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Amini E, Etemadi M, Shahabi S, Barth CA, Honarmandi F, Karami Rad M, Lankarani KB. Barriers and enabling factors for utilizing physical rehabilitation services by Afghan immigrants and refugees with disabilities in Iran: a qualitative study. BMC Public Health 2024; 24:893. [PMID: 38528498 DOI: 10.1186/s12889-024-18374-4] [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: 08/22/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Individuals with a migrant background often underutilize physical rehabilitation services (PRS) compared to the host population. This disparity is attributed to various barriers, including limited access to information, language barriers, illiteracy, and cultural factors. To improve PRS utilization by Afghan immigrants and refugees in Iran, it is crucial to identify these barriers and enabling factors. In response, this study explored the barriers and enabling factors for utilizing PRS among Afghan immigrants and refugees with disabilities in Iran. METHODS This qualitative study was conducted in Iran between January and March 2023. Participants were selected through convenient and snowball sampling. Individual, semi-structured interviews were carried out both in face-to-face and online formats. Data analysis occurred concurrently with data collection, using the directed content analysis approach. RESULTS Findings from our research indicate that common barriers to PRS utilization among Afghan immigrants and refugees include insufficient insurance coverage, high service costs, expensive transportation and accommodation, limited knowledge about Iran's health system, inadequate awareness of available supports, restricted access to PRS in remote areas, impatience among PRS providers, fear of arrest and deportation, a lack of trust in modern treatments, stringent immigration rules, high inflation rates limiting the ability to pay for PRS, and limited social support. On the other hand, several enabling factors were identified, such as strengthening insurance coverage, utilizing the capacities of charities and NGOs, providing information about available services, promoting respectful behavior by healthcare providers towards patients, facilitating cultural integration, and increasing immigrants' awareness of available services and eligibility criteria. CONCLUSION The barriers and enabling factors uncovered in this study offer valuable insights into the complexities surrounding PRS utilization by Afghan immigrants and refugees with disabilities in Iran. Understanding and addressing these factors is essential for developing targeted interventions and policies that can improve access and utilization, ultimately leading to enhanced health outcomes for this vulnerable population.
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Affiliation(s)
- Elaheh Amini
- The International Committee of the Red Cross, Tehran Delegation, Tehran, Iran
| | - Manal Etemadi
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Cornelia Anne Barth
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Farzaneh Honarmandi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Karami Rad
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Yan Z, Han F, Gao R, Jing Q, Gao Q, Cai W. Impact of public health education on the health status of the older migrant population. Front Public Health 2022; 10:993534. [PMID: 36176523 PMCID: PMC9513352 DOI: 10.3389/fpubh.2022.993534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 01/26/2023] Open
Abstract
Background Due to an increasing aging population, China has experienced a rapid expansion in its internal older migrant population who face greater health risks and who have a relatively high demand for health education. Public health education is an important means of preventing diseases and promoting health. However, many studies have focused on the utilization, with few studies examining the impact of public health education on the health of the older migrant population in China. Objectives This study analyzed the impact of public health education on the health of the older migrant population in China. Methods Based on data obtained from the National Migrant Population Health and Family Planning Dynamic Monitor Survey (2018), logistic models and propensity score matching were used to analyze the impact of public health education on the health of the older migrant population. Results The self-assessed health of China's older migrant population was good, and the acceptance rate of public health education was 40.81%. The public health status of the older migrant population receiving public health education significantly improved (p < 0.05). After correcting for endogeneity among the variables, public health education increased the probability of improving the older migrant population's self-assessed health by 5.4-6.1% (p < 0.01). Heterogeneity analysis found that public health education had a greater impact on the health of older men with an education level of middle school and below, and especially on the older migrant population in the eastern region of China. Conclusions Public health education positively affected the health status of the older migrant population. The characteristics and preferences of the older migrant population involving different genders, regions, and educational levels need to be considered, public health education needs to be standardized, and appropriate education methods need to be adopted that suit the older migrant population. Reference suggestions are provided for improving the health level of the older migrant population.
