Racially discriminatory experiences among older chronically ill people of Turkish origin in Germany

Abstract Background Racism in health care is rarely clearly identified as such in Germany. Barriers to access are more often addressed, but people's experiences of discrimination rarely receive attention (Schellenberg & Tusch 2021, Kristiansen 2016). Internationally, racism is recognized as a determinant of health and there is a discourse that it must be addressed in order to achieve health equity (Weil 2022). This qualitative secondary data analysis focuses on racially discriminatory experiences among older chronically ill people of Turkish origin in the context of medical and drug care in Germany. Methods 11 expert interviews and 11 problem-centred interviews with chronically ill people of Turkish origin and their relatives in Germany were conducted in the MedikaMig-Project with regard to care practices, continuity of drug care and polypharmacy and analysed with structuring qualitative content analysis (Mayring 2015). Results The analysis yielded 7 superordinate categories and 27 subcategories, identifying racial discrimination in access to care, the treatment situation and communication, and in the consideration of transnational lifestyles. Patients are often helpless, sometimes trying to put their experiences into perspective or to be treated by Turkish doctors in order to avoid these discriminatory experiences. Conclusions Racial discrimination is pervasive in health care and should not be hidden behind other terms that mask discrimination. An intersectional approach allows us to understand which individuals are particularly affected and what they need to be protected from racism in health care. Key messages • Structural racism in health care needs to be clearly named and examined from an intersectional perspective in further research projects. • Elderly patients with Turkish origin need empowerment and contact persons after racist experiences to find ways to deal with discriminating experiences that are sometimes perceived as traumatic.


Background:
Racism in health care is rarely clearly identified as such in Germany. Barriers to access are more often addressed, but people's experiences of discrimination rarely receive attention (Schellenberg & Tusch 2021, Kristiansen 2016. Internationally, racism is recognized as a determinant of health and there is a discourse that it must be addressed in order to achieve health equity (Weil 2022). This qualitative secondary data analysis focuses on racially discriminatory experiences among older chronically ill people of Turkish origin in the context of medical and drug care in Germany. Methods: 11 expert interviews and 11 problem-centred interviews with chronically ill people of Turkish origin and their relatives in Germany were conducted in the MedikaMig-Project with regard to care practices, continuity of drug care and polypharmacy and analysed with structuring qualitative content analysis (Mayring 2015).

Results:
The analysis yielded 7 superordinate categories and 27 subcategories, identifying racial discrimination in access to care, the treatment situation and communication, and in the consideration of transnational lifestyles. Patients are often helpless, sometimes trying to put their experiences into perspective or to be treated by Turkish doctors in order to avoid these discriminatory experiences.

Conclusions:
Racial discrimination is pervasive in health care and should not be hidden behind other terms that mask discrimination. An intersectional approach allows us to understand which individuals are particularly affected and what they need to be protected from racism in health care. Key messages: Structural racism in health care needs to be clearly named and examined from an intersectional perspective in further research projects. Elderly patients with Turkish origin need empowerment and contact persons after racist experiences to find ways to deal with discriminating experiences that are sometimes perceived as traumatic.

Abstract citation ID: ckac129.731
Diversity competence: what should be prioritised in an online course? An adapted delphi study

Background:
Population diversity is a reality in our societies and requires health systems and health professionals to adapt to the needs of diverse patient groups, including migrants and ethnic minorities. This study aims to investigate topics and methods that should be prioritised in an online course on diversity competence in healthcare delivery to improve health care encounters and provide health services that meet the unique needs of all patients in order to reduce health disparities.

Methods:
The study uses an adapted Delphi method including two rounds, combining some open-ended questions with predefined items, asking 31 European academic experts and health professionals within the field of migrant health to rate training content and teaching methods. Consensus for training topics was set to 80% and for teaching methods 70%.

Results:
The only item reaching 100% consensus as being important or very important to include was 'health effects of migration (pre-, mid-and post-migration risk factors)'. Other highscoring items were 'social determinants of health' (97%) and 'discrimination within the healthcare sector' (also 97%). A general trend was to focus more on reflective practice since almost all items in the reflection section reached consensus. 'Reflection on own stereotypes and prejudices' reached the highest consensus in this section (97%).

Conclusions:
Experts' prioritisations of teaching content and methods for diversity training can help the design of short online trainings for health professionals and reduce extensive course content, thereby fostering professional development and enabling diversity competence trainings to be implemented in cases of scarce resources.
iii298 European Journal of Public Health, Volume 32 Supplement 3, 2022