%CI = 0.38–0.73). Being female was associated with higher odds of protective behavior for most outcomes. Exceptions were wearing face masks and adapting the own work situation. Associations between respondents' age and individual behavior change were inconsistent and mostly weak. Conclusion: Disease specific knowledge is essential in order to enable people to judge information on COVID-19. Health education programs aiming at improving COVID-19 knowledge are helpful to build up appropriate practices and reduce the spread of the disease. Strategies are needed to guarantee easy access and better dissemination of high-quality news and fact-checks. Socioeconomic characteristics should be taken into account in the development of infection control measures

Telefonische Befragungen bei alten Menschen: Ausschöpfung, Kontakthäufigkeit und Verweigerungen

'Obgleich telefonische Befragungen in der empirischen Sozialforschung in den letzten Jahren an Bedeutung gewonnen haben, gibt es in Deutschland kaum Erfahrungen mit diesem Instrument im Rahmen von sozialwissenschaftlich-gerontologischen Untersuchungen. Im vorliegenden Beitrag werden Maßnahmen zur Ausschöpfungsoptimierung (Mehrfachkontaktierung von Schwer-Erreichbaren und Konvertierung von Verweigerern) bei einer telefonischen Befragung alter Menschen (60 Jahre und älter) thematisiert. Dabei wird insbesondere der Frage nachgegangen, ob sich leicht erreichbare von schwer erreichbaren Haushalten bzw. Personen und temporäre Verweigerer von kooperationsbereiten Befragungsteilnehmern hinsichtlich soziodemographischer und sozioökonomischer Merkmale unterscheiden. Die Ergebnisse lassen darauf schließen, daß dem Problem der Verweigerung bei der Planung und Durchführung telefonischer Befragungen alter Menschen größere Aufmerksamkeit geschenkt werden sollte als dem Problem der Erreichbarkeit.' (Autorenreferat)'Although telephone surveys have become more important for empirical research in recent years, there is not much experience in using telephone interviews in socio-gerontological research. In this article measures to optimise response rate (repeated telephone calls and converting temporary refusers) in a telephone survey of older people (>60 years) are discussed We focus on the following two questions: f irst, whether persons who can be reached easily differ from those who are diffi cult to contact. Secondly we ask whether temporary refusers differ from cooperative respondents as far as their sociodemographic and socioeconomic characteristics are concerned. Results indicate that the problem of refusal has higher relevance for the planning and conductiong of telephone interviews with older people, compared to the problem of reachability.' (author's abstract)

Socioeconomic inequalities, health damaging behavior, and self-perceived health in Serbia: a cross-sectional study

Aim To analyze the association of socioeconomic factors with self-perceived health in Serbia and examine whether this association can be partly explained by health behavior variables. Methods We used data from the 2007 Living Standards Measurement Study for Serbia. A representative sample of 13 831 persons aged ≥20 years was interviewed. The associations between demographic factors (age, sex, marital status, and type of settlement), socioeconomic factors (education, employment status, and household consumption tertiles), and health behavior variables (smoking, alcohol consumption) and self-perceived health were examined using logistic regression analyses. Results A stepwise gradient was found between education and self-perceived health for the total sample, men, and women. Compared to people with high education, people with low education had a 4.5 times higher chance of assessing their health as poor. Unemployed (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.29-2.10), inactive (OR, 2.82; 95% CI, 2.49-3.19), and the most deprived respondents (OR, 1.17; 95% CI, 1.02-1.34) were more likely to report poor self-perceived health than employed persons and the most affluent group. After adjustment for demographic and health behavior variables, the magnitudes of all associations decreased but remained clearly and significantly graded. Conclusions This study revealed inequalities in self-perceived health by socioeconomic position, in particular educational and employment status. The reduction of such inequalities through wisely tailored interventions that benefit people’s health should be a target of a national health policy in Serbi

