RESPOND - Improving regional health system responses to the challenges of migration through tailored interventions for asylum-seekers and refugees (English Version)
Fragetext:We would like to know more about your experience with health care in Germany. Please remember your last visit to a doctor or other medical provider. Please rate at this last visit... [Wir möchten gerne mehr über Ihre Erfahrung mit der Gesundheitsversorgung in Deutschland wissen. Bitte denken Sie an Ihren letzten Besuch bei einem Arzt oder einem anderen medizinischen Versorger. Bitte bewerten Sie bei diesem letzten Besuch…]
Befund zur Multi-Item-Skala:Questions 17d and 17f were systematically tested, while only spontaneous reactions - if any - of the test persons are available for the other questions.
Findings on the question as a whole:
Serbian
Test person SER01 points out that she actually cannot answer the entire battery of questions, as she has not visited a doctor in Germany so far. Especially questions 17d, 17e and 17f therefore remain unanswered.
Russian
Test person RUS02 and the interpreter in this interview point out that the first sentence of the introduction in the Russian questionnaire was translated incorrectly: "[...] your experience in health care cooperation...".
Empfehlungen zur Multi-Item-Skala:Introduction: Before this battery of questionnaires, it should first be asked when the last visit to a primary care physician, specialist or other medical care provider took place. If no visit in Germany has taken place so far, respondents are asked to skip this question:
When was the last visit to a primary care physician, specialist or other medical provider, such as XXX? [Wann erfolgte der letzte Besuch bei einem Hausarzt, Facharzt oder einem anderen medizinischen Versorger, wie z.B. XXX?]
Month / Year [Monat / Jahr]
No visit in Germany [Kein Besuch in Deutschland] -> continue with question X [-> weiter mit Frage X]
The translation of the introduction in the Russian questionnaire should be reconsidered.
Answer options: An additional answer category "Can't judge" should be included, in case certain things that are asked in the questionnaire battery are not relevant for respondents. For example, if there is only one doctor on duty or speaking the language, the attending doctor cannot be selected at that moment.
Eingesetzte kognitive Technik/en:General Probing, Specific Probing
Items
Itemtext
Item getestet
a) …the waiting time for your turn? [die Wartezeit, bis Sie an der Reihe waren?]
Itemtext:a) …the waiting time for your turn? [die Wartezeit, bis Sie an der Reihe waren?]
Empfehlungen:Due to the spontaneous remark in the interview, we recommend a slight rewording: ... the waiting time in the doctor’s office until it was your turn? [… die Wartezeit in der Praxis, bis Sie an der Reihe waren?]
Befund zum Item:Arabic
AR01 asks spontaneously whether this refers to the waiting time until you get an appointment with the doctor or whether it refers to the waiting time in the waiting room.
Thema der Frage:Gesundheit/ Arztbesuche & Behandlungen
Konstrukt:Health system responsiveness (a) Prompt attention, b) Dignity, c) Communication, d) Autonomy, e) Confidentiality, f) Choice)
Ja
b) …your experiences in how far you were received respectfully and spoken to respectfully? [… Ihre Erfahrungen, inwiefern Sie respektvoll empfangen und mit Ihnen respektvoll gesprochen wurde?]
Nein
c) …your experiences in how far were things explained to you in an understandable way by the doctors / staff? […Ihre Erfahrungen, inwiefern Ihnen von den Ärzten / dem Personal Dinge verständlich erklärt wurden?]
Itemtext:c) …your experiences in how far were things explained to you in an understandable way by the doctors / staff? […Ihre Erfahrungen, inwiefern Ihnen von den Ärzten / dem Personal Dinge verständlich erklärt wurden?]
Empfehlungen:In question 17c it is not clear whether this is a question of explaining the medical facts or of difficulties in understanding due to (lack of) language skills.
Befund zum Item:-
Thema der Frage:Gesundheit/ Arztbesuche & Behandlungen
Konstrukt:Health system responsiveness (a) Prompt attention, b) Dignity, c) Communication, d) Autonomy, e) Confidentiality, f) Choice)
Ja
d) …your experiences in how far you were involved in decisions concerning your treatment? [… Ihre Erfahrungen, inwiefern Sie in Entscheidungen, die Ihre Behandlung betrafen, miteinbezogen wurden?]
Itemtext:d) …your experiences in how far you were involved in decisions concerning your treatment? [… Ihre Erfahrungen, inwiefern Sie in Entscheidungen, die Ihre Behandlung betrafen, miteinbezogen wurden?]
Empfehlungen:In question 17d, two respondents (in Farsi and Russian) have substantive difficulties with the question, as it is not clear to them to what extent they should be "involved" as patients. Both persons leave the question unanswered. We recommend rephrasing this question as follows: To what extent were you able to participate in deciding on your treatment? [Inwieweit Sie über Ihre Behandlung mitentscheiden konnten?]
