Racially discriminatory experiences among older chronically ill people of Turkish origin in Germany

Background

Racism in health care is rarely clearly identified as such in Germany. Barriers to access are more often addressed, but people's experiences of discrimination rarely receive attention (Schellenberg & Tusch 2021, Kristiansen 2016). Internationally, racism is recognized as a determinant of health and there is a discourse that it must be addressed in order to achieve health equity (Weil 2022). This qualitative secondary data analysis focuses on racially discriminatory experiences among older chronically ill people of Turkish origin in the context of medical and drug care in Germany.

Methods

11 expert interviews and 11 problem-centred interviews with chronically ill people of Turkish origin and their relatives in Germany were conducted in the MedikaMig-Project with regard to care practices, continuity of drug care and polypharmacy and analysed with structuring qualitative content analysis (Mayring 2015).

Results

The analysis yielded 7 superordinate categories and 27 subcategories, identifying racial discrimination in access to care, the treatment situation and communication, and in the consideration of transnational lifestyles. Patients are often helpless, sometimes trying to put their experiences into perspective or to be treated by Turkish doctors in order to avoid these discriminatory experiences.

Conclusions

Racial discrimination is pervasive in health care and should not be hidden behind other terms that mask discrimination. An intersectional approach allows us to understand which individuals are particularly affected and what they need to be protected from racism in health care.

Key messages

• Structural racism in health care needs to be clearly named and examined from an intersectional perspective in further research projects.

• Elderly patients with Turkish origin need empowerment and contact persons after racist experiences to find ways to deal with discriminating experiences that are sometimes perceived as traumatic.

Racism-critical self-reflection of professors of public health in Germany

Background

In public discourse, universities are rarely understood as places of institutionalized discrimination, but rather as places of enlightenment and intercultural cosmopolitanism (Nghi Ha 2016). Existing studies focus on students’ perspectives on institutionalized discrimination. In this context, the critical self-reflection on racism is particularly relevant for people who are in positions of power, as their attitudes and actions have a direct impact on many other people, such as in the case of professors on students, academic and non-academic staff. The study reconstructs to what extent conscious or unconscious attitudes in terms of critical whiteness manifest themselves in the attitudes and, in the actions of professors in health sciences and co-constitute the realities of staff and students.

Methods

Based on the critical whiteness concept according to Dietze (2009) a reconstructive, qualitative-empirical analysis (Bohnsack 2000) of eight episodic interviews (Flick 2011) with public health professors in Germany was conducted. Attitudes of professors are examined with regard to the critical reflection of their own power position in dealing with employees and students.

Results

Interviewees have heterogeneous reflective skills and few structurally anchored opportunities for racism-critical self-reflection in their professional environment. The spaces are demanded by students or staff or initiated by themselves, expecting resistance from colleagues. Unconscious racism is sometimes present even with a high degree of reflexivity.

Conclusions

Criticism of racism must be systematically addressed in schools of public health in order to create spaces for reflection where staff can reflect on and identify their racisms and develop collective action for racism-sensitive teaching and workplace.

Key messages

Emergency room services for people affected by sexualized and/or intimate partner violence in Berlin

Background

People affected by intimate partner violence (IPV) and/or sexualized violence (especially women, children and LGBTIQ*) have long-term health consequences (WHO 2016: 6). The WHO Guideline (2013) and the Istanbul Convention (2016) demand systematic and structurally anchored services at the level of care, education, training of health professions and public health research. The aim of this study was to evaluate the service provided at emergency rooms (ERs) in hospitals in Berlin, Germany.

Methods

A questionnaire with quantitative and qualitative questions including dimensions of existing interventions, available resources of trained staff and institutional frameworks was sent to the management of the 37 hospitals with ERs in Berlin. Descriptive-statistical methods were used to analyze the current state of care provided. (Response rate: 76 percent (n = 28))

Results

The care often depends on individual decisions of staff members of the ER: 5 ERs report the existence of a Standard Operating Procedure (SOP) for IPV, 6 for sexualised violence. Awareness of demographic characteristics of diversity varies widely across ERs; no staff specifically trained to serve for the needs of LGBTIQ* is available; 25% offer a gender-specific choice of doctors; 11 ERs co-hospitalize children affected by IPV.

