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Ludwig J, Barbek R, von dem Knesebeck O. Education and suicidal ideation in Europe: A systematic review and meta-analysis. J Affect Disord 2024; 349:509-524. [PMID: 38199415 DOI: 10.1016/j.jad.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Understanding predictors of suicidal ideation (SI) is crucial for preventing suicides. Given Europe's high suicide rates and the complex nature of SI, it is essential to also examine social determinants like education as potential risk factors for SI in this region. This systematic review and meta-analysis investigates the association between formal/vocational education and SI in Europe. METHODS Electronic databases (PubMed, Web of Science, PsycINFO, PSYNDEX) were searched until November 2022. Included studies involved European populations examining associations between education and SI. Pooled Odds Ratios (OR) with 95 % confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed with the heterogeneity variance τ2 and I2 statistic; subgroup analyses were performed based on study characteristics. Risk of bias was assessed using an adaption of the Newcastle-Ottawa Scale. RESULTS From 20,564 initial studies, 41 were included in the meta-analysis (outlier-adjusted, 96,809 study participants). A negative, insignificant association (OR = 0.86, 95 % CI: 0.75; 1.00) was observed between education and SI, with significant heterogeneity (τ2 = 0.09, I2 = 73 %). Subgroup analyses indicated that population type, age group, categorization of education, timeframe of SI assessment, and study quality significantly moderated the effect size. LIMITATIONS Heterogeneity across studies limits generalizability. The cross-sectional design precludes establishing causal relationships, and social desirability bias may have underestimated the association between education and SI. CONCLUSIONS This systematic review and meta-analysis suggests a trend towards a protective effect of education on the emergence of SI in Europe. Future research, preferably with longitudinal study design examining various covariates, should systematically consider educational inequalities in SI.
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Affiliation(s)
- Julia Ludwig
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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von dem Knesebeck O, Klein J. Perceived discrimination in health care in Germany- results of a population survey. Int J Equity Health 2024; 23:39. [PMID: 38409013 PMCID: PMC10898096 DOI: 10.1186/s12939-024-02132-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND It has consistently been shown that perceived discrimination is associated with adverse health outcomes. Despite this uncontested relevance, there is a lack of research on the experiences of discrimination in health care. Therefore, the following research questions were addressed: (1) How often do people in Germany report having been discriminated in health care due to different reasons? (2) Which socio-demographic groups are most afflicted by perceived discrimination in health care? METHODS Analyses are based on a cross-sectional online survey conducted in Germany. An adult population sample was randomly drawn from a panel which was recruited offline (N = 2,201). Respondents were asked whether they have ever been discriminated in health care due to the following reasons: age, sex/gender, racism (i.e. migration history, religion, language problems, colour of skin), health issues or disability (i.e. overweight, mental illness/addiction, disability), socio-economic status (SES, i.e. income, education, occupation). RESULTS 26.6% of the respondents reported discrimination experiences. Perceived discrimination due to health issues or disability was most frequent (15%), followed by age (9%) and SES (8.9%). Discrimination due to racism and sex/gender was less frequently reported (4.1% and 2.5%). Younger age groups, women, and 2nd generation migrants as well as respondents with low income and low education were more likely to report any kind of discrimination in health care. Two groups were found to be at special risk for reporting discrimination in health care across different reasons: women and younger age groups. Discrimination due to racism was more prevalent among respondents who have immigrated themselves than those who were born in Germany but whose parents have immigrated. Discrimination due to SES was significantly associated with (low) income but not with education. CONCLUSIONS More than a quarter of the adult population in Germany reported experiences of discrimination in health care. Such experiences were more frequent among lower SES groups, migrants, women, and younger people. Results underline the necessity of interventions to reduce the magnitude and consequences of discrimination in health care. Future studies should apply an intersectional approach to consider interactions between social inequality indicators regarding discrimination and to identify risk groups that are potentially afflicted by multiple discrimination.
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Affiliation(s)
- Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Barbek R, Toussaint A, Löwe B, von dem Knesebeck O. Intersectional inequalities in somatic symptom severity in the adult population in Germany found within the SOMA.SOC study. Sci Rep 2024; 14:3820. [PMID: 38360818 PMCID: PMC10869707 DOI: 10.1038/s41598-024-54042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
Somatic symptoms are common in a wide range of medical conditions. In severe cases, they are associated with high individual and economic burden. To explore social inequalities in somatic symptom severity (SSS) and to identify social groups with highest SSS, we applied an intersectional research approach. Analyses are based on cross-sectional data of the adult population living in Germany (N = 2413). SSS was assessed with the Somatic Symptom Scale-8. A multiple linear regression model with three-way interaction of gender, income and history of migration and post-hoc pairwise comparison of estimated marginal means was conducted. Analyses revealed intersectional inequalities in SSS along the axis of gender, income, and history of migration. Highest SSS was found in males with low income whose parent(s) immigrated, females with low income who immigrated themselves, and females with low income and no history of migration. Intersectional approaches contribute to a more comprehensive understanding of health disparities. To reduce disparities in SSS, proportionate universal interventions combining universal screening and targeted treatment seem promising.
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Affiliation(s)
- Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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Koens S, Klein J, Härter M, Strauß A, Scherer M, Schäfer I, von dem Knesebeck O. [Intended utilization of health care services in cases of mental illnesses with varying urgency]. Psychiatr Prax 2024. [PMID: 38359870 DOI: 10.1055/a-2230-3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To investigate variations in intended utilization in cases of an acute psychotic episode, an alcohol related or depressive disorder depending on different case characteristics. METHODS A telephone survey with case vignettes was conducted (N=1,200). Vignettes varied in terms of urgency of symptoms, daytime, sex of the afflicted person and age/mental disorder. The respondents were asked to indicate whom they would contact first in the described case. RESULTS Outpatient physicians were named most frequently as the first point of contact (61.1%) while only 6.5% of the respondents named emergency medicine including the medical on call service (8.1% in high urgency cases, i. e. emergencies that did not tolerate any delay). Intended utilization varied by urgency and age/mental illness. CONCLUSION More Information about the need to seek medical help immediately in cases of mental illnesses with high urgency should be provided.
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Affiliation(s)
- Sarah Koens
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf
| | - Jens Klein
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf
| | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - Annette Strauß
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - Martin Scherer
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - Ingo Schäfer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
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Klein J, Koens S, Scherer M, Strauß A, Härter M, von dem Knesebeck O. Variations in the intended utilization of emergency care in case of gastrointestinal diseases. Health Policy 2024; 140:104970. [PMID: 38194836 DOI: 10.1016/j.healthpol.2023.104970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/22/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
Frequent utilization of emergency care and overcrowded emergency departments (EDs) are highly relevant topics due to their harmful consequences for patients and staff. The present study examines variations of intended health care use in urgent and non-urgent cases among the general population. In a cross-sectional telephone survey, a sample of N = 1,204 adults residing in Hamburg, Germany, was randomly drawn. At the beginning of the survey, one of 24 different vignettes (case stories) describing symptoms of inflammatory gastrointestinal diseases were presented to the participants. The vignettes varied in sex (male/female), age (15, 49, 72 years), daytime (Tuesday morning, Tuesday evening), and urgency (low, high). Participants were asked in an open-ended question about their primal intended utilization if they or their children would be affected by such symptoms. Overall, about 14 % chose emergency facilities (ED, ambulance, emergency practice) despite presentation of non-urgent conditions (n = 602). Intended emergency care use varied considerably even if the degree of urgency was comparable. Adolescence, male sex, and symptoms occurring in the evening were associated with increased ED and ambulance use. Inappropriate utilization of ED and ambulance (analyses regarding utilization due to non-urgent problems) was more often observed among male respondents and those with a migration background (1st generation). Information campaigns focused on emergency care use and reorganisation of emergency care wards are possible interventions.
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Affiliation(s)
- Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annette Strauß
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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von dem Knesebeck O, Löwe B, Lüdecke D, Bobardt JS, Barbek R. Public knowledge and beliefs about the irritable bowel syndrome - results from the SOMA.SOC study. BMC Public Health 2024; 24:219. [PMID: 38238839 PMCID: PMC10797779 DOI: 10.1186/s12889-024-17784-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Despite the epidemiological and economic relevance of the irritable bowel syndrome (IBS), there is a lack of research on what the general public knows and thinks about this condition (IBS literacy). Therefore, the aim of this study was to explore public knowledge and beliefs about IBS in Germany. Moreover, associations of knowledge and beliefs about IBS with socio-demographic characteristics as well as illness and treatment experiences were analysed. METHODS Analyses made use of a national telephone survey (N = 1,205). A carefully developed vignette describing a person with typical symptoms of IBS was presented. Respondents were then asked to name the disease in question and beliefs about causes and treatment options were assessed. For the analyses respondents were divided into three groups: (1) people who never had IBS symptoms, (2) people who had or have IBS symptoms but never were in treatment and (3) individuals who reported to be or have been treated for IBS symptoms. RESULTS Less than 4% of the respondents recognized IBS after presentation of the vignette. About 75% positively evaluated treatability while psychotherapy was evaluated more effective than medication. Stress and unhealthy lifestyle were the most frequently endorsed possible causes of the presented IBS symptoms. There were variations in knowledge and beliefs about IBS according to age, gender, and education. We found minor differences in beliefs and knowledge between individuals who had or have symptoms but never were in treatment and those without respective illness experience. Respondents with illness/treatment experiences rated their knowledge significantly better than those without any experiences. CONCLUSIONS Results indicate low levels of public knowledge about IBS regarding illness recognition in Germany. A majority disagreed that they have good knowledge about IBS symptoms. Against this background, it seems reasonable to develop and test interventions to improve IBS literacy by increasing knowledge about symptoms, causes and treatment options.
