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Family caregivers of migrants with dementia constitute a population group that is hard to reach for research participation due to factors such as shame about the disease and past experiences of discrimination. In this article, research-ethical challenges associated with participant recruitment and qualitative data collection among relatives of migrants with dementia are discussed. Over a period of 8 years, 3 studies were conducted to investigate the experiences of family caregivers for persons with dementia of Turkish descent in Germany. Across these studies, a total of 32 family caregivers were interviewed. In this article, based on the "Principles of Biomedical Ethics" according to Beauchamp and Childress (2009), research-ethical conflicts associated with sampling methods and the presence of third parties during qualitative interviews are discussed. The potential risks emanating from sampling strategies and the presence of third parties during interviews regarding the voluntary nature of study participation are examined. Additionally, this article formulates recommendations for ensuring truly voluntary participation and protecting both the participants (family caregivers) and relatives with dementia from harm. These practical recommendations aim to help future researchers to avoid ethical pitfalls and represent a roadmap for making necessary methodological decisions. [ABSTRACT FROM AUTHOR]

Background: Evidence shows that living with diabetes mellitus type 1 (T1DM) in adolescent age is particularly challenging and difficult to manage. A high level of health literacy is important to prevent and avoid debilitating complications. Despite the increasing prevalence and incidence of T1DM by adolescent and the large use of digital health interventions, little is known about the association between this use and health literacy. This systematic review provides an overview on the impact of digital health interventions for adolescents with type 1 diabetes on health literacy and derive recommendations for further research. Methods: Electronic searches were performed in five databases in Medline (Medline, PubMed + via PubMed), The Cochrane Library, EMBASE (via Ovid), Web of Science and PsycINFO from 2011 to 2021. In addition, grey literature searches were conducted in Google Scholar, OAlster and Trip. Relevant studies that have been missed by electronic and hand-searching strategies were searched in the reference lists of all included studies. The review followed PRISMA guidelines. Two researchers independently screened abstracts for initial eligibility and applied the inclusion and exclusion criteria to the relevant full-text articles. Quality was assessed using the tools RoB2 Cochrane, ROBINS I, NOS (Newcastle–Ottawa Scale), CASP (Critical Appraisal Skills Programme) for primary studies and Amstar-2 for secondary studies. Results: Out of 981 studies, 22 were included in the final review. Most primary studies included in this review were judged as moderate overall risk of bias or with some concerns and most of the secondary studies as critically low quality reviews. Our findings suggest that the interplay of health care providers (HCP) and patients through social media helps the management of the disease. This corroborates Bröder et al.' (2017) dimension of 'communication and interactions' in their concept of health literacy. Conclusions: For adolescents with T1DM, social media may be a specific and beneficial intervention for an improved communication and interaction with their HCP. Further research should investigate what specific form of social media suits best for which adolescents. Trial registration: The study protocol was registered on the 15th of November 2021 on Prospero (reg. NR: CRD42021282199). [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Discussion Trial Registration Scientific research has consistently emphasised the high levels of stress encountered by family caregivers of individuals living with dementia. However, conventional self‐help approaches remain underutilised. The ‘Diversity‐On’ study addresses this issue. The study employs a storytelling approach to develop and evaluate an online self‐help program that is participatory and diversity‐sensitive, thereby ensuring congruence with diverse identities and lifeworlds.The study uses a mixed‐methods design, comprising the allocation and implementation of the intervention, the development of stories, a process evaluation (N = 20) and an outcome evaluation (quantitative: N = 130, qualitative: N = 20). The study's primary focus is its comprehensive participatory approach, integrated throughout the research process. The study is dependent on the input of a number of stakeholders, all of whom are committed to advocating for the concerns of patients.Given its participatory methodology and intersectional perspective, the ‘Diversity‐On’ study is anticipated to yield a number of significant outcomes. The study has the potential to empower family caregivers of individuals living with dementia who are under high stress, empowering them to take part in self‐help groups despite multiple barriers, thus alleviating their burden. Additionally, it has the capacity to promote the well‐being of caregiving relatives who are providing care and are experiencing high levels of stress. The study's objective is to maintain home care arrangements for as long as possible, in accordance with the values and preferences of care recipients and their families. The study intends to develop and assess a customised online self‐help resource that is suitable for a diverse range of users and that remains accessible beyond the study period.The project is subsequently registered in ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Introduction: Unpaid care work is mainly performed by women, whose mental health is more affected by caregiving burden and work-family conflict compared to men. COVID-19 containment measures may have exacerbated existing gender inequalities in both unpaid care work and adverse mental health outcomes. This scoping review provides an overview of recent evidence on the impact of COVID-19 containment measures on unpaid care work and mental health for subgroups of caregivers at the intersection of gender and other social differences (e.g., ethnicity, age, class) in Europe. Methods and analysis: Our study was informed and guided by Arksey and O'Malley's methodological framework. We searched six academic databases (Medline, PsycInfo, Scopus, CINAHL, Social Sciences Abstracts, Sociological Abstracts, ASSIA) and hand-searched the reference lists of selected articles to identify relevant peer-reviewed research articles published between 1 March 2020 and 7 September 2022. In addition, we conducted a grey literature search using Google Scholar and a targeted hand search on known international and European websites. We included studies that reported gender-disaggregated results on unpaid care work and mental health in the context of COVID-19 containment measures in Europe. Two reviewers independently screened all abstracts and full texts for eligibility and extracted the relevant data. The results were synthesised narratively. Results and discussion: Our results suggest a greater gender gap in unpaid care work division and, to a lesser extent, in mental health, which is unfavourable towards women and mothers. Despite this, we see a break in the traditional division of childcare, with fathers taking on a greater role in family work, which makes us optimistic about the division of care work in the post-COVID-19 era. This research also shows that among European women, population groups often understudied, such as women who are single parents, disabled or of colour, have the highest increase in unpaid care work and greatest deterioration in wellbeing. [ABSTRACT FROM AUTHOR]

