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 patientoriented 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.
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.
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