RESPOND - Improving regional health system responses to the challenges of migration through tailored interventions for asylum-seekers and refugees (English Version)
Einleitungstext:The following questions deal with difficulties that may arise due to health problems. Health problems include illnesses that can be long or short lasting, injuries, mental or emotional problems, and drug or alcohol problems.
Think back to the last four weeks and answer the following questions in terms of how much difficulty you have had in carrying out the following activities. Please mark only one answer for each question.
[In den folgenden Fragen geht es um Schwierigkeiten, die aufgrund von Gesundheitsproblemen entstehen können. Gesundheitsprobleme beinhalten Krankheiten, die lang oder kurz andauernd sein können, Verletzungen, mentale oder emotionale Probleme sowie Drogen- oder Alkoholprobleme.
Denken Sie an die letzten vier Wochen zurück und beantworten Sie die folgenden Fragen im Hinblick darauf, wie viele Schwierigkeiten Sie bei der Durchführung der nachfolgenden Aktivitäten hatten. Kreuzen Sie bei jeder Frage bitte nur eine Antwort an.]
Fragetext:How many difficulties have you had in the last four weeks? [Wie viele Schwierigkeiten hatten Sie in den letzten vier Wochen?]
Antwortkategorien
None [Keine]
Low [Geringe]
Moderate [Mäßig]
Strong [Starke]
Very strong/not possible [Sehr starke/nicht möglich]
Befund zur Multi-Item-Skala:Questions 3.5, 3.6 and 3.7 were systematically tested, while the other questions were only answered spontaneously, if at all.
Serbian
The interpreter notes that the connection between the introductory text "How many difficulties have you had in the last four weeks" and the items, e.g. "To concentrate on something for 10 minutes?" is "inelegantly solved" in the Serbian translation and therefore not clear.
Arabic
Test person AR01 points out that the answer category "None" in the Arabic questionnaire was translated as "No", which means that the translation here is not quite correct.
Empfehlungen zur Multi-Item-Skala:Question in total: In answering this item battery, the intention of the question that difficulties may arise due to health problems is pushed into the background. The respondents often only answer whether they have these difficulties, not whether they have these problems due to health problems.
We therefore recommend to only ask the question to people who have had health problems in the last 4 weeks:
"Due to your health problems, how easy or difficult has it been for you in the last 4 weeks…? [„Aufgrund Ihrer gesundheitlichen Probleme, wie leicht oder schwer ist es Ihnen in den letzten 4 Wochen gefallen…]
… to focus on something (for at least 10 minutes)? [… sich auf eine Sache (mindestens 10 Minuten) zu konzentrieren?]
… to walk a longer distance (about one kilometer)? [… eine längere Strecke (ca. einen Kilometer) zu Fuß zu gehen?]
… to wash your entire body without help (bathing, showering)? [… sich ohne Hilfe zu waschen (Bad, Dusche nehmen)?]
… to get dressed without help? [… sich ohne Hilfe anzuziehen?]
… to speak with people you do not know? [… mit Personen zu sprechen, die Sie nicht kennen?]
… to stay in contact with friends? [… mit Freunden in Kontakt zu bleiben?]
… to cope with your everyday life?
[… Ihren Alltag zu bewältigen?]
In this case an additional filter question would have to be connected in advance.
Answer options:
Very easy / Rather easy / Rather difficult / Very difficult / Not possible at all [Sehr leicht / eher leicht / eher schwer / sehr schwer / war überhaupt nicht möglich]
Furthermore, we recommend adding an additional answer category "No friends" to "Contact with friends" for all respondents who do not maintain/have friendships.
Sonstiges:The test persons FAR01, FAR02, RUS01, RUS02 and SER02 did not answer this block of questionnaires because the questionnaire had to be shortened after the first four interviews in order to keep the duration of the interviews within reasonable limits.
Eingesetzte kognitive Technik/en:General Probing, Specific Probing, Emergent Probing.
Items
Itemtext
Item getestet
a) To focus on something for 10 minutes? [Sich für 10 Minuten auf etwas zu konzentrieren?]
Itemtext:a) To focus on something for 10 minutes? [Sich für 10 Minuten auf etwas zu konzentrieren?]
Empfehlungen:[See recommendations for total question 3]
Befund zum Item:Serbian
In test person SER01, question 3a shows major problems with understanding the question. The interpreter has to explain repeatedly what the question is about and the test person corrects her answer from "none" to "low": "Oh, I wonder if I can concentrate on something for 10 minutes?”
Arabic
Test person AR02 also has problems understanding the question. For her it is not clear what the word "concentrate" refers to, i.e. whether it refers to learning or sports, for example. In the end, AR02's answer refers to the general ability to concentrate, which is in the sense of the question designer.
Thema der Frage:Gesundheit/ Beschwerden
Konstrukt:Difficulties due to health problems
Ja
b) To walk a longer distance (about one kilometre)? [Eine längere Strecke (ca. einen Kilometer) zu Fuß zu gehen?]
Nein
c) To wash your entire body? [Ihren gesamten Körper zu waschen?]
Itemtext:c) To wash your entire body? [Ihren gesamten Körper zu waschen?]
Empfehlungen:[See recommendations for total question 3]
Befund zum Item:Arabic
Test person AR01 asks how the item is to be understood, whether "showering" is meant. The formulation in the Arabic translation of the questionnaire of "to wash your entire body" is a little unusual. According to the test person it would be simpler and clearer to talk about bathing or showering. In addition, an article (the) was missing in Arabic, so that the formulation was not quite grammatically correct.