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Affiliation(s)
- Zaohong Yan
- Intensive Care Unit, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Fang Han
- Department of Pathology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Runguo Gao
- School of Public Health, Weifang Medical University, Weifang, China
| | - Qi Jing
- School of Management, Weifang Medical University, Weifang, China
| | - Qianqian Gao
- School of Management, Weifang Medical University, Weifang, China,*Correspondence: Qianqian Gao
| | - Weiqin Cai
- School of Management, Weifang Medical University, Weifang, China,Weiqin Cai
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Fauser D, Banaschak H, Zimmer JM, Golla A, Schmitt N, Mau W, Bethge M. Rehabilitation utilization of non-migrant and migrant persons with back pain: A cohort study using different definitions of migrant background. EClinicalMedicine 2022; 46:101351. [PMID: 35330800 PMCID: PMC8938875 DOI: 10.1016/j.eclinm.2022.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Medical rehabilitation (MR) by the German Pension Insurance is approved to maintain and to restore work ability and to avoid disability pensions. Studies on the rehabilitation utilization by people with a migration background (PMB) compared to people without a migration background (non-PMB) showed heterogeneous results, which may be partly due to different definitions of migration status. The aim of this paper was to test whether there are differences in utilization of MR between employed PMB and non-PMB with self-reported back pain. Methods We used data from a large German cohort study that analyzed the effectiveness of MR for individuals with back pain and was conducted between 1st January 2017 and 31st December 2019. Employees aged 45 to 59 years who reported back pain in the last three months completed the baseline questionnaire in 2017. We used four definitions of migration background (MB) to differentiate by first- and second-generation migration, by one- and two-sided migration background, by language, or by nationality. Data on rehabilitation utilization was extracted from administrative records covering the period until the end of 2018. Findings Data of 6,713 participants were included, and 514 individuals utilized MR during follow-up. Adjusted analyses showed a decreased risk of rehabilitation utilization in people with a first-generation MB (HR = 0·46; 95% CI 0·29; 0·72), people with a two-sided MB (HR = 0·47; 95% CI 0·31; 0·72), people whose native language was not German (HR = 0·52; 95% CI 0·30; 0·91), and people without German nationality (HR = 0·29; 95% CI 0·12; 0·72) when compared to non-PMB. Interpretation This study showed that employees with a MB reporting back pain had a significantly reduced risk for utilization of rehabilitation services. This underutilization could be observed considering different definitions of MB. Future research on rehabilitation utilization by PMB should consider the impact of different definitions on the results. Funding The study was funded by the German Research Foundation (grant numbers: BE 5885/2-1; MA 6981/2-1). The German Research Foundation functions as a self-governing institution for the promotion of science and research in Germany.
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Affiliation(s)
- David Fauser
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Hannes Banaschak
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Julia-Marie Zimmer
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - André Golla
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Nadine Schmitt
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Interdisciplinary Centre of Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Bethge
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
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Schröder CC, Breckenkamp J, du Prel JB. Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs? PLoS One 2022; 17:e0263643. [PMID: 35130330 PMCID: PMC8820604 DOI: 10.1371/journal.pone.0263643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022] Open
Abstract
Due to demographic change with an ageing workforce, the proportion of employees with poor health and a need for medical rehabilitation is increasing. The aim was to investigate if older employees with migrant background have a different need for and utilization of medical rehabilitation than employees without migrant background. To investigate this, self-reported data from older German employees born in 1959 or 1965 of the first and second study wave of the lidA cohort study were exploratory analyzed (n = 3897). Subgroups of employees with migrant background were separated as first-generation, which had either German or foreign nationality, and second-generation vs. the rest as non-migrants. All subgroups were examined for their need for and utilization of medical rehabilitation with descriptive and bivariate statistics (chi-square, F- and post-hoc tests). Furthermore, multiple logistic regressions and average marginal effects were calculated for each migrant group separately to assess the effect of need for utilization of rehabilitation. According to our operationalizations, the foreign and German first-generation migrants had the highest need for medical rehabilitation while the German first- and second-generation migrants had the highest utilization in the bivariate analysis. However, the multiple logistic model showed significant positive associations between their needs and utilization of rehabilitation for all subgroups. Further in-depth analysis of the need showed that something like under- and oversupply co-exist in migrant groups, while the foreign first-generation migrants with lower need were the only ones without rehabilitation usage. However, undersupply exists in all groups independent of migrant status. Concluding, all subgroups showed suitable use of rehabilitation according to their needs at first sight. Nevertheless, the utilization does not appear to have met all needs, and therefore, the need-oriented utilization of rehabilitation should be increased among all employees, e.g. by providing more information, removing barriers or identifying official need with uniform standards.