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Affiliation(s)
- Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Martinstr.52, 20246, Hamburg, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, UKE, Hamburg, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Martinstr.52, 20246, Hamburg, Germany
| | - Johanna S Bobardt
- Department of General Practice and Primary Care, UKE, Hamburg, Germany
| | - Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Martinstr.52, 20246, Hamburg, Germany
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Künzli N, Woodrow C, Berger A, Czabanowska K, Iacoviello L, Lucas R, Madarasova Geckova A, Merten S, Knesebeck OVD, Mantwill S, Panico S, Osorio L, Ribeiro AI, Chiodini P, Suggs LS, Coulibaly J. Chocolate Eaters Do Not Necessarily Win a Nobel Prize-Authors in Special Issues Do Not Necessarily Publish Lower Quality Papers. Int J Public Health 2023; 68:1606967. [PMID: 38188126 PMCID: PMC10768841 DOI: 10.3389/ijph.2023.1606967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Nino Künzli
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Swiss School of Public Health, Zürich, Switzerland
| | - Christopher Woodrow
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Swiss School of Public Health, Zürich, Switzerland
| | - Anke Berger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Swiss School of Public Health, Zürich, Switzerland
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute (CAPHRI), FHML, Maastricht University, Maastricht, Netherlands
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, LUM University, Casamassima, Italy
| | - Raquel Lucas
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Pavol Jozef Šafárik University in Košice, Košice, Slovakia
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Sarah Mantwill
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Lyda Osorio
- Centro Internacional de Entrenamiento e Investigaciones Médicas Universidad del Valle, Cali, Colombia
| | - Ana Isabel Ribeiro
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Paolo Chiodini
- Medical Statistics Unit—University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - L. Suzanne Suggs
- Swiss School of Public Health, Zürich, Switzerland
- Institute of Communication and Public Policy, Faculty of Communication, Culture, and Society, Università della Svizzera Italiana, Lugano, Switzerland
| | - Jean Coulibaly
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
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Koens S, Klein J, Scherer M, Strauß A, Härter M, Schäfer I, Lüdecke D, von dem Knesebeck O. Perceived treatment urgency of common mental disorders in the German population. Sci Rep 2023; 13:22711. [PMID: 38123622 PMCID: PMC10733386 DOI: 10.1038/s41598-023-49969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Perceived treatment urgency of mental disorders are important as they determine utilization of health care. The aim was to analyze variations in perceived treatment urgency in cases of psychosis (adolescents), alcoholism (adults), and depression (older adults) with two levels of severity each by characteristics of the case and the respondents. A telephone survey (N = 1200) with vignettes describing cases of psychosis, alcoholism, and depression was conducted in Hamburg, Germany. Vignettes varied by symptom severity and sex. Perceived treatment urgency was assessed by three items. A sum scale was calculated. Linear regression models were computed to analyze differences in perceived urgency by characteristics of the case (severity, sex) and the respondents (sex, age, education, migration background, illness recognition, personal affliction). Perceived treatment urgency was significantly higher in severe cases and varied by education. Additionally, regarding psychosis, estimated urgency varied significantly by correct illness recognition. With regard to depression, perceived urgency differed significantly by age and correct illness recognition. Interaction effects between case severity and sociodemographic characteristics of the respondents, personal affliction, and correct recognition of the disorder were found. The identified differences should be considered in the development of interventions on mental health literacy with regard to adequate urgency assessment.
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Affiliation(s)
- Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Annette Strauß
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Klockmann I, Jaß L, Härter M, von dem Knesebeck O, Lüdecke D, Heeg J. Multi-staged development and pilot testing of a self-assessment tool for organizational health literacy. BMC Health Serv Res 2023; 23:1407. [PMID: 38093331 PMCID: PMC10720162 DOI: 10.1186/s12913-023-10448-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Until now a comprehensive, consensus-based tool that can be used by a variety of health care organizations for assessing their organizational health literacy (OHL) is not available. Therefore, we aimed to develop and test a literature- and consensus-based self-assessment tool. METHODS The study is based on a scoping review that was previously published by the authors. For the development of the self-assessment tool, the criteria identified in the literature were synthesized with criteria gained through group discussions with representatives of different types of health care organizations (N = 27) all based in Hamburg (Germany). Consensus on the criteria was reached by conducting a Delphi process (N = 22). A review by the project's patient advisory council was included in the process. The self-assessment tool was converted into an online tool and refined by a pretest. Finally, the online survey was piloted (N = 53) and the reliability and item loadings for each scale were analyzed. RESULTS In total, 77 criteria (items) characterizing a health literate health care organization were developed and grouped into five main categories (scales): (1) "easy access and navigation", (2) "integration, prioritization, and dissemination of OHL", (3) "qualification, quality management, evaluation, and needs assessment", (4) "communication with target groups", and (5) "involvement and support of target groups". The results of the online survey showed that the tool is suitable for assessing an organization's status quo on OHL. The psychometric analysis showed good to excellent internal consistency. Item analyses of the developed self-assessment tool was satisfactory. CONCLUSIONS We were able to define a set of 77 items to characterize OHL, which were integrated into a new, comprehensive, and consensus-based self-assessment tool to identify areas for improvement. We found evidence that the self-assessment tool, based on the identified criteria, consists of the assumed five scales. Further research should analyze the validity of the self-assessment tool on a higher detail level.
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Affiliation(s)
- Izumi Klockmann
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Leonie Jaß
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniel Lüdecke
- Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johanna Heeg
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Lüdecke D, von dem Knesebeck O. Worsened self-rated health in the course of the COVID-19 pandemic among older adults in Europe. Eur J Public Health 2023; 33:1148-1154. [PMID: 37568252 PMCID: PMC10710346 DOI: 10.1093/eurpub/ckad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Governments across Europe deployed non-pharmaceutical interventions to mitigate the spread of coronavirus disease 2019 (COVID-19), which not only showed clear benefits but also had negative consequences on peoples' health. Health inequalities increased, disproportionally affecting people with higher age or lower education. This study analyzed associations between social factors and worsened self-rated health of elderly people in the course of the COVID-19 pandemic, taking different stringencies of government mandates as well as infection rates into account. METHODS Data stem from the European SHARE survey. The main outcome was a binary indicator of worsened self-rated health. Analyses included data from two waves (2020 and 2021) during the pandemic (N = 48 356 participants, N = 96 712 observations). Predictors were age, sex, education and living together with a partner, and two macro indicators that reflected the stringency of government response mandates and COVID-19 infection rates. Data were analyzed using logistic mixed-effects regression models. RESULTS Older age [odds ratio (OR) 1.73, confidence interval (CI) 1.65-1.81] and female sex (OR 1.26, CI 1.20-1.32) were positively associated and higher education (OR 0.74, CI 0.70-0.79) was negatively associated with worsened self-rated health. Not living together with a partner showed higher odds of worsened self-rated health (OR 1.30, CI 1.24-1.36). Inequalities increased from 2020 to 2021. Associations between worsened self-rated health and government response mandates or infection rates were inconsistent. CONCLUSION Self-rated health worsened in the course of the pandemic and health disparities increased. Possible future pandemics require targeted interventions to minimize adverse health outcomes, in particular among old, potentially isolated, and deprived people.
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Affiliation(s)
- Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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von dem Knesebeck O, Barbek R. Public stigma toward fatigue-do social characteristics of affected persons matter? Results from the SOMA.SOC study. Front Psychol 2023; 14:1213721. [PMID: 37637898 PMCID: PMC10450932 DOI: 10.3389/fpsyg.2023.1213721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives Although public stigma imposes a great burden on those affected with manifold negative consequence there is not much known about public stigma related to fatigue. Therefore, this study addresses the following research questions: (1) What is the magnitude of public stigma toward individuals with fatigue? (2) Are there differences in public stigma depending on the social characteristics of the affected person (sex, occupation, and migration)? Methods Analyses are based on a national telephone survey in Germany (N = 1,209). A vignette describing a person with symptoms of fatigue was presented to the respondents. Vignettes were varied according to sex, occupational status, and migration status. Stigma toward the person presented in the vignette was measured by stereotypes and negative emotional reactions (anger). Results Of the stereotypes under study, "hypersensitive" was most frequently endorsed by the respondents (35.7%), followed by "weak will" (27.2%). About 15-20% of the respondents agreed that they react with anger, annoyance or incomprehension. There were considerable differences in fatigue stigma according to the social characteristics of the affected person. In two social groups public stigma was particularly pronounced: (1) male persons with a low occupational status and a migration background; (2) female persons with a high occupational status and without a migration status. In contrast, women with a low occupational status and a migration background were less stigmatized. Conclusion Individuals suffering from fatigue symptoms are confronted with stereotypes and negative emotional reactions by the public. Magnitude of public stigma considerably varies according to social characteristics of the afflicted person. Future studies should consider applying an intersectional approach to identify groups that are at risk of multiple stigma.
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Affiliation(s)
- Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Vonneilich N, Becher H, Bohn B, Brandes B, Castell S, Deckert A, Dragano N, Franzke CW, Führer A, Gastell S, Greiser H, Keil T, Klett-Tammen C, Koch-Gallenkamp L, Krist L, Leitzmann M, Meinke-Franze C, Mikolajczyk R, Moreno Velasquez I, Obi N, Peters A, Pischon T, Reuter M, Schikowski T, Schmidt B, Schulze M, Sergeev D, Stang A, Völzke H, Wiessner C, Zeeb H, Lüdecke D, von dem Knesebeck O. Associations of Migration, Socioeconomic Position and Social Relations With Depressive Symptoms - Analyses of the German National Cohort Baseline Data. Int J Public Health 2023; 68:1606097. [PMID: 37533684 PMCID: PMC10391163 DOI: 10.3389/ijph.2023.1606097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives: We analyze whether the prevalence of depressive symptoms differs among various migrant and non-migrant populations in Germany and to what extent these differences can be attributed to socioeconomic position (SEP) and social relations. Methods: The German National Cohort health study (NAKO) is a prospective multicenter cohort study (N = 204,878). Migration background (assessed based on citizenship and country of birth of both participant and parents) was used as independent variable, age, sex, Social Network Index, the availability of emotional support, SEP (relative income position and educational status) and employment status were introduced as covariates and depressive symptoms (PHQ-9) as dependent variable in logistic regression models. Results: Increased odds ratios of depressive symptoms were found in all migrant subgroups compared to non-migrants and varied regarding regions of origins. Elevated odds ratios decreased when SEP and social relations were included. Attenuations varied across migrant subgroups. Conclusion: The gap in depressive symptoms can partly be attributed to SEP and social relations, with variations between migrant subgroups. The integration paradox is likely to contribute to the explanation of the results. Future studies need to consider heterogeneity among migrant subgroups whenever possible.
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Affiliation(s)
- Nico Vonneilich
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Barbara Bohn
- NAKO e.V., Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Berit Brandes
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Nico Dragano
- Institute for Medical Sociology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Claus-Werner Franzke
- Institute for Prevention and Cancer Epidemiology, University of Freiburg Medical Center, Freiburg, Baden-Württemberg, Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Sylvia Gastell
- NAKO Study Center, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
| | - Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, Faculty of Medicine, University of Würzburg, Würzburg, Bavaria, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Carolina Klett-Tammen
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Lena Koch-Gallenkamp
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Leitzmann
- Deptartment of Epidemiology and Preventive Medicine, University Medical Center Regensburg, Regensburg, Bavaria, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Ilais Moreno Velasquez
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
| | - Nadia Obi
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Center München, Helmholtz Association of German Research Centres (HZ), Neuherberg, Germany
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
- Berlin Institute of Health (BIH), Charité University Medicine Berlin, Berlin, Germany
| | - Marvin Reuter
- Subject Sociology, University of Bamberg, Bamberg, Bavaria, Germany
| | - Tamara Schikowski
- Leibniz-Institut für Umweltmedizinische Forschung (IUF), Dusseldorf, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Matthias Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
- Institute of Nutrition Science, Faculty of Mathematics and Natural Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Dmitry Sergeev
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hill JN, Krüger K, Boczor S, Kloppe T, von dem Knesebeck O, Scherer M. Patient-centredness in primary care walk-in clinics for refugees in Hamburg. BMC Prim Care 2023; 24:112. [PMID: 37149641 PMCID: PMC10163696 DOI: 10.1186/s12875-023-02060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND The huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg. METHODS Videotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients' reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations. RESULTS Patient-centredness of all consultations on average was 64% (95% CI 60-67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65-94), the lowest in respiratory ones with 55% (49-61). Longer consultations resulted in higher MPCC scores. CONCLUSIONS The level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness. PRACTICE IMPLICATIONS We recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.
