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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.

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.

BackgroundGermany is a popular destination for immigrants, and migration has increased in recent years. It is therefore important to collect reliable data on migrants’ health. The Robert Koch Institute, Berlin, Germany, has launched the Improving Health Monitoring in Migrant Populations (IMIRA) project to sustainably integrate migrant populations into health monitoring in Germany.ObjectiveOne of IMIRA’s objectives is to implement a feasibility study (the IMIRA survey) that focuses on testing various interventions to increase the reachability of migrants with health interview surveys. Possible causes of nonresponse should be identified so as to increase participation in future surveys.MethodsThe survey target populations were Turkish, Polish, Romanian, Syrian, and Croatian migrants, who represent the biggest migrant groups living in Germany. We used probability sampling, using data from the registration offices in 2 states (Berlin and Brandenburg); we randomly selected 9068 persons by nationality in 7 sample points. We applied age (3 categories: 18-44, 45-64, and ≥65 years) and sex strata. Modes and methods used to test their usability were culturally sensitive materials, online questionnaires, telephone interviews, personal contact, and personal interviews, using multilingual materials and interviewers. To evaluate the effectiveness of the interventions, we used an intervention group (group A) and a control group (group B). There were also focus groups with the interviewers to get more information about the participants’ motivation. We used the European Health Interview Survey, with additional instruments on religious affiliation, experience of discrimination, and subjective social status. We evaluated results according to their final contact result (disposition code).ResultsWe collected data from January to May 2018 in Berlin and Brandenburg, Germany. The survey had an overall response rate of 15.88% (1190/7494). However, final disposition codes varied greatly with regard to citizenship. In addition to the quantitative results, interviewers reported in the focus groups a “feeling of connectedness” to the participants due to the multilingual interventions. The interviewers were particularly positive about the home visits, because “if you are standing at the front door, you will be let in for sure.”ConclusionsThe IMIRA survey appraised the usability of mixed-mode or mixed-method approaches among migrant groups with a probability sample in 2 German states. When conducting the survey, we were confronted with issues regarding the translation of the questionnaire, as well as the validity of some instruments in the survey languages. A major result was that personal face-to-face contact was the most effective intervention to recruit our participants. We will implement the findings in the upcoming health monitoring study at the Robert Koch Institute.

Background A total of 3,419 new HIV diagnoses were reported in Germany in 2016, with migrants from sub-Saharan Africa (misSA) accounting for 14.1%. To understand the driving factors behind the epidemiological situation, we conducted a quantitative cross-sectional survey on knowledge, attitudes, behavior, and practices regarding HIV and sexually transmitted infections (STIs) among misSA living in six German cities utilizing participatory health research. Methods Participants were recruited by peer researchers. Levels of knowledge, information needs, and preferred methods of information dissemination were analyzed to inform future prevention planning. Additionally, we analyzed sexual behavior and other risk factors for contracting HIV and STIs. The results may facilitate the formulation of targeted prevention messages in the future. Results We included 2,432 participants in the analysis. General knowledge about HIV was adequate, as 86.9% were aware of the presented information. Statements about HIV co-infections were prior knowledge for 53.4% of the participants and about German HIV policies and HIV testing for 54.7%. Knowledge about other STIs differed, ranging from 69.6% who have ever heard of gonorrhea to 23.8% who have ever heard of genital warts. Groups with particular knowledge gaps were i) younger misSA, ii) recent migrants, iii) misSA without regular access to the German health care system, iv) misSA of lower socioeconomic status, and v) misSA with Muslim religious affiliation. The majority of participants reported information needs (72.8%), and 71.3% wanted to obtain this information from health professionals. Male misSA were more likely to report five or more sexual partners compared to females. Less than half of participants reported always using condoms with non-steady sexual partners (46.8%). Reasons for not using condoms differed between males and females. A considerable proportion of females (16.3%) and males (6.8%) experienced sexualized violence. More than one fourth of women (26.9%) were affected by female genital mutilation/cutting. Discussion Future prevention planning should focus on sub-groups with particular knowledge gaps, recognizing their preferred methods of information dissemination. Prevention messages for male misSA should focus on their own risk perception and for female misSA on empowerment, e.g. to negotiate condom use.

