Die Besonderheit des Werkes besteht darin, dass verschiedene Bereiche der Umsetzungsqualität einer Frühen Hilfe für sozial benachteiligte Familien differenziert sowohl aus der Sicht der Praxis als auch der Durchführungsforschung betrachtet werden. Dies geschieht am konkreten Beispiel des Hausbesuchsprogramms 'Pro Kind', in dem Hebammen und Sozialpädagoginnen die Projektakteure im Feld sind, die die Familien in ca. zweiwöchigem Rhythmus zu Hause besuchen. Die Familienbegleitung beginnt in der Schwangerschaft und endet mit dem zweiten Geburtstag des Kindes
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This short review considers how 'ethnicity' and 'superdiversity' are used alongside 'diversity' in health research in a sample of recent journal articles. Diversity appears regularly in health inequalities research where the term is used to justify a focus on particular minorities presented as especially vulnerable to ill health or to being in receipt of inadequate services. Given the complexity of what is covered by 'diversity' there is a tendency to focus on a single dimension for intervention, such as language or 'health literacy'. The development of cultural competency or cultural safety is a common response to diversity in health service provision. The review considers gaps in how diversity is treated and the way that superdiversity is largely being used as yet another synonym of diversity. The translation of terms into English, as the dominant language in the political economy of academic publishing, introduces further uncertainty in pinpointing the local dimension of diversity that is under research. The ways that 'superdiversity' is gradually appearing does not (yet) undo such uncertainty. Highlights Diversity appears regularly in health inequality literature but is poorly defined Diversity used synonymously with other terms (culture, ethnicity, race, language) Superdiversity used as an amplifier Language or 'health literacy' often nominate as aspect of diversity for intervention Cultural competence or cultural safety encompass progressive aspirations but less often specific practical responses to the challenges of diversifying diversity Health professionals do not see responding to diversity as their responsibility Gaps Specified relationships between inequality, inequity and diversity Positive effects of diversity on health outcomes and on inequality Evaluation of effect of increased workforce diversity on health equality Evaluation of effectiveness of cultural competency/safety programmes Professional structures and culture rarely included as part of the problem Effects of political and economic context, especially austerity and globalisation, on health services' response to diversity How dimensions of diversity relate to one another across locations How vocabulary of superdiversity relates to that of ethnicity, racism and multiculturalism
"Das Thema Prävention genießt derzeit große gesellschaftliche Aufmerksamkeit und die Anzahl einzelner kriminalpräventiver Maßnahmen oder Programme steigt beständig. Bemängelt wird im Allgemeinen, dass Präventionsprojekte in Deutschland zu selten evaluiert werden, so dass nicht zwischen wirksamen und unwirksamen Programmen unterschieden werden kann (Rössner, Bannenberg, Sommerfeld et al., 2002). Gerade der Nachweis der Programmwirksamkeit ist von großer Bedeutung, wenn Entscheidungsträger vor der Frage stehen, welches der vielen vorliegenden Präventionsprogramme umgesetzt werden soll. Von ebenso großer Bedeutung ist in diesem Zusammenhang aber auch das Wissen über die Implementation eines Programms für die richtige Einschätzung der Programmwirksamkeit und die Übertragung auf andere soziale Kontexte. Dieser Beitrag gibt zunächst einen Überblick über den Stand der Implementationsforschung in kriminalpräventiven Programmen im Allgemeinen. Vor diesem Hintergrund werden jeweils Desiderate für die Implementationsforschung abgeleitet und in einem dritten Schritt auf den speziellen Fall der Implementionsforschung zum kriminalpräventiven Modellprojektes Pro Kind übertragen." (Autorenreferat)
'Das Thema Prävention genießt derzeit große gesellschaftliche Aufmerksamkeit und die Anzahl einzelner kriminalpräventiver Maßnahmen oder Programme steigt beständig. Bemängelt wird im Allgemeinen, dass Präventionsprojekte in Deutschland zu selten evaluiert werden, so dass nicht zwischen wirksamen und unwirksamen Programmen unterschieden werden kann (Rössner, Bannenberg, Sommerfeld et al., 2002). Gerade der Nachweis der Programmwirksamkeit ist von großer Bedeutung, wenn Entscheidungsträger vor der Frage stehen, welches der vielen vorliegenden Präventionsprogramme umgesetzt werden soll. Von ebenso großer Bedeutung ist in diesem Zusammenhang aber auch das Wissen über die Implementation eines Programms für die richtige Einschätzung der Programmwirksamkeit und die Übertragung auf andere soziale Kontexte. Dieser Beitrag gibt zunächst einen Überblick über den Stand der Implementationsforschung in kriminalpräventiven Programmen im Allgemeinen. Vor diesem Hintergrund werden jeweils Desiderate für die Implementationsforschung abgeleitet und in einem dritten Schritt auf den speziellen Fall der Implementionsforschung zum kriminalpräventiven Modellprojektes Pro Kind übertragen.' (Autorenreferat)