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Affiliation(s)
| | - Jürgen Breckenkamp
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jean-Baptist du Prel
- Department of Occupational Health Science, University of Wuppertal, Wuppertal, Germany
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Georges D. The effect of informal caregiving on physical health among non-migrants and Ethnic German Immigrants in Germany: a cohort analysis based on the GSOEP 2000-2018. BMC Public Health 2022; 22:121. [PMID: 35042500 PMCID: PMC8764847 DOI: 10.1186/s12889-022-12550-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of people in need of care in Germany has been rising since decades, which is related to an increasing need and relevance of informal caregiving. Likewise, the number of people with a migration background has been increasing. This study aims to analyse the impact of informal caregiving on physical health in comparative perspective for Ethnic German Immigrants (EGI) - the largest and oldest immigrant group in Germany - and non-migrant Germans (NMG). METHODS The sample was drawn from the years 2000-2018 of the German Socio-Economic Panel (n = 26,354). NMG (n = 24,634) and EGI (n = 1,720) were categorized into non-caregivers (n = 24,379) and caregivers (n = 1,975), where the latter were distinguished by 1) their caregiving status and history (current, former, and never caregiver) and 2) the number of years in the caregiver role. Generalized Estimating Equations were applied to examine main effects and the interaction effects of caregiving status and migration background for changes in physical health (n = 102,066 observations). RESULTS Adjusting for socioeconomic, household related, and individual characteristics, NMG and EGI had similar caregiving patterns and physical health. However, the interaction between migration background and caregiving revealed significantly higher declines in physical health for currently caregiving EGI. Sensitivity analyses indicated that particularly socioeconomic resources moderated this effect. CONCLUSIONS Findings suggest that caregiving is associated with declines in physical health, particularly in the long term and for EGI. This implies that care-related disadvantages accumulate over time and that the association of caregiving, health and associated determinants are culturally diverse and shaped by migration background. Both the health disadvantages of caregivers and EGI might be mitigated by a positive social and socioeconomic setting, which highlights the relevance of supporting structures and benefits for these subgroups.
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Affiliation(s)
- Daniela Georges
- Faculty of Economic and Social Sciences, Institute of Sociology and Demography, University of Rostock, Ulmenstrasse 69, 18057, Rostock, Germany.
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Gonzalez-Jaramillo N, Marcin T, Matter S, Eser P, Berlin C, Bano A, Heg D, Franco OH, Windecker S, Räber L, Wilhelm M. Clinical outcomes and cardiac rehabilitation in underrepresented groups after percutaneous coronary intervention: an observational study. Eur J Prev Cardiol 2021; 29:1093-1103. [PMID: 34894217 DOI: 10.1093/eurjpc/zwab204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/07/2021] [Accepted: 11/18/2021] [Indexed: 12/28/2022]
Abstract
AIMS Underrepresentation of migrants, women, and older adults in cardiovascular disease (CVD) trials may contribute to disparate care and survival. Among patients who underwent percutaneous coronary intervention (PCI), we aimed to investigate the associations of (i) underrepresented groups with major adverse cardiac events (MACE), CVD mortality, and non-CVD mortality, (ii) underrepresented groups with cardiac rehabilitation (CR) uptake, and (iii) CR uptake with outcomes. METHODS AND RESULTS We included 15 211 consecutive patients from the CARDIOBASE Bern PCI registry (2009-18). In multi-state models comparing transition probabilities of events, sex was not associated with increased risk of any event. For each year increase in age, the increased risk of non-CVD and CVD mortality was 8% [95% confidence interval (CI) 6-9%]. Being migrant was associated with a lower risk of non-CVD mortality [hazard ratio (HR) (95% CI) 0.49 (0.27-0.90)] but not with CVD mortality. In logistic regression analysis, CR uptake was lower among women [odds ratio (95% CI) = 0.72 (0.57-0.86)] and older adults [0.32 (0.27-0.38)], but not among migrants. In cox regression, CR was independently associated with lower all-cause [HR (95% CI) = 0.12 (0.03-0.37)] and CVD mortality [0.1 (0.02-0.7)], but not with MACE [1.08 (0.8-1.4)]. CONCLUSION Among underrepresented groups undergoing PCI, age, but not migration status nor sex, contributed to disparities in mortality. Migrant status did not result in lower attendance of CR. Considering the protective associations of CR on CVD mortality independent of age, sex, and migration status, the lower uptake in women and older adults is noteworthy.