Public Continuum Beliefs for Different Levels of Depression Severity

Introduction: The notion that depression is a disorder that moves along a continuum is well-established. Similarly, the belief in the continuity of mental illness is considered an important element in the stigma process. Against this background, it is the aim of this study to examine whether public continuum beliefs vary with the severity of depressive symptoms. Methods: Analyses were based on computer-assisted telephone interviews (CATIs) conducted in winter 2019/2020 in Germany (N = 1,009, response rate 46.8%). Using three vignettes representing mild, moderate, and severe depressive symptoms, beliefs regarding the continuity of symptoms, specifically a fundamental difference, were assessed with seven items. Sociodemographic characteristics and own experiences with depression (affliction and contact) were introduced as covariates. Results: Significant differences between the three groups of severity were found for the majority of the items measuring continuum beliefs or perceived fundamental difference. However, only few items showed a linear trend indicating a parallel between symptom severity and beliefs. Multivariate regression models showed that a moderate degree of depression was positively associated with stronger continuum beliefs but also with greater perceived difference compared to the mild degree, while no significant associations emerged for the severe vignette. Limitations: Although a comparison of our sample with official statistics supports the external validity, we cannot rule out a selection bias. It is arguable in how far short case vignettes convey a holistic picture of a person affected by depressive symptoms. Conclusion: Our results do not indicate a parallel between symptom severity and public continuum beliefs

Are health care inequalities unfair? A study on public attitudes in 23 countries

Background: In this article we focus on the following aims: (1) to analyze national and welfare state variations in the public perception of income-related health care inequalities, (2) to analyze associations of sociodemographic, socioeconomic, health-related, and health care factors with the perception of health care inequalities. Methods: Data were taken from the International Social Survey Programme (ISSP), an annually repeated cross-sectional survey based on nationally representative samples. 23 countries (N = 37,228) were included and assigned to six welfare states. Attitude towards income-related health care inequalities was assessed by asking: "Is it fair or unfair that people with higher incomes can afford better health care than people with lower incomes?" with response categories ranging from "very fair" (1) to "very unfair" (5). On the individual level, sociodemographic (gender, age), socioeconomic (income, education) health-related (self-rated health), and health care factors (health insurance coverage, financial barriers to health care) were introduced. Results: About two-thirds of the respondents in all countries think that it is unfair when people with higher incomes can afford better health care than people with lower incomes. Percentages vary between 42.8 in Taiwan and 84 in Slovenia. In terms of welfare states, this proportion is higher in Conservative, South European, and East European regimes than in East Asian, Liberal, and Social-Democratic regimes. Multilevel logistic regression analyses show that women, people affected by a low socioeconomic status, poor health, insufficient insurance coverage, and foregone care are more likely to perceive income-related health care inequalities as unfair. Conclusions: In most countries a majority of the population perceives income-related health care inequalities as unfair. Large differences between countries were observed. Welfare regime classification is important for explaining the variation across countries

Stichprobenrealisierung bei einer bundesweiten telefonischen Befragung alter Menschen

'Im vorliegenden Beitrag wird die Stichprobenrealisierung bei einer bundesweiten telefonischen Befragung von in Privathaushalten lebenden alten Menschen (60 Jahre und älter) beschrieben. Dabei steht die Frage nach den Auswirkungen von Proxy-Interviews und Konvertierungsmaßnahmen auf die Zusammensetzung der Stichprobe im Zentrum der Analysen. Ein Vergleich zwischen Personengruppen mit unterschiedlich ausgeprägter Befragbarkeit und Kooperationsbereitschaft zeigt, dass durch die ausschöpfungssteigernden Maßnahmen mehr Hochaltrige, Verheiratete, alte Menschen mit geringer Bildung und geringem Einkommen sowie alte Menschen mit schlechterem Gesundheitszustand in die Untersuchung einbezogen werden konnten. Zudem ergeben sich zum Teil deutliche Unterschiede in der Ausprägung multivariater Zusammenhänge zwischen kooperationsbereiten Befragungsteilnehmern und temporären Verweigerern. Die Ergebnisse verdeutlichen die Notwendigkeit ausschöpfungssteigernder Maßnahmen zur Reduzierung von durch Ausfällen bedingten Verzerrungen insbesondere bei telefonischen Befragungen alter Menschen.' (Autorenreferat)'The article describes a survey of older people (> 60 years) living in private accommodation in Germany. The aim was to investigate the impact of proxy-interviews and successful conversion on the structure of the realised sample. A comparison of groups shows that conversion techniques lead to higher participation of the oldest old, of married people, and of people with either low socio-economic status or poor health. In addition, considerable differences were found in multivariate relationships between co-operative respondents on the one hand and those initially unwilling to participate on the other. Our findings point to the importance of employing response enhancement measures to reduce non-response, in particular in telephone surveys of older and elderly people.' (author's abstract)