Die Epidemiologie erfasst die Gesundheit und gesundheitsrelevante Lebensverhaltnisse von Bevolkerungsgruppen. Auch wenn epidemiologische Daten und die daraus gewonnenen Empfehlungen von Akteuren in Public Health und der Krankenversorgung regelmasig genutzt werden, kann ihr Anwendungsbezug weiter ausgebaut werden. Die Arbeit gibt exemplarische Antworten auf die Frage, ob mithilfe partizipativer Ansatze der Anwendungsbezug von epidemiologischen Studien verbessert werden kann. Zudem wird untersucht, welchen Nutzen die Stakeholder aus Forschung, Praxis und den Bevolkerungsgruppen aus ihrer Zusammenarbeit ziehen konnen und welche Herausforderungen die Anwendung partizipativer Ansatze mit sich bringt. In einem Scoping Review wurden epidemiologische Studien und Publikationen uber Gesundheitsberichte mit partizipativem Design zusammengetragen. In Bezug auf die Handlungsfelder, Untersuchungsebenen und involvierten Stakeholder wurden die partizipativen Ansatze und die verwendeten Forschungsmethoden hinsichtlich ihrer Verwendung, ihres Anwendungsbezugs und ihrer Herausforderungen analysiert. In epidemiologischen Studien werden partizipative Ansatze zu vielfaltigen Forschungsfragen, auf verschiedenen Untersuchungsebenen und in unterschiedlichen Handlungsfeldern verwendet. Dabei werden gangige quantitative und qualitative Forschungsmethoden eingesetzt. Trotz vielfaltiger Herausforderungen kann gezeigt werden, dass partizipative Ansatze den Anwendungsbezug epidemiologischer Studien verbessern konnen.

Background Although 36.5% of minors in Germany had a migration background (MB) in 2017, data on their health situation is scarce. The project ‘Improving Health Monitoring in Migrant Populations’ (IMIRA) initiated in 2016 aims to expand health reporting on the health situation of people with MB, for which a core indicator set was developed. We are describing the health situation of adolescents based on selected core indicators. Methods Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS wave 2) (2014-2017) are used; adolescents from 11 to 17 years are considered. Prevalences and 95% confidence intervals are calculated for the following indicators: General health status, overweight, hazardous alcohol consumption and use of pediatric or general practitioner’s services. These indicators are stratified along socio-demographic (gender, age, socio-economic status (SES)) and migration-related characteristics (MB, parents’ duration of stay, language spoken at home). Results There are hardly any migration-related differences in the general health status and the use of general medical services. While adolescents with MB are more often affected by overweight (without MB: 11.2%, one-sided: 18.9%, both-sided: 19.8%), they show less often risky alcohol consumption (without MB: 14.5%, one-sided: 7.8%, both-sided: 4.4%). There are differences in health behavior according to SES, parents’ duration of stay in Germany and language spoken at home. Conclusions Overall, the health of adolescents is good, regardless of their MB, and general medical services are used equally. Differences in health behavior cannot be reduced solely to the (non-)existence of a MB, but need a deeper consideration of more specific migration-related characteristics and the SES. Key messages The general health status and health care utilization do not differ between adolescents with and without MB. In contrast, the results on indicators of health behavior vary.

Background A quarter of the population living in Germany are people with a migration background (PMB). In this context, the Robert Koch Institute (RKI) has the task of designing the health monitoring system that has been established in recent years in such a way that PMB are adequately taken into account in statements on the health situation of the German population. Methods The Improving Health Monitoring in Migrant Populations (IMIRA) project was initiated at the end of 2016 with the aim of improving the inclusion of MMH in health monitoring. Literature research, expert interviews and feasibility studies were carried out to identify strategies for access routes, recruitment measures, the dismantling of language barriers and the inclusion of MHH, which are incorporated into the concept of Monitoring 4.0, the further development of RKI health monitoring. Results In order to sustainably improve the accessibility of PMB in RKI health monitoring, a sequential study design with multilingual administration modes is planned within interview surveys. Personal contact through home visits and face-to-face interviews as well as the use of interpretation are essential to increase the willingness to participate. Strengthening the diversity sensitivity of the staff, as well as anti-discriminatory reporting, and promoting the participation of PMB and practitioners are additional components. Conclusions The IMIRA project has led to important findings that will be implemented in the long-term health monitoring of the RKI. The improved accessibility of PMB for health surveys enables a reflected presentation of the health situation of PMB, which does justice to the heterogeneity of the population living in Germany. Main messages • In order to include PMB sustainably in health monitoring we need to, develop dynamic study designs, bridge language gaps, establish personal contact, increase diversity sensibility and encourage participation of PMB in development of research processes.

