RESPOND - Improving regional health system responses to the challenges of migration through tailored interventions for asylum-seekers and refugees (English Version)
Fragetext:On a scale from very easy to very difficult, how easy do you think it is… [Auf einer Skala von sehr einfach bis sehr schwierig, wie einfach ist es Ihrer Meinung nach…]
Befund zur Multi-Item-Skala:Questions 75 and 80 were systematically tested, while only spontaneous reactions - if any - from the test persons were available for the other questions.
Findings on the question as a whole:
Arabic
Test person AR01 states that the answer category "rather difficult" was translated in Arabic as "a little difficult" or "difficult in some way". The translator agrees that the answer categories should be checked again and translated slightly differently.
Farsi
Test person FAR01 does not understand the introduction. The wording: "On a scale from very easy to very difficult, please answer the following questions" would be more understandable for them. The way the introduction is written (...how easy do you think it is...), the subject assumes that she should only answer the easy questions.
Russian
In an interview with RUS02, the interpreter points out that the introduction is imprecisely translated, but does not explain why.
Empfehlungen zur Multi-Item-Skala:In general, it should be noted that in the context of a refugee interview, a distinction should be made between language barriers and technical barriers. Otherwise, no recommendation for action can be derived from the results (e.g. making greater use of interpreters or training doctors in didactics).
Question: We recommend to simplify the question linguistically:
How easy or difficult is it for you…? [Wie einfach oder schwer fällt es Ihnen …?]
Answer options: We recommend adding a "do not know" or "does not apply" category (especially for question 77).
Eingesetzte kognitive Technik/en:General Probing, Specific Probing.
Items
Itemtext
Item getestet
a) …to understand what your doctor is saying? […zu verstehen, was Ihr Arzt sagt?]
Itemtext:a) …to understand what your doctor is saying? […zu verstehen, was Ihr Arzt sagt?]
Empfehlungen:-
Befund zum Item:Arabic
In the interview with test person AR02, the interpreter asks whether the understanding in question 72 is related to the technical or to the linguistic, the test person referred to the linguistic understanding when answering.
Farsi
Test person FAR01 answered the question with "rather easy", explaining that she could talk to the dentist in English. Here, too, the focus is not on technical understanding but on linguistic understanding.
Thema der Frage:Gesundheit/ Krankheitswissen & -informationen
Konstrukt:Health competence
Ja
b) …to understand the instructions of your doctor or pharmacist regarding the use of the prescribed medication? […die Anweisungen Ihres Arztes oder Apothekers zur Einnahme der verschriebenen Medikamente zu verstehen?]
Nein
c) …to judge when you should get a second opinion from another doctor? […zu beurteilen, wann Sie eine zweite Meinung von einem anderen Arzt einholen sollten?]
Itemtext:c) …to judge when you should get a second opinion from another doctor? […zu beurteilen, wann Sie eine zweite Meinung von einem anderen Arzt einholen sollten?]
Empfehlungen:In this question, the term "second opinion" should be reworded or the pro-cedure explained, as this terminology has led to problems of understanding for almost all test persons.
Befund zum Item:Arabic
AR02 has problems with the term "second opinion". According to the interpreter it is not clear in the Arabic translation that the second opinion is about the same medical case again. This could be translated more precisely.
After the interviewer clarifies what is meant by this, the test person states that she always asks for a second opinion, as she no longer has confidence in individual doctors and will certainly consult another one. Since the test person always proceeds in this way, she states that it is easy to make this decision.
Farsi
Test persons FAR01, FAR02 and the interpreters agree that the question was poorly translated: "When do they have to get the second opinion?"
FAR01 misunderstands the question and thinks of a follow-up appointment with the same doctor and not a second opinion from another doctor.
On the other hand, FAR02 understands the question correctly, but states that she does not know anyone in Germany who could recommend another doctor to her, which is why she has never asked for a second opinion. Therefore the test person is uncertain what to tick. Without an interviewer she would have chosen "very difficult".
Russian
Test person RUS01 notes that question 17f and 18c are very similar: "same question" . Furthermore, the test person states that she does not know that it is her right to get a second opinion. The interpreter then explains that the understanding of the question depends on how long one has been living in Germany, as this behaviour is generally very unusual in Russia.
RUS02 also shows problems of understanding: "What does it mean to be able to get a second opinion?“ . It is also unclear what exactly is to be assessed in the question of when a second opinion should be obtained or how easy this should be. The interpreter confirms that the question was translated unluckily: "Estimating when you can get a second opinion from a doctor?”. Both test persons leave the question unanswered.
Thema der Frage:Gesundheit/ Krankheitswissen & -informationen
Konstrukt:Health competence
Ja
d) …to make decisions regarding your illness with the help of the information the doctor gives you? […mit Hilfe der Informationen, die Ihnen der Arzt gibt Entscheidungen bezüglich Ihrer Krankheit zu treffen?]
Itemtext:d) …to make decisions regarding your illness with the help of the information the doctor gives you? […mit Hilfe der Informationen, die Ihnen der Arzt gibt Entscheidungen bezüglich Ihrer Krankheit zu treffen?]
Empfehlungen:The difference to question 17d should be highlighted.
Befund zum Item:Serbian
Test person SER02 answers spontaneously: "It is not difficult to understand what the doctor is saying." However, the test subject seems to make no reference to their decision behavior regarding the disease.
