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Hintergrund Alkohol wird bei Personen mit Migrationshintergrund, insbesondere ab dem 50. Lebensjahr, zu einem Problem. Praventionsmasnahmen erreichen diese Gruppe aber nur unzulanglich. Vor diesem Hintergrund wurde ein transkulturelles Praventionskonzept zur Primarpravention alkoholbezogener Storungen entwickelt und evaluiert.

Hintergrund: Kulturelle und migrationsspezifische Aspekte scheinen die Inanspruchnahme von Gesundheitsleistungen in dieser Gruppe zu beeinflussen. Es existieren allerdings keine Instrumente, welche solche Einflussfaktoren erfassen. Methoden: Systematische Literaturrecherche zur Identifikation der Schwierigkeiten, welche Migranten bei der Inanspruchnahme von Gesundheitsmasnahmen erleben. Die abgeleiteten Aspekte wurden im Rahmen einer Querschnittbefragung von Menschen mit russischem, turkischem, italienischem und spanischem Migrationshintergrund uberpruft. Zur psychometrischen Testung wurden Faktoren- und Reliabilitatsanalysen durchgefuhrt. Ergebnisse: Es wurde 24 Grunde fur Nicht-Inanspruchnahme identifiziert. Die faktoranalytische Testung zeigte eine Losung mit 2 Subskalen („Sprach- und informationsbezogene Grunde fur Nicht-Inanspruchnahme von Gesundheitsleistungen“; Chronbach’s α=0,928; „Erfahrungen mit bzw. Einstellungen zur Gesundheitsversorgung“; α=0,879) und einer Gesamtskala (α=0,945). Die Akzeptanz lag zwischen 80,0 und 96,3%. Schlussfolgerungen: Die Ergebnisse bestatigen die theoretisch abgeleiteten Aspekte. Zur Generalisierbarkeit ist eine weitere Uberprufungen der psychometrischen Qualitaten des Instruments sowie seine Anwendung in anderen Populationen notwendig.