Background: Racism in the healthcare system has become a burgeoning focus in health policy-making and research. Existing research has shown both interpersonal and structural forms of racism limiting access to quality healthcare for racialised healthcare users. Nevertheless, little is known about the specifics of racism in the inpatient sector, specifically hospitals and rehabilitation facilities. The aim of this scoping review is therefore to map the evidence on racial discrimination experienced by people receiving treatment in inpatient settings (hospitals and rehabilitation facilities) or their caregivers in high-income countries, focusing specifically on whether intersectional axes of discrimination have been taken into account when describing these experiences. Methods: Based on the conceptual framework developed by Arksey and O'Malley, this scoping review surveyed existing research on racism and racial discrimination in inpatient care in high-income countries published between 2013 and 2023. The software Rayyan was used to support the screening process while MAXQDA was used for thematic coding. Results: Forty-seven articles were included in this review. Specifics of the inpatient sector included different hospitalisation, admission and referral rates within and across hospitals; the threat of racial discrimination from other healthcare users; and the spatial segregation of healthcare users according to ethnic, religious or racialised criteria. While most articles described some interactions between race and other social categories in the sample composition, the framework of intersectionality was rarely considered explicitly during analysis. Discussion: While the USA continue to predominate in discussions, other high-income countries including Canada, Australia and the UK also examine racism in their own healthcare systems. Absent from the literature are studies from a wider range of European countries as well as of racialised and disadvantaged groups other than refugees or recent immigrants. Research in this area would also benefit from an engagement with approaches to intersectionality in public health to produce a more nuanced understanding of the interactions of racism with other axes of discrimination. As inpatient care exhibits a range of specific structures, future research and policy-making ought to consider these specifics to develop targeted interventions, including training for non-clinical staff and robust, transparent and accessible complaint procedures. [ABSTRACT FROM AUTHOR]