BACKGROUND: The large increase in numbers of refugees and asylum seekers in Germany and most of Europe has put the issue of migration itself, the integration of migrants, and also their health at the top of the political agenda. However, the dynamics of refugee health are not yet well understood. From a life-course perspective, migration experience is associated with various risks and changes, which might differ depending on the socioeconomic status (SES) of refugees in their home country. The aim of this paper was to analyze the relationship between pre-migration SES and self-reported health indicators after migration among Syrian refugees. Specifically, we wanted to find out how their SES affects the change in health satisfaction from pre- to post-migration. METHODS AND FINDINGS: We used data from the 2016 refugee survey, which was part of the German Socio-Economic Panel (GSOEP). Although cross-sectional by design, this survey collected information referring to the current situation as a refugee in Germany as well as to their situation before migration. Using a sample of 2,209 adult Syrian refugees who had entered Germany between 2013 and 2016, we conducted a cross-sectional and a quasi-longitudinal (retrospective) analysis. The mean ± SD age was 35 ± 11 years, with 64% of the participants being male. Our results showed a positive association between pre-migration self-reported SES and several subjective health indicators (e.g., health satisfaction, self-reported health, mental health) in the cross-sectional analysis. However, the quasi-longitudinal analysis revealed that the socioeconomic gradient in health satisfaction before migration was strongly attenuated after migration (SES-by-time interaction: −0.48, 95% CI −0.61 to −0.35, p < 0.001; unstandardized regression coefficients, 5-point SES scale and 11-point health outcome scale). Similar results were produced after controlling for sociodemographic characteristics, experiences during the migration passage, and the current situation in Germany. A ...
Abstract Background Forced displacement is a crucial determinant of poor health. With 31 people displaced every minute worldwide, this is an important global issue. Addressing this, the Participation Revolution workstream from the World Humanitarian Summit's Localisation commitments has gained traction in attempting to improve the effectiveness of humanitarian aid. Simultaneously, digital health initiatives have become increasingly ubiquitous tools in crises to deliver humanitarian assistance and address health burdens.
Objective This scoping review explores how the localisation agenda's commitment to participation has been adopted within digital health interventions used by displaced people in low-and-middle-income countries.
Methods This review adopted the Arksey and O'Malley approach and searched five academic databases and three online literature repositories with a Population, Concept and Context inclusion criteria. Data were synthesised and analysed through a critical power lens from the perspective of displaced people in low-and-middle-income-countries.
Results 27 papers demonstrated that a heterogeneous group of health issues were addressed through various digital health initiatives, principally through the use of mobile phones. The focus of the literature lay largely within technical connectivity and feasibility assessments, leaving a gap in understanding potential health implications. The varied conceptualisation of the localisation phenomenon has implications for the future of participatory humanitarian action: Authorship of reviewed literature primarily descended from high-income countries exposing global power dynamics leading the narrative. However, power was not a central theme in the literature: Whilst authors acknowledged the benefit of local involvement, participatory activities were largely limited to informing content adaptations and functional modifications within pre-determined projects and objectives.
Conclusion With over 100 million people displaced globally, effective initiatives that meaningfully address health needs without perpetuating harmful inequalities are an essential contribution to the humanitarian arena. The gap in health outcomes evidence, the limited constructions of health, and the varying and nuanced digital divide factors are all indicators of unequal power in the digital health sphere. More needs to be done to address these gaps meaningfully, and more meaningful participation could be a crucial undertaking to achieve this. Registration The study protocol was registered before the study (10.17605/OSF.IO/9D25R) at https://osf.io/9d25r.
