[How are Pediatric Hospitals in North-Rhine Westfalia Prepared to Overcome Language Barriers? A Pilot Study Exploring The Structural Quality of Inpatient Care]

[Usability and Efficiency of a Digital Communication Assistance Tool to Obtain Medical History from Non-German-Speaking Patients]

AIM

In the DICTUM-Friedland study, a medical history-taking app was implemented in an initial reception facility for refugees and asylum seekers. This app can be used to obtain from patients information about the most frequent general medical complaints and risk factors in 13 different languages or dialects. A report (synopsis) is generated, based on each patient's given data, in the German language. Usability and efficiency of obtaining medical history were the criteria evaluated in order to test and optimize the app for use in a broader general medical setting.

METHODS

From May to December 2018, the app was tested in the waiting room of the general medical ward in the refugee camp in Friedland in southern Lower Saxony, Germany. Patients were asked to complete a short digital questionnaire about the usability of the app immediately after finishing the query. Sociodemographic data were partly collected with the same questionnaire and partly extracted from patient records. The efficiency was evaluated on the basis of the correspondence between the entered complaints (ICPC-2) and the diagnoses of the doctors (ICD-10).

RESULTS

In total, the app was used 353 times, and based on these, 283 medical histories were taken. The median time for entering the complaints was 10:27 minutes. The use of the audio output (60% of patients used this option) did not influence the usability. The majority of the users (76%) rated the app as easy to use and 65% of the users stated that they were able to enter their main complaints. Both assessments were independent of the age and sex of the users, but the educational level had a slightly more positive influence. The efficiency test showed that 51% (n=144) of the synopses matched fully and 28% (n=79) of the synopses matched partially with the medical diagnoses.

CONCLUSION

The systematic survey of the most frequent general medical complaints enables a more precise medical history taking in patients with whom a normal interview is not possible due to language barriers. Thus it serves as a support for the medical history taking. The app is easy to use and not prone to the errors of online translations.

Communication challenges between nurses and migrant paediatric patients

Background

Many people receiving medical treatment in Switzerland speak none of the country's four languages or English, which is a major communicative barrier for health staff. Appropriate treatment in hospitals depends on the successful communication between hospital staff and patients. Consequently, migrant patients can be particularly challenging for hospital staff.

Aims

The aim of this project was to examine the following topics: (a) which communicative challenges hospital nurses are confronted with in the care of migrant paediatric patients and how they cope with them, and (b) what requirements nurses (and other stakeholders) have regarding a digital communication aid to improve the care of migrant paediatric patients in the hospital setting.

Methods

This study used a qualitative approach. The following steps of data collection were undertaken: (a) two literature searches corresponding to the research questions, (b) a focus group interview with paediatric hospital nurses, (c) observation of communication between paediatric nurses/healthcare professionals and children/parents through shadowing, (d) short interviews with paediatric nurses who were being shadowed, and (e) a focus group interview with experts. Data analysis was based on thematic analysis and was supported by MAXQDA software.

Results

Evaluation of the data showed there are multiple communicative challenges that emerge in the care of migrant paediatric patients. These challenges influence each other and appear at different moments in the hospital stay. Additionally, the results revealed that digital communication aids must be user friendly and easily accessible.

Conclusions

This study highlights the areas of hospital care in which a digital communication aid could be feasible. However, many of the described communication challenges stem from issues that cannot be solved solely with a digital communication aid. Instead, strategies to tackle these issues must be embedded in the training of nursing staff, in the hospital management strategy and at the political level.

Inequalities in health care utilization among migrants and non-migrants in Germany: a systematic review

BACKGROUND

Despite the growing number of people with migrant background in Germany, a systematic review about their utilization of health care and differences to the non-migrant population is lacking. By covering various sectors of health care and migrant populations, the review aimed at giving a general overview and identifying special areas of potential intervention.

METHODS

A systematic review was conducted in PubMed database including records that were published until 1st of June 2017. Further criteria for eligibility were a publication in a peer-reviewed journal written in English or German language. The studies have to report quantitative and original data of a population residing in Germany. The appropriateness of the studies was judged by both authors. Studies were excluded if native controls were not originated from the same sample. Moreover, indicators of health care utilization have to assess individual behaviour like consultation or participation rates. 63 studies met the inclusion criteria for a qualitative synthesis of the findings.

RESULTS

The overall findings indicate a lower utilization among migrants, although the results vary in terms of health care sector, indicator of health care utilization and migrant population. For specialist care, medication use, therapist consultations and counselling, rehabilitation as well as disease prevention (early cancer detection, prevention programs for children and oral health check-ups) a lower utilization among people with migrant background was found. The lower usage was particularly shown for migrants of the 1st generation, people with two-sided migrant background, children/adolescents and women. Due to the methodological heterogeneity a meta-analysis was not feasible. As most of the studies were cross-sectional, no causal interpretations could be drawn.

CONCLUSIONS

The inequalities in utilization could not substantially be explained by differences in the socioeconomic status. Other reasons of lower utilization could be due to differences in need, preferences, information, language and formal access barriers (e.g. charges, waiting times, travel distances or lost wages). Different migrant-specific and migrant-sensitive strategies are relevant to address the problem for certain health care sectors and migrant populations.

TRIAL REGISTRATION

The review protocol was registered on PROSPERO ( CRD42014015162 ).