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Affiliation(s)
- Josephine Nana Hill
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Katarina Krüger
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrid Boczor
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Kloppe
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Dreier M, Ludwig J, Härter M, von dem Knesebeck O, Rezvani F, Baumgardt J, Pohontsch NJ, Bock T, Liebherz S. Evaluation of an online suicide prevention program to improve suicide literacy and to reduce suicide stigma: A mixed methods study. PLoS One 2023; 18:e0284944. [PMID: 37115766 PMCID: PMC10146514 DOI: 10.1371/journal.pone.0284944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Low-threshold e-health approaches in prevention to reduce suicide stigma are scarce. We developed an online program containing video reports on lived experience of suicide and evidence-based information on suicidality. We evaluated the program by a mixed methods design. We examined pre-post-changes of program completers (n = 268) in suicide literacy, suicide stigma (self and perceived), and self-efficacy expectation of being able to seek support in psychologically difficult situations using linear mixed models. To examine reported changes and helpful program elements 12-26 weeks after program completion, we content analyzed transcripts of telephone interviews (n = 16). Program completers showed more suicide literacy (Cohen's d = .74; p < .001), higher self-efficacy expectations to seek support (d = .09; p < .01), lower self-stigma (subscales glorification/normalization: d = -.13, p = .04; isolation/depression: d = -.14; p = .04; stigma: d = -.10; p = .07; n = 168) compared to baseline. We found no significant differences in perceived suicide stigma. We identified lived experience reports, the possibility of sharing own narrative on stigma and suicidality, and information on support as helpful elements. The current online program can increase suicide literacy and self-efficacy expectations to seek support and reduce self-stigma. We recommend a larger randomized controlled trial with longer follow-up to confirm these findings.
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Affiliation(s)
- Mareike Dreier
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Ludwig
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Farhad Rezvani
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Baumgardt
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bock
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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von dem Knesebeck O, Barbek R, Makowski AC. Social inequalities in aggravating factors of somatic symptom persistence (SOMA.SOC): study protocol for a mixed-method observational study focusing on irritable bowel syndrome and fatigue. BMJ Open 2023; 13:e070635. [PMID: 37094902 PMCID: PMC10151849 DOI: 10.1136/bmjopen-2022-070635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Some studies indicate that persistent somatic symptoms (PSS) are more prevalent among individuals with a low socioeconomic status (SES) and a migration background. However, factors explaining social inequalities in PSS are largely unknown. It is expected that aggravating factors of PSS like illness perception, illness beliefs (health literacy, stigma), illness behaviour and health anxiety may play an important role for this explanation. The SOMA.SOC study will examine social inequalities (according to SES and migration) in factors contributing to symptom persistence in irritable bowel syndrome (IBS) and fatigue. METHODS AND ANALYSIS The project will collect both quantitative and qualitative data. Quantitative data will be gathered via a representative telephone survey in Germany (N=2400). A vignette design will be used depicting patients varying in sex, condition (IBS/fatigue), occupational status (low/high) and migration (yes/no). In the survey, we will assess public knowledge and beliefs (eg, health literacy), attitudes (stigma) and personal experiences with the condition (eg, somatic symptom burden). Complementary, longitudinal qualitative interviews will be conducted with patients (n=32 at three time points, resulting in N=96 interviews) who will also vary according to sex, condition, occupational status and migration. Patients will be recruited from primary care practices in Hamburg. The interviews will cover origin and development of the condition, coping and help-seeking as well as social interactions and perception of the disease by others (eg, perceived stigma). SOMA.SOC is part of the interdisciplinary SOMACROSS (Persistent SOMAtic Symptoms ACROSS Diseases) research unit. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of the Hamburg Medical Association on 25 January 2021 (reference number: 2020-10194- BO-ff). Informed consent will be obtained from all participants. The main findings will be submitted for publication in peer-reviewed journals within 12 months of study completion.
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Affiliation(s)
- Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Christin Makowski
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Ludwig J, Brunner F, Wiessner C, Briken P, Gerlich MG, von dem Knesebeck O. Public attitudes towards sexual behavior-Results of the German Health and Sexuality Survey (GeSiD). PLoS One 2023; 18:e0282187. [PMID: 36930669 PMCID: PMC10022782 DOI: 10.1371/journal.pone.0282187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
Population-level data on predictors for attitudes towards sexual behavior are missing for Germany. The current study investigated sexual attitudes in the German population with regard to sociodemographic and sociocultural factors. Data originated from the German Health and Sexuality Survey (GeSiD; N = 4,955) carried out from October 2018 to September 2019. Computer-assisted face to face interviews were conducted with a large self-administered component due to the sensitive topics of the survey. Public acceptance towards several aspects of sexual behavior (extramarital sex, abortion, same sex sexual activities, sex work, promiscuity, sex without love) was investigated. Age, gender, education, religious aspects and migration background were introduced as predictors into logistic regression analyses. Overall, respondents rather rejected promiscuity (61%) and extramarital sex (81%) and rather supported same sex sexual activities (63-70%). Male respondents more likely rejected same sex sexual activities and abortion. Higher education was associated with more acceptance towards the sexual behaviors whereas first generation migrants, Muslim faith and religious devoutness were associated with less acceptance. Results indicate that gender is relevant in terms of sexual attitudes with male respondents tending to have more traditional and heteronormative gender role values. Furthermore, education, culture and religion play an important role concerning the liberality towards sexual behaviors. Acculturation processes of second generation migrants may lead to an adaptation of values. Comprehensive and culturally sensitive sex education may focus on differences concerning sexuality-related norms and values.
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Affiliation(s)
- Julia Ludwig
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Franziska Brunner
- Center for Psychosocial Medicine, Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Wiessner
- Center for Experimental Medicine, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Center for Psychosocial Medicine, Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Olaf von dem Knesebeck
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Künzli N, Berger A, Czabanowska K, Lucas R, Madarasova Geckova A, Mantwill S, von dem Knesebeck O. «I Do Not Have Time»-Is This the End of Peer Review in Public Health Sciences? Public Health Rev 2022; 43:1605407. [PMID: 36467128 PMCID: PMC9716458 DOI: 10.3389/phrs.2022.1605407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 02/19/2024] Open
Affiliation(s)
- Nino Künzli
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Swiss School of Public Health, Zürich, Switzerland
- University of Basel, Basel, Switzerland
| | - Anke Berger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Raquel Lucas
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Pavol Jozef Šafárik University in Košice, Košice, Slovakia
| | - Sarah Mantwill
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Dreier M, Ludwig J, Baumgardt J, Bock T, Knesebeck OVD, Härter M, Liebherz S. Entwicklung und psychometrische Überprüfung eines
Kurzfragebogens zur Selbstwirksamkeitserwartung im Umgang mit psychisch
belastenden Situationen (SWEP). Psychiatr Prax 2022; 50:128-136. [PMID: 36379452 DOI: 10.1055/a-1939-9322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Zusammenfassung
Ziel der Studie Entwicklung und psychometrische
Überprüfung eines 6-Item-Instruments zur Erfassung von
Selbstwirksamkeitserwartung, sich in psychisch belastenden Situationen
Unterstützung suchen zu können (SWEP).
Methodik Entwicklung von Items, Ermittlung von Verteilungscharakteristika,
Faktorenstruktur und interner Konsistenz der Skala anhand einer
Paper-Pencil-Befragung (N=269) und einer Untersuchung einer
Online-Intervention zur Suizidprävention (N=802). Bestimmung der
Retest-Reliabilität und diskriminanten Validität zu Skalen, die
suizidspezifisches Wissen und einen Aspekt von Suizidstigma erfassten.
Ergebnisse Die Hauptkomponentenanalyse ergab für die SWEP-Skala
ein eindimensionales Konstrukt mit hoher interner Konsistenz (Cronbachs
α=0,83 bzw. α=0,89). Es zeigten sich inhaltlich
plausible Korrelationen zu anderen Konstrukten und erste Hinweise auf eine hohe
Retest-Reliabilität.
Schlussfolgerung Die SWEP-Skala ist ein reliables, augenscheinlich
valides, kurzes Instrument zur Erfassung von Selbstwirksamkeitserwartung, sich
in psychisch belastenden Situationen Unterstützung suchen zu
können.