Healthcare has long been a gendered enterprise, with women taking responsibility for maintaining health and engaging with service providers. Universal healthcare provision notwithstanding, women nonetheless undertake a range of healthcare work, on their own account and on behalf of others, which remains largely invisible. As part of a multi-method comparative European study that looked at access to healthcare in diverse neighbourhoods from the point of view of people's own health priorities, the concept of "healthcare bricolage" describes the process of mobilizing resources and overcoming constraints to meet particular health needs. Bricolage mediates between different kinds of resources to meet particular challenges and describing these processes makes visible that work which has been unseen, over-looked and naturalised, as part of a gendered caring role. Drawing on 160 semi-structured interviews and a survey with 1,755 residents of highly diverse neighbourhoods in Germany, UK, Sweden and Portugal, this article illustrates the gendered nature of healthcare bricolage. The complex variations of women's bricolage within and beyond the public healthcare system show how gendered caring roles intersect with migration status and social class in the context of particular healthcare systems.
"Migration-driven diversity means European cities are becoming increasingly superdiverse. Some European neighbourhoods have become places where newcomers arrive from across the world, speaking many different languages, from a range of socio-economic backgrounds and faith traditions and with diverse religious beliefs and practices, while living alongside long-established migrant and White European populations. This book focuses on what this increasing population diversity means for how people and local health and welfare service providers seek to address everyday health concerns - from minor and chronic conditions to acute and urgent problems. Using an innovative mixed method approach crossing multiple disciplines and drawing together rich qualitative and robust quantitative data, this book offers unique insight into the complex and intricate actions, which often vary over space and time, implemented by both residents and care providers from eight superdiverse localities in four European countries, each with different health and welfare traditions. The book introduces the concept of welfare bricolage using it as a mechanism to explore the structures and rationales underpinning need and actions, and how resources are connected across welfare regimes and borders and within locales. The book illustrates how, in the face of increasingly marketised, cash-strapped, restrictive and institutionally racist welfare states and healthcare regimes, individuals and service providers strive to address need. By focusing on welfare regimes, migration histories, everyday actions and resources within neighbourhoods Exploring Welfare Bricolage in Europe's Superdiverse Neighbourhoods offers unique insight into what people and providers actually do when faced with health concerns. The book highlights the role of structure and agency and moves beyond conventional approaches that focus on specific groups or sectors to research health and welfare by looking at whole populations and entire welfare ecosystems. The book's theoretical, methodological and empirical contributions will be of use to scholars, practitioners and policymakers interested in welfare, healthcare, diversity and migration"--
Bildungspolitik wird in den westlichen Industrienationen häufig als ausschließliche Aufgabe des Nationalstaates betrachtet. Seit den 1990ern ist jedoch zu beobachten, dass internationale Organisationen (IOs) eine immer größere Rolle im Politikfeld Bildung spielen, indem sie neue Formen der Governance entwickeln. Dies führt dazu, dass die staatliche Vorherrschaft in der Bildungspolitik zunehmend in Frage gestellt wird. Dennoch ist bisher unklar, welche konkreten Effekte der Einfluss internationaler Organisationen hat. Zum einen wäre es möglich, dass sie einheitliche Lösungen für Probleme im Bildungsbereich vorschlagen, die von vielen Nationalstaaten geteilt werden, was zu einer größeren zwischenstaatlichen Konvergenz der Bildungspolitik führen könnte. Zum anderen wäre denkbar, dass nationale Institutionen ihrer eigenen Logik folgen, was eine Annäherung nationaler Pfade verhindern würde. Um ein besseres Verständnis der Dynamiken in diesem Zwei-Ebenen-Spiel zu ermöglichen, soll in diesem Arbeitspapier ein analytischer Rahmen entwickelt werden, anhand dessen das Zusammenspiel der nationalen und internationalen Determinanten von Wandel in der Bildungspolitik untersucht werden kann. Es wird angenommen, dass IOs mit Hilfe verschiedener Governance Instrumente versuchen, nationale Bildungspolitik zu beeinflussen. Allerdings reagieren Nationalstaaten nicht zwangläufig uniform auf diese internationalen Stimuli, sondern entsprechend ihrer Transformationskapazitäten. Diese werden hauptsächlich von nationalen Vetospielern und nationalen Leitideen von Bildung beeinflusst. Aufbauend auf diesen Annahmen entwickeln wir ein einfaches Modell zur Analyse des Wandels von Bildungspolitik, der durch IO Governance ausgelöst und durch nationale Transformationskapazitäten gesteuert wird.
