Measuring deterioration of small-area housing environment: Construction of a multi-dimensional assessment index and validation in shared refugee accommodation

Mohsenpour, Amir; Biddle, Louise; Krug, Katja; Bozorgmehr, Kayvan

doi:10.1016/j.ssmph.2020.100725

Cited by 10 publications

(11 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The surveyed participants were representative for the overall population in the state Baden-Wuerttemberg with respect to nationality, age, and sex as reported elsewhere. [2] All instruments used are internationally established and if not were validated separately[2, 26] and, if needed, underwent a rigorous translation and pre-testing process. [34] Individual level was accurately linked to collected contextual data or to geo-referenced data at highest level of resolution, as such minimising the risk of misclassification bias.…”

Section: Discussionmentioning

confidence: 99%

“…SHED’s theoretical framework, its construction, piloting, and validation, including proven high intra- and interrater reliability, have been reported elsewhere in detail. [26] The composite SHED index score is calculated based on individual item’s z-transformation (to standardize item scores across different scales) and normalization (to scale all item scores in the range of 0–1). We then split the index score into four relative quartiles of distribution, ranging from Q1 (lowest) to Q4 (highest level of deterioration).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: a cross-sectional, population-based, multi-level analysis in a German federal state

Mohsenpour

Biddle

Bozorgmehr

2022

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundAsylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health.MethodsWe drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany’s 3rd largest federal state. Individual-level data on depression (PHQ2) and anxiety (GAD2) symptoms as well as sociodemographic- and asylum-related covariates, was collected and linked to contextual geo-referenced data on housing environment (‘Small-area Housing Environment Deterioration’ index, number of residents, remoteness, urbanity and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects.ResultsOf 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with >=50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. The accommodation-level median odds ratio for GAD2 was 2.10 with contextual-level variance of 16%.For odds of reporting GAD2 / PHQ2, the highest degree of deterioration (OR 2.22; 95% CI 0.52-9.59 / 1.99;0.55-7.18), large accommodation size (1.34;0.59-3.06. / 1.12;0.56-2.26), remoteness (2.16;0.32-14.79 / 3.79;0.62-23.18) and district urbanity (3.05;0.98-9.49 / 1.14;0.46-2.79) showed higher, but statistically not significant, point-estimates. District deprivation demonstrated higher odds for GAD2 (1.21;0.51-2.88) and, inversely, lower odds for PHQ2 (0.88;0.41-1.89).ConclusionWe found tendencies for, but no significant, contextual effects of housing environment on ASR mental health in accommodation centres. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.Research in contextWhat is already known on this subjectResearch on mental health of asylum seekers and refugees (ASR) has focused on pre- and peri-migratory factors, and increasingly recognizes post-migratory factors and their importance in restoring, sustaining, and protecting health to enable societal integration and participation. Research on the small-area housing environment, and its potential health effects is still scarce, and often limited by high-levels of aggregation of contextual factors, crude or not-standardised measurements on housing characteristics, and risk of compositional bias due to selective migration into housing environments.What this study addsWe make use of the quasi-random allocation of ASR to state-provided, collective accommodation centres, and link individual-level data on health and socio-demographic variables with small-area measures of contextual housing environment at accommodation-level to explore potential effects while minimising the risk of compositional bias. Accommodation-level factors contribute considerably to mental health variance. A tendency towards higher odds of reporting symptoms of generalized anxiety could be observed for housing deterioration, higher numbers of residents, remoteness as well as district urbanity and deprivation. Similar tendencies were estimated for reporting symptoms of depression except for deprivation potentially functioning protectively. Confirmatory research with appropriate sample size calculations as well as mediation and structural equation analysis are needed. Results may guide policy makers in design and planning of needs-based health services and housing infrastructure.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: a cross-sectional, population-based, multi-level analysis in a German federal state

