Mammographie-Screening bei Frauen mit türkischem Migrationshintergrund - Ein Fokus auf Teilnahme unter Berücksichtigung der Informierten Entscheidung

Berens E-M. Mammographie-Screening bei Frauen mit türkischem Migrationshintergrund - Ein Fokus auf Teilnahme unter Berücksichtigung der Informierten Entscheidung. Bielefeld: Universität Bielefeld; 2016.Hintergrund: Menschen mit türkischem Migrationshintergrund sind eine wichtige Zielgruppe im Kontext von Public Health, denn sie machen einen bedeutenden Anteil an der Wohnbevölkerung Deutschlands aus und haben zudem andere Krankheitsrisiken und -ressourcen im Vergleich zur Mehrheitsbevölkerung. Als Maßnahme zur Früherkennung von Brustkrebs wird für Frauen von 50 bis 69 Jahren Mammographie-Screening angeboten. Da Mammographie-Screening jedoch neben einigen Vorteilen auch Nachteile hat, spielt die Informierte Entscheidung für oder gegen eine Teilnahme am Mammographie-Screening-Programm eine wichtige Rolle. Befunde aus Deutschland zu Teilnahmeraten türkischer Migrantinnen sowie zu den Einflussfaktoren oder der Informierten Entscheidung gibt es bislang nicht. Die theoretische Betrachtung ist ebenso defizitär. Fragestellung und Methode: Aufgrund der mangelnden Studienlage zu teilnahmerelevanten Aspekten bei Frauen mit türkischem Migrationshintergrund in Deutschland werden Fragestellungen zur Teilnahme, deren Einflussfaktoren sowie der Informierten Entscheidung bei Frauen mit türkischem Migrationshintergrund abgeleitet. Datengrundlage bilden Routinedaten von Mammographie-Screening-Einheiten und Einwohnermeldeämtern, semi-strukturierte qualitative Interviews sowie Response- und Befragungsdaten einer Querschnitterhebung. Verbindendes Element der verschiedenen Analysen ist die Betrachtung teilnahmerelevanter Aspekte bei Frauen mit türkischem Migrationshintergrund. Ergebnisse: Insgesamt zeigen sich keine Unterschiede in der Teilnahmerate am Mammographie-Screening-Programm zwischen Frauen mit und ohne türkischem Migrationshintergrund. Frauen mit türkischem Migrationshintergrund treffen jedoch zu einem deutlich geringeren Anteil eine Informierte Entscheidung für oder gegen die Teilnahme am Mammographie-Screening-Programm. Neben soziodemografischen Faktoren zeigen sich vor allem die Krankheitsvorstellungen, das generelle Gesundheitsverhalten, das Einladungsverfahren, persönliche Empfehlungen sowie Barrieren als teilnahmerelevant. Zudem spielen das Wissen über Brust-krebs und Mammographie-Screening sowie die persönlichen Einstellungen eine wichtige Rolle. Schlussfolgerungen: Die Teilnahmerate ist kein geeigneter Indikator zur Beurteilung gleicher Zugangschancen verschiedener Bevölkerungsgruppen im Rahmen des Mammographie-Screening. Vielmehr sollte die Informierte Entscheidung im Mittelpunkt stehen. Maßnahmen zur Förderung der Informierten Entscheidung sind insbesondere bei Frauen mit türkischem Migrationshintergrund dringend notwendig und sollten dabei migrationssensibel gestaltet sein

Health literacy among different age groups in Germany : results of a cross-sectional survey

BACKGROUND: Health literacy is of increasing importance in public health research. It is a necessary pre-condition for the involvement in decisions about health and health care and related to health outcomes. Knowledge about limited health literacy in different age groups is crucial to better target public health interventions for subgroups of the population. However, little is known about health literacy in Germany. The study therefore assesses the prevalence of limited health literacy and associated factors among different age groups. METHODS: The Health Literacy Survey Germany is a cross-sectional study with 2,000 participants aged 15 years or older in private households. Perceived health literacy was assessed via computer-assisted personal interviews using the HLS-EU-Q-47 questionnaire. Descriptive analyses, chi-square tests and odds ratios were performed stratified for different age groups. RESULTS: The population affected by limited perceived health literacy increases by age. Of the respondents aged 15-29 years, 47.3 % had limited perceived health literacy and 47.2 % of those aged 30-45 years, whereas 55.2 % of the respondents aged 46-64 years and 66.4 % aged 65 years and older showed limited perceived health literacy. In all age groups, limited perceived health literacy was associated with limited functional health literacy, low social status, and a high frequency of doctor visits. CONCLUSIONS: The results suggest a need to further investigate perceived health literacy in all phases of the life-course. Particular attention should be devoted to persons with lower social status, limited functional health literacy and/or a high number of doctor visits in all age groups