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Affiliation(s)
- Mareike Dreier
- Institut und Poliklinik für Medizinische Psychologie,
Universitätsklinikum Hamburg-Eppendorf Zentrum für Psychosoziale
Medizin, Hamburg, Germany
| | - Julia Ludwig
- Institut für Medizinische Soziologie,
Universitätsklinikum Hamburg-Eppendorf Zentrum für Psychosoziale
Medizin, Hamburg, Germany
| | - Johanna Baumgardt
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik,
Vivantes Klinikum Am Urban, Berlin, Germany
| | - Thomas Bock
- Klinik und Poliklinik fur Psychiatrie und Psychotherapie,
Universitätsklinikum Hamburg-Eppendorf Zentrum für Psychosoziale
Medizin, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institut für Medizinische Soziologie,
Universitätsklinikum Hamburg-Eppendorf Zentrum für Psychosoziale
Medizin, Hamburg, Germany
| | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie,
Universitätsklinikum Hamburg-Eppendorf Zentrum für Psychosoziale
Medizin, Hamburg, Germany
| | - Sarah Liebherz
- Institut und Poliklinik für Medizinische Psychologie,
Universitätsklinikum Hamburg-Eppendorf Zentrum für Psychosoziale
Medizin, Hamburg, Germany
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Barbek R, Henning S, Ludwig J, von dem Knesebeck O. Ethnic and migration-related inequalities in health anxiety: A systematic review and meta-analysis. Front Psychol 2022; 13:960256. [PMID: 36092037 PMCID: PMC9462455 DOI: 10.3389/fpsyg.2022.960256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Health anxiety exists on a continuum ranging from the absence of health awareness to the obsessive fear of having a serious illness despite reassurance. Its pathological manifestation can be diagnosed as hypochondriacal or illness anxiety or somatic symptom disorder. Health anxiety is associated with psychological distress and adverse life events, among others, and leads to considerable economic burden. Compared to the majority population, migrants, and ethnic minorities often face major health inequalities. Several mental illnesses and psychosomatic complaints are more common among these groups. To date, potential ethnic and migration-related inequalities in health anxiety have not been clearly described. However, they are of high relevance for the provision of adequate health care of this diverse and potentially vulnerable group. Thus, we conducted a systematic review and meta-analysis of health anxiety in migrants and ethnic minorities. Methods A systematic literature search of PubMED, Web of Science, PsycINFO, and PSYNDEX was conducted, covering all studies published until 1st of December 2021. Studies were selected if they employed validated measurement tools of health anxiety and examined migrants and/or ethnic minorities in comparison with the majority population. Meta-analytic methods were applied by using a random-effect model. The study quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Results We identified 18 studies from 445 studies initially screened. Of these, 14 studies conducted in North America with a total number of 5,082 study participants were included in the meta-analysis. The pooled effect size indicated a higher risk of health anxiety in migrants and ethnic minorities compared to the majority population (OR 1.39, 95%-CI 1.01-1.92). The results proved not to be robust according to publication bias (adjusted OR 1.18, 95%-CI 0.83-1.69) and fail-safe N (2/3 < benchmark N = 75) and are limited due to heterogeneity (I 2 = 57%), small sample sizes and an overall low quality of included studies. Conclusion To address the diversity of migrants and ethnic minorities, inter-sectional approaches across different countries are needed in research to shed further light on social inequalities in health anxiety linked to migration. Systematic review registration PROSPERO, registration number CRD42022298458.
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Affiliation(s)
- Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Koens S, Strauß A, Klein J, Schäfer I, von dem Knesebeck O. Public perceptions of urgency of severe cases of COVID-19 and inflammatory gastrointestinal disease. PLoS One 2022; 17:e0273000. [PMID: 35951633 PMCID: PMC9371268 DOI: 10.1371/journal.pone.0273000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is evidence that perceived urgency of medical complaints is associated with emergency care utilization. Patients’ perception of urgency can differ from physicians’ assessment. This study explored public perceptions of urgency of severe cases of COVID-19 and inflammatory gastrointestinal disease and analyzed variations in perceptions of urgency by characteristics of the afflicted person in the vignettes and sociodemographic characteristics of respondents. Methods Vignettes with severe symptoms of either inflammatory gastrointestinal disease or COVID-19 with comparable urgency of treatment were used in a telephone survey in Germany (N = 1,207). Besides disease, the vignettes varied in terms of sex, age (child, middle-aged person, old person) and daytime (Tuesday morning, Tuesday evening). Respondents were asked to rate the urgency of the reported symptoms with four items. A sum scale was computed. Variations in perceptions of urgency according to vignette characteristics and sociodemographic characteristics of the respondents (sex, age, educational level, migration background, children (yes/no) and personal affliction) were analyzed using a linear regression model. Results In terms of vignette characteristics, multivariate analysis showed a lower estimated urgency for males, as well as for the middle-aged and aged persons, compared to the child vignettes, and for COVID-19, compared to inflammatory gastrointestinal disease. Regarding the characteristics of the respondents, estimated urgency increased with age and was lower among respondents, who were previously affected by the symptoms themselves. Conclusion Although urgency in the vignettes was comparable, variations in estimated urgency by age and sex of the afflicted person and the described disease as well as age and personal affliction of the respondents were identified. This could result in an inadequate health care service utilization. Therefore, variations in public perceptions of urgency should be considered in the planning of public campaigns on adequate health care services utilization.
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Affiliation(s)
- Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Annette Strauß
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Josam I, Grothe S, Lüdecke D, Vonneilich N, von dem Knesebeck O. Burdening and Protective Organisational Factors among International Volunteers in Greek Refugee Camps—A Qualitative Study. IJERPH 2022; 19:ijerph19148599. [PMID: 35886458 PMCID: PMC9324479 DOI: 10.3390/ijerph19148599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
A majority of the workforce in the humanitarian aid consists of volunteers who partly suffer from health problems related to their voluntary service. To date, only a fraction of the current research focuses on this population. The aim of this qualitative explorative study was to identify burdening and protective organisational factors for health and well-being among humanitarian aid volunteers in a Greek refugee camp. To this end, interviews with 22 volunteers were held on site and afterwards analysed by using qualitative content analysis. We focused on international volunteers working in Greece that worked in the provision of food, material goods, emotional support and recreational opportunities. We identified burdening factors, as well as protective factors, in the areas of work procedures, team interactions, organisational support and living arrangements. Gender-specific disadvantages contribute to burdening factors, while joyful experiences are only addressed as protective factors. Additionally, gender-specific aspects in the experience of team interactions and support systems were identified. According to our findings, several possibilities for organisations to protect health and well-being of their volunteers exist. Organisations could adapt organisational structures to the needs of their volunteers and consider gender-specific factors.
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Lüdecke D, von dem Knesebeck O. Decline in Mental Health in the Beginning of the COVID-19 Outbreak Among European Older Adults-Associations With Social Factors, Infection Rates, and Government Response. Front Public Health 2022; 10:844560. [PMID: 35359766 PMCID: PMC8963994 DOI: 10.3389/fpubh.2022.844560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Governments across the world have deployed a wide range of non-pharmaceutical interventions (NPI) to mitigate the spread of COVID-19. Certain NPIs, like limiting social contacts or lockdowns, had negative consequences for mental health in the population. Especially elder people are prone to mental illnesses during the current pandemic. This article investigates how social factors, infections rates, and stringency of NPIs are associated with a decline in mental health in different European countries. Methods Data stem from the eighth wave of the SHARE survey. Additional data sources were used to build macro indicators for infection rates and NPIs. Two subsamples of persons with mental health problems were selected (people who reported being depressed, n = 9.240 or nervous/anxious, n = 10.551). Decline in mental health was assessed by asking whether depressive symptoms or nervousness/anxiety have become worse since the beginning of the COVID-19 outbreak. For each outcome, logistic regression models with survey-design were used to estimate odds ratios (OR), using social factors (age, gender, education, living alone, and personal contacts) and macro indicators (stringency of NPIs and infection rates) as predictors. Results Higher age was associated with a lower likelihood of becoming more depressed (OR 0.87) or nervous/anxious (OR 0.88), while female gender increased the odds of a decline in mental health (OR 1.53 for being more depressed; OR 1.57 for being more nervous/anxious). Higher education was only associated with becoming more nervous/anxious (OR 1.59), while living alone or rare personal contacts were not statistically significant. People from countries with higher infection rates were more likely to become more depressed (OR 3.31) or nervous/anxious (OR 4.12), while stringency of NPIs showed inconsistent associations. Conclusion A majority of European older adults showed a decline in mental health since the beginning of the COVID-19 outbreak. This is especially true in countries with high prevalence rates of COVID-19. Among older European adults, age seems to be a protective factor for a decline in mental health while female gender apparently is a risk factor. Moreover, although NPIs are an essential preventative mechanism to reduce the pandemic spread, they might influence the vulnerability for elderly people suffering from mental health problems.
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Affiliation(s)
- Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Klein J, Strauß A, Koens S, Schäfer I, von dem Knesebeck O. Intended healthcare utilisation in cases of severe COVID-19 and inflammatory gastrointestinal disease: results of a population survey with vignettes. BMJ Open 2022; 12:e057644. [PMID: 35361649 PMCID: PMC8971358 DOI: 10.1136/bmjopen-2021-057644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To examine variations in intended healthcare utilisation in severe cases of COVID-19 and inflammatory gastrointestinal disease (IGD). DESIGN Representative cross-sectional telephone survey. SETTING AND PARTICIPANTS 1207 randomly drawn adults of the city of Hamburg, Germany, between November 2020 and January 2021. OUTCOME MEASURES Different vignettes with severe symptoms were presented varying in sex, age (child, middle-aged person, older person), daytime (Tuesday morning or Tuesday evening) and disease (COVID-19 or IGD), while the degree of urgency was equivalent for all cases. The respondents were asked for the intended healthcare utilisation resulting in three different alternatives: general practitioner (GP)/paediatrician, medical on-call service ('116117') and emergency care (accident and emergency department, emergency practice, rescue service). In multivariate analyses, associations of characteristics of the vignettes and participants (sex, age, education, migration background) with intended healthcare utilisation were tested. In a further step, analyses were conducted separately for IGD and COVID-19. RESULTS Regarding the vignettes' characteristics, intended utilisation of GP/paediatrician is associated with female sex, higher age, daytime (morning) and COVID-19 symptoms, the medical on-call service with male sex, daytime (evening) and COVID-19 symptoms and the emergency medicine with younger age, daytime (evening) and IGD. Women chose more often the GP/paediatrician, men preferred emergency medicine. Only in case of IGD, higher educated persons more often chose the medical on-call service while people with a migration background decided less often for medical on-call service and emergency medicine. CONCLUSIONS Despite comparable urgency, the findings suggest variations of intended healthcare utilisation depending on various characteristics of the vignettes and respondents. Depending on the type of disease inequalities vary. Overall, information about healthcare alternatives in severe cases has to be improved and clear pathways to facilitate healthcare utilisation has to be further developed.
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Affiliation(s)
- Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Hamburg, Germany
| | - Annette Strauß
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Hamburg, Germany
| | - Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Hamburg, Germany
| | - Ingmar Schäfer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Hamburg, Germany
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Marx G, Koens S, von dem Knesebeck O, Scherer M. Age and gender differences in diagnostic decision-making of early heart failure: results of a mixed-methods interview-study using video vignettes. BMJ Open 2022; 12:e054025. [PMID: 35273048 PMCID: PMC8915297 DOI: 10.1136/bmjopen-2021-054025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Men and women at any age show similar symptoms and signs of heart failure (HF). Since early HF symptoms are ambiguous, doctors may overlook HF as possible cause and misinterpret the signs. The aim was to analyse differences in general practitioners' (GPs) HF diagnosis and diagnostic certainty by patient age and gender and to identify reasons for possible differences. DESIGN Factorial design with video vignettes presenting patients (played by professional actors) with early HF symptoms was used. Video vignettes differed regarding patients' gender (male/female), age (55 years/75 years) and migration background (no/yes: Turkish), while the dialogue was identical. GPs were asked about possible diagnoses and certainty of diagnoses (quantitative) and to narrate their thoughts on considered diagnoses (qualitative). SETTING General practices in northern Germany. PARTICIPANTS 128 GPs stratified by gender and length of clinical experience (≤15 years or >15 years). RESULTS GPs considered HF more often in women than men (predicted probabilities with 95% CI: 0.83 (0.68 to 0.92) vs 0.63 (0.44 to 0.79), p=0.02), especially in older women compared with younger men (predicted probabilities with 95% CI: 0.89 (0.68 to 0.96) vs 0.52 (0.31 to 0.72), p=0,03). Suspected HF was not reasoned by the patient's gender and only seldom by the patient's age, but by reported symptoms. Diagnostic certainty of HF was higher in women than in men (predicted proportions with 95% CI: 0.48 (0.39 to 0.58) vs 0.36 (0.27 to 0.45), p=0.01), with highest certainty in older women and lowest in younger men (0.57 (0.45 to 0.69) vs 0.27 (0.17 to 0.37), p<0.01). GPs explained their certainty referring to both typical HF symptoms and their gut feeling. CONCLUSION Despite an identical dialogue, the study showed differences by patients' gender and age in frequency and certainty of HF diagnosis. In order to avoid that GPs overlook or misinterpret early signs of HF, it is important to critically reflect diagnostic decisions and possible social influences.
