@misc{IashchenkoSchuettigBammertetal., author = {Iashchenko, Iryna and Sch{\"u}ttig, Wiebke and Bammert, Philip and Schneider, Udo and Spallek, Jacob and Rattay, Petra and Schneider, Sven and Moor, Irene and Pischke, Claudia and Sundmacher, Leonie}, title = {Can invitation systems increase participation in preventive health screening among adolescents? : an evaluation of a state-wide intervention in Germany using a difference-in-differences analysis of claims data}, series = {European Journal of Public Health}, volume = {35}, journal = {European Journal of Public Health}, number = {2}, publisher = {Oxford University Press}, address = {Oxford}, issn = {1464-360X}, doi = {10.1093/eurpub/ckaf026}, pages = {312 -- 318}, abstract = {In Germany, routine screenings are used to monitor the health and development of children and adolescents, enabling timely discovery and treatment of health issues. One such screening, called J1, is recommended for adolescents aged 12-14 years, but participation is only 43\%. In the state of Bavaria, a lack of awareness is the main reason cited for not attending. 'Your Ticket to J1' was an invitation system implemented across the state to inform adolescents about the screening. Our study investigated whether this intervention increased J1 participation and if its effects varied by family socioeconomic position (SEP). We used pseudonymized data from a large statutory health insurer from 2016 to 2018 and containing 267 650 observations. To investigate the effect of the intervention, we employed a difference-in-differences analysis at the individual level. Assuming parallel trends at the state level, we compared J1 participation rates between Bavaria and other German states before and after the intervention. We additionally stratified analyses by SEP. The intervention led to an increase in J1 participation by about 1\%. In the stratified regressions, the effect size was larger for children from families with a lower SEP. J1 participation increased by about 4\% among adolescents whose primary insured parent had the lowest occupational status. A state-wide invitation system had a small but statistically significant positive impact on J1 participation and might reduce socioeconomic inequities in healthcare utilization. Informing adolescents about J1 appears to increase participation, particularly among those from families with a lower SEP.}, language = {en} } @incollection{RazumButlerSpallek, author = {Razum, Oliver and Butler, Jeffrey and Spallek, Jacob}, title = {Gesundheitliche Chancen und Risiken von Migrant*innen: Handlungsm{\"o}glichkeiten einer kommunalen Gesundheitspolitik.}, series = {Handbuch Lokale Integrationspolitik.}, booktitle = {Handbuch Lokale Integrationspolitik.}, editor = {Gesemann, Frank and Filsinger, Dieter and M{\"u}nch, Sybille}, edition = {2. Auflage}, publisher = {Springer VS}, address = {Wiesbaden}, isbn = {978-3-658-43195-2}, doi = {10.1007/978-3-658-43195-2_34-1}, pages = {1 -- 23}, abstract = {Migrant*innen haben gesundheitliche Vor- und Nachteile gegen{\"u}ber der nicht-migrierten Bev{\"o}lkerung. Der Zusammenhang zwischen Migration und Gesundheit ist mehrdimensional, weitere - insbesondere soziale - Faktoren m{\"u}ssen bei der Interpretation beachtet werden. Erkl{\"a}rungsmodelle bilden die Komplexit{\"a}t des Zusammenhangs ab. Die zentralen Modelle haben eine Perspektive auf den gesamten Lebenslauf von migrierten Menschen (vor, w{\"a}hrend und nach der Migration). Sie helfen der kommunalen Gesundheitspolitik, geeignete Daten zu erheben und wirksame Interventionen zu entwickeln.}, language = {de} } @misc{HoffmannMichalskiDraganoetal., author = {Hoffmann, Stephanie and Michalski, Niels and Dragano, Nico and Spallek, Jacob}, title = {Does individual-level socio-economic position modify the association between area-level deprivation and early childhood language development? : a multilevel analysis of cross-sectional population data from Germany}, series = {European journal of public health}, journal = {European journal of public health}, publisher = {Oxford University Press}, address = {Oxford}, doi = {10.1093/eurpub/ckaf082}, pages = {1 -- 6}, abstract = {Early childhood is a public health priority for enhancing health equity across the life course. Children are susceptible to individual-level socio-economic position (SEP) and the socio-economic deprivation of their place of residence, both of which contribute to differences in psychomotor development, including language. This study investigates whether individual-level SEP modifies the association between area-level deprivation and language development. This study used population-based, cross-sectional data from a School