Arabic
Test person AR01 has no difficulty in answering the question. She thinks about her meniscus surgery and found it difficult to decide whether she should have the surgery or not.
Test person AR02 has no confidence in doctors due to her experience with them. For example, when an orthopaedic surgeon prescribes her an insole, she feels that he is only testing but is not sure if it really helps.
Farsi
Test person FAR01 has no problem understanding the question, but no answer option is applicable to her, as she has never had a disease for which she should decide.
Test person FAR02 states that it is quite easy to make decisions when the doctor gives information about the disease.
Russian
Test person RUS01 claims to be able to make decisions fairly quickly based on information obtained from doctors.
Test person RUS02 answers accordingly: "It is easy to accept the information you get from the doctor, if I say it is too complicated, the disease does not go away" .
Both test persons find the answer to the question rather easy.
English
Test person ENG01 states that she usually receives good advice from doctors to help her deal with her illness and symptoms.
Thema der Frage:Gesundheit/ Krankheitswissen & -informationen
Konstrukt:Health competence
Ja
e) …to follow the instructions of your doctor or pharmacist? [...den Anweisungen Ihres Arztes oder Apothekers zu folgen?]
Nein
f) …to find information about support possibilities for psychological problems such as stress or depression? […Informationen über Unterstützungsmöglichkeiten bei psychischen Problemen, wie Stress oder Depression, zu finden?]
Itemtext:f) …to find information about support possibilities for psychological problems such as stress or depression? […Informationen über Unterstützungsmöglichkeiten bei psychischen Problemen, wie Stress oder Depression, zu finden?]
Empfehlungen:-
Befund zum Item:Arabic
Test person AR01 claims not to be able to answer the question because she has never had psychological problems.
Farsi
Just like test person AR01, test person FAR01 does not check anything here, as she never had such problems.
Russian
According to test person RUS01, the answer options do not match the question. If you have no experience with this, there should be a "don't know" or "don't fit" category. When asked by the interviewer whether the question could not be answered purely theoretically, the interpreter answers: "That is too theoretical, nobody knows" .
Also test person RUS02 does not know why this question is not answered. As with the other test persons, this one also has no experience with stress and depression, so no answer option applies.
Thema der Frage:Gesundheit/ Krankheitswissen & -informationen
Konstrukt:Health competence
Ja
g) …to understand health warnings about behaviour such as smoking, little exercise or excessive drinking? […Gesundheitswarnungen vor Verhaltensweisen, wie Rauchen, wenig Bewegung oder übermäßiges Trinken zu verstehen?]
Itemtext:g) …to understand health warnings about behaviour such as smoking, little exercise or excessive drinking? […Gesundheitswarnungen vor Verhaltensweisen, wie Rauchen, wenig Bewegung oder übermäßiges Trinken zu verstehen?]
Empfehlungen:This question leaves it open whether it is about German media or media in general, i.e. whether it is about language difficulties or media competence. We would therefore recommend deleting this question in this context.
Befund zum Item:Serbian
Test person SER01 claims not to know what to tick, as she smokes but does not drink. She does not seem to relate the question to the understanding of health warnings about harmful behaviour but thinks of herself personally and thus misunderstands the question.
Thema der Frage:Gesundheit/ Krankheitswissen & -informationen
Konstrukt:Health competence
Ja
h) …to understand why you need screening? […zu verstehen, warum Sie Vorsorgeuntersuchungen brauchen?]
Nein
i) …to assess whether the information on health risks in the media is trustworthy? […zu beurteilen, ob die Informationen über Gesundheitsrisiken in den Medien vertrauenswürdig sind?]
Itemtext:i) …to assess whether the information on health risks in the media is trustworthy? […zu beurteilen, ob die Informationen über Gesundheitsrisiken in den Medien vertrauenswürdig sind?]
Empfehlungen:-
Befund zum Item:Serbian
The test person SER02 states that he does not understand the question and does not know what to tick. When asked, he chooses the answer option "rather easy".
Arabic
Test person AR01 has no comprehension problems with this question. She says she has general trust in the media, but not blind trust. One always hears study results from time to time and shortly afterwards contradictory study results are reported. For example, study 1 says that a child should only eat one ice cream a week and shortly after study 2 is published saying it is ok for children to eat one ice cream a day. Some say you shouldn't eat fat, others say it is ok...etc.
Test person AR02 answers with "rather difficult" and states that she has language difficulties. Here it is unclear whether the question is meant professionally or linguistically, the test person refers to the linguistic component.
Farsi
Test person FAR01 emphasizes the media and the information they provide are easy to understand. The interpreter points out that the test person misunderstands the question: the test person’s understanding refers to her understanding of the media and not to her trust in them.
The interpreter in the interview with test person FAR02 notes that "health risks" in Farsi was translated as "hygiene risks". In addition, the test person explains that she automatically links media to advertising and thinks that something should be sold. Therefore, she generally feels that the media is not trustworthy.
Russian
The test persons RUS01 and RUS02 choose the answer option "rather difficult" and justify this by the fact that contradictory information is disseminated in the media (RUS01) or that journalists are not medical professionals and it would therefore be reckless to trust this information (RUS02).
English
Test person ENG01 finds it difficult to trust information from the media, as she cannot ask questions (like with a doctor) and does not know who put the information in the media or who was responsible for writing it. She had read that some of her medications are addictive, but her doctor could not confirm this.
Thema der Frage:Gesundheit/ Krankheitswissen & -informationen
General Probing, Specific Probing.