Participation in breast cancer screening among women of Turkish origin in Germany – a register-based study

Berens E-M, Stahl L, Yilmaz-Aslan Y, Sauzet O, Spallek J, Razum O. Participation in breast cancer screening among women of Turkish origin in Germany – a register-based study. BMC Women's Health. 2014;14(1): 24.Background Population-based breast cancer screening programs were implemented to reduce breast cancer mortality and to improve recovery chances. Breast cancer screening participation among migrant women differs from that of autochthonous populations in several European countries. Here we investigate for the first time participation among women of Turkish origin in Germany. Methods Data of five screening units covering 2010 and 2011 as well as associated population registries were analysed. Women of Turkish origin were identified using a name-based algorithm. Participation ratios among women of Turkish origin and odds ratios compared to women of non-Turkish origin were calculated. Analyses were stratified and adjusted for age-groups and screening unit. Results A total of 208,500 participants in the five breast screening units were included, out of 423,649 eligible women in the catchment areas (participation 49.2%). Women of Turkish origin have a slightly higher chance to participate in breast cancer screening than women without Turkish origin (OR 1.17; 95% CI: 1.14-1.21). Only women of Turkish origin aged 65–69 years have a lower chance to participate than women without Turkish origin (OR: 0.71; 95% CI: 0.66-0.75). Conclusion In spite of low participation in preventive measures among migrant populations, the overall breast cancer screening participation among women of Turkish origin in Germany seems to be higher compared to women of non-Turkish origin. Turkish women aged 65 years and above have a lower chance of participation than younger Turkish women. There is need for further research to study factors affecting participation in screening among migrant and non-migrant populations in Germany

2. Internationales Symposium Gesundheitskompetenz – Forschung, Praxis, Politik. 2./3. Mai 2019. Abstractband

Schaeffer D, Berens E-M, Bauer U, Okan O, eds. 2. Internationales Symposium Gesundheitskompetenz – Forschung, Praxis, Politik. 2./3. Mai 2019. Abstractband. Bielefeld: Universität Bielefeld; 2019

A cross-sectional study on informed choice in the mammography screening programme in Germany (InEMa): a study protocol

Berens E-M, Reder M, Kolip P, Spallek J. A cross-sectional study on informed choice in the mammography screening programme in Germany (InEMa): a study protocol. BMJ Open. 2014;4(9):e006145.Introduction: Breast cancer is the most prevalent cancer among women. In Germany, women are invited to a population-based mammography screening programme for the first time at the age of 50. Since it is still discussed whether the benefits of mammography screening outweigh its harms, the concept of informed choice has gained importance. The objective of this cross-sectional study is to assess the proportion of informed choices in the mammography screening programme. A special focus is on the examination of the impact of Turkish migration background and educational level on informed choices. Methods and analysis: The proportion of informed choices is evaluated in a cross-sectional study with 3-month follow-up for behavioural implementation of the screening intention. A randomly selected sample of 17 000 women aged 50 years living in Westphalia-Lippe, a region in the Federal State of North-Rhine Westphalia, is invited to participate in this study. To reach adequate numbers of Turkish women, all possibly Turkish women in the sample are identified through a name algorithm and contacted. The sample is drawn from women registered in the study area for which the registration offices consented to supply data for the study (88% of all towns/cities in the study region). Women identified through the Turkish name algorithm received all materials in German and Turkish. The primary outcome is informed choice. Data are collected on informed choice components (knowledge, attitude, decision/implementation) as well as on its possible determinants (eg, health behaviour, perceived behavioural control, subjective norms, invitation status, migration background and other demographic variables). Data are collected before the screening appointment and at 3 months follow-up. Ethics and dissemination: The study was approved by the ethical committee of the Medical Faculty of Muenster University. Results will be published in a relevant scientific journal and communicated to respondents and relevant institutions

Gesundheitskompetenz der Bevölkerung in Deutschland: Ergebnisbericht

Schaeffer D, Vogt D, Berens E-M, Hurrelmann K. Gesundheitskompetenz der Bevölkerung in Deutschland: Ergebnisbericht. Bielefeld: Universität Bielefeld, Fakultät für Gesundheitswissenschaften; 2017.Stand: Dezember 2016, geringfügig überarbeitete Fassung vom 27. Februar 201

Development of the Informed Choice in Mammography Screening Questionnaire (IMQ): factor structure, reliability, and validity