Entry Survey in Germany (2021; female: n = 9751, male: n = 10 623; age in years: ≤6 n = 11 423; 6-≤7 n = 8 746; >7 n = 205; native language: German n = 18 752; not German n = 943; bilingual n = 679), which was linked to the 'German Index of Socioeconomic Deprivation' (GISD). Binary multilevel models [odds ratio (OR), 95\% CI] were used to analyse the interaction of GISD (measured continuously) with individual-level SEP (categorized as high/medium/low) according to delayed language development (DLD in \% yes/no), which was assessed using validated instruments of 'social-pediatric screening of developmental status for school entry'. Individual SEP was tested as a moderator by stratifying the analyses. The interaction of GISD with SEP was associated with DLD (ORmediumSEP*GISD = 1.13; 1.04-1.24; ORlowSEP*GISD = 1.27; 1.13-1.43), with the main effect of GISD (OR = 0.85; 0.77-0.93). In SEP stratification, GISD was only partially associated with DLD (ORhighSEP = 0.81; 0.73-0.91; ORmediumSEP = 0.97; 0.89-1.07; ORlowSEP = 1.14; 0.99-1.32). This study demonstrates an association between area-level deprivation and DLD that is modified by individual-level SEP. The findings underscore the importance of stratification by individual-level SEP in analysing area-level effects on health, as the area-level effects can be contradictory according to individual-level SEP.}, language = {en} } @misc{HoffmannTschornSpallek, author = {Hoffmann, Stephanie and Tschorn, Mira and Spallek, Jacob}, title = {Social inequalities in early childhood language development during the COVID-19 pandemic : a descriptive study with data from three consecutive school entry surveys in Germany}, series = {International Journal for Equity in Health}, volume = {23}, journal = {International Journal for Equity in Health}, number = {2}, publisher = {BioMed Central}, address = {London}, issn = {1475-9276}, doi = {10.1186/s12939-023-02079-y}, pages = {1 -- 13}, abstract = {Background Social health inequalities are still of great public health importance in modern societies. The COVID-19 pandemic may have affected social inequalities in people's health due to containment measures. As these measures particularly affected children, they might have been particularly vulnerable to increased social inequalities. The aim of the study was to describe health inequalities during the pandemic based on language delay (LD) in children in order to inform public health interventions for a population at risk of long-term health and education inequalities. Methods Data of 5-7 year old children from three consecutive school entry surveys in the German federal state of Brandenburg were used, including data compulsorily collected before the pandemic (2018/2019: n = 19,299), at the beginning of the pandemic (2019/2020: n = 19,916) and during the pandemic (2020/2021: n = 19,698). Bivariate and multivariate binary regression analyses [OR, 95\% CI] cross-sectionally examined the relationship between the prevalence of LD [yes/no] and social inequalities, operationalized by family socioeconomic position [SEP low/middle/high], migration background [native-German language/non-native German language] and length of kindergarten attendance [< 4 years/ ≥ 4 years]. Factors contributing to inequality in LD were examined by socioeconomic stratification. Results Cross-sectionally, LD prevalence has decreased overall (2018/2019: 21.1\%, 2019/2020: 19.2\%, 2020/2021: 18.8\%), and among children from both high SEP and native German-speaking families. As LD prevalence increased among children from families with low SEP and remained stable among non-native German speakers, social inequalities in LD prevalence increased slightly during the pandemic i) by low SEP (2018/2019: OR = 4.41, 3.93-4.94; 2020/2021: OR = 5.12, 4.54-5.77) and ii) by non-German native language (2018/2019: OR = 2.22, 1.86-2.66; 2020/2021: OR = 2.54, 2.19-2.95). During the pandemic, both migration background and kindergarten attendance determined LD prevalence in the high and middle SEP strata. However, the measured factors did not contribute to LD prevalence in children from families with low SEP. Conclusion Social inequalities in LD increased due to opposing trends in prevalence comparing low and high SEP families. To promote health equity across the life course, early childhood should be of interest for tailored public health actions (e.g. through targeted interventions for kindergarten groups). Further analytical studies should investigate determinants (e.g., parental investment).