Conclusions

The institutional framework and the awareness of demographic characteristics of diversity in ERs influence the services provided on a regular basis to people affected by IPV and/or sexualized violence. Development of SOP, qualification of health care professionals (HCP) and systematic collection and evaluation of related data are needed in order to implement the WHO guidelines and the provisions of the Istanbul Convention.

Key messages

Public health research regarding the care provided for people affected by IPV or sexualized violence by ERs in Berlin demonstrate the demand for guiding standard procedures and qualification of HCP. The systematic collection and evaluation of relevant data should be implemented in all countries that have signed the Istanbul Convention.

Polypharmacy in elderly migrants: perspectives of chronically ill migrants on E-Health-Applications

Background

Polypharmacy occurs frequently among the elderly and is associated with an increased risk of falls and medication-related adverse events. Especially people with migration backgrounds may receive inappropriate medication due to language barriers or experiences of discrimination in healthcare. This study aimed to assess barriers to drug therapy in elderly migrants and to generate user experience data for the development of an e-health application.

Methods

10 interviews, respectively, with chronically ill individuals of Turkish descent and with family caregivers. The 20 interviews were analyzed qualitatively by means of structuring content analysis.

Results

Medication is connected to uncertainty for respondents and most are affected by polypharmacy. Medication is not always taken regularly, especially among respondents living transnationally. Adherence depends on trust and the quality of doctor-patient relationships. The number of medications required and their side effects are a source of dissatisfaction, but elderly migrants develop a variety of coping strategies. Smartphone use is common among respondents and they are open to using an application for medication prescription and intake management.

Conclusions

Interprofessional care teams are needed in order to reduce uncertainty regarding medication management, to improve health literacy and to strengthen alliances between stakeholders. Additionally, collaboration between diversity-sensitive nursing care specialists and physicians is needed to provide accessible information, thus improving continuity of intake and adherence. E-health applications have the potential to improve medication management and information exchange between all stakeholders, thus facilitating correct medication use.

Key messages

Diversity-sensitive care can improve drug therapy for elderly migrants by removing language, information and trust barriers. Elderly migrants are open to web-applications for medication management.

Polypharmacy and drug misuse in elderly migrants: care practice and interprofessional collaboration

Background

Polypharmacy is associated with an increased risk of falls and adverse events in the elderly. Factors such as inappropriate infrastructure for resolving language barriers can make people with migration backgrounds more vulnerable to polypharmacy. This study aimed to assess barriers in the drug therapy of elderly migrants and to obtain input for an e-health application supporting medication management and interprofessional communication.

Methods

10 expert interviews were conducted with health professionals working with chronically ill patients of Turkish descent. The sample included physicians, pharmacists, social workers and nursing professionals. The interviews were analyzed using structuring content analysis.

Results

Respondents perceived language barriers and discontinuities in medication prescription as key problems in the drug therapy of elderly migrants. Changes in the brand of medication prescribed were highlighted as particularly damaging to patient-provider relationships. Interprofessional communication was deemed important, with physicians and pharmacists expressing dissatisfaction in this area. Some respondents saw potential in the e-health application, while others cited concerns about data protection or the digital capabilities of elderly migrants.

Conclusions

Healthcare professionals may require support in providing information in a variety of languages. Additionally, more interprofessional collaboration is desired but it is necessary to first establish better channels of communication. An e-health application could help achieve clearer communication between stakeholders. However, it is necessary to work in close cooperation with professionals when designing the application to ensure that it can be implemented in practice.

Key messages

Language barriers and inconsistent prescription practices harm patient-provider relationships. Better channels of communication are needed to provide less fragmented care to elderly migrants.

“Queer Migrants Welcome” in Public Health Teaching

Background

People with heterogeneous sexual orientations and gender identities are rarely the focus of public health research or teaching. LGBTQ people (Lesbian, Gay, Bisexual, Transgender, Queer) are particularly at risk of being discriminated against in accessing and using health care. In order to give students of public health a perspective that is sensitive to diversity and which will allow them to consider LGBTQ people in their future research, teaching and practice, these topics must be actively reflected on during their studies.