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Affiliation(s)
- Gabriella Marx
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Dietmaier JM, Knesebeck OVD, Heesen C, Kofahl C. Personality and its association with self-management in Multiple Sclerosis. Mult Scler Relat Disord 2022; 61:103752. [DOI: 10.1016/j.msard.2022.103752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/24/2022]
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Barbek RME, Makowski AC, von dem Knesebeck O. Social inequalities in health anxiety: A systematic review and meta-analysis. J Psychosom Res 2022; 153:110706. [PMID: 34954602 DOI: 10.1016/j.jpsychores.2021.110706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The association between a low socioeconomic status and poor health, also known as social inequalities in health, has been shown in numerous studies. This also applies to most mental illnesses, such as somatization or anxiety disorders. It is unclear, however, whether social inequalities are evident in health anxiety as well. Therefore, this review and meta-analysis systematically examines social inequalities in health anxiety. METHODS A systematic literature search was conducted covering all studies published until August 2021. The databases PubMED, Web of Science, PsycINFO, and PSYNDEX were screened to identify quantitative studies using validated tools to measure health anxiety and examining the association with socioeconomic status. Meta-analytic methods were applied by using random-effect models. The study quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool. RESULTS Overall, 37 studies were eligible for meta-analysis. Effect sizes of 27 studies using screening scales and 10 studies using diagnostic interviews to measure health anxiety were calculated separately. Meta-analyses revealed a significant association between socioeconomic status and health anxiety (r - 0.14, 95%-CI -0.18 to -0.09 (screening scales) and OR 0.63, 95%-CI 0.43 to 0.92 (diagnostic interviews)), indicating a lower risk for health anxiety in people with higher socioeconomic status. CONCLUSION Findings suggest that the health-related disadvantage of socially deprived people is also evident regarding health anxiety. This should be considered in programs to reduce social inequalities in health. PROSPERO registration number CRD42021237550.
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Affiliation(s)
- Rieke M E Barbek
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, 20246 Hamburg, Germany.
| | - Anna Christin Makowski
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, 20246 Hamburg, Germany.
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, 20246 Hamburg, Germany.
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Löwe B, Andresen V, Van den Bergh O, Huber TB, von dem Knesebeck O, Lohse AW, Nestoriuc Y, Schneider G, Schneider SW, Schramm C, Ständer S, Vettorazzi E, Zapf A, Shedden-Mora M, Toussaint A. Persistent SOMAtic symptoms ACROSS diseases - from risk factors to modification: scientific framework and overarching protocol of the interdisciplinary SOMACROSS research unit (RU 5211). BMJ Open 2022; 12:e057596. [PMID: 35063961 PMCID: PMC8785206 DOI: 10.1136/bmjopen-2021-057596] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Persistent somatic symptoms (PSS) are highly prevalent in all areas of medicine; they are disabling for patients and costly for society. The subjective symptom burden often correlates poorly with the underlying disease severity, and patients' needs for effective treatment are far from being met. Initial evidence indicates that, in addition to disease-specific pathophysiological processes, psychological factors such as expectations, somatosensory amplification and prior illness experiences contribute to symptom persistence in functional as well as in somatic diseases. However, prospective studies investigating the transition from acute to chronic somatic symptoms, integrating pathophysiological, psychological and social factors, are scarce. A better understanding of the multifactorial mechanisms of symptom persistence is crucial for developing targeted mechanism-based interventions for effective prevention and treatment of PSS. Thus, the overall aim of the interdisciplinary SOMACROSS research unit is to identify generic and disease-specific risk factors and aetiological mechanisms of symptom persistence across a range of diseases. METHODS AND ANALYSIS Seven projects will investigate risk factors and mechanisms of symptom persistence in a total of 3916 patients across 10 medical conditions. All study designs are prospective and share common assessment points, core instruments and outcome variables to allow comparison and validation of results across projects and conditions. Research will focus on the identification of generic and disease-specific mechanisms associated with unfavourable symptom course. The development of a multivariate prediction model will facilitate the understanding of the course of PSS across diseases. ETHICS AND DISSEMINATION All individual SOMACROSS studies were approved by the ethics committees of the Medical Chambers Hamburg and Münster, Germany. Findings will be disseminated through peer-reviewed publications, scientific conferences and the involvement of relevant stakeholders, patients and the lay public. This interdisciplinary research unit will fundamentally contribute to earlier recognition of patients at risk, and to the development of prevention and tailored treatment concepts for PSS.
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Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Viola Andresen
- Department of Gastroenterology, Israelitic Hospital, Hamburg, Germany
| | - Omer Van den Bergh
- Research Group on Health Psychology, University of Leuven, Leuven, Belgium
| | - Tobias B Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychology, Helmut-Schmidt-University/University of the Armed Forces Hamburg, Hamburg, Germany
- Institute of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gudrun Schneider
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Münster, Münster, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sonja Ständer
- Department of Dermatology, Medical University Center Münster, Münster, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Makowski AC, von dem Knesebeck O. Public depression stigma does not vary by symptom severity. J Ment Health 2022; 32:434-442. [PMID: 35014921 DOI: 10.1080/09638237.2021.2022626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous studies on public depression stigma did not include different severity levels and thus, did not adequately consider the continuum notion of depressive disorders. AIMS We address the following research questions: 1. Are there differences in public depression stigma according to different severity levels? 2. Is stigma associated with sociodemographic characteristics, experience with depressive symptoms, and symptom severity? METHODS Computer-assisted telephone interviews were conducted in winter 2019/2020 in Germany (N = 1009). Three vignettes representing mild, moderate, and severe depressive symptoms were used. Three indicators of stigma were assessed: negative stereotypes, anger reactions, and desire for social distance. Age, sex, education, and experience with depression (own affliction, contact) were additionally introduced into multiple linear regression analyses. RESULTS Overall, negative stereotypes, anger reactions, and desire for social distance do not significantly vary by depression symptom severity. All components of depression stigma showed positive associations with age, while anger was negatively associated with experiences. CONCLUSIONS Our results do not indicate that public depression stigma is more pronounced when symptoms are more severe. Conclusion is ambivalent: Persons with severe depression do not seem to be additionally burdened by increased stigma, but the German public holds stigmatizing attitudes even towards individuals with mild depressive symptoms.
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Affiliation(s)
- Anna C Makowski
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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von dem Knesebeck O, Koens S, Schäfer I, Strauß A, Klein J. Public Knowledge About Emergency Care-Results of a Population Survey From Germany. Front Public Health 2022; 9:787921. [PMID: 35071168 PMCID: PMC8777036 DOI: 10.3389/fpubh.2021.787921] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Knowledge and beliefs about health and health care are part of the general concept of health literacy. Studies demonstrated that large parts of the population report inadequate health literacy. There are only few studies specifically addressing public knowledge and beliefs about emergency care. We examine magnitude and social variations of public knowledge about emergency care in Germany. Methods: Analyses make use of a telephone survey conducted in Hamburg, Germany. Random sample consisted of 1,207 adult respondents. We asked whether the respondents know various emergency care services. Moreover, capabilities of dealing with an emergency case were assessed. Sex, age, education, and migration background were introduced as predictors into regression models. Results: 98% of the respondents stated to know the rescue service, while 74% knew the medical on call service and 49% were aware of an emergency practice nearby. About 71% of the interviewees said it was easy for them to find out whom to turn to in a case of a medical emergency. Fewer respondents found it easy to evaluate when to use emergency medical services and to evaluate whether a health problem is a medical emergency. Knowledge and capabilities were positively associated with education and negatively related to migration background. Conclusions: This study indicates a lack of public knowledge about emergency care and social inequalities in public knowledge according to education and migration status. Findings suggest that interventions are needed to improve public knowledge and that considering social inequalities should be a basic principle for such interventions.
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Affiliation(s)
- Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of General Practice and Primary Care, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Annette Strauß
- Department of General Practice and Primary Care, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Dreier M, Ludwig J, Baumgardt J, Härter M, von dem Knesebeck O, Bock T, Liebherz S. [Development of an online intervention on suicidality-providing knowledge and reducing suicide stigma]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:47-57. [PMID: 34902052 PMCID: PMC8732802 DOI: 10.1007/s00103-021-03471-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/24/2021] [Indexed: 12/05/2022]
Abstract
Bei Suizidalität können die Angst, von anderen stigmatisiert zu werden, sowie Selbststigmatisierung und unzureichende Informationen dazu führen, dass Hilfsangebote weniger oder gar nicht in Anspruch genommen werden. E‑Mental-Health-Interventionen sind eine Möglichkeit, niederschwellig viele Betroffene über die Thematik zu informieren und auf persönliche Hilfsangebote vorzubereiten. Am Universitätsklinikum Hamburg-Eppendorf wurde eine komplexe Intervention entwickelt, gefördert im Rahmen des Förderschwerpunkts „Suizidprävention (A: Entstigmatisierung)“ des Bundesministeriums für Gesundheit. Entwicklung und Inhalte dieser Onlineintervention sollen im vorliegenden Beitrag beschrieben werden. Nach einer repräsentativen Telefonbefragung der deutschen Allgemeinbevölkerung, mit der Wissenslücken und Stigmatisierungstendenzen zum Thema Suizid untersucht wurden, entstand auf Basis eines australischen Suizidpräventionsprojekts und in Zusammenarbeit mit Betroffenen und Angehörigen die Onlineintervention „8 Leben – Erfahrungsberichte und Wissenswertes zum Thema Suizid“. Darin wurden sowohl wissenschaftlich-klinische Fakten rund um das Thema Suizidalität als auch eine gesellschaftlich-kulturelle Perspektive beleuchtet sowie auf Selbsthilfemöglichkeiten und professionelle Hilfsangebote verwiesen. Es wurden Videoerfahrungsberichte von Betroffenen und Angehörigen gezeigt. Aktuell wird das Projekt ausgewertet. Eine Weiterführung ist geplant. In der Intervention werden verschiedene Sichtweisen gezeigt und die Personen, die die Intervention in Anspruch nehmen, werden sowohl auf kognitiver als auch auf emotionaler Ebene angesprochen. Aufgrund der Prävalenz von Suizidalität und der dennoch bestehenden Tabuisierung des Themas scheinen seriöse, evidenzbasierte und niedrigschwellige Präventions- und Informationsangebote besonders relevant.
