Objective: The goal of this study was to investigate barriers to utilisation of cancer rehabilitation by querying a large sample of various professionals in health care with a comprehensive set of barriers. Methods:We developed a questionnaire comprising 55 barriers to utilisation of cancer rehabilitation and administered it to four different types of medical, care and social work experts involved in the referral to cancer rehabilitation. An exploratory factor analysis was conducted and the extracted factors were ranked by mean values.Additionally, ANOVAs were calculated to test for group differences.Results: Our sample (N = 606) consisted of 249 physicians, 194 social workers, 105 nurses and 55 psychologists in Germany. We identified seven barrier-dimensions: low appreciation of rehabilitation by professionals, insufficient coordination, insufficient application procedure, rehabilitation requirements not met, patients' unfulfilled demands, patients' social responsibilities and patients' coping style, with the latter being rated as the most obstructive thereof. Furthermore, we found statistically significant group differences for six of these factors with small-to medium-sized effects. Conclusion:Our results support previous publications implicating the patients' coping style as a barrier. We furthermore found evidence for barriers relating to processes and organisational issues, thereby expanding on the scope of patient-oriented publications. Suggestions for improving patients' health services accessibility are made.

Zusammenfassung Ziel der Studie In dieser von der Deutschen Rentenversicherung (DRV) Bund geförderten Studie wurden Barrieren bei der Antragstellung zu onkologischen Rehabilitationsleistungen aus Sicht von verschiedenen Expertengruppen untersucht. Methodik In einer exploratorischen multizentrischen qualitativen Querschnittsstudie wurden 61 teilstrukturierte Interviews mit in der onkologischen Versorgung tätigen Experten durchgeführt: Ärzte (n=26), Sozialarbeiter (n=22), Psychologen/Psychoonkologen (n=6), Pflegepersonal/Medizinische Fachangestellte (n=5), Verwaltungsangestellte der DRV (n=2). Mittels eines Leitfadens wurden die Teilnehmer zu ihren Erfahrungen mit Reha-Anträgen sowie ihren Einschätzungen und Bewertungen bezüglich möglicher Barrieren im Prozess der Antragstellung befragt. Die Auswertung der Interviewdaten erfolgte EDV-gestützt nach der qualitativen Inhaltsanalyse von Mayring. Ergebnisse Die Befragten waren im Mittel 52,51 Jahre alt (SD=10,06; min=25, max=71) und arbeiteten im Durchschnitt seit 19,26 Jahren (SD=10,15; min=1, max=42) in der Beratung oder Behandlung von onkologischen Patienten. Insgesamt wurden 854 Aussagen codiert und den folgenden drei Hauptkategorien zugeordnet: Expertenbezogene, Systembezogene und Patientenbezogene Barrieren. Zentral in der erstgenannten Hauptkategorie war die Skepsis bezüglich des Nutzens von Rehabilitationsleistungen und ein unzureichend gedeckter Informationsbedarf aufseiten der Experten. In der Hauptkategorie Systembezogene Barrieren wurden Aspekte erwähnt, die das Antragsverfahren, die geringe Verfügbarkeit z. B. von ambulanten Reha-Angeboten sowie die Abwesenheit eines funktionierenden Zuweisungssystems thematisierten. Die Hauptkategorie Patientenbezogene Barrieren umfasste psychosoziale Faktoren, wie bspw. verschiedene Themen der Krankheitsverarbeitung, wie den Wunsch des Patienten nach Hause zu kommen und den Alltag wieder erleben zu können sowie die Angst, mit der Krankheit konfrontiert zu werden. Schlussfolgerung Durch die explorative Studie konnten potenzielle Barrieren bei der Beantragung von onkologischen Rehabilitationsleistungen aus Expertensicht abgebildet werden. Die Befunde bilden insbesondere die Grundlage für ein multidimensionales Assessmentinstrument, mittels dessen die Barrieren standardisiert erfasst und individuelle Handlungsempfehlungen abgeleitet werden können.

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The spread of the COVID-19 pandemic had a wide range of impacts on living conditions, opportunities and mental health. As discussed by society and supported by some studies, young people were particularly affected. The aim of this review was to provide an overview of research that explicitly addressed the mental health outcomes of adolescents’ and young adults’ transition. A systematic literature search in PubMed, PsycInfo, PSYNDEX, Embase and LIVIVO was conducted in February 2022. 42 of 2562 screened publications from industrialized/high-income countries were included and analyzed. All included publications show that the mental health of young people worsened during the pandemic. Several studies suggest(ed) that youths with less education and low socioeconomic status were affected most. Regarding different stages of adolescence, study results are heterogeneous. Evidence indicates that schools as institutions are important settings for everyday lives, personal development and education of young people. The review shows that there is a need for research and scientifically validated recommendations for practice. Further consideration should focus on the implementation of sustainable structures on the local level to strengthen resilience, minimize risk factors for young people’s mental health and create opportunities for valuable transitions.

"For me, Pressure at School is the Most Relevant in my Life" - Empirical Based Implications for Life World Orientation in Health Promotion at School School is a key system that supports all processes of adolescent development. Next to qualification, as one part of personality development, all developmental tasks of adolescence can take place within the school environment, through close interplay. This interplay both influences, and is influenced by young people's health which is essential to promote adolescent development and foster wellbeing in everyday life for young people. On one hand, risk taking behaviour can impact health and developmental progress. On the other hand, biopsychosocial changes can emerge to challenge young people in terms of coping with life and managing the tasks of normal adolescent development. Experiencing ill health can further limit young people's access to systems and social interaction essential to promote development. In this instance, life world orientation in health promotion becomes one fundamental part of social work, especially school social work (Rademaker, 2017b). In this paper a holistic perspective on health is formulated, as an essential part of young people's daily life. The paper specifically focusses on social work's potential to empower young people to engage with their available resources to promote health related agency. A triangulated study (2013-2015) provides an empirical example. Based on a questionnaire with 500 pupils aged 15-16 years (N = 395), three health types could be identified, a healthy, an unhealthy and one in average, and prototypical cases (N = 12) were interviewed in focus group discussions. The interplay of resources and structural borders in the life world of the participants could be reconstructed to provide understanding of how health related agency emerges in the lives of young people and shape their option to health.