1
|
Grochtdreis T, König HH, Dams J. Flight-related determinants of health-related quality of life of asylum seekers and refugees in Germany: a longitudinal study based on the German Socio-Economic Panel (SOEP). BMC Public Health 2024; 24:1965. [PMID: 39044148 PMCID: PMC11264381 DOI: 10.1186/s12889-024-19489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Germany played a key role as receiving country during the so-called refugee and displacement crisis with about 5 million asylum seekers arriving in the EU between 2014 and 2020. It is well known that asylum seekers and refugees (ASRs) have a high burden of disease and are particularly prone to mental disorders such as trauma, stress-related and affective disorders. Not much is known about the determinants of health-related quality of life (HrQoL) among ASRs, especially in the context of the flight. Therefore, the aim of this study was to analyze the associations between flight-related characteristics and HrQoL of ASRs in Germany. METHODS The sample of this study was based on five consecutive waves of the Survey of Refugees samples of the German Socio-Economic Panel (n = 8015; 14,314 observations). Mental and physical HrQoL was measured using the mental (MCS) and physical (PCS) component summary scores of the SF-12v2. Associations between flight-related characteristics and HrQoL were examined using multilevel mixed-effects linear regressions. RESULTS The different countries of birth were associated with varying MCS and PCS scores. The MCS and PCS scores were lower among ASRs with an economic situation below average in their countries of origin. Persecution, discrimination, and poor living conditions as reasons for leaving the county were associated with lower MCS scores. ASRs who were dissatisfied with their own living situation and who were discriminated often due to their origin had both lower MCS and PCS scores. Not feeling welcome in Germany and missing people from one's country of origin were both associated with lower MCS scores. No worries about not being able to stay in Germany or not being able to return to one's country of origin were both associated with higher MCS scores. CONCLUSIONS The economic situation in the country of origin and the presence of persecution, discrimination, and/or poor living conditions as reason for flight may be pre-flight-related determinants of HrQoL of ASRs in Germany. Possible post-flight-related determinants can be the residence status, the satisfaction with one's living situation, discrimination due to one's origin and a feeling of missing people from one's country of origin. With regard to those determinants, the clarity about the residence status, reducing racial discrimination and the mourning of flight-related circumstances must be ensured.
Collapse
Affiliation(s)
- Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| |
Collapse
|
2
|
Adedeji A, Olonisakin TT, Buchcik J, Metzner F, Tsabedze W, Boehnke K, Idemudia ES. The multicultural conceptualisation of well-being : The role of culture and circumstance in operationalising well-being in South Africa: A mixed-methods approach. BMC Public Health 2023; 23:2041. [PMID: 37858144 PMCID: PMC10585799 DOI: 10.1186/s12889-023-16966-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Exploring and understanding indicators of better life outcomes have remained popular among social and health researchers. However, the subjective approach to measuring well-being has raised questions on the appropriateness of standard measures of well-being in multicultural settings. The current study examines generalised well-being and its dependence on the implicit understanding of individual culture and circumstances. METHODS A mixed-method approach with a cross-sectional design and focus group discussions was adopted. Fifteen focus group discussions with 66 participants were conducted in four provinces of South Africa. Descriptive statistics, correlations, regression analysis and analysis of variance were computed for quantitative data. The focus group discussions were analysed using a content analysis approach. The recorded focus group discussions were transcribed using the intelligent verbatim technique. Data analysis was done stepwise using open, axial, and selective coding techniques. RESULTS Quantitative analysis showed a strong and significant association between quality of life and income and a moderate association with educational attainment. The open coding technique for qualitative data confirmed 11 different subconstructs of well-being, mentioned 403 times during the 15 focus group discussions. Furthermore, well-being indicators varied based on participants' racial identity. CONCLUSIONS The findings confirm personal circumstance and culture as significant for interpreting results from well-being research. Furthermore, it supports Maslow's Hierarchy of Needs, highlighting the movement from deficiency needs to growth needs after deficiency needs are met. Research must adopt a more sociological approach to improve the accuracy and implementibility of findings when using standardised measures of well-being.
