[The contribution of health conferences and health regions to regional planning and management in health care: an overview at the federal states level]. / Der Beitrag von Gesundheitskonferenzen und Gesundheitsregionen zu regionaler Planung und Steuerung im Gesundheitswesen ­ ein Überblick auf Ebene der Bundesländer.

Demands for increased health care coordination and cooperation have been raised for a long time in Germany. Over the past years, the public health services in the federal states have initiated networks at the regional level dealing with health-related topics, namely health conferences and health regions. In the areas of health promotion and prevention, health care services and nursing care sector, these networks make an important contribution to regional planning and management by setting up networks among relevant municipal players and developing a more comprehensive approach. This narrative review, worked out in collaboration with experts from the German federal states, aims to present an overview of the characteristics, key topics and results of health conferences and health regions. Furthermore, we describe differences and similarities between the approaches in the federal states as well as the respective supporting measures in the context of funding programmes and the legal basis. The results show that health conferences and health regions are established in a great number of administrative districts in the federal states. There have been many health conferences and health regions since years and, according to the evaluations, show positive impacts on regional cooperation across departmental, sectoral and professional boundaries. They deal with a wide range of topics related to local needs and problems aiming to use synergies and meet challenges in the regional provision of healthcare and prevention measures. Besides building network capacities, the assessment of local needs and the development of strategies, health conferences and health regions also initiate numerous local cooperation projects to improve the health of the population. Against the background of expected future challenges that will have to be faced by the public health services, we finally discuss the significance of regional planning and management functions of the public health services. We also we provide some recommendations related to the conditions for setting up health conferences and health regions and discuss their future development.

Digitization in health-related self-help - Results of an online survey among self-help organizations in Germany.

Background: Nowadays, much hope and expectations are associated with digitization in the health sector. The digital change also affects health-related self-help. A nationwide survey of self-help organizations (SHOs) aimed to show chances and limitations in the use of interactive IT tools like webforums, online meetings or social media as well as digital infrastructures for their organizational management. In this survey, we also determined whether SHO staff themselves have support and qualification needs with regard to this topic. Design: The online survey was conducted between 14 November and 8 December 2019, i.e., immediately before the outbreak of the Covid-19 pandemic. The questionnaire consisted of 50 questions consisting of 180 single items which could be answered in 30-40 min. After two reminder letters, 119 questionnaires of the SHOs were gathered and analysed. Results: SHOs already have a lot of experience with digital media/tools (e.g., own homepage, social media, cloud computing). Some tools are attested a "high" or "very high" benefit by more than 80% of users. Perceived benefits, however, are also facing a number of problems, ranging from lack of resources to data protection issues. Despite, or even because of the limits of digitization, there is great desire and need for support and further training in SHOs (and self-help groups). Conclusions: At many points in the survey it was shown that digital media can be a useful extension of "traditional" collective self-help. Taking into account the risks and limitations associated with digital tools, SHOs can be central stakeholders in digitization in health-related self-help. Patient or Public Contribution: The study was financially supported by the Federal Ministry of Health, Germany. A detailed representation of the results is publicly available at: https://www.uke.de/dish.

[Patient and public involvement in health-related research: How is the selection of participants reported?] / Bürger- und Patientenbeteiligung in der gesundheitsbezogenen Forschung: Wie wird über die Auswahl von Teilnehmenden berichtet?