Background Participatory epidemiology aims to involve public health professionals, health activists, and community representatives in epidemiological studies. Paramount are equitable research partnerships for identifying the causes of health problems, generating data, and finding ways to address health related issues. Alongside the research process, co-creation informs various aspects of participatory epidemiology. Methods A scoping review was conducted to develop the conceptual foundations of participatory epidemiology. Workshops with staff from public health administration and public health practitioners were held to check feasibility of the concept for public health monitoring, policy making and the development of relevant public health recommendations. From this research, principles and practices of co-creation were identified. Results Co-creation is of importance for participatory epidemiology. 1) Methodologically: Co-creation asks to apply multiple perspectives (research, practice, communities) in data collection and synthesis, what may require the adaption of a given study design. 2) Research practice: Co-creation in participatory epidemiology means producing epidemiologic evidence while contributing to concrete public health interventions, two goals that have to be balanced. 3) Personal attitudes: In participatory epidemiology academic researchers, practitioners, and community representatives are requested to acknowledge each other as co-researching partners, which can be challenging for each of them. Conclusions Co-creation is a prerequisite for establishing equitable research partnerships. In participatory epidemiology, co-creation offers ways to produce meaningful knowledge for research and practice. Main messages Participatory epidemiology offers ways of producing epidemiologic evidence while contributing to public health practice. Co-creation is a prerequisite, way, and attitude to conduct meaningful research, hopefully for all of those who are involved.

Introduction Although more than one third of minors living in Germany have a migration background (MB), valid data on the health of this population are still lacking. The German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS wave 2, 2014-2017) provides population-based data to make reliable statements on the health of adolescents with and without MB. Methods Survey data from KiGGS wave 2 are used to describe the general health status, mental health and the prevalence of allergic diseases in 3-to 17-year-old children and adolescents (n = 13,568). To determine overweight, body height and weight are measured (n = 3,463). In addition to MB (without/one-sided/two-sided), the socio-economic status (SES) and the length of stay of the parents in Germany are taken into account. Results Children and adolescents with two-sided MB show a physician-diagnosed atopic dermatitis (3.5%vs.6.9%) and attention deficit hyperactivity disorder (ADHD) (1.5%vs.5.1%) less frequently than their peers without MB, but more often a moderate or poor general health status (6.1%vs.3.9%). Adolescents with two-sided MB are also more often affected by overweight than those without MB (22.1%vs.12.2%). If only participants with MB are considered, their health situation is often associated with the SES and partly also with the length of stay of the parents. Discussion Health differences between children and adolescents with and without MB vary by the observed indicator. The heterogeneity of children and adolescents with MB, which can be partly determined by the SES or the length of stay of the parents, should be considered in target-group-specific interventions. Main messages The vast majority of children and adolescents in Germany grow up healthy and a MB is not per se associated with a poorer health status. Our results suggest that considering MB as the sole determinant of health to reflect the impact of migration on health is insufficient. Key messages Migration background is not per se associated with a poorer health status. Socioeconomic status and parents’ length of stay are derminants associated with poorer health outcomes among children and adolescents with migration background.

Background Prior research has identified perceptions of relative social status to affect mental health. We investigated whether migrants to Germany who perceive that they would have a higher relative social status if they were still in their country of origin experience more depressive symptoms than those who perceive no such status discrepancy. Methods Cross-sectional data were derived from a random sample of residents in the Berlin-Brandenburg region with a Croatian, Polish, Romanian, Syrian and/or Turkish citizenship (n = 728). Participants’ perception of their relative social status in Germany was measured using the MacArthur Scale of subjective social status (SSS). An adapted version of this scale was used to assess respondents’ hypothetical SSS in their country of origin if they had not migrated. Depressive symptoms were measured with the eight-item depression scale of the Patient Health Questionnaire. Diagonal reference models were used to examine whether discrepancies between the two status ratings were associated with depressive symptom severity. Results Most respondents reported a higher (35.6%) or similar (49.0%) hypothetical SSS in their country of origin compared to their SSS in Germany. Respondents whose SSS in Germany was lower than their hypothetical SSS in their country of origin experienced the most severe depressive symptoms. In the diagonal reference models, this association remained statistically significant (p < 0.05), even after adjusting for objective socioeconomic position and other covariates. The pattern was similar for both refugees and non-refugees. Conclusions Our findings indicate that perceptions of having a lower social status in Germany than hypothetically in one’s country of origin are concomitant with poorer mental health among migrants. Prospective data are needed to address questions of causation and the direction of effects. Key messages Migrants who perceived that they would have a higher social status if they had not left their country of origin reported higher depressive symptoms than those with no such status discrepancy. This association persisted after adjusting for objective socioeconomic position in Germany.