Collapse
Affiliation(s)
- Adekunle Adedeji
- Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany.
- Bremen International Graduate School of Social Sciences (BIGSSS), Constructor University, Bremen, Germany.
- Faculty of Humanities, North West University, Mafikeng, South Africa.
| | - Tosin Tunrayo Olonisakin
- Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
- Faculty of Humanities, North West University, Mafikeng, South Africa
- Department of Psychology and Behavioural Studies, Ekiti State University, Ado-Ekiti, Nigeria
| | - Johanna Buchcik
- Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Franka Metzner
- Center for Psychosocial Medicine, Department of Medical Psychology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Wandile Tsabedze
- Faculty of Humanities, North West University, Mafikeng, South Africa
| | - Klaus Boehnke
- Bremen International Graduate School of Social Sciences (BIGSSS), Constructor University, Bremen, Germany
| | | |
Collapse
|
3
|
Cho HJ, Kang K, Park KY. Health-related quality of life of migrant workers: a systematic literature review. BMC Public Health 2023; 23:1004. [PMID: 37254085 DOI: 10.1186/s12889-023-15981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/25/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Currently, the number of migrant workers residing in Korea is continuously increasing, which is exacerbating the workforce shortage in its society. Migrant workers experience health problems or stress due to rapid environmental changes, consequently impairing their quality of life (QoL). Accordingly, this literature review aimed to prepare basic data by identifying factors related to the health-related quality of life (HRQoL) of migrant workers in Korea. METHOD In total, the literature search used seven databases to find all documents corresponding to related subject words until June 7, 2022, including PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Regional Information Sharing Systems, Korean Medical database, Science ON, and DataBase Periodical Information Academic. Furthermore, this study used the Cochrane Library and Google Scholar to manually search, to include comprehensive literature. Moreover, both English and Korean were used to search for the main terms. RESULTS In total, nine articles were selected. The World Health Organization Quality of Life Brief Version tool was used in six studies to measure HRQoL. Factors affecting the HRQoL of domestic migrant workers included general characteristics such as monthly income and residence period, physical and psychological health-related characteristics such as health promotion behaviour, medical service satisfaction, and depression, and social factors such as social support and cultural adaptation stress. Social support was an important variable affecting the QoL. Particularly, increased social support improved health-related QoL. In addition, higher medical service satisfaction and lower cultural adaptation stress increased HRQoL. CONCLUSIONS Social factors such as social support and cultural adaptation stress affect the HRQoL of migrant workers. Therefore, the social integration program should be expanded to ensure that migrant workers can adapt to the domestic culture at an early stage. In addition, people require active support to improve the QoL in Korea through activities such as self-help groups to help them cope with stressful situations and experience positive emotions. Moreover, it is necessary to provide information on domestic medical services as well as support for medical information for self-health management to improve the quality of medical services for migrant workers.
Collapse
Affiliation(s)
- Hyun-Jin Cho
- College of Nursing, Pusan National University, Yangsan-si, South Korea
| | - Kyoungrim Kang
- College of Nursing, Research Institute of Nursing Science, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea.