Public Continuum Beliefs for Different Levels of Depression Severity

Introduction: The notion that depression is a disorder that moves along a continuum is well-established. Similarly, the belief in the continuity of mental illness is considered an important element in the stigma process. Against this background, it is the aim of this study to examine whether public continuum beliefs vary with the severity of depressive symptoms.Methods: Analyses were based on computer-assisted telephone interviews (CATIs) conducted in winter 2019/2020 in Germany (N = 1,009, response rate 46.8%). Using three vignettes representing mild, moderate, and severe depressive symptoms, beliefs regarding the continuity of symptoms, specifically a fundamental difference, were assessed with seven items. Sociodemographic characteristics and own experiences with depression (affliction and contact) were introduced as covariates.Results: Significant differences between the three groups of severity were found for the majority of the items measuring continuum beliefs or perceived fundamental difference. However, only few items showed a linear trend indicating a parallel between symptom severity and beliefs. Multivariate regression models showed that a moderate degree of depression was positively associated with stronger continuum beliefs but also with greater perceived difference compared to the mild degree, while no significant associations emerged for the severe vignette.Limitations: Although a comparison of our sample with official statistics supports the external validity, we cannot rule out a selection bias. It is arguable in how far short case vignettes convey a holistic picture of a person affected by depressive symptoms.Conclusion: Our results do not indicate a parallel between symptom severity and public continuum beliefs

Intended healthcare utilisation in cases of severe COVID-19 and inflammatory gastrointestinal disease: results of a population survey with vignettes

Objectives: To examine variations in intended healthcare utilisation in severe cases of COVID-19 and inflammatory gastrointestinal disease (IGD).Design Representative cross-sectional telephone survey. Setting and participants 1207 randomly drawn adults of the city of Hamburg, Germany, between November 2020 and January 2021. Outcome measures: Different vignettes with severe symptoms were presented varying in sex, age (child, middle-aged person, older person), daytime (Tuesday morning or Tuesday evening) and disease (COVID-19 or IGD), while the degree of urgency was equivalent for all cases. The respondents were asked for the intended healthcare utilisation resulting in three different alternatives: general practitioner (GP)/paediatrician, medical on-call service ('116117') and emergency care (accident and emergency department, emergency practice, rescue service). In multivariate analyses, associations of characteristics of the vignettes and participants (sex, age, education, migration background) with intended healthcare utilisation were tested. In a further step, analyses were conducted separately for IGD and COVID-19. Results: Regarding the vignettes' characteristics, intended utilisation of GP/paediatrician is associated with female sex, higher age, daytime (morning) and COVID-19 symptoms, the medical on-call service with male sex, daytime (evening) and COVID-19 symptoms and the emergency medicine with younger age, daytime (evening) and IGD. Women chose more often the GP/paediatrician, men preferred emergency medicine. Only in case of IGD, higher educated persons more often chose the medical on-call service while people with a migration background decided less often for medical on-call service and emergency medicine. Conclusions: Despite comparable urgency, the findings suggest variations of intended healthcare utilisation depending on various characteristics of the vignettes and respondents. Depending on the type of disease inequalities vary. Overall, information about healthcare alternatives in severe cases has to be improved and clear pathways to facilitate healthcare utilisation has to be further developed.Data are available on reasonable request

A study based on claims data from a German health insurance fund

Background The objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. Two research questions are addressed: (1) How strong is the association between age and care dependency risk 1 year after stroke and (2) can this association be explained by burden of disease? Methods The study is based on claims data from a German statutory health insurance fund. The study population was drawn from all continuously insured members with principal diagnoses of ischaemic stroke, hemorrhagic stroke, or transient ischaemic attack in 2007 who survived for 1 year after stroke and who were not dependent on care before their first stroke (n = 2864). Data were collected over a 1-year period. People are considered to be dependent on care if they, due to a physical, mental or psychological illness or disability, require substantial assistance in carrying out activities of daily living for a period of at least 6 months. Burden of disease was assessed by stroke subtype, history of stroke, comorbidities as well as geriatric multimorbidity. Regression models were used for data analysis. Results 21.6 % of patients became care dependent during the observation period. Post-stroke care dependency risk was significantly associated with age. Relative to the reference group (0–65 years), the odds ratio of care dependency was 11.30 (95 % CI: 7.82–16.34) in patients aged 86+ years and 5.10 (95 % CI: 3.88–6.71) in patients aged 76–85 years. These associations were not explained by burden of disease. On the contrary, age effects became stronger when burden of disease was included in the regression model (by between 1.1 and 28 %). Conclusions Our results show that age has an effect on care dependency risk that cannot be explained by burden of disease. Thus, there must be other underlying age- dependent factors that account for the remaining age effects (e.g., social conditions). Further studies are needed to explore the causes of the strong age effects observed