In Germany, reliable information on the health of people with migration background (PMB) is scarce. Therefore, the Robert Koch Institute initiated the project "Improving health monitoring in migrant populations (IMIRA)" to improve the inclusion of PMB into the federal health monitoring.The objective of this article is to identify challenges and strategies in accessing migrant populations with epidemiological research.A total of 24 guided interviews with experts from Germany were conducted. Experts were scientists from various disciplines with a research focus on migration, civil servants in the area of migration, and experts from the field. The interview focused on challenges and strategies regarding access to migrants in research. The written summaries of the interviews were analyzed.Challenges in accessing PMB include language, sociodemographic and cultural barriers, fears, structural, and practical difficulties. Further challenges arise from the heterogeneity and motivation of the groups. Strategies to increase accessibility among PMB can be found in the research process, methods, communication, and diversity-sensitive research culture. Confidence-building is considered significant.Experts report a variety of strategies that focus on addressing and including PMB directly: strengthening of participatory approaches, new forms of translation, and measures to increase trust in research should be the focus of future efforts. The willingness to participate in epidemiological research can be increased with appropriate strategies and thus data on the health of migrant populations can be improved sustainably.

Even though 36.5% of children and adolescents living in Germany have a migration background (MB), data on the health of this population is scarce. With population-based data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), reliable statements can be given.Data from KiGGS Wave 2 is used in order to report on general health status, mental health, and the distribution of allergic diseases among children and adolescents aged 3-17 years (n = 13,568). To determine overweight, standardized measurements of body weight and height (n = 3463) were used. In addition to the MB (none/one-sided/two-sided), the socioeconomic status (SES) is considered. In multivariate analyses among children and adolescents with MB, SES and the parents' duration of stay in Germany were included.Participants with a two-sided MB show lower prevalence of neurodermatitis (3.5% vs. 6.9%) and ADHS (2.0% vs. 5.1%) than those without a migration background and higher prevalence of fair to poor general health status (6.1% vs. 3.9%). Children and adolescents with a two-sided migration background are more often affected by overweight than those without migration background (22.1% vs. 12.2%). After considering SES, the chances of a diagnosed neurodermatitis and ADHS remain higher and the chances for overweight are lower in children and adolescents with a migration background than among those without migration background. If only children with MB are considered, SES and partially the parents' duration of stay in Germany are associated with health outcomes.Differences in the general health status of children and adolescents with and without MB vary depending on the observed indicators. The heterogeneity of children and adolescents with MB, e.g. regarding SES and parents' duration of stay, should be considered when planning and implementing measures of health promotion.

Participatory epidemiology is a concept that promotes the active involvement and cooperation of researchers and researched populations. The collaboration may relate to individual sections or to the entire course of an epidemiologic study. Participatory epidemiology comprises the following aspects: a joint definition of research objectives and research questions, the cooperative definition of the population groups under study and their health-related contexts, the selection or development of appropriate survey instruments, and dialogical forms of interpreting the results. Participatory epidemiology aims to create knowledge with practical relevance to all stakeholders.

Die partizipative Epidemiologie ist ein Konzept, das die aktive Einbeziehung und möglichst gleichberechtigte Zusammenarbeit von Forschenden und Beforschten in einzelnen Abschnitten oder im gesamten epidemiologischen Studienverlauf vorsieht. Sie umfasst folgende Aspekte: die kooperative Definition von Forschungszielen und Forschungsfragen, die partnerschaftliche Bestimmung zu erforschender Bevölkerungsgruppen und deren gesundheitsrelevanter Lebenswelten, die Auswahl oder Entwicklung angemessener Erhebungsinstrumente sowie dialogische Formen der Ergebnisinterpretation. Die partizipative Epidemiologie zielt auf die Schaffung von Erkenntnissen mit praktischer Relevanz für alle Beteiligten. Participatory epidemiology is a concept that promotes the active involvement and cooperation of researchers and researched populations. The collaboration may relate to individual sections or to the entire course of an epidemiologic study. Participatory epidemiology comprises the following aspects: a joint definition of research objectives and research questions, the cooperative definition of the population groups under study and their health-related contexts, the selection or development of appropriate survey instruments, and dialogical forms of interpreting the results. Participatory epidemiology aims to create knowledge with practical relevance to all stakeholders.