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Affiliation(s)
- Mareike Dreier
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Julia Ludwig
- Institut für Medizinische Soziologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Johanna Baumgardt
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin, Deutschland
| | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Olaf von dem Knesebeck
- Institut für Medizinische Soziologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Thomas Bock
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Sarah Liebherz
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Makowski AC, Härter M, Schomerus G, von dem Knesebeck O. What Does the Public Know About Varying Depression Severity?-Results of a Population Survey. Int J Public Health 2021; 66:607794. [PMID: 34744574 PMCID: PMC8565267 DOI: 10.3389/ijph.2021.607794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: In this study, we examine the public's knowledge about different levels of depression severity in Germany. Methods: Data stem from a national telephone survey in Germany. A total of 1,009 persons participated, response rate was 46.8%. A vignette was presented with signs of mild, moderate or severe depression. Participants were asked what they think the person has, which persons and services are helpful and how effective different treatment options are. Differences between the three vignettes were tested with 95% confidence intervals and χ 2-tests. Results: 55.3% of the respondents identified depression as the health problem in question. Participants who heard the vignette with moderate symptomatology recognized depression more often. Across groups, a general practitioner was named most frequently concerning helpful persons/services. Effectiveness of psychotherapy received high levels of approval, online therapy and books were less often rated as effective. There were only few significant differences between the three vignettes. Conclusions: This is the first study examining public depression literacy for different severity levels. Small differences between severity levels indicate a lack of knowledge, which may have adverse consequences for adherence to treatment, especially for mild depression.
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Affiliation(s)
- Anna Christin Makowski
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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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: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Spinler K, Valdez R, Aarabi G, Dingoyan D, Reissmann DR, Heydecke G, von dem Knesebeck O, Kofahl C. Development of the Oral Health Literacy Profile (OHLP)-Psychometric properties of the oral health and dental health system knowledge scales. Community Dent Oral Epidemiol 2021; 49:609-616. [PMID: 34347293 DOI: 10.1111/cdoe.12688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/17/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Current oral health literacy (OHL) instruments vary in focus, methodology, administration time and burden. The widely used word recognition tests fail to encompass important OHL domains, while others exceed time frames for use in practical settings, require an interviewer or mainly measure self-assessments. This paper describes the development of the Oral Health Literacy Profile (OHLP), introduces its components and evaluates the psychometric properties of its two core modules, the knowledge tests. METHODS A preliminary version of the questionnaire was developed and assessed for content validity, relevance and redundancy by an expert panel. It was tested in a convenience sample (n = 95) leading to the creation of a 28-item questionnaire, which was afterwards tested in a second convenience sample (n = 193). Item difficulty, discrimination, internal reliability and construct validity were assessed for the oral health knowledge (OHK) and dental health system knowledge (DHSK) modules. RESULTS The items showed acceptable range of difficulty (ideal: 7 items; easy: 5 items; and difficult: 3 items) and good to very good discriminatory power (the point-biserial index (PBI) > 0.30: all items). Construct validity was considered to be fulfilled when 75% of the hypotheses of expected group differences were met. Satisfactory internal reliability was observed. CONCLUSION With all its components, the OHLP is a suitable short instrument to assess the most relevant dimensions of the multifaceted construct of OHL. PRACTICE IMPLICATION The OHLP can be widely used in research, especially suitable in practical settings, and thereby identify patients who may benefit from oral health education.
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Affiliation(s)
- Kristin Spinler
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richelle Valdez
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Demet Dingoyan
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Ralph Reissmann
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bremer D, Klockmann I, Jaß L, Härter M, von dem Knesebeck O, Lüdecke D. Which criteria characterize a health literate health care organization? - a scoping review on organizational health literacy. BMC Health Serv Res 2021; 21:664. [PMID: 34229685 PMCID: PMC8259028 DOI: 10.1186/s12913-021-06604-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/02/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Organizational health literacy (OHL) aims to respond to the health literacy needs of patients by improving health information and services and making them easier to understand, access, and apply. This scoping review primarily maps criteria characterizing health literate health care organizations. Secondary outcomes are the concepts and terminologies underlying these criteria as well as instruments to measure them. METHODS The review was carried out following the JBI Manual on scoping reviews. The databases CINAHL, Cochrane Library, JSTOR, PsycINFO, PubMed, Web of Science Core Collection, and Wiley Online Library were searched in July 2020. Three researchers screened the records and extracted the data. The results were synthesized systematically and descriptively. RESULTS The literature search resulted in 639 records. After removing duplicates, screening by title and abstract, and assessing full-texts for eligibility, the scoping review included 60 publications. Criteria for OHL were extracted and assigned to six main categories (with 25 subcategories). The most prevalent topic of organizational health literacy refers to communication with service users. Exemplary criteria regarding this main category are the education and information of service users, work on easy-to-understand written materials as well as oral exchange, and verifying understanding. The six main categories were defined as 1) communication with service users; 2) easy access & navigation; 3) integration & prioritization of OHL; 4) assessments & organizational development; 5) engagement & support of service users, and 6) information & qualification of staff. The criteria were based on various concepts and terminologies. Terminologies were categorized into four conceptual clusters: 1) health literacy in various social contexts; 2) health literate health care organization; 3) organizational behavior, and 4) communication in health care. 17 different assessment tools and instruments were identified. Only some of the toolkits and instruments were validated or tested in feasibility studies. CONCLUSIONS Organizational health literacy includes a significant number of distinct organizational criteria. The terminologies used in the OHL literature are heterogeneous based on a variety of concepts. A comprehensive, consensus-based conceptual framework on OHL is missing.
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Affiliation(s)
- Daniel Bremer
- Department of Medical Psychology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Izumi Klockmann
- Department of Medical Sociology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Leonie Jaß
- Department of Medical Sociology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Daniel Lüdecke
- Department of Medical Sociology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Maehder K, Werner S, Weigel A, Löwe B, Heddaeus D, Härter M, von dem Knesebeck O. How do care providers evaluate collaboration? - qualitative process evaluation of a cluster-randomized controlled trial of collaborative and stepped care for patients with mental disorders. BMC Psychiatry 2021; 21:296. [PMID: 34098913 PMCID: PMC8184353 DOI: 10.1186/s12888-021-03274-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collaborative and stepped care (CSC) models are recommended for mental disorders. Their successful implementation depends on effective collaboration between involved care providers from primary and specialist care. To gain insights into the collaboration experiences of care providers in CSC against the backdrop of usual mental health care, a qualitative process evaluation was realized as part of a cluster-randomized controlled trial (COMET) of a collaborative and stepped care model in Hamburg (Germany). METHODS Semi-structured interviews were conducted with N = 24 care providers from primary and specialist care (outpatient psychotherapists and psychiatrists, inpatient/ day clinic mental health providers) within and outside of COMET at the trial's beginning and 12 months later. Interviews were analyzed applying a qualitative structuring content analysis approach, combining deductive and inductive category development. RESULTS Usual mental health care was considered deficient in resources, with collaboration being scarce and mainly taking place in small informal networks. Within the COMET trial, quicker referral paths were welcomed, as were quarterly COMET network meetings which provided room for exchange and fostered mutual understanding. Yet, also in COMET, collaboration remained difficult due to communication problems, the unfavorable regional distribution of the COMET care providers and interprofessional discrepancies regarding each profession's role, competencies and mutual esteem. Ideas for improvement included more localized networks, the inclusion of further professions and the overall amelioration of mental health care regarding resources and remuneration, especially for collaborative activities. CONCLUSIONS The process evaluation of the COMET trial revealed the benefits of creating room for interprofessional encounter to foster collaborative care. Despite the benefits of faster patient referrals, the COMET network did not fulfill all care providers' prior expectations. A focus should be set on interprofessional competencies, mutual perception and role clarification, as these have been revealed as significant barriers to collaboration within CSC models such as COMET. TRIAL REGISTRATION The COMET trial (Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers) has been registered on July 24, 2017 under the trial registration number NCT03226743 .
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Affiliation(s)
- Kerstin Maehder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Silke Werner
- grid.13648.380000 0001 2180 3484Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Weigel
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Heddaeus
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- grid.13648.380000 0001 2180 3484Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schubert M, Ludwig J, Freiberg A, Hahne TM, Romero Starke K, Girbig M, Faller G, Apfelbacher C, von dem Knesebeck O, Seidler A. Stigmatization from Work-Related COVID-19 Exposure: A Systematic Review with Meta-Analysis. Int J Environ Res Public Health 2021; 18:ijerph18126183. [PMID: 34201024 PMCID: PMC8226580 DOI: 10.3390/ijerph18126183] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
Stigmatization from work-related COVID-19 exposure has not been investigated in detail yet. Therefore, we systematically searched three databases: Medline, Embase, and PsychInfo (until October 2020), and performed a grey literature search (until February 2021). We identified 46 suitable articles from 24 quantitative and 11 qualitative studies, 6 systematic reviews, 3 study protocols and 1 intervention. The assessment of stigmatization varied widely, ranging from a single-item question to a 22-item questionnaire. Studies mostly considered perceived self-stigma (27 of 35 original studies) in healthcare workers (HCWs) or hospital-related jobs (29 of 35). All articles reported on stigmatization as a result of work-related COVID-19 exposure. However, most quantitative studies were characterized by convenience sampling (17 of 24), and all studies-also those with an adequate sampling design-were considered of low methodological quality. Therefore, it is not possible to determine prevalence of stigmatization in defined occupational groups. Nevertheless, the work-related stigmatization of occupational groups with or without suspected contact to COVID-19 is a relevant problem and increases the risk for depression (odds ratio (OR) = 1.74; 95% confidence interval CI 1.29-2.36) and anxiety (OR = 1.75; 95% CI 1.29-2.37). For promoting workers' health, anti-stigma strategies and support should be implemented in the workplace.
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Affiliation(s)
- Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
- Correspondence:
| | - Julia Ludwig
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.L.); (O.v.d.K.)
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
| | - Taurai Monalisa Hahne
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany; (T.M.H.); (C.A.)
