Interventions to Increase the Reachability of Migrants in Germany With Health Interview Surveys: Mixed-Mode Feasibility Study

Abstract

Background Germany is a popular destination for immigrants, and migration has increased in recent years. It is therefore important to collect reliable data on migrants’ health. The Robert Koch Institute, Berlin, Germany, has launched the Improving Health Monitoring in Migrant Populations (IMIRA) project to sustainably integrate migrant populations into health monitoring in Germany. Objective One of IMIRA’s objectives is to implement a feasibility study (the IMIRA survey) that focuses on testing various interventions to increase the reachability of migrants with health interview surveys. Possible causes of nonresponse should be identified so as to increase participation in future surveys. Methods The survey target populations were Turkish, Polish, Romanian, Syrian, and Croatian migrants, who represent the biggest migrant groups living in Germany. We used probability sampling, using data from the registration offices in 2 states (Berlin and Brandenburg); we randomly selected 9068 persons by nationality in 7 sample points. We applied age (3 categories: 18-44, 45-64, and ≥65 years) and sex strata. Modes and methods used to test their usability were culturally sensitive materials, online questionnaires, telephone interviews, personal contact, and personal interviews, using multilingual materials and interviewers. To evaluate the effectiveness of the interventions, we used an intervention group (group A) and a control group (group B). There were also focus groups with the interviewers to get more information about the participants’ motivation. We used the European Health Interview Survey, with additional instruments on religious affiliation, experience of discrimination, and subjective social status. We evaluated results according to their final contact result (disposition code). Results We collected data from January to May 2018 in Berlin and Brandenburg, Germany. The survey had an overall response rate of 15.88% (1190/7494). However, final disposition codes varied greatly with regard to citizenship. In addition to the quantitative results, interviewers reported in the focus groups a “feeling of connectedness” to the participants due to the multilingual interventions. The interviewers were particularly positive about the home visits, because “if you are standing at the front door, you will be let in for sure.” Conclusions The IMIRA survey appraised the usability of mixed-mode or mixed-method approaches among migrant groups with a probability sample in 2 German states. When conducting the survey, we were confronted with issues regarding the translation of the questionnaire, as well as the validity of some instruments in the survey languages. A major result was that personal face-to-face contact was the most effective intervention to recruit our participants. We will implement the findings in the upcoming health monitoring study at the Robert Koch Institute.

Barriers to Accessing Medicines among Syrian Asylum Seekers and Refugees in a German Federal State

“…Conducting research in refugee populations is challenging as the population is difficult to reach and sample for a variety of reasons such as inadequate sampling frames, language or cultural issues, concerns about privacy, or fear due to experiences in home countries [ 31 , 32 ]. To address the challenges of participant recruitment and to enhance our understanding of the study matter, we enlisted the help of Syrian activists and other prominent members of the Syrian community in NRW who voluntarily took part in different stages of our research, including during the development of our questionnaire.…”

Results and Strategies for a Diversity-Oriented Public Health Monitoring in Germany

“…A second reminder letter then announced a home visit to a subsample of study persons ( n = 1822) with Romanian, Syrian, or Turkish nationalities in Berlin. During the home visits, in two different subsamples, either the telephone number of a study person willing to participate was obtained to conduct a bilingual telephone interview, or a face-to-face-interview was performed directly at the participants’ home [ 47 ].…”

Investigating associated factors of primary and specialist health care utilization among people with selected nationalities: results of a multilingual survey in two German federal states

“…Seven primary sampling units (PSU) within two German federal states were selected: Berlin (five districts: Mitte, Neukölln, Charlottenburg-Wilmersdorf, Friedrichshain-Kreuzberg, and Tempelhof-Schöneberg) was selected to represent urban regions and Brandenburg (two cities with at least 33,000 inhabitants: Cottbus and Fürstenwalde/Spree) to represent less urban regions. Within these sample points, a pre-defined number of addresses ( n = 9068 in total) were randomly drawn from local population registers at resident registration offices [ 43 ]. Moving into a residence in Germany, both Germans and Non-Germans have to register within 2 weeks at the resident registration offices of their municipality [ 44 ].…”

“…Participants were sequentially able to take part via online, telephone, or personal interview in the languages of Arabic, Croatian, German, Polish, Romanian, or Turkish. The overall response rate was 15.9% [ 43 ]. The study concept, design, and methodology are described in more detail elsewhere [ 43 , 46 ].…”

“…The overall response rate was 15.9% [ 43 ]. The study concept, design, and methodology are described in more detail elsewhere [ 43 , 46 ].…”