Cross-cultural care – personal or professional?

The range of services and information focusing on home-based and outpatient care is quite large. Yet oftentimes these services are not sufficiently targeted towards the sociocultural needs and expectations of people with an immigrant background. Now, the "OPEN – Interkulturelle Öffnung in der Pflegeberatung" (English: OPEN- Cross-Cultural Openness in Health Care Counseling) project that’s sponsored by the German Federal Ministry of Education and Research wants to change this.


Photo: Project team OPEN

Sabrina Khamo Vazirabad (second person from the right) with the whole research team of the three involved universities; © Projekt OPEN

Until September of 2017, the joint research project of the RheinMain Wiesbaden/Rüsselsheim University of Applied Sciences under project leader Professor May, the Frankfurt University of Applied Sciences under the direction of Professor Schulze and the Catholic University of Applied Sciences in Mainz led by Professor Löcherbach and Professor Hermsen, are working on identifying information pertaining to health care and individual care counseling based on culture-specific aspects and aimed at the needs of older persons with an immigrant background.

The findings are meant to lower the inhibition threshold to increasingly make use of health and long-term care insurance services, to tailor consulting services in care support sites even more toward the needs of persons with an immigrant background and to better connect local organizations. What’s more, the processes and methods of consulting and interface management tested during the project are meant to be introduced into a wide range of standard services. The task of the Frankfurt team led by Andre Terjung and Sabrina Khamo Vazirabad and directed by Professor Schulze is to transfer the results into qualification modules for care consultants.

Communicating with the target audience

The initial phase of the project which began in October of 2014 has since been completed. "Together with the target group, we questioned - among other things - in nine future workshops where barriers are being created and why care counseling is not being comprehensively utilized," explains Sabrina Khamo Vazirabad, one of the project’s scientific assistants. An actual impact on the care situation due to the immigrant background was not explicitly detectable during the data analysis. However, so far two predominant behavioral patterns could be detected.

"The first pattern falls under a personal-emotional-holistic frame of reference," Khamo Vazirabad continues. "One person with immigrant background described the importance of being cared for by family members as 'food for the soul', and is thus among the representatives for this type." Even when they are in need of care, those people prefer to be on their own and in their familiar surroundings. Information and communication primarily take place through family, friends and the neighborhood. That’s why it goes without saying for parents that the children they raised will also take care of them when they are old. They also prefer to visit their family doctor versus a specialist.

This is opposed by the "professional, matter-of-fact" behavioral pattern. This pattern is characterized by an increased trust in skilled experts and institutions. People that could be classified into this category would readily move into a nursing home for example or accept similar services. "Both patterns obviously only characterize potential opposites. There still can be a larger scope between them," explains Khamo Vazirabad. "Although we were so far not able to quantify this, the first behavioral pattern appears to be more distinct."
Photo: Asian woman smiling at her husband

For many people it is natural to care for their family members when they are old - no matter with or without an immigrant background; © Witthaya Phonsawat

Cultural diversity

The project team already approached people who come from very different cultural groups. Among others, they were of Turkish, Persian, Moroccan, Spanish or even Russian origins. However, Khamo Vazirabad points out that you cannot and should not make generalizations. "Many cultural influences shape the care situation. The respective migration history and understanding of health for example also play an important role and influence the attitude towards care in a very individual manner."

During the initial phase of the project, many people with immigrant background also criticized that compared with many other countries and cultural groups, Germany is said to have a different understanding of health and disease, also as it pertains to a diagnosis. In Germany, the focus is said to usually be on potential organ defects. The focus is less on the overall condition of the body.

Making care more accessible

The focus of the remaining project phases will now be to improve the quality of consulting services by discussing the results of the conducted consultations, and by trying out actual tools together with the associates of the cooperating care support sites. Another emphasis will be on improving networking between existing organizations within the region as well as within the community.

To do this, the team is going to develop portals and use and test them in the regions. They will locate existing groups, such as women’s organizations for example. These can subsequently continue to educate the target group. The use of cross-cultural honorary teams is also conceivable. "If we are able to integrate them into the community, they could assist in potentially lowering existing inhibition thresholds," explains Khamo Vazirabad. "Overall access would be easier and more effective with a more personal and emotional approach."

Distributing flyers at popular spots in the community such as pharmacies, hair salons, or grocery stores, for instance, is also being contemplated. Aside from educating the target group, it is equally important to sensitize pharmacies, physicians and community services about the subject. After all, the target group specifically criticized the lack of information on available services. Oftentimes, but not exclusively, language barriers are the reason for this. "We hope it will be possible in the long-term to find ways to create and continuously build trust in institutions in persons with an immigrant background," says Khamo Vazirabad. "Ultimately, many services are not only able to offer actual assistance for persons in need of care but also for the family caregivers."

More about the project OPEN (only in German) at:
Photo: Nadine Lormis; Copyright: B. Frommann

© B. Frommann

Nadine Lormis
(Translated by Elena O'Meara.)