BACKGROUND: Healthy ageing is an important concern for many societies facing the challenge of an ageing population. Physical activity (PA) is a major contributor to healthy ageing; however insufficient PA levels are prevalent in old age in Germany. Community capacity building and community involvement are often recommended as key strategies to improve equitable access to prevention and health promotion. However, evidence for the effectiveness of these strategies is scarce. This study aims to assess the community readiness for PA promotion in local environments and to analyse the utility of strategies to increase community readiness for reaching vulnerable groups. METHODS/DESIGN: We designed a mixed method intervention trial comprising three study modules. The first module includes an assessment of community readiness for PA interventions in older adults. The assessment is carried out in a sample of 24 municipalities in the Northwest of Germany using structured key informant interviews. In the second module, eight municipalities with the low community readiness are selected from the sample and randomly assigned to one of two study groups: active enhancement of community readiness (intervention) versus no enhancement (control). After enhancing community readiness in the active enhancement group, older adults in both study groups will be recruited for participation in a PA intervention. Participation rates are compared between the study groups to evaluate the effects of the intervention. In addition, a cost-effectiveness analysis is carried out calculating recruitment costs per person reached in the two study groups. In the third module, qualitative interviews are conducted with participants and non-participants of the PA intervention exploring reasons for participation or non-participation. DISCUSSION: This study offers the potential to contribute to the evidence base of reaching vulnerable older adults for PA interventions and provide ideas on how to reduce participation barriers. Its findings will inform governmental authorities, professionals, academics, and NGOs with an estimate of resources necessary to achieve equitable access to physical activity programs for vulnerable older adults. TRIAL REGISTRATION: German Clinical Trials Register DRKS00009564 (Date of registration 03-11-2015)
Education policy making is often considered an exclusive domain of the nation state in western industrialised countries. Since the 1990s, however, international organisations (IOs) have started to play a greater role in the field of education by developing new forms of governance. As a consequence, the predominance of the nation state in education becomes an increasingly contested issue. Yet, it is not clear what kind of effects IO governance will have, whether it brings about greater convergence among national education policies by promoting uniform solutions for commonly shared problems, or whether national institutions continue to follow their own logic, thereby hindering equal responses to IO governance. In order to develop a better understanding of the dynamics in this two-level game, this paper sets out to develop an analytical framework for examining the interplay between international and national determinants of change in the field of education. We argue that IOs apply different governance instruments by which they seek to influence national education policy making. However, the degree to which nation states will respond to these international stimuli is likely to be mediated by national transformation capacities, most prominently veto players and nationally rooted ideas of education. Based on these basic assumptions, we develop a parsimonious model in which we assess the influence of IO governance on national education policy making mediated through national transformation capacities. ; Bildungspolitik wird in den westlichen Industrienationen häufig als ausschließliche Aufgabe des Nationalstaates betrachtet. Seit den 1990ern ist jedoch zu beobachten, dass internationale Organisationen (IOs) eine immer größere Rolle im Politikfeld Bildung spielen, indem sie neue Formen der Governance entwickeln. Dies führt dazu, dass die staatliche Vorherrschaft in der Bildungspolitik zunehmend in Frage gestellt wird. Dennoch ist bisher unklar, welche konkreten Effekte der Einfluss internationaler Organisationen hat. Zum einen wäre es möglich, dass sie einheitliche Lösungen für Probleme im Bildungsbereich vorschlagen, die von vielen Nationalstaaten geteilt werden, was zu einer größeren zwischenstaatlichen Konvergenz der Bildungspolitik führen könnte. Zum anderen wäre denkbar, dass nationale Institutionen ihrer eigenen Logik folgen, was eine Annäherung nationaler Pfade verhindern würde. Um ein besseres Verständnis der Dynamiken in diesem Zwei-Ebenen-Spiel zu ermöglichen, soll in diesem Arbeitspapier ein analytischer Rahmen entwickelt werden, anhand dessen das Zusammenspiel der nationalen und internationalen Determinanten von Wandel in der Bildungspolitik untersucht werden kann. Es wird angenommen, dass IOs mit Hilfe verschiedener Governance Instrumente versuchen, nationale Bildungspolitik zu beeinflussen. Allerdings reagieren Nationalstaaten nicht zwangläufig uniform auf diese internationalen Stimuli, sondern entsprechend ihrer Transformationskapazitäten. Diese werden hauptsächlich von nationalen Vetospielern und nationalen Leitideen von Bildung beeinflusst. Aufbauend auf diesen Annahmen entwickeln wir ein einfaches Modell zur Analyse des Wandels von Bildungspolitik, der durch IO Governance ausgelöst und durch nationale Transformationskapazitäten gesteuert wird.