Background: After retirement, people of Turkish origin often spend several months of the year in Turkey.With higher age, the risk of suffering fromchronic diseases increases. During circular migration between Germany and Turkey, discontinuities may occur in the medication and medical care of chronic diseases. To date, there is a lack of in-depth analyses of barriers to medication and medical care of this group. Methods: Qualitative interviews regarding barriers and needs in medication and medical care in Turkey and Germany were conducted with elderly Turkish circular migrants suffering from chronic diseases, family physicians (FPs), and nurse assistants. The data were analyzed using qualitative content analysis according to Mayring. Results: Elderly Turkish migrants face various social, legislative, and communicative barriers regarding prescriptions and health care, which impede access to the Turkish health care system. Furthermore, some circular migrants are inadequately informed about their medication. Communication barriers, FPs' time shortages, and patients' experiences with discrimination can impede care in Germany. An unclear care situation in the patients' land of origin can lead to ethical conflicts in German FPs. The involvement of relatives in treatment planning, a good medical relationship between FPs and patients, and early discussion of planned stays in Turkey have a positive effect on care. Conclusion: To improve health care access for circular migrants, adaptations to transnational health care structures are required. FPs in Germany need to be equipped with the necessary resources to meet the needs of patients while respecting diversity. Active inquiries about travel plans and uncertainty or dissatisfaction regarding the patient's medication in general can prevent discontinuities in medication. [ABSTRACT FROM AUTHOR]

Background: Pensioners of Turkish origin residing in Germany often engage in circular migration between the two countries, thereby experiencing discontinuities in prescribed medication and medical care for chronic diseases, with the risk of deteriorating health status. So far, discontinuities in prescriptions and care have not been analyzed quantitatively. Methods: Routine data of elderly chronically ill Turkish-origin members of a German statutory health insurance scheme were analyzed for discontinuities in prescriptions and care compared to non-Turkish members. The study was based on data on bronchial asthma, diabetes mellitus, hypertension, and coronary heart disease from the AOK Rhineland/Hamburg from 2012-2018. Results: Discontinuities in prescribed medication and general care were significantly more frequent among Turkish than non-Turkish persons for several chronic diseases. Particularly for diabetes mellitus and bronchial asthma, Turkish persons had high odd ratios for discontinuities. Discontinuities tended to occur less frequently among Turkish persons aged 60-64 years compared to those of retirement age. Conclusion: A relevant proportion of Turkish persons show healthcare disparities. Comparing the pattern of discontinuities among groups, age, and disease, circular migration seems a likely cause. Family physicians in Germany need to be aware of circular migration patterns. They should address longer stays in Turkey as one possible reason for irregular medication and health care early, to prevent inadequate care. [ABSTRACT FROM AUTHOR]

Population aging and the associated changes in demographic structures and healthcare needs is a key challenge across Europe. Healthy aging strategies focus on ensuring the ability to maintain health, quality of life and independent living at old age. Concurrent to the process of population aging, the demographics of Europe are affected by increased migration resulting in substantial ethnic diversity. In this paper, we narratively review the health profile of the growing proportion of aging migrants in Europe, outline key factors shaping health among this diverse group and consider ways of addressing their healthcare needs. Although factors shaping aging processes are largely similar across populations, migrant-specific risk factors exist. These include exposure to health risks before and during migration; a more disadvantaged socioeconomic position; language barriers and low health literacy; cultural factors influencing health-seeking behaviours; and psychosocial vulnerability and discrimination affecting health and quality of life. Overall, migrants experience the same morbidity and mortality causes as the native populations, but with different relative importance, severity and age of onset and with substantial differences within and between migrant groups. Little is known regarding health behaviours among aging migrants, although differences in cancer screening behaviours have been identified. Indications of widening health differentials between migrants and native populations with age and informal barriers to quality healthcare for aging migrants are causes of concern. In conclusion, there is a need for attention to migration alongside other determinants of healthy aging. The diversity in individual characteristics, life course processes and contextual factors shaping aging processes among migrants point to the need for a sensitive and comprehensive approach to policies, practices and research within the field of healthy aging. This is important to accommodate for the needs of the growing number of aging migrants in Europe and counter inequities in health and well-being at old age. [ABSTRACT FROM AUTHOR]