| | - Kyo-Yeon Park
- College of Nursing, Pusan National University, Yangsan-si, South Korea
| |
Collapse
|
4
|
Rishworth A, Cao T, Niraula A, Wilson K. Navigating the quality-of-life impacts of a chronic inflammatory disease (CID) among South Asian children and parents. Soc Sci Med 2023; 326:115914. [PMID: 37104969 DOI: 10.1016/j.socscimed.2023.115914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 03/18/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
This study investigates quality-of-life impacts (QOL) associated with managing a chronic inflammatory disease (CID) among first and second generation South Asian children and parents in the Greater Toronto Area, Ontario. While empirical evidence on both the rise of CIDs among immigrants and the QOL impacts of managing a CID is increasing, little attention has been given to the QOL impacts of managing a CID among immigrant adult children and their families. Drawing on analysis of 24 in-depth interviews with adult children and parents (14 adult children, 10 parents) the results indicate that first and second generation South Asian adult children and parents experience challenges acquiring a CID diagnosis (e.g., bureaucratic issues, transportation, inconsistent and unavailable physician care), and encounter multidimensional short- and long-term QOL implications associated with CID management. These challenges are compounded further by culturally insensitive care and language barriers in the health system. QOL impacts associated with CID management among adult children ranged from comfort and peace of mind due to increased ability to participate in daily life, while others reported intensified anxiety, stress and depression due to their inability to fully engage in daily life. Although all parents reported heightened stress due to their child's CID diagnosis and new management regimens, parents employed different coping mechanisms that created new short term QOL challenges for their families. The findings suggest that a patient centered approach to CID diagnosis and management, informed by personal experiences, cultural sensitivities and lived experiences of QOL representations are needed to mitigate negative QOL outcomes across a patient's life and deliver appropriate evidence informed care for those in need.
Collapse
Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, Mississauga Ontario, Canada.
| | - Tiffany Cao
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, Mississauga Ontario, Canada.
| | | | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, Mississauga Ontario, Canada.
| |
Collapse
|
5
|
Sengoelge M, Nissen A, Solberg Ø. Post-Migration Stressors and Health-Related Quality of Life in Refugees from Syria Resettled in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2509. [PMID: 35270200 PMCID: PMC8909133 DOI: 10.3390/ijerph19052509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
The link between post-migration stressors and mental ill health is well documented in refugees resettled in high-income host countries, but the consequences of these stressors on refugees' health-related quality of life (HRQoL) are less known. This study examined the association between post-migration stressors and HRQoL among Syrian adult refugees resettled in Sweden using a preference-based value set obtained from the general Swedish population. A total of 1215 Syrian adults, ages 18-64 years, granted residency in Sweden, responded to a postal questionnaire in 2016 regarding various aspects of their resettlement. The European Quality of Life Five Dimensions Five Level (EQ-5D-5L) questionnaire was used to assess HRQoL through an EQ-5D-5L index score (range; 0=dead to 1=full health). The index score was preference weighted using a Swedish population value set. Predictors were four self-reported post-migration stressors related to daily living in the host country: financial strain, social strain, competency strain and perceived discrimination divided into low, medium and high levels of experienced stress. Multivariable linear regression models were employed to assess the association between post-migration stressors and HRQoL index score, adjusting for potentially traumatic events in the pre- and peri-migration phase as well as sociodemographic confounders/covariates (sex, age, education, civil status, immigration year). The Syrian refugees had a mean EQ-5D-5L index score of 0.863 (SD = 0.145). There was strong evidence of a negative dose-response association in both unadjusted and adjusted models between HRQoL and the post-migration stressors financial strain and social strain-i.e., there was a stepwise, and statistically significant, decrease in HRQoL when going from low to medium to high strain. Competency strain and discrimination were only associated with lower HRQoL when experienced at high levels in fully adjusted models. High exposure to potentially traumatic experiences before or during flight was also associated with lower HRQoL. Syrian refugees resettled in Sweden reported a lower HRQoL than the general Swedish population and lower than age-matched Swedish adults. The present study results point to the possible adverse effects of post-migration stressors on HRQoL.
