German Health Update Fokus (GEDA Fokus) among Residents with Croatian, Italian, Polish, Syrian, or Turkish Citizenship in Germany: Protocol for a Multilingual Mixed-Mode Interview Survey

Abstract

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

COVID-19 vaccination status among people with selected citizenships: results of the study GEDA Fokus

“…‘German Health Update: Fokus (GEDA Fokus)’ is a multilingual survey of people with selected citizenships (Croatian, Italian, Polish, Syrian, and Turkish), that was conducted as part of the project ‘Improving Health Monitoring in Migrant Populations’ (IMIRA II) at the Robert Koch Institute (RKI). The study aimed to collect comprehensive information on health status, health behaviour, living conditions, and the utilisation of health services, as well as to enable differentiated statements according to sociodemographic and migration-related characteristics [ 43 ]. The (core) indicators developed within the framework of IMIRA I to describe the health situation of people with a migration background formed a thematic focus of the survey content [ 33 ].…”

“…The selection of five citizenships (population) was based on model calculations using the foreigner statistics [ 45 ] and register movements [ 46 ] of the Federal Statistical Office from 2015–2017. Thus, the size of the citizenship groups, as well as the dynamics of people (inward and outward migration), were taken into account [ 43 ]. Thus, our study population included persons between 18 and 79 years of age with Croatian, Italian, Polish, Syrian, or Turkish citizenship who had their main residence in one of the selected cities and municipalities at the time of the data collection [ 43 ].…”

“…Thus, the size of the citizenship groups, as well as the dynamics of people (inward and outward migration), were taken into account [ 43 ]. Thus, our study population included persons between 18 and 79 years of age with Croatian, Italian, Polish, Syrian, or Turkish citizenship who had their main residence in one of the selected cities and municipalities at the time of the data collection [ 43 ]. Persons for whom a conditional blocking notice under § 52 of the Federal Registration Act is deposited in the population register and who are accordingly registered as residing in institutions (e.g., collective accommodation centres for refugees) were included in the sampling.…”

“…In addition to a multilingual web-based questionnaire, the participants could participate via a printed paper questionnaire in German or one of the five study languages (Arabic, Croatian, Italian, Polish, or Turkish). If there was no response, there was the possibility of a personal interview with partly multilingual interviewers or, in the larger cities, a telephone interview in the preferred language of the participant [ 43 ].…”

Editorial – Migration and health: Moving towards diversity-oriented public health monitoring at the Robert Koch Institute

“…The main objective of the IMIRA II project (2019–2023) is to describe the current health status of people with a history of migration in a differentiated manner. Findings on the improved inclusion in health surveys obtained in IMIRA were implemented here, and the health interview survey GEDA Fokus was conducted among people with five selected citizenships [ 8 ]. For GEDA Fokus, a register-based sample was drawn, and more than 6,000 people with Croatian, Italian, Polish, Syrian, or Turkish citizenship were interviewed about their health situation.…”