Thema der Frage:Gesundheit/ Beschwerden
Konstrukt:Difficulties due to health problems
Ja
d) To get dressed? [Sich anzuziehen?]
Nein
e) In dealing with people you do not know? [Im Umgang mit Personen, die Sie nicht kennen?]
Itemtext:e) In dealing with people you do not know? [Im Umgang mit Personen, die Sie nicht kennen?]
Empfehlungen:[See recommendations for total question 3]
Befund zum Item:This question reveals problems of understanding regarding the intention of the question.
Serbian
In an interview with test person SER01, the interpreter must first explain the question: "That he has problems with people he doesn't know. Is that the question?" . Test person SER01 interprets the question in the way that she gets on well with people, not that she has problems with people she does not know: "What can I tick? I get along well with people." (SER01) .
After asking more precisely which people the test person was thinking of, she answers as follows: "These are people I didn't know, we're not friends but we didn't have a fight either, nothing bad happened. [...] We didn't know each other, afterwards we were friends, but then we had a fight, I say it was nothing."
Arabic
The two interviews with the Arabic translation of the questionnaire also reveal ambiguities with regard to the intention of the question.
Test person AR01 misunderstands the intention of the question. She interprets the question as to how far dealing with people she does not know leads to psychological problems and not how far psychological (or other health problems) make dealing with such people more difficult. In answering the question, test person AR01 thinks of asylum seekers in a refugee accommodation who do not speak German or English (but only their mother tongue) and who therefore often could not communicate. This leads to psychological stress. The test person himself is not affected by this, as he speaks a little German. Their answer ("none") is therefore still "correct" in this case, even if she misunderstands the question.
Test person AR02 does not refer to health problems, but to characteristics of the 'foreign', such as religion or skin colour. The test person says that she has no difficulties in dealing with people she does not know.
English
Test person ENG01 claims to have "strong" problems in dealing with unknown persons due to the traumatic experiences in her home country (murder, torture). The test person justifies her answer by saying that she has the feeling that many people do not understand her or cannot understand her fate. Therefore she likes to be alone. The test person suffers from psychological problems due to traumatic experiences in her home country.
Thema der Frage:Gesundheit/ Beschwerden
Konstrukt:Difficulties due to health problems
Ja
f) To maintain a friendship? [Eine Freundschaft aufrechtzuerhalten?]
Itemtext:f) To maintain a friendship? [Eine Freundschaft aufrechtzuerhalten?]
Empfehlungen:[See recommendations for total question 3]
Befund zum Item:Serbian
In the interview with test person SER01 there are no reportable anomalies in this question. The test person has no problems maintaining a friendship; disputes and small problems are part of it in her opinion.
Arabic
Test person AR01 spontaneously notes that she is unaware of the connection between health problems and the maintenance of friendships. The test person asks whether she should interpret the item in meaning that the difficulty in maintaining friendships leads to psychological problems. The intention of the item is not clear to the test person and she interprets the item - like item 3e - as to whether the difficulty in maintaining friendships (e.g. due to lack of time) leads to health problems.
Test person AR02, as in question 3e, does not refer to health problems either. She justifies the choice of the answer category "low" with the fact that she neither belongs to Sunnis nor to Shiites, but since she mostly has to do with Sunnis or Shiites, she notices that she does not harmonize well with them.
The interviewers also note that the time frame of 4 weeks for a friendship is somewhat short.
English
Test person ENG01 ticks the answer "strong" and justified this by saying that she currently has no friends in the refugee camp. The test person further states that she does not like to let other people - again due to her history - get close to her. Therefore it is difficult to build up or maintain friendships.
Thema der Frage:Gesundheit/ Beschwerden
Konstrukt:Difficulties due to health problems
Ja
g) In coping with your work/school routine? [Bei der Bewältigung Ihres Arbeits-/Schulalltags?]
Itemtext:g) In coping with your work/school routine? [Bei der Bewältigung Ihres Arbeits-/Schulalltags?]
Empfehlungen:[See recommendations for total question 3]
Befund zum Item:The main aim of this question was to examine how respondents deal with this question when they do not have a work/school routine and which difficulty they choose.
Serbian
Test person SER01 goes to work and chooses the answer "low": "I go home from work, at home I sleep, then back to work." (SER01).
Arabic
Test person AR01 also has both a work and a school routine. The test person works in the morning and attends evening classes 3 times a week. There are no problems with understanding the question.Test person AR02 chooses the answer category "low". Again in the question, she does not refer to health problems, but feels generally uncomfortable working in an office. The test person states that she prefers to work in the garden instead, as she is not familiar with office routine.
English
Test person ENG01 is the only person stating that she currently has no work. She chooses the answer category "strong" difficulties. The test person has completed a Bachelor’s degree in her home country, but has nothing to do in the refugee camp. Due to the existing psychological problems, she also does not manage to motivate herself to read something and to keep herself busy or to concentrate on something for a longer period of time. This frustrates her a lot and makes her unhappy, according to her own statement.
The interviewer also notes that in the English translation of the questionnaire the translation of "school routine is missing; the question only refers to "day-to-day work".
General Probing, Specific Probing, Emergent Probing.