BACKGROUND Germany is a popular destination for immigrants, and migration has increased in recent years. It is therefore important to collect reliable data on migrants’ health. The Robert Koch Institute, Berlin, Germany, has launched the Improving Health Monitoring in Migrant Populations (IMIRA) project to sustainably integrate migrant populations into health monitoring in Germany. OBJECTIVE One of IMIRA’s objectives is to implement a feasibility study (the IMIRA survey) that focuses on testing various interventions to increase the reachability of migrants with health interview surveys. Possible causes of nonresponse should be identified so as to increase participation in future surveys. METHODS The survey target populations were Turkish, Polish, Romanian, Syrian, and Croatian migrants, who represent the biggest migrant groups living in Germany. We used probability sampling, using data from the registration offices in 2 states (Berlin and Brandenburg); we randomly selected 9068 persons by nationality in 7 sample points. We applied age (3 categories: 18-44, 45-64, and ≥65 years) and sex strata. Modes and methods used to test their usability were culturally sensitive materials, online questionnaires, telephone interviews, personal contact, and personal interviews, using multilingual materials and interviewers. To evaluate the effectiveness of the interventions, we used an intervention group (group A) and a control group (group B). There were also focus groups with the interviewers to get more information about the participants’ motivation. We used the European Health Interview Survey, with additional instruments on religious affiliation, experience of discrimination, and subjective social status. We evaluated results according to their final contact result (disposition code). RESULTS We collected data from January to May 2018 in Berlin and Brandenburg, Germany. The survey had an overall response rate of 15.88% (1190/7494). However, final disposition codes varied greatly with regard to citizenship. In addition to the quantitative results, interviewers reported in the focus groups a “feeling of connectedness” to the participants due to the multilingual interventions. The interviewers were particularly positive about the home visits, because “if you are standing at the front door, you will be let in for sure.” CONCLUSIONS The IMIRA survey appraised the usability of mixed-mode or mixed-method approaches among migrant groups with a probability sample in 2 German states. When conducting the survey, we were confronted with issues regarding the translation of the questionnaire, as well as the validity of some instruments in the survey languages. A major result was that personal face-to-face contact was the most effective intervention to recruit our participants. We will implement the findings in the upcoming health monitoring study at the Robert Koch Institute.

Background Among all newly diagnosed HIV cases in Germany in 2015, 16% originated from sub-Saharan Africa. Twelve percent of these infections were contracted within Germany and migrants from sub-Saharan Africa (misSA) are diagnosed later than Germans. Migrants, specifically those without health insurance, face many barriers accessing health care due to their residence status and cultural, socio-economic, legal and linguistic barriers. We assessed whether misSAs’ access to healthcare and utilization of HIV testing services depends on their health insurance status to inform prevention strategies. Methods From January 2015 to February 2016, we conducted a cross-sectional survey on knowledge, attitude, behavior, practice (KABP) regarding HIV, viral hepatitis and sexually transmitted infections among misSA in Germany. The survey was a community-based participatory research project; trained peer researchers recruited participants through outreach. To detect differences between participants with a regular health insurance card compared to asylum seekers with a medical treatment voucher or participants without health insurance or medical treatment voucher, unadjusted and adjusted Odds Ratios, chi-squared tests and 95% confidence intervals were calculated. Results A total of 1919 cases were considered. Overall, 83% had a health insurance card, 10% had a medical treatment voucher and 6% had no health insurance. Participants living in Germany for less than 5 years were less likely to have a health insurance card and more likely to have lower German language skills. Participants without health insurance visited a physician in case of health problems less often than participants with medical treatment voucher or a health insurance card (41.2% vs. 66.1% vs. 90%). Participants without health insurance reported less frequently visiting physicians or hospitals and were less likely to undergo a HIV test. Conclusion Having no health insurance or medical treatment voucher decreased the odds of contact with the healthcare system more than other socio-demographic characteristics. Furthermore, misSA without health insurance had lower odds of ever having done an HIV test than participants with health insurance. To increase health care utilization and testing and to ensure adequate medical care, all migrants should get access to health insurance without increasing costs and consequences for residence status.

