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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 DERR1-10.2196/43503

ZusammenfassungDeutschland ist ein Einwanderungsland und 2019 hatte mehr als jede vierte hier lebende Person einen sog. Migrationshintergrund. Bei dieser statistisch definierten Gruppe handelt es sich um einen heterogenen Personenkreis; nicht nur in Bezug auf die Herkunft, sondern auch auf die Lebenslagen oder beispielsweise die Zuzugsmotive oder Deutschkenntnisse. Diese Heterogenität lässt sich anhand der statistischen Annäherungskategorie Migrationshintergrund kaum abbilden, spezifische Aussagen über die Gesundheit von Menschen mit Migrationshintergrund sind nicht ohne Hinzuziehung weiterer Variablen möglich. Um Menschen mit Migrationshintergrund besser in das Gesundheitsmonitoring am Robert Koch-Institut (RKI) einzubeziehen und das Thema Migration und Gesundheit ganzheitlicher zu betrachten, wurde das Projekt IMIRA („Improving Health Monitoring in Migrant Populations“) durchgeführt. Der vorliegende Beitrag gibt einen Überblick über die wichtigsten Erkenntnisse, die im Rahmen dieses Projektes für die Forschungspraxis gewonnen wurden und trägt Empfehlungen für deren Übertragbarkeit in Bezug auf die medizinische Versorgung zusammen. So sind eine Weiterentwicklung mehrsprachiger Informations- und Aufklärungsmaterialien sowie die Einbeziehung von Vertreterinnen und Vertretern der Zielgruppe(n) unerlässlich. Darüber hinaus sollte in Behandlung und Diagnostik Sprachmittlung durch professionelle Dolmetscherinnen und Dolmetscher gewährleistet werden. Notwendig sind weiterhin Diversitätssensibilität und Diversität im Team. Die hier diskutierten Aspekte können auch im Bereich der Diabetologie nützlich sein. Zur Weiterentwicklung von Disease-Management-Programmen (DMP) sind partizipative Ansätze notwendig, um die DMP-Zugänglichkeit zu erhöhen.

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

In Deutschland besteht Bedarf an Informationen zur Gesundheit von Menschen mit Migrationshintergrund (MMH). Daher hat das Robert Koch-Institut das Projekt „Improving health monitoring in migrant populations“ (IMIRA) initiiert, um die Einbindung von MMH in das Gesundheitsmonitoring zu verbessern. Ziel des Beitrags ist die Identifikation von Herausforderungen und Strategien im Zugang zu MMH im Rahmen epidemiologischer Forschung. Es wurden 24 leitfadengestutzte Interviews mit Expertinnen und Experten aus Deutschland gefuhrt. Diese waren Wissenschaftlerinnen und Wissenschaftler verschiedener Disziplinen mit Forschungsschwerpunkt Migration, Personen des offentlichen Dienstes und aus der Praxis. Schwerpunkte des Interviews waren Herausforderungen und Strategien im Zugang zu MMH. Ausgewertet wurden die Ergebnisprotokolle der Interviews. Herausforderungen im Zugang zu MMH sind sprachliche, soziodemografische und kulturelle Barrieren, Angste sowie strukturelle und praktische Schwierigkeiten. Weitere Herausforderungen ergeben sich aus der Heterogenitat und Motivation der Gruppen. Strategien zur Verbesserung der Erreichbarkeit finden sich in Forschungsprozess, Methoden, Kommunikation und diversitatssensibler Forschungskultur. Vertrauensbildende Masnahmen werden als bedeutsam erachtet. Expertinnen und Experten zeigen eine Vielzahl von Strategien auf, die auf die direkte Ansprache und Einbeziehung von MMH fokussieren: Die Starkung partizipativer Ansatze, neue Ubersetzungsformen und Masnahmen zur Erhohung von Vertrauen in Forschung sollten zukunftig im Fokus stehen. So kann die Teilnahmebereitschaft von MMH in der epidemiologischen Forschung erhoht und langfristig die Informationslage zur Gesundheit von MMH verbessert werden.