}, language = {en} } @misc{MaassDockweilerHockeBolteetal., author = {Maaß, Laura and Dockweiler, Christoph and Hocke-Bolte, Zora and Hoffmann, Stephanie and Fischer, Florian and Forberger, Sarah and Gebert, Janika and Holl, Felix and Hrynyschyn, Robert and Kernebeck, Sven and Pischke, Claudia R. and Posselt, Jacqueline and Spallek, Jacob}, title = {Digital Public Health in Deutschland : Status quo, Herausforderungen und Zukunftsperspektiven}, series = {Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz}, volume = {68}, journal = {Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz}, publisher = {Springer}, address = {Berlin ; Heidelberg}, doi = {10.1007/s00103-024-03989-0}, pages = {176 -- 184}, abstract = {Dieses Positionspapier des Fachbereichs Digital Public Health der Deutschen Gesellschaft f{\"u}r Public Health e. V. definiert Digital Public Health (DiPH) und beschreibt deren Ziele sowie Potenziale. Ferner geht es auf die derzeitige Situation und Herausforderungen sowie Handlungsbedarfe in Deutschland ein. Der Schwerpunkt liegt hierbei auf der Darstellung der fl{\"a}chendeckenden F{\"o}rderung der (digitalen) Gesundheitskompetenz, der Anwendung von DiPH in der Pr{\"a}vention, Gesundheitsf{\"o}rderung und Versorgung, dem Einsatz innovativer, pr{\"a}ventiver Strategien zur Vorbeugung nicht{\"u}bertragbarer Krankheiten und der Lehre von DiPH innerhalb von Public-Health-Studieng{\"a}ngen. Zudem werden notwendige Maßnahmen und Forderungen zur St{\"a}rkung von DiPH in Deutschland res{\"u}miert.}, language = {de} } @misc{SchefflerSchoelerSchimboecketal., author = {Scheffler, Bettina and Sch{\"o}ler, Almut and Schimb{\"o}ck, Florian and R{\"o}sner, Katrin and Spallek, Jacob and Kopkow, Christian}, title = {Leitlinienkonforme Physiotherapie in der Rehabilitation nach Schlaganfall. Ergebnisse einer deutschlandweiten Online-Umfrage}, series = {19. Deutscher Kongress f{\"u}r Versorgungsforschung, Deutsches Netzwerk Versorgungsforschung e.V., 30.09.-01.10.2020, digital}, journal = {19. Deutscher Kongress f{\"u}r Versorgungsforschung, Deutsches Netzwerk Versorgungsforschung e.V., 30.09.-01.10.2020, digital}, doi = {10.3205/20dkvf406}, language = {de} } @misc{SchefflerSchoelerRoesneretal., author = {Scheffler, Bettina and Sch{\"o}ler, Almut and R{\"o}sner, Katrin and Schimb{\"o}ck, Florian and Spallek, Jacob and Kopkow, Christian}, title = {Evaluation and tailored implementation of guideline compliant physiotherapy in stroke rehabilitation in Germany - protocol of a mixed methods study}, series = {WFNR \& SOFMER 2020 - Abstracts of congress}, volume = {35}, journal = {WFNR \& SOFMER 2020 - Abstracts of congress}, number = {4}, issn = {1545-9683}, doi = {10.1177/1545968320988381}, language = {en} } @misc{SchefflerSchimboeckSchoeleretal., author = {Scheffler, Bettina and Schimb{\"o}ck, Florian and Sch{\"o}ler, Almut and R{\"o}sner, Katrin and Spallek, Jacob and Kopkow, Christian}, title = {Tailored GuideLine Implementation in STrokE Rehabilitation (GLISTER) in Germany. Protocol of a Mixed Methods Study Using the Behavior Change Wheel and the Theoretical Domains Framework}, series = {Frontiers in Neurology}, volume = {13}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2022.828521}, pages = {1 -- 10}, abstract = {Objective: Evidence-based guidelines are important for informing clinical decision-making and improving patient outcomes. There is inconsistent usage of guidelines among physical therapists involved in stroke rehabilitation, suggesting the existence of a gap between theory and practice. Addressing the German guideline "evidence-based rehabilitation of mobility after stroke (ReMoS)," the aims of this project are (1) to describe the current physical therapy practice within the context of stroke rehabilitation in Germany, (2) to evaluate barriers and facilitators of guideline usage, (3) to develop, and (4) to pilot test a theory-based, tailored implementation intervention for the benefit of guideline recommendations. Materials and Methods: This study uses a stepwise mixed methods approach for implementing a local guideline. A self-reported online questionnaire will be used to survey the current physical therapy practice in stroke rehabilitation. The same survey and systematic-mixed methods review will be used to evaluate the barriers and facilitators of guideline usage quantitatively. Semi-structured interviews will add a qualitative perspective on factors that influence ReMoS guideline implementation. The Behavior Change Wheel and Theoretical Domains Framework will be used to support the development of a tailored implementation intervention which will be pilot tested in a controlled study. Patient and physical therapy-related outcomes, as well as the appropriateness, such as acceptance and feasibility of the tailored implementation intervention, will be analyzed. Conclusion: This will be the first endeavor to implement a guideline in German stroke rehabilitation with a focus on changing care provider behavior based on the knowledge of current practice and determining factors using a tailored and theory-based intervention.