Reder M, Berens E-M, Spallek J, Kolip P. Development of the Informed Choice in Mammography Screening Questionnaire (IMQ): factor structure, reliability, and validity. BMC Psychology. 2019;7(1): 17.Background Informed choice is of ethical and practical importance in mammography screening. To assess the level to which decisions regarding such screening are informed is thus imperative, but no specific instrument has been available to measure informed choice in the German mammography screening programme. The aims of this study were to develop the Informed Choice in Mammography Screening Questionnaire (IMQ) and to find first evidence for the factor structure, reliability and validity of its different components. Methods The IMQ was sent to 17.349 women aged 50 in Westphalia-Lippe, Germany. The instrument has been developed after consideration of (1) the results of qualitative interviews on decision making in the mammography screening programme, (2) relevant literature on other informed choice instruments and (3) a qualitative study on influencing factors. The IMQ comprises 3 scales (attitude, norms, and barriers), 1 index (knowledge) and singular items covering intention to participate and sociodemographic variables. To assess the psychometric properties of the components of the IMQ, confirmatory factor and item response theory analyses were conducted. Additionally, reliability, validity and item statistics were assessed. Results 5.847 questionnaires were returned (response rate 33.7%). For attitude, the confirmatory factor analysis supported a one-factor structure. For norms, the model fit was not acceptable. Reliability levels were good with a Cronbach‘s α of.793 for attitude (4 items) and.795 for norms (5 items). For barriers, 9 items were deleted because of low discrimination indices; 6 items remained. The hypothesised assumption-subscale and the importance-subscale were confirmed, but these subscales showed poor reliabilities with Cronbach‘s α=.525 (4 items) and.583 (2 items). For the knowledge index, item response theory analysis showed that 6 out of 7 items were suitable. Hypotheses concerning the correlations between the different components were confirmed, which supported their convergent and divergent validity. Conclusion The results of this study demonstrated that the IMQ is a multidimensional instrument. Further development of the barriers and norms scales is necessary. The IMQ can be utilised to assess the level of informed choices as well as influencing factors

Informed choice in the German Mammography Screening Program by education and migrant status: Survey among first-time invitees.

Berens E-M, Reder M, Razum O, Kolip P, Spallek J. Informed choice in the German Mammography Screening Program by education and migrant status: Survey among first-time invitees. PLoS ONE. 2015;10(11): e0142316.Breast cancer is the most prevalent cancer among women and mammography screening programs are seen as a key strategy to reduce breast cancer mortality. In Germany, women are invited to the population-based mammography screening program between ages 50 to 69. It is still discussed whether the benefits of mammography screening outweigh its harms. Therefore, the concept of informed choice comprising knowledge, attitude and intention has gained importance. The objective of this observational study was to assess the proportion of informed choices among women invited to the German mammography screening program for the first time. A representative sample of 17,349 women aged 50 years from a sub-region of North Rhine Westphalia was invited to participate in a postal survey. Turkish immigrant women were oversampled. The effects of education level and migration status on informed choice and its components were assessed. 5,847 (33.7%) women responded to the postal questionnaire of which 4,113 were used for analyses. 31.5% of the women had sufficient knowledge. The proportion of sufficient knowledge was lower among immigrants and among women with low education levels. The proportion of women making informed choices was low (27.1%), with similar associations with education level and migration status. Women of low (OR 2.75; 95% CI 2.18–3.46) and medium education level (OR 1.49; 95% CI 1.27–1.75) were more likely to make an uninformed choice than women of high education level. Turkish immigrant women had the greatest odds for making an uninformed choice (OR 5.30, 95% CI 1.92–14.66) compared to non-immigrant women. Other immigrant women only had slightly greater odds for making an uninformed choice than non-immigrant women. As immigrant populations and women with low education level have been shown to have poor knowledge, they need special attention in measures to increase knowledge and thus informed choices

Strategiepapier #6 zu den Empfehlungen des Nationalen Aktionsplans. Gesundheitskompetenz in einer Gesellschaft der Vielfalt stärken: Fokus Migration

Adam Y, Berens E-M, Hurrelmann K, Zeeb H, Schaeffer D. Strategiepapier #6 zu den Empfehlungen des Nationalen Aktionsplans. Gesundheitskompetenz in einer Gesellschaft der Vielfalt stärken: Fokus Migration. Berlin: Nationaler Aktionsplan Gesundheitskompetenz; 2019

Gesundheitskompetenz - verständlich informieren und beraten: Material- und Methodensammlung zur Verbraucher- und Patientenberatung für Zielgruppen mit geringer Gesundheitskompetenz

Schmidt-Kaehler S, Vogt D, Berens E-M, Horn A, Schaeffer D. Gesundheitskompetenz - verständlich informieren und beraten: Material- und Methodensammlung zur Verbraucher- und Patientenberatung für Zielgruppen mit geringer Gesundheitskompetenz. Bielefeld: Universität Bielefeld, Fakultät für Gesundheitswissenschaften; 2017