Menschen mit Migrationshintergrund machen ein Viertel der in Deutschland lebenden Bevolkerung aus. Angesichts dessen und der starken Zuwanderung der letzten Jahre besteht zunehmend Bedarf an verlasslichen Informationen zur gesundheitlichen Situation von hierzulande lebenden Menschen mit Migrationshintergrund. Dem Robert Koch-Institut (RKI) kommt in diesem Zusammenhang die Aufgabe zu, das in den letzten Jahren aufgebaute Gesundheitsmonitoring und die seit vielen Jahren etablierte Gesundheitsberichterstattung auszubauen um Menschen mit Migrationshintergrund moglichst reprasentativ in die durchgefuhrten Surveys einzubeziehen und deren Gesundheitsstatus widerzuspiegeln. Im Rahmen der Kinder- und Jugendsurveys wurden Menschen mit Migrationshintergrund bereits recht gut erreicht, wahrend dies im Rahmen der Erwachsenensurveys am RKI nur unzureichend der Fall war. Um dies zu verandern, wurde das IMIRA (Improving Health Monitoring in Migrant Populations)-Projekt initiiert, mit dem Ziel, die Etablierung eines migrationssensiblen Gesundheitsmonitorings am RKI, das der Heterogenitat der in Deutschland lebenden Bevolkerung gerecht wird, voranzutreiben. Dies ist essenziell, um kunftig auch fur Menschen mit Migrationshintergrund zuverlassige Daten zu ihrem Gesundheitszustand und Gesundheitsverhalten sowie zu Bedarfen der gesundheitsbezogenen Versorgung bereitstellen zu konnen, die dann wiederum bei der Planung von Praventionsmasnahmen genutzt werden konnen.

Der Migrationshintergrund spielt in Analysen zur gesundheitlichen Ungleichheit in Deutschland eine wichtige Rolle. Die Heterogenitat der Menschen mit und ohne Migrationshintergrund erfordert eine differenzierte Erfassung migrationsbezogener Merkmale. Eine Ubersicht reprasentativer Datenquellen der Gesundheitsberichterstattung (GBE), die diese Heterogenitat erfassen, wurde zuletzt im Jahr 2008 erstellt. Ziel des Artikels ist eine Bestandsaufnahme vorhandener Datenquellen zur gesundheitlichen Lage von Menschen mit und ohne Migrationshintergrund. Ausgehend von den Datenhaltern der GBE (Internetprasenz bzw. Veroffentlichungen) wurden reprasentative Studien und Routinedatenquellen identifiziert. Eingeschlossen wurden alle Quellen, die mindestens ein migrationsbezogenes Merkmal berucksichtigen. Fur alle eingeschlossenen Studien wurden die migrationsbezogenen Merkmale, Informationen zur sozialen Lage und die gesundheitsbezogenen Indikatoren erfasst. Insgesamt konnten 46 Datenquellen (19 Routinedaten und 27 Studien) eingeschlossen werden. Die haufigsten Indikatoren des Migrationshintergrundes sind Staatsangehorigkeit (n = 36) und Geburtsland (n = 29). Die gesundheitsbezogenen Indikatoren decken eine Vielzahl an Themen ab. Routinedaten erheben weiterhin wenige Informationen zum Migrationshintergrund (meist nur Staatsangehorigkeit), womit die Analysepotenziale zur gesundheitlichen Lage begrenzt sind. Studiendaten ermoglichen dagegen weit differenziertere Analysen. Die tatsachlichen Analysemoglichkeiten der Datenquellen und die daraus resultierenden inhaltlichen Erkenntnisse waren nicht Gegenstand dieses Artikels.

Im Rahmen der Studie zu sexueller Gesundheit mit Migrantinnen und Migranten aus Subsahara Afrika (MiSSA-Studie) wurden Methoden der partizipativen Gesundheitsforschung eingesetzt. So haben Community-Mitglieder und andere Akteurinnen und Akteure das Studiendesign mitentwickelt und Peer Researcher die Datenerhebung durchgefuhrt. Ziel dieses Beitrags ist die Auswertung des Einsatzes partizipativer Methoden im Rahmen eines epidemiologischen Forschungsprozesses und der qualitativen Evaluation des Einsatzes von Elementen der partizipativen Gesundheitsforschung wahrend der MiSSA-Studie mit Vertreterinnen und Vertretern der beteiligten Akteursgruppen. Unsere Erfahrungen zeigen, dass dieses Vorgehen von Beforschten und anderen Akteurinnen und Akteuren begrust wurde und dass der Zugang zur sowie die Akzeptanz in der Community verbessert wurde. Es wurde aber auch klar, dass die Etablierung nachhaltiger Strukturen im Rahmen der Forschungsplanung mitbedacht werden muss. Die MiSSA-Studie zeigt, dass die Anwendung partizipativer Forschungsansatze in der Epidemiologie moglich und bei einigen schwer erreichbaren Personengruppen auch notwendig sein kann, um diese fur Forschung erreichbar zu machen.