}, language = {en} } @misc{SchefflerSchimboeckSchoeleretal., author = {Scheffler, Bettina and Schimb{\"o}ck, Florian and Sch{\"o}ler, Almut and R{\"o}sner, Katrin and Spallek, Jacob and Kopkow, Christian}, title = {Current physical therapy practice and implementation factors regarding the evidence-based 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline in Germany: a cross-sectional online survey}, series = {BMC neurology}, volume = {22}, journal = {BMC neurology}, issn = {1471-2377}, doi = {10.1186/s12883-022-02780-5}, pages = {1 -- 13}, abstract = {Background Evaluation of the current physical therapy practice for German stroke rehabilitation with respect to the 'Rehabilitation of Mobility after Stroke (ReMoS)' guideline recommendations and the associated implementation factors. Methods A descriptive cross-sectional study employing an online survey was performed among German physical therapists in 2019. The survey consisted of three sections with open and closed questions: 1) self-reported use of ReMoS recommendations, 2) barriers of guideline use and 3) socio-demographic characteristics. The benchmark level for guideline adherent physical therapy was set at > 80\%. Results Data from 170 questionnaires were eligible for analysis. Participants' mean age was 41.6 years, 69.4\% were female, while 60.1\% had no academic degree. The ReMoS guideline was unknown to 52.9\% of the responders. Out of all the 46 ReMoS guideline recommendations, only 'intensive walking training without a treadmill' was reported to be performed in a guideline adherent manner. Respondents usually denied any personal limitations, such as limited knowledge, or that the ReMoS guideline did not fit their routine practice. Conclusions Among German physical therapists, the ReMoS guideline is not well-known and many interventions are not performed as recommended, illustrating the discrepancies between the ReMoS guideline recommendations and current physical therapy practice. Interventions aimed at overcoming this gap should consider both knowledge of existing barriers and facilitators of guideline usage.}, language = {en} } @misc{SchefflerSchimboeckSchoeleretal., author = {Scheffler, Bettina and Schimb{\"o}ck, Florian and Sch{\"o}ler, Almut and R{\"o}sner, Katrin and Spallek, Jacob and Kopkow, Christian}, title = {Implementierung der „Rehabilitation der Mobilit{\"a}t nach Schlaganfall (ReMoS)" - Leitlinie: Eine Querschnittbefragung von Physiotherapeut*innen in Deutschland}, series = {5. Forschungssymposium Physiotherapie, FSPT2022 Abstractband}, journal = {5. Forschungssymposium Physiotherapie, FSPT2022 Abstractband}, doi = {https://doi.org/10.26127/BTUOpen-5923}, pages = {39 -- 40}, language = {de} } @misc{PanDeSantisMuellmannetal., author = {Pan, Chen-Chia and De Santis, Karina Karolina and Muellmann, Saskia and Hoffmann, Stephanie and Spallek, Jacob and Pedros Barnils, Nuria and Ahrens, Wolfgang and Zeeb, Hajo and Sch{\"u}tz, Benjamin}, title = {Sociodemographics and digital health literacy in using wearables for health promotion and disease prevention : cross-sectional nationwide survey in Germany}, series = {Journal of prevention}, volume = {46}, journal = {Journal of prevention}, number = {3}, publisher = {Springer US}, address = {New York}, issn = {2731-5533}, doi = {https://doi.org/10.1007/s10935-024-00821-y}, pages = {371 -- 391}, abstract = {Background Wearable technologies have the potential to support health promotion and disease prevention. However, it remains unclear how the role of social determinants of health (SDoH) and digital determinants of health (DDoH) plays in this context. Objective This study investigates differences in sociodemographic factors and digital health literacy between wearable users and non-users, whether the association with wearable use varies across age groups and its potential mediator. Methods A cross-sectional nationwide telephone survey was conducted in November 2022 in a panel of adult internet users in Germany. Assessments included self-reported wearable use, sociodemographic factors (sex, age, education, household size and income, and residence region), and digital health literacy (measured with the eHealth Literacy Scale, eHEALS). Associations between wearable use, sociodemographic factors and digital health literacy were analyzed using binomial logistic regression models in the total sample and with age group stratification, with a supplementary mediation analysis