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Background Germany has a long history of migration. In 2020, more than 1 person in every 4 people had a statistically defined, so-called migration background in Germany, meaning that the person or at least one of their parents was born with a citizenship other than German citizenship. People with a history of migration are not represented proportionately to the population within public health monitoring at the Robert Koch Institute, thus impeding differentiated analyses of migration and health. To develop strategies for improving the inclusion of people with a history of migration in health surveys, we conducted a feasibility study in 2018. The lessons learned were implemented in the health interview survey German Health Update (Gesundheit in Deutschland aktuell [GEDA]) Fokus, which was conducted among people with selected citizenships representing the major migrant groups in Germany. Objective GEDA Fokus aimed to collect comprehensive data on the health status and social, migration-related, and structural factors among people with selected citizenships to enable differentiated explanations of the associations between migration-related aspects and their impact on migrant health. Methods GEDA Fokus is an interview survey among people with Croatian, Italian, Polish, Syrian, or Turkish citizenship living in Germany aged 18-79 years, with a targeted sample size of 1200 participants per group. The gross sample of 33,436 people was drawn from the residents’ registration offices of 99 German municipalities based on citizenship. Sequentially, multiple modes of administration were offered. The questionnaire was available for self-administration (web-based and paper-based); in larger municipalities, personal or phone interviews were possible later on. Study documents and the questionnaire were bilingual—in German and the respective translation language depending on the citizenship. Data were collected from November 2021 to May 2022. Results Overall, 6038 respondents participated in the survey, of whom 2983 (49.4%) were female. The median age was 39 years; the median duration of residence in Germany was 10 years, with 19.69% (1189/6038) of the sample being born in Germany. The overall response rate was 18.4% (American Association for Public Opinion Research [AAPOR] response rate 1) and was 6.8% higher in the municipalities where personal interviews were offered (19.3% vs 12.5%). Overall, 78.12% (4717/6038) of the participants self-administered the questionnaire, whereas 21.88% (1321/6038) took part in personal interviews. In total, 41.85% (2527/6038) of the participants answered the questionnaire in the German language only, 16.69% (1008/6038) exclusively used the translation. Conclusions Offering different modes of administration, as well as multiple study languages, enabled us to recruit a heterogeneous sample of people with a history of migration. The data collected will allow differentiated analyses of the role and interplay of migration-related and social determinants of health and their impact on the health status of people with selected citizenships. International Registered Report Identifier (IRRID) DERR1-10.2196/43503

The promotion of health literacy at a young age can protect, maintain and improve health across the life course. Yet to date, a sound data basis on adolescent health literacy as a requirement for the development of strategies to promote health literacy has not been given. This paper presents a study protocol for the online survey “Health Literacy Among Adolescents” (GeKoJu) that collects the first nation-wide representative data on self-reported generic health among adolescents aged 14–17 years in Germany. The objectives of the survey are (1) to assess the distribution of generic health literacy among adolescents in Germany, (2) to identify socio-demographic and social factors in regard to health literacy and (3) to assess the association of health literacy and health-related outcomes. The cross-sectional survey was conducted from September 2019 through December 2019. A two-stage stratified cluster sampling strategy was applied. Individuals invited to participate in the survey (N = 6608) were randomly selected among German-speaking adolescents aged 14–17 years, with permanent residence in Germany. Generic health literacy is measured with the “Measurement of Health Literacy Among Adolescents-Questionnaire” (MOHLAA-Q). Data collection also covers questions on health behavior, subjective health status, personal and social resources, socio-demographic and social factors and health services use. Results of the GeKoJu survey will provide data for the development of strategies to promote generic health literacy among families, in schools, communities and health care.

For the third time, wave 2 of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is conducted in the context of health monitoring at the Robert Koch Institute, now provides representative cross-sectional data for Germany. Completed in 2017, data for the cross-sectional component of KiGGS Wave 2 was collected in the form of an interview and examination survey. Interview survey data was collected from 15,023 participants, meaning that the required number of participants has been reached. A randomly selected subgroup of 3,567 participants was also examined. The overall response rate was 40.1%. Differences in response rates were registered regarding certain sociodemographic characteristics. Weighting was applied to compensate for differences in willingness to participate related to age, gender, geographic region, nationality and education factors. Weighting ensures that assessments of the health of children and adolescents in Germany are representative for the population. The data serves to estimate prevalence rates and, through comparison with the results from previous survey waves, to analyse trends. A set of measures were taken to recruit a sufficiently large group of participants and ensure that the net sample reflects the composition of the overall population to the highest degree. For future surveys, further measures ought to be taken in order to improve the integration of hard-to-reach subgroups.

BackgroundThe implementation of an Internet option in an existing public health interview survey using a mixed-mode design is attractive because of lower costs and faster data availability. Additionally, mixed-mode surveys can increase response rates and improve sample composition. However, mixed-mode designs can increase the risk of measurement error (mode effects).ObjectiveThis study aimed to determine whether the prevalence rates or mean values of self- and parent-reported health indicators for children and adolescents aged 0-17 years differ between self-administered paper-based questionnaires (SAQ-paper) and self-administered Web-based questionnaires (SAQ-Web), as well as between a single-mode control group and different mixed-mode groups.MethodsData were collected for a methodological pilot of the third wave of the "German Health Interview and Examination Survey for Children and Adolescents". Questionnaires were completed by parents or adolescents. A population-based sample of 11,140 children and adolescents aged 0-17 years was randomly allocated to 4 survey designs—a single-mode control group with paper-and-pencil questionnaires only (n=970 parents, n=343 adolescents)—and 3 mixed-mode designs, all of which offered Web-based questionnaire options. In the concurrent mixed-mode design, both questionnaires were offered at the same time (n=946 parents, n=290 adolescents); in the sequential mixed-mode design, the SAQ-Web was sent first, followed by the paper questionnaire along with a reminder (n=854 parents, n=269 adolescents); and in the preselect mixed-mode design, both options were offered and the respondents were asked to request the desired type of questionnaire (n=698 parents, n=292 adolescents). In total, 3468 questionnaires of parents of children aged 0-17 years (SAQ-Web: n=708; SAQ-paper: n=2760) and 1194 questionnaires of adolescents aged 11-17 years (SAQ-Web: n=299; SAQ-paper: n=895) were analyzed. Sociodemographic characteristics and a broad range of health indicators for children and adolescents were compared by survey design and data collection mode by calculating predictive margins from regression models.ResultsThere were no statistically significant differences in sociodemographic characteristics or health indicators between the single-mode control group and any of the mixed-mode survey designs. Differences in sociodemographic characteristics between SAQ-Web and SAQ-paper were found. Web respondents were more likely to be male, have higher levels of education, and higher household income compared with paper respondents. After adjusting for sociodemographic characteristics, only one of the 38 analyzed health indicators showed different prevalence rates between the data collection modes, with a higher prevalence rate for lifetime alcohol consumption among the online-responding adolescents (P<.001).ConclusionsThese results suggest that mode bias is limited in health interview surveys for children and adolescents using a mixed-mode design with Web-based and paper questionnaires.