Background: Diversity in Europe has both increased and become more complex posing challenges to both national and local welfare state regimes. Evidence indicates specific barriers for migrant, faith and minority ethnic groups when accessing healthcare. However, previous studies of health in diverse cities in European countries have mainly adopted an ethno-national focus. Taking into account the new complexity of diversity within cities, a deeper and multi-faceted understanding of everyday health practices in superdiverse contexts is needed to support appropriate healthcare provision. Methods/Design: This protocol describes a mixed method study investigating how residents in superdiverse neighbourhoods access healthcare. The study will include participant observation and qualitative interviewing as well as a standardised health survey and will be carried out in eight superdiverse neighbourhoods - with varying deprivations levels and trajectories of change - in four European countries (Germany, Portugal, Sweden and UK). In each neighbourhood, trained polylingual community researchers together with university researchers will map formal and informal provision and infrastructures supportive to health and healthcare. In-depth interviews with residents and healthcare providers in each country will investigate local health-supportive practices. Thematic analysis will be used to identify different types of help-seeking behaviours and support structures across neighbourhoods and countries. Using categories identified from analyses of interview material, a health survey will be set up investigating determinants of access to healthcare. Complex models, such as structural equation modelling, will be applied to analyse commonalities and differences between population groups, neighbourhoods and countries. Discussion: This study offers the potential to contribute to a deeper understanding of how residents in superdiverse neighbourhoods deal with health and healthcare in everyday practices. The findings will inform governmental authorities, formal and informal healthcare providers how to further refine health services and how to achieve equitable access in diverse population groups.
BACKGROUND: Diversity in Europe has both increased and become more complex posing challenges to both national and local welfare state regimes. Evidence indicates specific barriers for migrant, faith and minority ethnic groups when accessing healthcare. However, previous studies of health in diverse cities in European countries have mainly adopted an ethno-national focus. Taking into account the new complexity of diversity within cities, a deeper and multi-faceted understanding of everyday health practices in superdiverse contexts is needed to support appropriate healthcare provision. METHODS/DESIGN: This protocol describes a mixed method study investigating how residents in superdiverse neighbourhoods access healthcare. The study will include participant observation and qualitative interviewing as well as a standardised health survey and will be carried out in eight superdiverse neighbourhoods – with varying deprivations levels and trajectories of change – in four European countries (Germany, Portugal, Sweden and UK). In each neighbourhood, trained polylingual community researchers together with university researchers will map formal and informal provision and infrastructures supportive to health and healthcare. In-depth interviews with residents and healthcare providers in each country will investigate local health-supportive practices. Thematic analysis will be used to identify different types of help-seeking behaviours and support structures across neighbourhoods and countries. Using categories identified from analyses of interview material, a health survey will be set up investigating determinants of access to healthcare. Complex models, such as structural equation modelling, will be applied to analyse commonalities and differences between population groups, neighbourhoods and countries. DISCUSSION: This study offers the potential to contribute to a deeper understanding of how residents in superdiverse neighbourhoods deal with health and healthcare in everyday practices. The findings will inform governmental authorities, formal and informal healthcare providers how to further refine health services and how to achieve equitable access in diverse population groups.