examining digital health literacy as a mediator in the relationship between age and wearable use. Results Overall, 24\% (223/932) of participants (52\% male, mean age 55.6 years) reported using wearables for health. Wearable use was lower among participants aged 65 and above, with lower educational attainment, living in 1-2 person households, with below-average household income, and residing in smaller cities or former East Germany. Wearable use prevalence is substantially lower in older age groups (18-40: 36\%; 41-64: 26\%; 65+:14\%). Wearable users reported higher levels of digital health literacy (mean: 30.7, SD = 5) than non-users (mean: 28.3, SD = 6). Stratified analyses indicate that the association between digital health literacy and wearable use varies by age group, with significant positive association observed in older age groups (OR = 1.00, 95\% CI: 0.94 to 1.07 in age group 18-40; OR = 1.07, 95\% CI: 1.03 to 1.12 in age group 41-64; OR = 1.11, 95\% CI: 1.04 to 1.19 in age group 65+). Mediation analysis indicated that digital health literacy partially mediates the relationship between age and wearable use (indirect effect: coefficient = -0.0156, 95\% CI: -0.0244 to -0.00791, p <.001). Conclusions This study indicates sociodemographic disparities in wearable use among the German population and differences in digital health literacy between wearable users and non-users. A generational divide in wearable use was identified, with older adults being less likely to embrace this technology. This was especially true for older adults with lower digital health literacy. Future public health initiatives employing health technologies should take SDoH and DDoH into consideration to ensure effective and equitable impacts.}, language = {en} } @misc{DeSantisMartensChristiansonetal., author = {De Santis, Karina Karolina and Martens, Lea and Christianson, Lara and Bangert, Benjamin and Hoffmann, Stephanie and Spallek, Jacob and Zeeb, Hajo}, title = {Attitudes of older people towards telerehabilitation : a scoping review protocol}, series = {Open science framework}, journal = {Open science framework}, publisher = {Center for Open Science}, address = {Charlottesville, VA}, doi = {10.17605/OSF.IO/F965Z}, pages = {1 -- 8}, language = {en} } @misc{TallarekLeinweberJostetal., author = {Tallarek, Marie and Leinweber, Julia and Jost, Annemarie and Spallek, Jacob}, title = {Setting the frame : how midwives balance professional accountability with birth autonomy in Germany : a grounded theory study}, series = {Women and birth : journal of the Australian College of Midwives}, volume = {39}, journal = {Women and birth : journal of the Australian College of Midwives}, number = {1}, publisher = {Elsevier BV}, address = {Amsterdam}, issn = {1871-5192}, doi = {10.1016/j.wombi.2025.102143}, pages = {1 -- 8}, abstract = {Introduction: Promoting birthing persons' autonomy is essential to woman-centred maternity care and associated with birthing persons' positive birth experiences. Although midwives play a crucial role in promoting or hindering birth autonomy, little is known about how they navigate birth autonomy in Germany. This study aimed to identify midwives' experiences and strategies of engaging with birthing persons' autonomy in different German settings. Material and methodology: Semi-structured interviews were conducted with 12 midwives from hospitals, birth centres, and home birth environments in Germany. The interviews were recorded, transcribed verbatim, and analysed according to Grounded Theory Methodology (GTM) developed by Strauss \& Corbin. In total, 2944 codes were grouped into five categories ("Phenomenon", "Causal conditions", "Context", "Action strategies", and "Consequences") and integrated into one model. Elements of Reflexive GTM facilitated the reflection on researcher positionality. Results: Midwives continuously balance multiple, often competing, demands, among them the need to define a framework that gives them confidence to stand behind every aspect of the care they provide. The midwives achieve this by interpreting various contextual conditions, prioritising them, defining their professional boundaries and options, and matching maternal preferences with these. Throughout the birth process, they monitor changes and dynamically adjust established boundaries as needed. Discussion: The study results enhance our understanding of the evolving and context-sensitive process of decision-making during childbirth. Discourses around birth autonomy would benefit from adequate terminology that reflects this complexity. In sum, this study contributes to current discourses on midwifery practice, education, and policy.}, language = {en} }