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Int. J. Environ. Res. Public Health 2017, 14(8), 894; https://doi.org/10.3390/ijerph14080894

How Do Countries’ Health Information Systems Perform in Assessing Asylum Seekers’ Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries

1
Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
2
Netherlands Association of Community Health Services, 3524 SJ Utrecht, The Netherlands
3
Health Collective Berlin, 12053 Berlin, Germany
4
Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany
5
Department of Public Health and Epidemiology, Academic Medical Centre, 1105 AZ Amsterdam, The Netherlands
*
Author to whom correspondence should be addressed.
Academic Editors: Jimmy T. Efird and Pollie Bith-Melander
Received: 6 June 2017 / Revised: 25 July 2017 / Accepted: 3 August 2017 / Published: 8 August 2017
(This article belongs to the Special Issue Refugee Health)
View Full-Text   |   Download PDF [864 KB, uploaded 9 August 2017]   |  

Abstract

Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods: Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson’s rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0–97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results: In the independent rating, Pearson’s rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health, socio-economic status and health behaviour. The relative gap in the HIATUS component “data sources and availability” was much higher in Germany (92%) than in NL (28%). Conclusions: The standardised tool (HIATUS) proved useful for assessment of country HIS performance in two countries by consensus-based rating. HIATUS revealed substantial limitations in HIS capacity to assess the health situation of asylum seekers in both countries. The tool allowed for between-country comparisons, revealing that capacities were lower in DE relative to NL. Monitoring and benchmarking gaps in HIS capacity in further European countries can help to strengthen HIS in the future. View Full-Text
Keywords: health information system; health systems research; health systems strengthening; asylum seeker; refugee; health inequality; performance; Germany; The Netherlands health information system; health systems research; health systems strengthening; asylum seeker; refugee; health inequality; performance; Germany; The Netherlands
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Bozorgmehr, K.; Goosen, S.; Mohsenpour, A.; Kuehne, A.; Razum, O.; Kunst, A.E. How Do Countries’ Health Information Systems Perform in Assessing Asylum Seekers’ Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries. Int. J. Environ. Res. Public Health 2017, 14, 894.

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