Collapse
Affiliation(s)
- Mathilde Sengoelge
- Department of Health Sciences, The Swedish Red Cross University College, 121 41 Huddinge, Sweden
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.N.); (Ø.S.)
| | - Alexander Nissen
- Department of Health Sciences, The Swedish Red Cross University College, 121 41 Huddinge, Sweden
- Division for Forced Migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway
| | - Øivind Solberg
- Department of Health Sciences, The Swedish Red Cross University College, 121 41 Huddinge, Sweden
- Norwegian Church Aid, 0130 Oslo, Norway
| |
Collapse
|
6
|
Belau MH, Becher H, Kraemer A. Loneliness as a mediator of social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. BMC Public Health 2021; 21:2233. [PMID: 34879832 PMCID: PMC8656054 DOI: 10.1186/s12889-021-12303-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background Since 2015, more than one million people fled to Germany – mainly from war-affected countries. Nevertheless, little is known about social determinants in refugees located in Germany. This study aims to test the mediation effect of loneliness between social relationships, comprising social integration and social support, and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. Methods The investigation utilizes data from the FlueGe Health Study (N=326), a cross-sectional study conducted by Bielefeld University. The data was collected between February and November 2018 and included interviews and examinations. Participants were recruited from shared and private accommodation in several cities in North Rhine-Westphalia, Germany. We first analyzed correlations between social integration, social support, loneliness, and physical and mental component of health-related quality of life. We then conducted mediation analyses using structural equation modeling. Results The majority of respondents were socially isolated, perceiving a moderate degree of loneliness and social support. In addition, the physical and mental components of health-related quality of life indicate that participants predominantly experienced mental rather than physical impairments. Results from mediation analyses showed indirect effects of loneliness on the association between social integration and mental health (ß = 0.495, 95% bias-corrected and accelerated confidence interval (BCa CI) = [0.018, 0.972]), and between social support and both physical (ß = 0.022, 95% BCa CI = [0.004, 0.040]) and mental health (ß = 0.067, 95% BCa CI = [0.037, 0.097]). Conclusions Loneliness played a mediating role in the association between social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. The results provide implications for both, health policy and the host society. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12303-5.
Collapse
Affiliation(s)
- Matthias Hans Belau
- School of Public Health, Bielefeld University, Bielefeld, Germany. .,Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | |
Collapse
|
7
|
Buchcik J, Borutta J, Nickel S, von dem Knesebeck O, Westenhöfer J. Health-related quality of life among migrants and natives in Hamburg, Germany: An observational study. J Migr Health 2021; 3:100045. [PMID: 34405190 PMCID: PMC8352133 DOI: 10.1016/j.jmh.2021.100045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/03/2020] [Accepted: 04/10/2021] [Indexed: 10/27/2022] Open
Abstract
Purpose The aim of this observational study was firstly, to assess the Health-related Quality of Life (HrQoL) among migrants and German natives in Hamburg, Germany, using the SF-12 mental and physical summary scores and secondly, to evaluate the contribution of selected sociodemographic and socioeconomic variables to explain the variance in mental and physical HrQoL separately for migrants and natives. Methods Face-to-face interviews were conducted with n=809 participants between May 2018 and July 2019 in six randomly selected statistical districts of Hamburg grouped into four levels of socioeconomic status (SES). The SF-12 questionnaire was used to measure the HrQoL. Socioeconomic (school education, income) and sociodemographic (age, gender, marital status, children) data was recorded, too. Results Migrants and natives scored higher in mental (migrants: M=45.77, SD=7.66; natives: M=47.60, SD=6.14) than in physical HrQoL (migrants: M=42.55, SD=5.55; natives: M=42.03, SD=4.71). Natives had a significantly higher (p<0.001) SF-12 mental summary score than migrants. There was a positive association between education and mental HrQoL (β=0.248, p=2.308) in the migrant but not in the native group. Due to limitations of the study the results of the impact of migration on the HrQoL require interpretation. Conclusion Differences between migrants and German natives in HrQoL were partially confirmed. Future research should differentiate more strongly between migration contexts as well as other determinants of health (e.g. early life, social support, unemployment) and their policy implications according to the WHO.