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
- Institute of Sociology, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Thüringer Weg 9, 09126 Chemnitz, Germany
| | - Maria Girbig
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
| | - Gudrun Faller
- Department of Community Health, Hochschule für Gesundheit, 44801 Bochum, Germany;
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany; (T.M.H.); (C.A.)
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.L.); (O.v.d.K.)
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany; (A.F.); (K.R.S.); (M.G.); (A.S.)
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Lueckmann SL, Hoebel J, Roick J, Markert J, Spallek J, von dem Knesebeck O, Richter M. Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review. Int J Equity Health 2021; 20:58. [PMID: 33568126 PMCID: PMC7874661 DOI: 10.1186/s12939-020-01375-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/28/2020] [Indexed: 12/05/2022] Open
Abstract
Background Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries. Methods We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria. Results Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES. Conclusion This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare. PROSPERO registration number CRD42019123222. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01375-1.
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Affiliation(s)
- Sara Lena Lueckmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany. .,University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Jens Hoebel
- Division of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julia Roick
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.,University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Jenny Markert
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.,University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.,University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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Abstract
BACKGROUND While a growing number of studies analyze the magnitude and predictors of mental health literacy, little is known about suicide-specific knowledge and beliefs ("suicide literacy"). AIMS To examine suicide literacy among the German population and to investigate associations between suicide literacy and suicide stigma. METHODS Telephone interviews were conducted in Germany (N = 2002, response rate: 47.3%). The literacy of suicide scale (LOSS-SF) was used covering the knowledge domains "signs," "risk factors," "causes/nature" and "treatment/prevention." In multiple regression analyses, associations between the LOSS-SF and the three dimensions "stigma," "normalization/glorification," and "depression/isolation" of the stigma of suicide scale (SOSS-SF) were examined controlling for several covariates. RESULTS Respondents showed most knowledge concerning "treatment and prevention" (>80% correct answers). Lower suicide literacy was found in the domains "risk factors" (33-60% correct answers) and "signs for suicidal ideation" (45-53%). Suicide literacy was negatively associated with age, while it was positively associated with education, own affliction, and personal contact. Moreover, suicide literacy showed negative associations with all three dimensions of the SOSS-SF. CONCLUSIONS There are deficits in suicide literacy in the German public that may increase suicide stigma. Addressing those deficits in information-campaigns and encouraging personal contact could help decrease suicide stigma.
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Affiliation(s)
- Julia Ludwig
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Dreier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Over the past few decades, a community-based approach was seen to be the "gold standard" for health promotion and disease prevention, especially in the field of socially deprived neighborhoods in urban areas. Up to the beginning of the 2000s, earlier reviews provide valuable information on activities in this context. However, in their conclusions they were limited to North America and Europe. Therefore, we conducted a systematic literature review on community-based health promotion and prevention programs worldwide. The Pubmed and PsycINFO databases were screened for relevant articles published between January 2002 and December 2018, revealing 101 potentially eligible publications out of 3646 hits. After a systematic review process including searching the reference lists, 32 papers met the inclusion criteria and were included in the review. Twenty-four (75.0%) articles reported improvements in at least one health behavior, health service access, health literacy, and/or a range of health status outcomes. Large-scale community-based health promotion programs, however, often resulted in limited or missing population-wide changes. Possible reasons are methodological limitations, concurrent context effects, and limitations of the interventions used. Our results confirm that community-based interventions are promising for health promotion and disease prevention but so far their potential is not fully realized. For the future, such interventions should aim at proximal outcomes and invest in community capacity building.
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Affiliation(s)
- Stefan Nickel
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Makowski AC, Schomerus G, von dem Knesebeck O. Public Continuum Beliefs for Different Levels of Depression Severity. Front Psychiatry 2021; 12:666489. [PMID: 34177655 PMCID: PMC8219923 DOI: 10.3389/fpsyt.2021.666489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The notion that depression is a disorder that moves along a continuum is well-established. Similarly, the belief in the continuity of mental illness is considered an important element in the stigma process. Against this background, it is the aim of this study to examine whether public continuum beliefs vary with the severity of depressive symptoms. Methods: Analyses were based on computer-assisted telephone interviews (CATIs) conducted in winter 2019/2020 in Germany (N = 1,009, response rate 46.8%). Using three vignettes representing mild, moderate, and severe depressive symptoms, beliefs regarding the continuity of symptoms, specifically a fundamental difference, were assessed with seven items. Sociodemographic characteristics and own experiences with depression (affliction and contact) were introduced as covariates. Results: Significant differences between the three groups of severity were found for the majority of the items measuring continuum beliefs or perceived fundamental difference. However, only few items showed a linear trend indicating a parallel between symptom severity and beliefs. Multivariate regression models showed that a moderate degree of depression was positively associated with stronger continuum beliefs but also with greater perceived difference compared to the mild degree, while no significant associations emerged for the severe vignette. Limitations: Although a comparison of our sample with official statistics supports the external validity, we cannot rule out a selection bias. It is arguable in how far short case vignettes convey a holistic picture of a person affected by depressive symptoms. Conclusion: Our results do not indicate a parallel between symptom severity and public continuum beliefs.
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Affiliation(s)
- Anna C Makowski
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Perez A, Thiede L, Lüdecke D, Ebenebe CU, von dem Knesebeck O, Singer D. Lost in Transition: Health Care Experiences of Adults Born Very Preterm-A Qualitative Approach. Front Public Health 2020; 8:605149. [PMID: 33425841 PMCID: PMC7793891 DOI: 10.3389/fpubh.2020.605149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/05/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction: Adults Born Very Preterm (ABP) are an underperceived but steadily increasing patient population. It has been shown that they face multiple physical, mental and emotional health problems as they age. Very little is known about their specific health care needs beyond childhood and adolescence. This article focuses on their personal perspectives: it explores how they feel embedded in established health care structures and points to health care-related barriers they face. Methods: We conducted 20 individual in-depth interviews with adults born preterm aged 20–54 years with a gestational age (GA) below 33 weeks at birth and birth weights ranging from 870–1,950 g. Qualitative content analysis of the narrative interview data was conducted to identify themes related to self-perceived health, health care satisfaction, and social well-being. Results: The majority (85%) of the study participants reported that their former prematurity is still of concern in their everyday lives as adults. The prevalence of self-reported physical (65%) and mental (45%) long-term sequelae of prematurity was high. Most participants expressed dissatisfaction with health care services regarding their former prematurity. Lack of consideration for their prematurity status by adult health care providers and the invisibility of the often subtle impairments they face were named as main barriers to receiving adequate health care. Age and burden of disease were important factors influencing participants' perception of their own health and their health care satisfaction. All participants expressed great interest in the provision of specialized, custom-tailored health-care services, taking the individual history of prematurity into account. Discussion: Adults born preterm are a patient population underperceived by the health care system. Longterm effects of very preterm birth, affecting various domains of life, may become a substantial burden of disease in a subgroup of formerly preterm individuals and should therefore be taken into consideration by adult health care providers.
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Affiliation(s)
- Anna Perez
- Section Neonatology and Pediatric Intensive Care Medicine, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luise Thiede
- Section Neonatology and Pediatric Intensive Care Medicine, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Lüdecke
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chinedu Ulrich Ebenebe
- Section Neonatology and Pediatric Intensive Care Medicine, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Section Neonatology and Pediatric Intensive Care Medicine, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Berger A, Madarasova Geckova A, von dem Knesebeck O, Künzli N. 100 years of IJPH: looking back and ahead. Int J Public Health 2020; 65:1517-1518. [PMID: 33164117 DOI: 10.1007/s00038-020-01522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Anke Berger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavel Jozef Safarik University, Kosice, Slovakia
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Swiss School of Public Health, Zurich, Switzerland
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Lüdecke D, von dem Knesebeck O. Protective Behavior in Course of the COVID-19 Outbreak-Survey Results From Germany. Front Public Health 2020; 8:572561. [PMID: 33072712 PMCID: PMC7543680 DOI: 10.3389/fpubh.2020.572561] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/24/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: The COVID-19 outbreak means far-reaching changes in the organization of daily lives. Disease-related literacy and factors such as age, gender, or education play a major role in shaping individual practices of protective behavior. This paper investigates different types and frequency of practicing protective behaviors, as well as socio-demographic factors that are associated with such behavioral change. Methods: Data stem from a cross-sectional survey in Germany. Three thousand seven hundred and sixty-five people were contacted, 3,186 participated in the survey. Information on behavior to lower the risk of becoming infected with COVID-19 was assessed by nine items (answer options yes/no). For each item, logistic regression models were used to estimate odds ratios (OR), using education, sex, and age as main predictors and adjusting for partnership status and household composition. Results: People with lower educational level were less likely to avoid gatherings (OR = 0.63; 95%CI = 0.48–0.83), adapt their work situation (OR = 0.66; 95%CI = 0.52–0.82), reduce personal contacts and meetings (OR = 0.71; 95%CI = 0.55–0.93), or increase hand hygiene (OR = 0.53; 95%CI = 0.38–0.73). Being female was associated with higher odds of protective behavior for most outcomes. Exceptions were wearing face masks and adapting the own work situation. Associations between respondents' age and individual behavior change were inconsistent and mostly weak. Conclusion: Disease specific knowledge is essential in order to enable people to judge information on COVID-19. Health education programs aiming at improving COVID-19 knowledge are helpful to build up appropriate practices and reduce the spread of the disease. Strategies are needed to guarantee easy access and better dissemination of high-quality news and fact-checks. Socioeconomic characteristics should be taken into account in the development of infection control measures.
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Affiliation(s)
- Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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von dem Knesebeck O, Scherer M, Marx G, Koens S. Medical decision making among patients with heart failure - does migration background matter? BMC Fam Pract 2020; 21:189. [PMID: 32921317 PMCID: PMC7488718 DOI: 10.1186/s12875-020-01260-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/02/2020] [Indexed: 01/14/2023]
Abstract
Background Some studies, mainly coming from the U.S., indicate disparities in heart failure (HF) treatment according to migration/ethnicity. However, respective results are inconsistent and cannot be transferred to other health care systems. Thus, we will address the following research question: Are there differences in the diagnosis and management of HF between patients with and without a Turkish migration background in Germany? Methods A factorial experimental design with video vignettes was applied. In the filmed simulated initial encounters, professional actors played patients, who consulted a primary care physician because of typical HF symptoms. While the dialog was identical in all videos, patients differed in terms of Turkish migration history (no/yes), sex (male/female), and age (55 years/75 years). After viewing the video, primary care physicians (N = 128) were asked standardized and open ended questions concerning their decisions on diagnosis and therapy. Results Analyses revealed no statistically significant differences (p < 0.05), but a consistent tendency: Primary care doctors more often asked lifestyle and psychosocial questions, they more often diagnosed HF, they gave more advice to rest and how to behave in case of deterioration, they more often auscultated the lung, and more often referred to a specialist when the patient has a Turkish migration history compared to a non-migrant patient. Differences in the medical decisions between the two groups ranged between 1.6 and 15.8%. In 10 out of 12 comparisons, differences were below 10%. Conclusions Our results indicate that are no significant inequalities in diagnosis and management of HF according to a Turkish migration background in Germany. Primary care physicians’ behaviour and medical decision making do not seem to be influenced by the migration background of the patients. Future studies are needed to verify this result and to address inequalities in HF therapy in an advanced disease stage.