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Affiliation(s)
- Nathalia Gonzalez-Jaramillo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Sophia Matter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Arjola Bano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
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Breckenkamp J, Dyck M, Schröder CC, Schönfeld S, du Prel JB, Razum O, Hasselhorn HM. [Utilization of Medical Rehabilitation and Access Barriers for Persons with a Migrant Background - Results of the lidA Cohort Study]. REHABILITATION 2020; 60:11-20. [PMID: 33152776 DOI: 10.1055/a-1276-6811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Rehabilitation services are considerably less used by persons with a migration background of working age in Germany than by persons without migration background. One reason could be access barriers. They can arise both from the structures of the health/rehabilitation system as well as from influences of the personal environment, e. g. financial burdens incurred through the use of rehabilitation or cultural expectations. In addition to the migration status, other factors such as country of origin, reasons for immigration, length of stay as well as the religious affiliation and social status could influence the utilization of medical rehabilitation. It was examined to what extent differences in utilisation are due to the migration background and to migration-independent personal barriers to access. METHODS The lidA-study is a nationwide, representative prospective cohort study among employees with insurable employment born in 1959 and 1965 with a focus on work, age, health and employment. Data from the first (2011) and the second wave (2014) were combined for the analyses. In addition to bivariate analyses to describe the sample according to migration status, logistic regression analyses were carried out to estimate the odds ratios for the influence of migration background or nationality and other factors on the use of a medical rehabilitation measure. RESULTS The chance of receiving medical rehabilitation is increased for migrants of the 1st generation (odds ratio (OR) 1.56, 95% confidence interval (CI): 1.09-2.25). If predominantly or exclusively no German is spoken at home, this could be associated with a comparatively much lower chance of utilisation (OR: 0.56, 95% CI: 0.28-1.15). Because only nationality is often available in routine data to determine the status of migration, another model only considers migrants and 2nd generation nationals and examines the influence of nationality on utilisation. A foreign nationality was not associated with a higher utilisation (OR: 1.07, 95% CI: 0.55-2.08). DISCUSSION Results of previous studies on the use of medical rehabilitation for people with a migration background are inconsistent. This could be due to different examined population groups, different indications for rehabilitation, a temporal change in utilisation and the various study designs as well as data sources. We found a higher use of medical rehabilitation services by persons with a migrant background (1st generation) compared to non-migrant persons. One reason could be our more precise definition of the migration background compared to analyses of routine data. If predominantly or exclusively another language than German is spoken at home, the utilisation tends to be lower. The finding coincides with a lack of German language skills described as an access barrier in the literature.
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Affiliation(s)
- Jürgen Breckenkamp
- AG3 Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld.,Lehrstuhl für Arbeitswissenschaft, Fakultät für Maschinenbau und Sicherheitstechnik, Bergische Universität Wuppertal
| | - Maria Dyck
- AG3 Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Chloé Charlotte Schröder
- Lehrstuhl für Arbeitswissenschaft, Fakultät für Maschinenbau und Sicherheitstechnik, Bergische Universität Wuppertal
| | - Simone Schönfeld
- AG3 Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Jean-Baptist du Prel
- Lehrstuhl für Arbeitswissenschaft, Fakultät für Maschinenbau und Sicherheitstechnik, Bergische Universität Wuppertal
| | - Oliver Razum
- AG3 Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - Hans Martin Hasselhorn
- Lehrstuhl für Arbeitswissenschaft, Fakultät für Maschinenbau und Sicherheitstechnik, Bergische Universität Wuppertal
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