[Rehabilitants' Expectations and Informational Needs Concerning Inpatient Psychosomatic Rehabilitation - Results of a Qualitative Analysis]

[Forms of Use of Psychosomatic Rehabilitation by Patients - A Study on the Significance of the Moment of Entrance in the Rehabilitation Setting and the Dependence on the Individual Situation at Admission to Rehabilitation]

BACKGROUND AND AIMS

As expectancies of patients and physicians in psychosomatic rehabilitation are not always congruent, we focused on the patients' subjective expectancies toward rehabilitation in relation to the perceived benefit of the treatment for return to work and on the individual forms of utilization of the therapeutic services in the setting of psychosomatic clinics. A special focus was given to the changes in the patients' evaluations and coping behaviours over a follow-up period of 18 months.

METHODS

N=105 participants (F-3/F-4 Main-Diagnosis, specific vocational problems, under 3 months jobless) of 4 psychosomatic rehabilitation settings were asked for their situation at the end of the rehabilitation by means of a questionnaire. 33 patients out of the questionnaire-sample who consented to participate were interviewed for 3 times (6, 12 and 18 months after release from the clinic) by means of episodic-narrative interviewing technique.

RESULTS

Some characteristic expectancies and modes of use of the psychosomatic rehabilitation setting by the patients could be identified. The uses of the clinics' therapeutic services by the patients are pointing to different subjective felt needs that correlate with the state of coping with the illness and other psychosocial features at the moment of entrance in the rehabilitation setting. The patients' actual situation can be identified by retrospective tracing his/her positioning on an ideal-typed trajectory of the whole illness process from the beginning of the first symptoms up to Return to work. The results give hints for more individualised and person-centred propositions in rehabilitation-settings.

[Barriers and Resources in Inpatient Psychosomatic Rehabilitative Care of Migrant Patients]

Patients from migrant descent access inpatient psychosomatic rehabilitative care less and achieve less treatment success than patients from the host populations. They are confronted with different process barriers in the healthcare system which combined with individual barriers can inhibit successful treatment. Studies have shown that working with migrant patients may also be challenging for healthcare providers.This study aims to assess and compare barriers and resources faced by migrant and non-migrant patients during their treatment in inpatient psychosomatic rehabilitative care. Also, the aim is to assess and compare barriers and resources faced by healthcare providers in treating migrant and non-migrant patients in order to identify barriers and resources specific to working with migrant patients.A total of 77 semi-structured interviews were conducted (20 migrant and 19 non-migrant patients as well as 14 migrant and 24 non-migrant healthcare providers). Data were transcribed and analyzed applying the method of qualitative content analysis (Mayring) with inductive categories.Migrant and non-migrant patients stated that they profit from the treatment in inpatient psychosomatic rehabilitative care. The greatest barriers for both migrant patients and healthcare providers are language barriers, cultural differences, differences in expectations regarding the treatment and limited organizational cultural competences. As far as organizational cultural competences are implemented, they are profitable for migrant patients and non-migrant healthcare providers. However, migrant healthcare workers seem responsible for implementing culturally competent care and suffer from increased workload.

Welche Faktoren fördern und behindern die Umsetzung migrationssensibler Versorgung?

Hintergrund Menschen mit Migrationshintergrund nehmen trotz eines höheren Bedarfs rehabilitative Leistungen seltener in Anspruch und weisen ungünstigere Ergebnisse auf als Menschen ohne Migrationshintergrund. Migrationssensible Versorgungsstrategien können einen Beitrag leisten, Barrieren abzubauen, denen Menschen mit Migrationshintergrund im Gesundheitssystem begegnen. Ziel der vorliegenden Studie ist es, hindernde und fördernde Faktoren für die Implementierung solcher Strategien aus der Perspektive von Gesundheitspersonal zu ermitteln.

Methodik Die Untersuchung basiert auf 8 qualitativen leitfadengestützten Fokusgruppeninterviews mit insgesamt 50 MitarbeiterInnen unterschiedlicher Berufsgruppen in orthopädischen Rehabilitationseinrichtungen in Nordrhein-Westfalen und Schleswig-Holstein.

Ergebnisse Das Gesundheitspersonal erachtet eine migrationssensible Versorgung als notwendig und ist motiviert, entsprechende Maßnahmen umzusetzen. Als Hindernis für die Implementierung werden v. a. fehlende personelle und finanzielle Ressourcen genannt, u.a. für das Einstellen zusätzlicher mehrsprachiger MitarbeiterInnen. Optimierungspotenziale wurden im Hinblick auf die fehlende Migrationssensibilität von Versorgungsträgern gesehen.

Schlussfolgerung Die aufgezeigten Barrieren müssen überwunden werden, um den Einsatz migrationssensibler Versorgungskonzepte zu fördern. Diese können der Ausgangspunkt für eine über Migrationssensibilität hinausgehende diversitätssensible Versorgung sein, die auch der Rolle weiterer Diversitätsmerkmale Rechnung trägt.