BACKGROUND AND OBJECTIVES: In recent years, the reporting on patient and public involvement (PPI) in health-related research has gained significantly in importance. However, little attention is being paid to the selection of target groups or participating citizens and patients. Individual contributions already point out that the selection is often described in a complex but ambiguous way; for example, individual groups are often not sufficiently differentiated from each other. The aim of our study is to provide an overview of the main topics, questions and challenges that are specific to the selection of participants in PPI by means of an explorative sample of different PPI documents (studies with PPI, studies on PPI, PPI guidelines, PPI websites, PPI journals). Based on this overview, we will make recommendations to help authors of studies and other relevant stakeholders in the planning, implementation and reporting of participant selection. METHODS: First, the explorative sample of the above-mentioned PPI documents was identified by conducting a systematic database and online search. A total of 46 documents were taken into account, including 11 studies with PPI, 12 studies on PPI, 12 guidelines, 6 websites and 5 journals. Relevant text passages were extracted from each of them and evaluated using deductively and inductively developed topic-specific categories. RESULTS: Overall, the selected PPI documents significantly vary a) in the use of terms, b) in the detailing of the individual aspects of participant selection, and c) in the description of the planning and implementation of participant selection. For the latter, there is usually a lack of systematic, comprehensive explanations, e. g., on how to weigh up a relevant number of participants, on objectives and methods in the selection process and on how to prepare participants. DISCUSSION: The various documents about and contributions to the topic of PPI should, in future, report more transparently and systematically on the selection of participants, especially to create practical added value for authors of studies. This includes, in particular, the description of the selection (studies with PPI), a complete overview of all relevant steps of the selection process (PPI guidelines), recommendations on how to deal with representativeness (studies on PPI), notes on reporting PPI (journals) as well as overviews of individual steps of the implementation process (PPI websites).

Quality of life and fear of disease progression are associated with aspects of health literacy in men with prostate cancer from Germany.

PURPOSE: Our research aimed to identify whether specific aspects of health literacy (HL) are associated with quality of life (QOL) and fear of progression (FOP) in men with prostate cancer (PC). METHODS: We conducted a cross-sectional study. Regarding HL, we surveyed communication skills, guideline awareness, and knowledge in several domains: PC, health care system, own physical condition, dealing with health problems. Research questions were addressed using regression models for QOL and FOP including sociodemographic and disease-related variables as additional predictors. RESULTS: One thousand five hundred seventy-seven men completed the questionnaire. Better QOL was statistically significant associated with communication skills (OR 2.24; CI 1.57-3.21), knowledge of dealing with health problems (OR 2.54; CI 1.74-3.72), and knowledge of own physical condition (OR 0.63; CI 0.42-0.95). FOP decreased with increasing communication skills (ß - 0.09; CI - 0.15 to - 0.04), knowledge of health care system (ß - 0.07; CI - 0.12 to - 0.02), and knowledge of dealing with health problems (ß - 0.21; CI - 0.27 to - 0.15). It increased with guideline awareness (ß 0.07; CI 0.02-0.11), PC knowledge (ß 0.11; CI 0.06-0.16), and knowledge about own physical condition (ß 0.11; CI 0.05-0.17). CONCLUSIONS: The findings lead to the hypothesis that some aspects of HL may have a positive and some a negative influence on men with PC. Men should not be overwhelmed by a recommendation for self-observation or by promotion of PC knowledge. Interventions are needed that provide knowledge for managing health problems. Communication in health care should be tailored to men's needs.

[Participation in self-help groups: impact on self-management and knowledge]. / Teilnahme an Selbsthilfegruppen: Wirkungen auf Selbstmanagement und Wissenserwerb.

BACKGROUND: Self-help groups (SHGs) are an inherent part of patient involvement and play an important role in the healthcare system. Until now, however, there has been a lack of systematic investigations and quantitative data about the individual impact of self-help for patients and relatives. OBJECTIVES: This study presents the results of a comparison between members of SHGs and non-members. Thereby, the effects of self-help shall be described in terms of empowerment and self-management. The study is part of the project "Health-related Collective Self-Help in Germany" (Gesundheitsbezogene Selbsthilfe in Deutschland-SHILD) funded by the Federal Ministry of Health. MATERIALS AND METHODS: The study was conducted with patients from five therapeutic areas (diabetes mellitus type 2, prostate cancer, multiple sclerosis, tinnitus, relatives of dementia patients). Participants administered a multidimensional questionnaire (paper-and-pencil or online). Of the 2870 participants in this analysis, 49% were active members of SHGs. RESULTS: Statistical analysis showed some significant, but small differences between the two groups in five out of seven scales of the Health Education Impact Questionnaire (heiQ) in favour of the SHG members. Furthermore, SHG members performed better in specific knowledge tests. Members see the importance of their group especially in social inclusion, psychosocial relief, coping with the disease and new insights in dealing with the disease. CONCLUSIONS: With respect to the study design we cannot rule out that differences might be based on personal characteristics influencing the decision to participate in a SHG or not. But as the results are controlled for confounders, the hypothesis that SHG participation has a positive impact on the outcomes rather than vice versa seems supported.

