Research

Removing Barriers to Medical Rehabilitation

Award for Rehabilitation Research for the joint project involving Lübeck, Bielefeld, and Witten/Herdecke – Particular Deficiencies for People with a Migrant Background.

For their research on the expectations that people with a migrant background have regarding healthcare treatment, two social medicine experts from Lübeck, along with their project partners from the Universities of Bielefeld and Witten/Herdecke, received this year’s Award for Rehabilitation Research from the North Rhine-Westphalia Association for Rehabilitation Sciences. The award was presented on 17 April 2019 as part of the Rehabilitation Sciences Colloquium in Berlin. Prof. Dr. Ruth Deck, Head of Rehabilitation at the Institute of Social Medicine and Epidemiology at the University of Lübeck and the University Medical Center Schleswig-Holstein, Campus Lübeck, and Dr. Jana Langbrandtner, a Lübeck-based researcher in the field, were involved in the joint project.

Although people with a migrant background sometimes have a greater need for rehabilitation, they are less likely to avail of treatment than people without a migrant background, while those who do avail of treatment often show worse results than the rest of the population. The researchers from Lübeck, Bielefeld, and Witten/Herdecke examined the reasons for this and took a particularly close look at the issue of expectations regarding treatment.

As part of the project “Expectations of people with a migrant background regarding treatment, and the possibility of considering these expectations in medical rehabilitation” (VeReMi), the researchers conducted surveys with GPs, patients, and healthcare employees at rehabilitation institutions, and also carried out interviews at orthopaedic institutions. All the information was gathered in North Rhine-Westphalia and Schleswig-Holstein. The project was financed by the German Pension Authority (DRV) and the German Society of Rehabilitation Research in Hamburg, Mecklenburg-Vorpommern and Schleswig-Holstein (vffr).

“In order to remove barriers and improve access to medical rehabilitation, the migrant-sensitive management of information  is particularly important,” says Prof. Dr. Ruth Deck. “We identified major deficiencies in this area.” People with a migrant background who know relatively little about medical rehabilitation went to the rehabilitation institution with various and often false expectations, were then disappointed, and struggled to commit to individual therapies. Another contributory factor is that the doctors treating the patients are often insufficiently or poorly informed about medical rehabilitation. “A finding that we already recognise from previous studies,” says Prof. Deck. A homepage for resident doctors (www.rehainfo-aerzte.de) aims to provide assistance.

The websites of the rehabilitation institutions themselves would also be a relatively easy way to bridge the lack of information on the part of all those involved. “However, few organisations already offer information about migrant-sensitive treatment on their websites,” explains Dr. Jana Langbrandtner, who examined the websites in question. “The aim should therefore be to offer easily comprehensible, straightforward, and needs-focused information that reduces the fears and uncertainties that people with a migrant background have regarding rehabilitation, while also promoting realistic expectations concerning treatment.”

The reasons why fewer people with a migrant background make use of rehabilitation as well as other, preventative measures, can be traced above all to the barriers to access that they encounter in the health system. These barriers include insufficient knowledge of the German language, a lack of information, as well as cultural needs and expectations that rehabilitation institutions do not give sufficient consideration to. To overcome these challenges, the project partners say that it is necessary to organise healthcare treatment, including rehabilitation, in a more diversity-friendly way.

Possible measures for dealing with the problem include training and seminars that help healthcare staff to be more aware of the diversity of their patients, not only with regard to their migrant background, but also concerning aspects such as age, gender, and socio-economic status. Furthermore, it is recommended that information be made available in various languages or, even better, via various media, irrespective of language.

The project results also show that institutions consider greater focus on diversity to be important. At the same time, a lack of financial resources and organisational problems are mentioned as factors that prevent implementation of appropriate treatment. Institutions therefore need structural and organisational support to surmount these obstacles.