Mohsenpour

Biddle

Bozorgmehr

2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…An instrument was developed to quantify the quality of housing in terms of its structural condition (small-area housing environment deterioration, SHED) and validated in a separate study [ 28 ]. Drawing on the Broken Windows Index [ 29 ], this instrument measures the condition of (1) window panes and glass, (2) walls and roof, (3) litter, (4) graffiti inside and outside the building, and (5) external spaces on the basis of five observer-based assessments.…”

Section: Methodsmentioning

confidence: 99%

“…Drawing on the Broken Windows Index [ 29 ], this instrument measures the condition of (1) window panes and glass, (2) walls and roof, (3) litter, (4) graffiti inside and outside the building, and (5) external spaces on the basis of five observer-based assessments. The instrument has been shown to be highly reliable when conducted in the form of independent individual ratings [ 28 ]. In the context of this study, however, it was used as a rating by a team, as the joint work on site did not create an independent, but a combined impression of the residential environment.…”

Section: Methodsmentioning

confidence: 99%

Monitoring the health and healthcare provision for refugees in collective accommodation centres: Results of the populationbased survey RESPOND

Biddle¹,

Hintermeier²,

Mohsenpour³

et al. 2021

Self Cite

View full text Add to dashboard Cite

To date, the integration of refugees in German health surveys is insufficient. The survey RESPOND (Improving regional health system responses to the challenges of forced migration) aimed to collect valid epidemiological data on refugee health status and healthcare provision. The core elements of the survey consisted of a population-based sampling procedure in Baden-Württemberg, multilingual questionnaires and a face-to-face approach of recruitment and data collection in collective accommodation centres with multilingual field teams. In addition, data on the geographical locations of accommodation centres and their structural quality were obtained. The results indicate a high overall health burden. The prevalence of depression (44.3%) and anxiety symptoms (43.0%) was high. At the same time, high unmet needs were reported for primary (30.5%) and specialist (30.9%) care. Despite sufficient geographical accessibility of primary care services, frequent ambulatory care sensitive hospitalisations, i.e. hospitalisations that could potentially have been avoided through primary care (25.3%), as well as subjective deficits in the quality of care, suggest barriers to accessing healthcare services. Almost half of all refugees (45.3%) live in accommodation facilities of poor structural quality. Collecting valid data on the health situation of refugees is possible through a combination of targeted sampling, multilingual recruitment and survey instruments as well as personal recruitment. The presented approach could complement established procedures for conducting health surveys and be extended to other federal states.

show abstract

“…Applying this index, RESPOND researchers assessed different domains of the physical environment of each collective accommodation centre visited. Based on the Broken-Window Index, the SHED measures the quality of windows, walls and outside spaces as well as the presence of garbage or graffities and an overall rating of the living environment on a scale from one to six (least to highest state of decay) (13). The geographical location was measured by the district the accommodation is located in, a binary variable indicating population density (below 150 inhabitants per km 2 were considered as rural, above this cut-off as urban following a definition of the Federal Institute for Research on Building, Urban Affairs and Spatial Development (BBSR)), and the distance to shops, medical and administrative services by foot and with public transport (based on GoogleMaps (GM) connections).…”

Section: Datamentioning

confidence: 99%

Type of refugee accommodation and health of residents: cross-sectional cluster analysis

Mohsenpour

Dudek

Bozorgmehr

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Few studies have assessed whether refugees health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on number of inhabitants, degree of housing deterioration and remoteness (distance to amenities) and assess the association with health in multivariate analyses. Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and general anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression. Our findings inform policymakers on layout and location of refugee collective accommodation centres.

show abstract

Measuring deterioration of small-area housing environment: Construction of a multi-dimensional assessment index and validation in shared refugee accommodation

Cited by 10 publications

References 52 publications

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: a cross-sectional, population-based, multi-level analysis in a German federal state

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: a cross-sectional, population-based, multi-level analysis in a German federal state

Monitoring the health and healthcare provision for refugees in collective accommodation centres: Results of the populationbased survey RESPOND

Type of refugee accommodation and health of residents: cross-sectional cluster analysis

Contact Info

Product

Resources

About