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S8 D. Dingoyan et al. / European Psychiatry 27 (2012) / supplement n°2 / S4-S9 him/herself. Moreover, all of the focus groups mentioned that women with Turkish migration backgrounds are not allowed to invite a male interviewer into their home without the presence of a male family member. Such an invitation could lead to confl icts with the social environment of the women, such as defamations. It was also repeatedly stated that the interviewer should be able to speak the Turkish language. 3.5. Tangible incentives For a three- hour interview, the overall mean tangible incentive was 29 € (range: 20- 45; n=36). One participant refused to specify an amount (“To me, it is more important if I will be helped at that moment. So, I will not name a sum.”) 3.6. Key fi gures Thirty- six participants stated that well- known public fi gures would positively affect participation in research studies. Only one participant expressed that there would not be a relation between participation willingness and well- known fi gures. On the basis of the questionnaire concerning the relevance of key fi gures, public fi gures from various social areas were identifi ed. Table 4 shows the top ten named fi gures and their degree of popularity. An internationally known fi lm director and a local hairdresser with Turkish migration backgrounds were most frequently mentioned. 4. Discussion Regarding the sample characteristics (e.g., age, country of birth, nationality, year of migration, school and professional qualifi cation), with the exception of gender, the sample composition is diverse and widely ranged (Table 1). As all participant statements were included in the content analysis, it can be assumed that the results of the focus groups are not distorted fundamentally by the smaller number of male participants. An exception is the category “role of women”, which will be Table 4 Top ten frequently mentioned key fi gures and their degree of popularity on a 0- 10 scale. well known key fi gures gender n popularity ø 1 Turkish buisnessman male 30 8 2 Turkish fi lm director male 27 7 3 Turkish physician male 23 7 4 Turkish federal politician male 22 7 5 German mayor male 22 7 6 Turkish local politician female 20 7 7 Turkish hairdresser male 20 4 8 Turkish local politician male 19 6 9 Turkish sportsman male 15 8 10 Turkish tv presenter male 15 7 discussed later. Moreover, it is not clear whether the low level of male participants is due to a generally lower willingness of men with Turkish migration backgrounds to participate in health research studies, or whether other factors (e.g. time- related or personal reasons, various factors infl uencing the recruitment process) may have played a role. Overall, the enrolment of participants with Turkish migration backgrounds into the focus groups was associated with several challenges. For the majority of invitees, the issue of “to know each other” was a motivating factor for their participation. Being accompanied by friends or relatives was the most often expressed condition for attendance. Furthermore, the feedback indicated that many participants had concerns about the research staff’s expectations of them and whether they would be able to meet them. In this context, some participants also reported concerns of being examined and providing incorrect answers. For these reasons, it seems adequate not to have audio and video taped the participants, so as not to excite their fears of being controlled or examined. These factors and the need to be accompanied by a trusted person may also be related to previously mentioned reasons for lower participation rates (perceived barriers), such as anxiety, mistrust and negative experiences in the interactions with the majority population. Considering the fi ndings of the perceived barriers, it is striking that most of the documented statements were related to the fi rst category, which refers to the traditional role of women. This result was not merely due to the large number of female participants. The women became increasingly conversational with each other, which led to more differentiated statements. Therefore, care should be taken in drawing conclusions that could result in unfounded generalisations or the stigmatisation of women and men with Turkish migration backgrounds. The results provide a wide range of potential participation barriers that should be considered in the process of study planning. Of note, some of the stated reasons for the lower participation rates were also reported in other studies, such as lack of knowledge, anxiety and mistrust of scientifi c institutions and the government. An extreme example of negative experiences with health research studies is the Tuskegee Syphilis Study. Many authors point out that this study became a symbol of research subject abuse of African Americans. It is discussed that these experiences affect the willingness to participate in health research studies until today [4,5,25]. The present study did not demonstrate such a clear association between a specifi c traumatic event and the willingness to participate. However, focus group participants mentioned negative experiences with governmental institutions (such as national authorities) as possible reasons for mistrust of health research studies. Thus, trust building through diverse resources is a key aspect that has been indicated in the literature [11,19,25] and by focus group participants (recommendations). When the participants were asked to name motivating factors for participation in future research, word- of- mouth promotion of the research project and the involvement of well- known key fi gures were mentioned as trust building methods. The importance of key fi gures and the social networking of the Turkish community should be considered to be a relevant resource to build trust and to enhance participation rates in health research studies [2,3,26]. As also mentioned in the focus groups, the transparent communication of the study objectives, interview conditions and relevance of Proofs