Collapse
Affiliation(s)
- Johanna Buchcik
- University of Applied Sciences (HAW Hamburg), Faculty of Life Sciences, Department of Health Sciences; Ulmenliet 20, 21033 Hamburg, Germany
| | - Jana Borutta
- University of Applied Sciences (HAW Hamburg), Faculty of Life Sciences, Department of Health Sciences; Ulmenliet 20, 21033 Hamburg, Germany
| | - Stefan Nickel
- University Medical Center Hamburg-Eppendorf (UKE), Center for Psychosocial Medicine, Institute of Medical Sociology; Martinistraße 52, 20246 Hamburg, Germany
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf (UKE), Center for Psychosocial Medicine, Institute of Medical Sociology; Martinistraße 52, 20246 Hamburg, Germany
| | - Joachim Westenhöfer
- University of Applied Sciences (HAW Hamburg), Faculty of Life Sciences, Department of Health Sciences; Ulmenliet 20, 21033 Hamburg, Germany
| |
Collapse
|
8
|
Buchcik J, Westenhöfer J, Fleming M, Martin CR. Is health-related quality of life the same for elderly polish migrants, Turkish migrants and German natives? Testing the reliability and construct validity of the Sf-36 health survey in a cross-cultural comparison. COGENT PSYCHOLOGY 2017. [DOI: 10.1080/23311908.2017.1280984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Johanna Buchcik
- Competence Center Gesundheit (CCG)–Competence Centre Health, University of Applied Sciences Hamburg , Alexanderstr. 1, 20099 Hamburg, Germany
| | - Joachim Westenhöfer
- Competence Center Gesundheit (CCG)–Competence Centre Health, University of Applied Sciences Hamburg , Alexanderstr. 1, 20099 Hamburg, Germany
| | - Mick Fleming
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University , Edinburgh EH11 4BN, UK
| | - Colin R. Martin
- Faculty of Society and Health, Buckinghamshire New University , High Wycombe, UK
| |
Collapse
|
9
|
Puthoopparambil SJ, Bjerneld M, Källestål C. Quality of life among immigrants in Swedish immigration detention centres: a cross-sectional questionnaire study. Glob Health Action 2015; 8:28321. [PMID: 26193898 PMCID: PMC4507748 DOI: 10.3402/gha.v8.28321] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/31/2015] [Accepted: 06/25/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Detention of immigrants negatively affects their health and well-being. Quality of life (QOL) is a broad concept incorporating the self-evaluation of one's own health and well-being that can provide an understanding of the health and well-being of immigrant detainees. The aim of this study was to estimate QOL among immigrant detainees in Sweden and to assess its relationship with the services provided in detention centres and with the duration of detention. DESIGN All immigrants in all five existing Swedish detention centres (N=193) were invited to participate in the study (n=127). In this cross-sectional study, QOL was measured using the WHOQOL-BREF questionnaire, which was administered by the first author. The questionnaire contained four additional questions measuring participants' satisfaction with the services provided in detention. Associations between QOL domain scores and service satisfaction scores were assessed using regression analysis. The Spearman's rank correlation coefficient was calculated to measure the degree of association between the duration of detention and QOL scores. RESULTS The mean QOL domain scores (out of 100) were 47.0, 57.5, 41.9, and 60.5 for the environmental, physical, psychological, and social domains, respectively. The level of support detainees received from detention staff was significantly positively associated with detainees' physical (βadjusted 3.93, confidence interval [CI] 0.06-7.80) and psychological (βadjusted 5.72, CI 1.77-9.66) domain scores. There was also significant positive association between detainees' satisfaction with the care they received from detention staff and the domain scores. The general health score in the WHOQOL-BREF was significantly associated with the detainees' ability to understand the Swedish or English languages. Although not statistically significant, a longer duration of detention was negatively correlated with QOL scores. CONCLUSION Immigrant detainees report low QOL. Services provided at the centres, especially the support received from detention staff, is positively associated with their QOL. A review of detention guidelines addressing language barriers, staff training, and duration of detention is highly recommended.
Collapse
Affiliation(s)
- Soorej J Puthoopparambil
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden;
| | - Magdalena Bjerneld
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Carina Källestål
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|