Methods

A website was built by a team of students of the Bachelor degree program in Health Communication at the School of Public Health, Bielefeld University in Germany. The aim of this course was to learn about the health situation and risks of LGTBQ people. One main emphasis of this project was to develop a medium that focuses on the perspective for newcomers, migrants and refugees in the context of LGTBQ health in a participatory way.

Results

The students developed an understanding of LGBTQ, migration and health largely independently through individual research and group discussion, decided to create an English-language website (https://queermigrantswelcome.jimdofree.com) and present existing findings in blog posts they wrote on their own. The pictures on the homepage were drawn by the students themselves, as they perceived the freely available LGBTQ pictures as too stereotypical. They contacted counselling centres for LGBTQ persons throughout Germany and asked in which language they offer counselling and have included these counselling possibilities on the homepage.

Conclusions

Already at the Bachelor’s level, students can design innovative media that can improve the health care of marginalized people and contribute to the dismantling of discriminatory structures. It is important that the students are given sufficient freedom to make their own decisions and identify with the topic, thus facilitating a major learning process.

Key messages

Desiderates in health communication can be reduced by well accompanied student projects. The topic LGBTQ must be implemented in the curricula of public health study programmes to reduce discrimination in health care.

Transnational medication management by elderly migrants – a mixed-methods approach

Background

Many elderly people of Turkish origin choose a transnational lifestyle and commute between Germany and Turkey every few months. These circular migrants often suffer from chronic diseases. The transnational lifestyle can lead to discontinuities in long-term medication and irregular check-ups. If continuity of care is not ensured transnationally, health risks arise.

Methods

In a mixed-methods study 8 expert-interviews with general practitioners and 25 guideline interviews were conducted with circular migrants to analyze their medication adherence. Additional quantitative analyses were conducted based on data from a German statutory health insurance popular with migrants to investigate discontinuities of prescribed medication.

Results

Cross-border care involves different health risks with regard to medication adherence. For example, patients in Germany rarely receive the amount of medication they need for their stay in Turkey and there are discontinuities in medication delivery. The multi-perspective insight into the patients’ experiences of medical care and the view of general practitioners shows strong variations of preferred strategies to handle the challenges of transnational medication management. Single strategies, such as leaving the health insurance card in one state for prescription and sending of medication through family members or asking for higher amounts of medication to store before travel, lead to frustration both at GPs’ and patients’ sides. GPs experience high pressure by the health system’s structure in providing good care for the patients, especially in providing enough time for information transfer between GPs and patients.

Conclusions

Transnational solutions for health care, and in particular medication care, such as an interprofessional collaborative care across borders or transnational e-health records need to be developed.

Key messages

A transnational lifestyle can lead to discontinuities in the provision of medication. Transnational, inter-professional cooperation is needed to ensure continuity of health care for circular migrants.

Self-help as a relief strategy for Turkish family caregiver of people with dementia? A Scoping Review

Background

The number of dementia patients with a migration background is rising in the process of demographic change in Germany. For people with a migration background, care is usually provided at home and is accompanied by an increased burden on relatives. Alleviating support services are rarely used.

Methods

The scoping review on burden and self-help as a relief strategy for Turkish family caregiver of people with dementia includes the databases PubMed, Livivo, CINAHL and Web of Science and is completed by a ’by hand’ analysis in Google and Google Scholar. A total of 24 publications were included in the analysis.

Results

Family caregiver of Turkish origin show a high degree of willingness to assume responsibility for care, show knowledge deficits with regard to support services and are exposed to heterogeneous burdens. People with a migration background hardly make use of self-help. Self-help as a relief strategy could be strengthened by needs-oriented and culturally diverse services.

Conclusions

There is a need for action to improve domestic care for people with a migrant background. This requires the involvement of stakeholders such as those in need of care, caring relatives and professional carers. Self-help for people with a migration background can be activated and promoted with target group-oriented approaches. The support measures should be designed to be sensitive to diversity and correspond to the heterogeneity of the users and their life situations.

Key messages

Self-help for migrants must be flexible and user-oriented. Diversity-sensitivity in self-help could address people who are difficult to reach.