the study should be emphasised [4,11,26]. Furthermore, culture and gender- specifi c aspects of the interview conditions (e.g., female interviewer for home visits) should be considered in the face of possibly far- reaching consequences on women with Turkish migration backgrounds (e.g., problems with the husband, defamation). Concerning the meaning of incentives, tangible and non- tangible incentives were considered additional motivating factors, and the mentioned mean value (29 €) for a three- hour interview was moderate. Interestingly, language diffi culties were not mentioned as a main reason for lower participation rates. This aspect was discussed at a later stage during the focus group meetings (contacting). In this context, the participants mentioned that it would be helpful if the interviewer spoke Turkish. Therefore, it can be assumed that language barriers are of relevance with regard to recruitment processes and interviews [28,23,22]. Furthermore, it was striking that many participants requested help when completing the questionnaires, although most of them were able to write their ideas on presentation cards. This could be also due to their unfamiliarity with investigations. 5. Conclusion The fi ndings on the perception of the focus groups about how health research is perceived by individuals with Turkish migration backgrounds and the implications for successful recruitment offer considerable recommendations for enhancing participation rates in further research. Feelings of mistrust and anxiety were embedded in negative experiences with German public authorities and interactions with Germans in daily life. Against this background, it is diffi cult but necessary for the research staff to build trust. In addition to a fi eld team that should include members of the target population, further relevant steps for a successful recruitment should make use of public promotions (especially word- of- mouth) and of key fi gures in the Turkish community with the priority of a transparent communication regarding the study project and its conditions. The willingness to participate should be supported by translated information and evaluation materials, considerations of culture and gender- specifi c aspects of the interview situation and the implementation of (non- ) tangible incentives. Confl ict of interest statement The authors declare that there is no confl ict of interests. References [1] Blohm M, Diehl C. Wenn Migranten Migranten befragen – Zum Teilnahmeverhalten von Einwanderern bei Bevölkerungsbefragungen. Zeitschrift für Soziologie. 2001;30(3):223- 42. [2] Branson RD, Davis JK, Butler KL. African Americans’ participation in clinical research: importance, barriers, and solutions. American J Surg 2007;193(1):32- 9. [3] Chandra A, Paul III DP. African American Participation in Clinical Trials: Recruitment Diffi culties and Potential Remedies. Hospital Topics 2003 2003;81(2):33- 8. D. Dingoyan et al. / European Psychiatry 27 (2012) / supplement n°2 /S4-S9 S9 [4] Corbie- Smith G, Thomas SB, Williams MV, Moody- Ayers S. Attitudes and Beliefs of African Americans Toward Participation in Medical Research. Journal of General Internal Medicine 1999;14(9):537- 46. [5] Corbie- Smith GM. Minority recruitment and participation in health research. N C Med J 2004;65(6):385- 7. [6] DeBaun MR, Gorelick PB, Som S. Strategies for Recruiting and Retaining Minorities. Front Neurol Neurosci 2009;25:118- 20. [7] Diehl C. Materialband und Endbericht zur Neuzuwandererbefragung- Pilotstudie – Erste und zweite Welle. Bundesinstitut für Bevölkerungsforschung beim Statistischen Bundesamt; 2007. [8] Durant RW, Davis RB, St. George DMM, Williams IC, Blumenthal C, Corbie- Smith GM. Participation in Research Studies: Factors Associated with Failing to Meet Minority Recruitment Goals. Ann Epidemiol 2007;17(8):634- 42. [9] Faseru B, Cox LS, Bronars CA, Opole I, Reed GA, Mayo MS, et al. Design, recruitment, and retention of African- American smokers in a pharmacokinetic study. BMC Medical Research Methodology 2010;10:6. [10] Ford JG, Howerton MW, Lai GY, Gary TL, Bolen S, Gibbons MC, et al. Barriers to Recruiting Underrepresented Populations to Cancer Clinical Trials: A Systematic Review. American Cancer Society 2007;112(2):228- 42. [11] Giuliano AR, Mokuau N, Hughes C, Tortolero- Luna G, Risendal B, Ho RCS, et al. Participation of Minorities in Cancer Research: The infl uence of Structural, Cultural, and Linguistic Factors. Annals of Epidemiology 2000 Nov;10(8):22- 34. [12] Halcomb EJ, Gholizadeh L, DiGiacomo M, Phillips J, Davidson PM. Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups. J Clin Nurs [Review]. 