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Affiliation(s)
- Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20146, Hamburg, Germany.
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20146, Hamburg, Germany
| | - Gabriella Marx
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20146, Hamburg, Germany
| | - Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20146, Hamburg, Germany
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Nickel S, von dem Knesebeck O. Do multiple community-based interventions on health promotion tackle health inequalities? Int J Equity Health 2020; 19:157. [PMID: 32912257 PMCID: PMC7488049 DOI: 10.1186/s12939-020-01271-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous systematic reviews of the impact of multi-component community-based health promotion interventions on reducing health inequalities by socio-economic status (SES) were restricted to physical activity and smoking behavior, and revealed limited and rather disillusioning evidence. Therefore, we conducted a comprehensive review worldwide to close this gap, including a wide range of health outcomes. METHODS The Pubmed and PsycINFO databases were screened for relevant articles published between January 1999 and August 2019, revealing 87 potentially eligible publications out of 2876 hits. In addition, three studies out of a prior review on the effectiveness of community-based interventions were reanalyzed under the new research question. After a systematic review process, 23 papers met the inclusion criteria and were included in the synthesis. RESULTS More than half (56.5%) of the studies reported improvements of socially disadvantaged communities overall (i.e. reduced inequalities at the area level) in at least one health behavior and/or health status outcome. Amongst the remaining studies we found some beneficial effects in the most deprived sub-groups of residents (8.2%) and studies with no differences between intervention and control areas (34.8%). There was no evidence that any program under review resulted in an increase in health disparity. CONCLUSIONS Our results confirm that community-based interventions may be reducing absolute health inequalities of deprived and disadvantaged populations, but their potential so far is not fully realized. For the future, greater attention should be paid to inequalities between sub-groups within communities when analyzing changes in health inequality over time.
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Affiliation(s)
- Stefan Nickel
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany
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Härter M, Bremer D, Scherer M, von dem Knesebeck O, Koch-Gromus U. [Impact of COVID-19-pandemic on Clinical Care, Work Flows and Staff at a University Hospital: Results of an Interview-study at the UKE]. Gesundheitswesen 2020; 82:676-681. [PMID: 32823355 PMCID: PMC7516358 DOI: 10.1055/a-1226-6828] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The study investigates the impact of the COVID-19 pandemic on health services with and without specific health care of COVID-19 patients through the eyes of leading physicians at the University Medical Center Hamburg-Eppendorf (UKE). METHODS From April 30 to May 12, 2020, four interviewers conducted 38 expert interviews via telephone, video or face-to-face by using a semi-standardized questionnaire. The standardized answers were analysed descriptively. The free text-answers were subject to a qualitative content analysis. The categories were analysed via quantitative frequency distributions. RESULTS All chief physicians with responsibility for inpatient and outpatient health care at the UKE took part in this study (N=38). The leading physicians reported numerous changes regarding occupancy in the hospital, patient composition, work flows and diagnostic as well as therapeutic measures. Additionally, various arrangements were necessary to cover the needs of prevention, treatment and follow-up care as well as protection of staff. Measures showed, on the one hand, a strong reduction in occupancy and workload in most inpatient and outpatient clinics. On the other hand, the amount of work also increased by fundamental transitions of work flows, communication, staff structure and hygiene measures. Many respondents commented positively on the rapid and efficient setup of a digital communication structure. Partially, staff was strained by the pandemic itself and by the associated measures. CONCLUSION The results of the study help to understand and assess the effects of the pandemic on health care, work flows and staff. The findings may support the specification and adaptation of prospective measures and processes for pandemic crisis situations. Future studies should investigate how staff beneath the highest executive level experienced and evaluated this crisis and consequences.
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Affiliation(s)
- Martin Härter
- Institut und Poliklinik für Medizinische Psycholgie, Center for Health Care Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Daniel Bremer
- Institut und Poliklinik für Medizinische Psycholgie, Center for Health Care Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Martin Scherer
- Institut und Poliklinik für Allgemeinmedizin, Center for Health Care Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Olaf von dem Knesebeck
- Institut für Medizinische Soziologie, Center for Health Care Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Uwe Koch-Gromus
- Institut und Poliklinik für Medizinische Psycholgie, Center for Health Care Research, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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Ludwig J, Liebherz S, Dreier M, Härter M, von dem Knesebeck O. [The Stigma of Suicide Scale: Psychometric Validation of the German Short Version (SOSS-SF-D)]. Psychiatr Prax 2020; 47:433-439. [PMID: 32588402 DOI: 10.1055/a-1145-3992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The Australian Stigma of Suicide Scale (SOSS-SF) was translated and tested for applicability and psychometric properties in Germany. Further, it was investigated whether the observed factors from the Australian original could be replicated in a German sample. METHODS Based on a nation-wide, representative telephone survey (N = 2,002), the 16 items of the SOSS-SF-D were examined with a principal component analysis (varimax rotation). Mean values, standard deviations and medians as well as the z-standardized values for skewness and kurtosis were determined. RESULTS The principal component analysis revealed 3 subscales (stigma, normalization/glorification, depression/isolation), just as in the Australian sample. Internal consistency of the subscales was acceptable (Cronbachs α: 0.64-0.78). CONCLUSION The SOSS-SF-D is a valid and short instrument for measuring the multidimensionality of attitudes towards suicidal persons.
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Affiliation(s)
- Julia Ludwig
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf
| | - Sarah Liebherz
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - Mareike Dreier
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
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Ludwig J, Liebherz S, Dreier M, Härter M, von dem Knesebeck O. Public Stigma Toward Persons with Suicidal Thoughts-Do Age, Sex, and Medical Condition of Affected Persons Matter? Suicide Life Threat Behav 2020; 50:631-642. [PMID: 32115757 DOI: 10.1111/sltb.12629] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Suicidal persons often face public stigmatization which affects help-seeking behavior and may lead to an additional suicide risk. There is not much known about differences in stigmatizing attitudes concerning characteristics of affected persons. The present study investigates public stigma toward suicidal persons in Germany by focussing on differences concerning sex, age, and medical condition of the affected person. METHOD A national telephone survey (N = 2,002) was conducted using case vignettes presenting a person with suicidal thoughts. Vignettes systematically varied in sex, age, and medical condition (depressive symptoms vs. cancer). Several components of stigma were assessed ("weakness of will" as a cause, separation, negative emotional reactions, and desire for social distance). RESULTS About 44% of the respondents agreed that a cause of suicidal thoughts is "weakness of will," and two thirds disagreed that they would feel and think the same as the described person. In terms of emotional reactions, fear was more pronounced than anger. Stigmatizing attitudes were particularly pronounced when the described person was female and depressive symptoms were presented. CONCLUSIONS Magnitude of public suicide stigma varies depending on the characteristics of the described person. Groups that are at special risk of being stigmatized should be considered in antistigma programs.
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Affiliation(s)
- Julia Ludwig
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Dreier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Koens S, Marx G, Gras C, Scherer M, Lüdecke D, von dem Knesebeck O. Physicians' information seeking behavior in patients presenting with heart failure symptoms - Does gender of physician and patient matter? Patient Educ Couns 2020; 103:S0738-3991(20)30288-3. [PMID: 32611486 DOI: 10.1016/j.pec.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To examine differences in the anamnesis in heart failure patients by patient and physician gender. METHODS A factorial experimental design with video vignettes was applied. While the dialog of an initial encounter because of heart failure symptoms was identical in all videos, patients, played by professional actors, differed in terms of gender (male/female), age (55 years/75 years) and Turkish migration history (no/yes). After viewing the video, 128 physicians (50 % female) were asked if they wanted to ask additional questions (yes/no) and if so, what they wanted to ask (open ended). A coding frame was conducted for the open ended question. RESULTS Compared to male physicians, female physicians more often said they wanted to ask additional questions, especially about psychosocial aspects. Physicians, particularly female physicians, wanted to ask male patients more often about lifestyle aspects compared to female patients. CONCLUSION Although the dialog was identical in all videos, some variations in the anamnestic approach regarding physician and patient gender were identified. This is in contrast to current heart failure guidelines that recommend a detailed anamnesis in all patients presenting themselves with heart failure symptoms. PRACTICE IMPLICATIONS Primary care physicians should reflect how possible gender stereotypes may influence their anamnestic behavior.
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Affiliation(s)
- Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gabriella Marx
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Colette Gras
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Maehder K, Löwe B, Härter M, Heddaeus D, von dem Knesebeck O, Weigel A. Psychotherapists' perspectives on collaboration and stepped care in outpatient psychotherapy-A qualitative study. PLoS One 2020; 15:e0228748. [PMID: 32023303 PMCID: PMC7002019 DOI: 10.1371/journal.pone.0228748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/21/2020] [Indexed: 01/10/2023] Open
Abstract
Objective Stepped and collaborative care with outpatient psychotherapy as one treatment step is guideline-recommended for mental health care. To date, the experiences and evaluation of psychotherapists regarding collaboration and stepped care have been neglected. In order to improve collaborative mental health care, this qualitative study aimed at identifying psychotherapists’ perspectives and needs within collaboration and stepped care. Methods Semi-structured qualitative interviews with 20 German outpatient psychotherapists were conducted and analyzed applying thematic analysis. The analysis was realized in a recursive process to first identify themes and then relate these themes back to the research questions with regard to collaboration and stepped care. Results Collaboration mainly took place in small networks, with general practitioners and psychiatrists as the most important partners and psychotherapists wishing to intensify collaboration. Main barriers for collaboration were seen in deficient resources and remuneration and in a perceived lack of esteem by other medical specialties. Stepped care was appreciated for intensified collaboration and low-threshold access to care. Doubts were cast on its implementation within current health care conditions, worries concerned a primacy of economic principles instead of patient-orientation. Among further needs, psychotherapists demanded increased knowledge about psychotherapy, especially among general practitioners. Conclusion Psychotherapists expressed ambivalent attitudes towards stepped and collaborative care, substantially influenced by health care conditions and the perceived own standing among care providers. Psychotherapists’ needs within stepped care comprise intensified collaboration, sufficient time, personal and financial resources for collaboration and opportunities for a constructive interprofessional dialogue.
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Affiliation(s)
- Kerstin Maehder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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