This study was part of a double-blind randomised controlled trial aimed to evaluate the effects of culture-sensitive patient information materials (PIM) compared with standard translated material. The study aimed to obtain the data for the development of culture sensitive PIM about unipolar depression for the 4 largest migrant groups in Germany (Turkish, Polish, Russian and Italian migration background).A qualitative study using 4 manual-based focus groups (FG), one for each migrant group, with 29 participants (9 with a Turkish (TüG), 8 with a Polish (PoG), 5 with a Russian (RuG) and 7 with an Italian (ItG) migration background) was conducted. The discussions were recorded, transcribed and analyzed using qualitative content analysis.7 categories were identified. For the (1.) development of a good culture-sensitive PIM an easy language, a clear structure, an assessable extent of information and the avoidance of stereotypes were highlighted cross-culturally in all four FG. RuG and PoG had the largest (2.) lack of information about the German health care system. Concerning the (3.) illness perception RuG named problems with recognizing and understanding depression. PoG, RuG and TüG thematized (4.) feared consequences of the illness and of professional helpseeking. ItG, PoG, RuG had fears concerning (5.) psychotropic drugs as a result from insufficient knowledge about medication. For (6.) doctor-patient relationship cultural specifics were identified in RuG and TüG and for (7.) migration or culture specific reasons for depression in RuG, ItG and TüG.Although the identified categories were relevant for all or for the majority of migrant groups, for most categories specific cultural aspects were discovered. These findings show the importance of a culture sensitive adaptation of PIM.Die Studie war ein Teil einer größeren, randomisiert-kontrollierten Studie, in der die Effekte kultursensitiver Patienteninformationsmaterialien (PIM) im Vergleich mit übersetzten PIM evaluiert wurden. Die vorliegende Studie hatte zum Ziel, Daten zur Entwicklung von PIM zu unipolarer Depression für die 4 größten Gruppen von Menschen mit Migrationshintergrund (türkischer, polnischer, russischer und italienischer Migrationshintergrund) in Deutschland zu gewinnen.Im Rahmen einer qualitativen Studie wurde pro Migrantengruppe jeweils eine leitfadenbasierte Fokusgruppe (FG) mit insgesamt n=29 Teilnehmenden (n=9 mit türkischem (TüG), n=8 polnischem (PoG), n=5 russischem (RuG), n=7 italienischem (ItG) Migrationshintergrund) durchgeführt, aufgezeichnet, transkribiert und mittels eines qualitativ-inhaltsanalytischen Analysemodells ausgewertet.Es konnten 7 Kategorien identifiziert werden. Über alle 4 FG wurde kulturübergreifend als wichtig die (1.) Gestaltung einer guten kultursensitiven PIM durch eine einfache Sprache, eine klare Struktur, einen überschaubareren Informationsumfang sowie die Vermeidung von Stereotypien erachtet. (2.) Informationsdefizite über das Gesundheitssystem zeigten sich v. a. bei der RuG und der PoG. Bezogen auf das (3.) Krankheitsbild der Depression wurden von der RuG Schwierigkeiten bzgl. des Erkennens und des Verstehens einer Depression beschrieben. In der PoG, der RuG und der TüG wurde die (4.) befürchteten Folgen der Erkrankung sowie der Inanspruchnahme professioneller Hilfe thematisiert. In den ItG, PoG und RuG wurden Angstgefühle aufgrund von Wissenslücken im Zusammenhang mit (5.) Psychopharmaka beschrieben. In der Kategorie (6.) Arzt-Patienten-Beziehung konnten kulturspezifische Besonderheiten für die RuG und die TüG und in der Kategorie (7.) migrations- und kulturspezifische Depressionsursachen für die RuG, die ItG und die TüG identifiziert werden.Obwohl einige Kategorien kulturübergreifend für alle bzw. für die Mehrheit untersuchter Migrantengruppen eine Relevanz zeigten, waren bei einer Vielzahl von Kategorien kulturelle Spezifika erkennbar. Dies spricht für die Wichtigkeit einer kultursensitiven Anpassung von PIM.

Objectives To evaluate the usefulness of culture-sensitive patient information material compared with standard translated material. Design Multicentre, double-blind randomised controlled trial. Setting 37 primary care practices. Participants 435 adult primary care patients with a migration background with unipolar depressive disorder or non-specific chronic low back pain were randomised. Patients who were unable to read in the language of their respective migration background were excluded. Sufficient data were obtained from 203 women and 106 men. The largest group was of Russian origin (202 patients), followed by those of Turkish (52), Polish (30) and Italian (25) origin. Interventions Intervention group: provision of culture-sensitive adapted material. Control group: provision of standard translated material. Main outcome measures Primary outcome: patient-rated usefulness (USE) assessed immediately after patients received the material. Secondary outcomes: patient-rated usefulness after 8 weeks and 6 months, symptoms of depression (PHQ-9), back pain (Back Pain Core Set) and quality of life (WHO-5) assessed at all time points. Results Usefulness was found to be significantly higher (t=1.708, one-sided p=0.04) in the intervention group (USE-score=65.08, SE=1.43), compared with the control group (61.43, SE=1.63), immediately after patients received the material, in the intention-to-treat analysis, with a mean difference of 3.65 (one-sided 95% lower confidence limit=0.13). No significant differences were found for usefulness at follow-up (p=0.16, p=0.71). No significant effect was found for symptom severity in depression (p=0.95, p=0.66, p=0.58), back pain (p=0.40, p=0.45, p=0.32) or quality of life (p=0.76, p=0.86, p=0.21), either immediately after receiving the material, or at follow-up (8 weeks; 6 months). Patients with a lower level of dominant society immersion benefited substantially and significantly more from the intervention than patients with a high level of immersion (p=0.005). Conclusion Cultural adaptation of patient information material provides benefits over high quality translations. Clinicians are encouraged to use culture-sensitive material in their consultations, particularly with low-acculturated patients. Trial registration number German Register for Clinical Trials: DRKS00004241, Universal Trial Number: U1111-1135-8043, Results.