2007;16(6):1000- 11. [13] Han H- R, Kang J, Kim KB, Ryu JP, Kim MT. Barriers to and Strategies for Recruiting Korean Americans for Community- Partnered Health Promotion Research. J Immigr Minor Health 2007;9(2):137- 46. [14] Harris KJ, Ahluwalia JS, Catley D, Okuyemi KS, Mayo MS, Resnicow K. Successful recruitment of minorities into clinical trials: The Kick It at Swope project. Nicotine & Tobacco Research 2003;5(4):575- 84. [15] Hatchett BF, Holmes K, Duran DA, Davis C. AFRICAN AMERICANS AND RESEARCH PARTICIPATION: The Recruitment Process. J Black Stud 2000;30(5):664- 75. [16] Hussain- Gambles M, Atkin K, Leese B. Why ethnic minority groups are underrepresented in clinical trials: a review of the literature. Health and Social Care in the Community 2004;12(5):382- 8. [17] Kamtsiuris P, Bergmann KE, Dippelhofer A, Hölling H, Kurth BM, Thefeld W. Der Pretest des Kinder- und Jugendgesundheitssurveys: Methodisc he Aspekte und Durchführung. Gesundheitswesen 2002;64(1):99- 106. [18] Mayring P. Qualitative Inhaltsanalyse- Grundlagen und Techniken. 8nd ed. Stuttgart, Germany: UTB Beltz Verlag; 2002. [19] Moreno- John G, Gachie A, Fleming CM, Nápoles- Springer A, Mutran E, Manson SM, et al. Ethnic Minority Older Adults Participating in Clinical Research: Developing Trust. Journal of Aging and Health 2004;16(5):93- 123. [20] Murthy VH, Krumholz HM, Gross CP. Participation in Cancer Clinical Trials: Race- , Sex- , and Age- Based Disparities. JAMA: The Journal of the American Medical Association 2004;291(22):2720- 6. [21] Paskett ED, Reeves KW, McLaughlin JM, Katz ML, McAlearney AS, Ruffi n MT, et al. Recruitment of Minority and Underserved Populations in the United States: The Centers for Population Health and Health Disparities Experience. Contemp Clin Trials 2008;29(6):847- 61. [22] Schenk L, Ellert U, Neuhauser H. Kinder und Jugendliche mit Migrationshintergrund in Deutschland – Methodische Aspekte im Kinder- und Gesundheitssurvey (KiGGS). Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2007;50(5):590- 9. [23] Schenk L, Neuhauser H. Methodische Standards für eine migrantensensible Forschung in der Epidemiologie. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2005;48(3):279- 86. [24] Schenk L. Migrantenspezifische Teilnahmebarrieren und Zugangsmöglichkeiten im Kinder- und Jugendgesundheitssurvey. Gesundheitswesen 2002;64(1):59- 68. [25] Shavers VL, Lynch CF, Burmeister LF. Racial Differences in Factors that Infl uence the Willingness to Participate in Medical Research Studies. Annals of Epidemiology 2002;12(4):248- 56. [26] Sterling YM, Peterson JW, Curley M. Challenges of Recruiting Minority Populations for Research. Journal for Specialists in Pediatric Nursing 1999;4(4):172- 4. [27] Wendler D, Kington R, Madans J, Van Wye G, Christ- Schmidt H, Pratt LA, et al. Are Racial and Ethnic Minorities Less Willing to Participate in Health Research? PLoS Med. 2006;3(2):e19. [28] Zeeb H, Razum O. Epidemiologische Studien in der Migrationsforschung: Ein einleitender Überblick. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2006;49(9):845- 52. Proofs
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Page 3 and 4: Vol. 27, Supplement n°2, June 2012
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Page 7 and 8: health of Turkish woman in Germany:
Page 9 and 10: studies [8,6,27]. Commonly suggeste
Page 11: lack of desire to obtain an educati
Page 15 and 16: clear is the picture regarding depr
Page 17 and 18: SD=15.9; t(183)= - 2.575; p=.011).
Page 19 and 20: as caring for children and taking c
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Page 23 and 24: were then scrutinized independently
Page 25 and 26: [6] Berry J, Kim U. Acculturation a
Page 27 and 28: A. Heredia Montesinos et al. / Euro
Page 29 and 30: 3.2. Interrelations of stigma, depr
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Page 33 and 34: F. Mammadova et al. / European Psyc
Page 35 and 36: [17] Su KP, Chiu TH, Huang CL, et a
Page 37 and 38: society, history (slavery and colon
Page 39 and 40: That the model is false suggests th
Page 41 and 42: 6. Ego disorders in psychosis - tra
Page 43 and 44: In this state, socially unaccepted
Page 45 and 46: generating a model of the self with
Page 47 and 48: Acknowledgements This work was supp
Page 49 and 50: to Kleinman, explanatory models con
Page 51 and 52: categories was performed very caref
Page 53 and 54: [31] Mayring P. Qualitative Inhalts
Page 55 and 56: patients (often with lower social s
Page 57 and 58: are listed by Turkish immigrants in
Page 59 and 60: [19] Schnegg M, Lang H. Die Analyse
Page 61 and 62: 1. Introduction The number of immig
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on the availability of service usag
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Studies in some European countries
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© 2012 Elsevier Masson SAS. All ri
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our study, we composed an assessmen
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With regard to content, the pilot a
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Acknowledgments We are very gratefu
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cross- cultural mental health train
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3.3.2. German experiences Despite t
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[31] Mösko M, Gil- Martinez F, Sch
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2. Psychosocial care as a necessary
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* First Rank Symptoms according to
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Epilogue A. Kleinman Esther and Syd
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