Befund zum Item:Serbian
Test person SER02 has no difficulty in answering the question. She describes the overall impression of her last visit to the doctor, which she remembers as very positive: "Nurse and doctor were nice and very good, explained everything well. It was a good examination, I was very satisfied." (SER02). It is unclear to what extent this overall impression also includes the focus of the item (involvement in decisions concerning treatment).
Arabic
Test person AR01 states that the attending physician explained the MRI images to her at her knee surgery and pointed out both the consequences of the procedure and alternatives to surgery. The test person finds the answer to this question very easy.
Test person AR02 explains that she has already seen seven orthopaedic surgeons because of her complaints and nobody knows exactly how her condition can be improved. The doctors had given her very few opportunities to have a say in the treatment.
Farsi
Test person FAR01 does not understand the intention or reason for the question. She states that she is the patient after all and does not know what to do from a medical point of view. That is why she goes to the doctor. The test person therefore leaves the question unanswered.
Test person FAR02 describes an experience at the dentist who had told her that a tooth had to be extracted. Since the test person did not want that, the dentist suggested a root canal treatment as an alternative, even though the tooth might have to be extracted later. At the test person's request, he also carried out the root canal treatment.
Russian
Test person RUS01 states that the treatment was "decided over [her] head" and she was not really involved in any decisions.
Test person RUS02 does not understand the intention of the question and therefore leaves the question unanswered: "What is meant by 'involved'? Whether one was asked or had to tell? It's not clear what is meant." (RUS02).
English
Test person ENG01 states that the treating physicians included her in the treatment and presented different possibilities of the therapy.
Thema der Frage:Gesundheit/ Arztbesuche & Behandlungen
Konstrukt:Health system responsiveness (a) Prompt attention, b) Dignity, c) Communication, d) Autonomy, e) Confidentiality, f) Choice)
Ja
e) ...your experience in how far was it ensured that you could speak confidentially with the person treating you? [… Ihre Erfahrungen, inwieweit dort sichergestellt wurde, dass Sie mit der Sie behandelnden Person vertraulich sprechen konnten?]
Nein
f) …your possibilities to choose the person treating you yourself? […Ihre Möglichkeiten, sich die Sie behandelnde Person selbst aussuchen zu können?]
Itemtext:f) …your possibilities to choose the person treating you yourself? […Ihre Möglichkeiten, sich die Sie behandelnde Person selbst aussuchen zu können?]
Empfehlungen:According to the two interviews, which were conducted in Russian, the principle of free choice of doctor is not known in Russia, so the interpreter first had to explain the intention of the question in more detail.
Irrespective of whether this is the case or whether respondents are only unaware that they are free to choose their doctor in Germany, the question arises if this option is appropriate for the context of a particular visit to be evaluated.
Befund zum Item:Serbian
Test person SER02 says that she would love it if her current doctor also became her primary care physician and she didn't have to change to another doctor due to relocation or other imponderables. The concept of free choice of doctor is understood by the test person.
Arabic
AR01 has no difficulty with the question. The test person claims to have been referred to a specialist by the primary care physician. She would have liked to have chosen another doctor but had to choose one because of the long waiting times with other doctors.
In answering the question, test person AR02 considered whether, for example in a joint practice, she could choose the treating orthopedist herself.
Farsi
Test person FAR01 finds the answer to the question "very easy" and states that she has chosen her current primary care physician herself and is satisfied with him.
Since test person FAR02 does not speak German and lives in a small village, she goes to a doctor to whom everyone there goes. The doctor in turn refers her to a specialist if one is needed. She herself does not feel that she has any say in the choice of doctors.
Russian
When answering the question, test person RUS01 thinks about whether it is possible to choose a specialist when referring a patient from a primary care physician to a specialist. In her experience, this possibility does not exist in Russia: "The doctor has to decide that, it does not exist in Russia" (RUS01). The test person would therefore not even think of asking for a doctor in Germany. The test person finds the answer to this question rather difficult, since the concept of free choice of doctor is unclear or unknown to him.
Test person RUS02 claims to have been treated by a Russian-speaking doctor during her hospital visit. There would have been no need (and probably not the possibility) to choose the doctor himself. Here it remains unclear whether the concept of free choice of doctor was understood.
English
Test person ENG01 has no difficulty in answering the question and understands the concept of free choice of doctor, which is the focus of this question.
Thema der Frage:Gesundheit/ Arztbesuche & Behandlungen
Konstrukt:Health system responsiveness (a) Prompt attention, b) Dignity, c) Communication, d) Autonomy, e) Confidentiality, f) Choice)