Background Chronic diseases, like diabetes mellitus, heart disease and cancer are leading causes of death and disability. These conditions are at least partially preventable or modifiable, e.g. by enhancing patients’ self-management. We aimed to examine the effectiveness of telephone-based health coaching (TBHC) in chronically ill patients. Methods and Findings This prospective, pragmatic randomized controlled trial compares an intervention group (IG) of participants in TBHC to a control group (CG) without TBHC. Endpoints were assessed two years after enrolment. Three different groups of insurees with 1) multiple conditions (chronic campaign), 2) heart failure (heart failure campaign), or 3) chronic mental illness conditions (mental health campaign) were targeted. The telephone coaching included evidence-based information and was based on the concepts of motivational interviewing, shared decision-making, and collaborative goal setting. Patients received an average of 12.9 calls. Primary outcome was time from enrolment until hospital readmission within a two-year follow-up period. Secondary outcomes comprised the probability of hospital readmission, number of daily defined medication doses (DDD), frequency and duration of inability to work, and mortality within two years. All outcomes were collected from routine data provided by the statutory health insurance. As informed consent was obtained after randomization, propensity score matching (PSM) was used to minimize selection bias introduced by decliners. For the analysis of hospital readmission and mortality, we calculated Kaplan-Meier curves and estimated hazard ratios (HR). Probability of hospital readmission and probability of death were analysed by calculating odds ratios (OR). Quantity of health service use and inability to work were analysed by linear random effects regression models. PSM resulted in patient samples of 5,309 (IG: 2,713; CG: 2,596) in the chronic campaign, of 660 (IG: 338; CG: 322) in the heart failure campaign, and of 239 (IG: 101; KG: 138) in the mental health campaign. In none of the three campaigns, there were significant differences between IG and CG in time until hospital readmission. In the chronic campaign, the probability of hospital readmission was higher in the IG than in the CG (OR = 1.13; p = 0.045); no significant differences could be found for the other two campaigns. In the heart failure campaign, the IG showed a significantly reduced number of hospital admissions (-0.41; p = 0.012), although the corresponding reduction in the number of hospital days was not significant. In the chronic campaign, the IG showed significantly increased number of DDDs. Most striking, there were significant differences in mortality between IG and CG in the chronic campaign (OR = 0.64; p = 0.005) as well as in the heart failure campaign (OR = 0.44; p = 0.001). Conclusions While TBHC seems to reduce hospitalization only in specific patient groups, it may reduce mortality in patients with chronic somatic conditions. Further research should examine intervention effects in various subgroups of patients, for example for different diagnostic groups within the chronic campaign, or duration of coaching. Trial Registration German Clinical Trials Register DRKS00000584

For migrants who are older than 50, alcohol frequently becomes a problem. Simultaneously alcohol-related prevention measures only reach this group insufficiently. Therefore, a transcultural concept for preventing alcohol-related disorders in elderly (≥ 45 years) migrants has been developed.The transcultural concept, which consisted of a prevention event as well as a cultural and language-sensitive information booklet, was evaluated in a cluster-randomized controlled trial (n = 310 immigrants). As a control condition there was a prevention event with materials from Deutsche Hauptstelle für Suchtfragen (German Centre for Addiction Issues). Data were obtained before and after the event, as well as after 6 months. All materials were available both in German and in Russian, Italian, Spanish and Turkish.Directly after the event, as well as 6 months thereafter, the transcultural approach was rated significantly better than the general prevention event. 73.4 % of the participants read the cultural and migration-sensitive booklet, whereas only 21.2 % in the control condition (p = 0.0001). Furthermore, significantly more participants of the transcultural approach reported a reduced alcohol consumption (49.4 vs. 16.7 %; p = 0.004) after 6 months.The consideration of diversity with respect to cultural, migration-related, socio demographic und linguistic aspects improves the effectiveness of prevention measures.