Health-seeking behaviour among newly arrived immigrants in Denmark

• Register: ISRCTN
• Last refreshed on: 26 August 2019
• Main ID: ISRCTN24905314
• Date of registration: 01/05/2018
• Prospective Registration: No
• Primary sponsor: Innovation Fund Denmark
• Public title: Health-seeking behaviour among newly arrived immigrants in Denmark
• Scientific title: Health-seeking behaviour among newly arrived immigrants in Denmark
• Date of first enrolment: 15/01/2012
• Target sample size: 1572
• Recruitment status: Completed
• URL: http://isrctn.com/ISRCTN24905314
• Study type: Interventional
• Study design: Prospective non-randomised intervention study (Other)
• Phase: Not Applicable

Countries of recruitment

Denmark

Contacts

• Name: Signe Smith Jervelund

Key inclusion & exclusion criteria

Inclusion criteria: The study population consisted of adult immigrants attending two language schools, CBSI and Vestegnens Language and Competence School, in the greater catchment area of Copenhagen in 2012 and 2013. To be eligible for the study, the immigrants had to have basic understanding of Danish (for this reason we omitted students from module 1) which also implies that the immigrants have lived in Denmark for some time and have had some experience with the Danish healthcare system. The trialists used Statistics Denmark’s definition of an immigrant as a person who is born in a foreign country of parents who both are foreign citizens or born in a foreign country. The participants represent the mixture of migrants in Denmark: labour migrants, family reunified and refugees with different educational backgrounds and countries of birth.
Exclusion criteria: Immigrants at module 1 at Danish language school (not sufficient Danish skills) and at module 6 (preparing for final Danish exam)

Age minimum:
Age maximum:
Gender: Both

Health Condition(s) or Problem(s) studied

Immigrants’ healthcare-seeking behaviour
Not Applicable

Intervention(s)

Immigrants are assigned to one of three groups who receive: a course of 12 hours on access to and optimal use of the Danish healthcare system; written information on the Danish healthcare system in their mother tongues; or no information (current situation). The intervention took place at Vestegnens Language and Competence School (VSK) which has two divisions, while the control group was formed by students at CBSI language school.

Survey data included three case vignettes on healthcare-seeking behaviour, true or false question on access to the Danish healthcare system, as well as satisfaction with the Danish healthcare system and were linked to registry data on socioeconomic characteristics and healthcare use in the year to follow. The intervention lasted 12 lectures (1 week of school) and took place in January. The follow-up took place app. 3 months after (in April-June).

Primary Outcome(s)

1. Immigrants’ healthcare-seeking behavior. To assess healthcare-seeking behaviour, three case vignettes with descriptions of persons with different healthcare needs at different times of the day were used: i) flu-like symptoms with a fever of 39.5°C (including sore throat and coughing); ii) chest pain; iii) major depression. The participants were asked to report on what they would do in the three cases by only choosing one of the following answer categories: a) talk to family and friends; b) go to pharmacy; c) call 112 (the Emergency Operations Centre); d) consult an out-of-hours-doctor; e) go to ER; f) contact GP; g) pray to God; h) nothing. To assess the “appropriateness” of service use, we applied an understanding of accessing healthcare services according to health need by the principle of using the lowest effective care level from the lens of a Western medicine oriented healthcare system. In the case of flu-like symptoms with relative high fever, where consulting a doctor may be appropriate but in most cases does not require emergency healthcare, the following actions were categorised as appropriate healthcare-seeking behaviour: consult out-of-hours-doctor and go to GP. Inappropriate healthcare-seeking behaviour was considered as: talk to family and friends, go to pharmacy, call 112, go to ER, pray to God and no actions. In the case of chest pain, where fast healthcare might be life-saving, the following actions were considered as appropriate healthcare-seeking behaviour: call 112, go to ER and go to GP. Inappropriate healthcare-seeking behaviour was considered as: talk to family and friends, go to pharmacy, consult out-of-hours-doctor, pray to God and no actions. In the case of major depression that requires healthcare or help to seek healthcare, the following actions were considered as appropriate healthcare-seeking behaviour: talk to family and friends, consult out-of-hours-doctor, go to ER and go to GP. Inappropriate healthcare-seeking behaviour was considered as: go to pharmacy, call 112, pray to God and no actions. The trialists also carried out sensitivity analyses for all three cases, where we added “pray to God” to the appropriate answer category as well as “talk to friends and family”, “go to pharmacy”, “pray to God” and “do nothing” for cases of flu-like symptoms. Timepoints: Measured at baseline and at follow-up (app. 3 months after).

2. Healthcare utilization. The healthcare services contacts assessed were as follows: ER (number of contacts), GP (number of contacts either telephone, email or in-person consultation), outpatient treatment at hospital (contact versus no contact), inpatient treatment at hospital (contact versus no contact), specialist doctor in private practice which needs referral from GP (contact versus no contact) and dentist (contact versus no contact). Timepoints: Utilisation of healthcare services was assessed by calculating the contacts to healthcare services a year prior to and the year after the intervention took place.

Secondary Outcome(s)

1. Immigrants’ knowledge. To assess whether the intervention affected self-perceived knowledge of the Danish healthcare systems, immigrants were asked: “In case of illness, do you know who to contact?” and “In case of an accident, do you know who to contact?”. Potential responses included ‘Yes, always,’ ‘Sometimes,’ ‘No, ’Don’t know’. We dichotomized the responses as “Yes, always” versus other. To assess whether the intervention affected actual knowledge of access to the Danish healthcare systems, immigrants were asked a number of positively and negatively formulated true and false questions e.g. “All children can receive several free vaccines at their doctor” and “You are welcome to contact an out-of-office-hours doctor from 8 am until 4 pm. Also when your general practitioner (GP) is open”. Potential responses included ‘True,’ and ‘False’. The responses were assessed based on pre-determined right or wrong answers. Timepoints: Measured at baseline and at follow-up (app. 3 months after).

2. Patient satisfaction. To assess whether the intervention affected satisfaction with the Danish healthcare system, immigrants were asked questions on satisfaction with their GP, specialist doctors in private practice and hospital doctors as well as whether Danish doctors are good at helping you when you are ill. E.g. “Are doctors at hospitals good in Denmark?”. Potential responses included ‘Yes, very good,’ ‘They are okay,’ ‘No, they are poor,’ ’I have never been at the hospital,’ ’Don’t know’. The trialists dichotomized the responses as “Yes, very good” versus other. Missing categories included ’I have never been at the hospital,’ ’Don’t know’. Timepoints: Measured at baseline and at follow-up (app. 3 months after).

Secondary ID(s)

11-115843

Source(s) of Monetary Support

Innovationsfonden, Helsefonden

Secondary Sponsor(s)

Helsefonden

Ethics review

Status:
Approval date:
Contact:

According to Danish law, no approval from an ethics committee is required when human tissue is not part of the research project. The Danish Data Protection Agency granted permission for the study. All potential participants received written information about the study (the information letter) underscoring study objectives, anonymity procedures, participants’ rights to withdraw and that (non-)participation had no consequences for the individual. The intervention groups received further oral infor

Results

• Results available: Yes
• Date Completed: 31/03/2016