Participation in a prostate cancer support group and health literacy.

BACKGROUND: To cope with prostate cancer (PC) and its consequences and to be certain about therapeutic alternatives, some patients seek mutual help in prostate cancer support groups (PCSGs), where they share information and find social support. Our study was intended to assess whether group participation is associated with health literacy (HL). METHODS: We compared PCSG members (n = 441) with PC patients without support group experiences (n = 135) in a cross-sectional design. For this purpose, HL was operationalized through PC-specific knowledge, noncancer-specific knowledge about health care, guideline awareness, and skills needed to apply health information to meet own needs. Binary logistic regression models were calculated. Socio-demographic data and disease-related characteristics were used as control variables. RESULTS: Knowledge about PC (OR, 2.2; CI, 1.3-3.7), the fact of having heard of guidelines (OR, 3.7; CI, 2.1-6.8) and having read one (OR, 5.1; CI, 2.8-9.4), and competencies regarding health service navigation (OR, 1.8; CI, 1.0-3.1) are associated with PCSG membership. No statistically significant associations could be found between PCSG membership and further skills questioned, as well as between membership and knowledge about noncancer-specific health care. CONCLUSION: PCSG membership is associated with HL in some areas only. In particular, the groups seem to provide an important platform for information exchange in the field of PC. The potentially conflicting results on PC knowledge and the application skills may arise from the different forms of measurement-knowledge was tested; skills were self-assessed.

Long-Term Outcomes, Education, and Occupational Level in Cochlear Implant Recipients Who Were Implanted in Childhood.

OBJECTIVES: To document the long-term outcomes of auditory performance, educational status, vocational training, and occupational situation in users of cochlear implants (CIs) who were implanted in childhood. DESIGN: This retrospective cross-sectional study of 933 recipients of CIs examined auditory performance, education and vocational training, and occupational outcomes. All participants received their first CI during their childhood between 1986 and 2000. Speech comprehension results were categorized using the categories of auditory performance (CAP) arranged in order of increasing difficulty ranging from 0 to 8. 174 of the 933 pediatric recipients of CIs completed a self-assessment questionnaire regarding their education and occupational outcomes. To measure and compare school education, qualifications were converted into International Standard Classification of Education levels (ISCED-97). Occupations were converted into International Standard Classification of Occupation-88 skill levels. Data from the German General Social Survey (Allgemeine Bevölkerungsumfrage der Sozialwissenschaften/ALLBUS) for 2012 were used as a basis for comparing some of the collected data with the general population in Germany. RESULTS: The results showed that 86.8% of the 174 participants who completed the survey used their devices more than 11 hr per day. Only 2% of the surveyed individuals were nonusers. Median CAP was 4.00 (0 to 8). Age at implantation was significantly correlated with CAP level (r = -0.472; p < 0.001). The mean ISCED level of the 174 surveyed recipients was 2.24 (SD = 0.59; range: 1 to 3). A significant difference (p = 0.001) between users' ISCED levels and those of respondents was found. Participants' ISCED levels and maternal educational levels were significantly correlated (r = 0.271; p = 0.008). The International Standard Classification of Occupation-88 skill levels were as follows: 5% achieved skill level 1; 77% skill level 2; 16% skill level 3; and 5% skill level 4. The average skill level achieved was 2.24 (range 1 to 4; SD = 0.57) which was significantly poorer (t(127) = 4.886; p = 0.001) than the mean skill level of the respondents (mean = 2.54; SD = 0.85). CONCLUSIONS: Data collection up to 17.75 (SD = 3.08; range 13 to 28) years post implant demonstrated that the majority of participants who underwent implantation at an early age achieved discrimination of speech sounds without lipreading (CAP category 4.00). Educational, vocational, and occupational level achieved by this cohort were significantly poorer compared with the German and worldwide population average. Children implanted today who are younger at implantation, and with whom more advanced up-to-date CIs are used, are expected to exhibit better auditory performance and have enhanced educational and occupational opportunities. Compared with the circumstances immediately after World War II in the 20th century, children with hearing impairment who use these implants have improved prospects in this regard.