Social Inequalities in Aggravating Factors of Somatic Symptom Persistence (RU SOMACROSS)

躯体症状持续加重因素中的社会不平等 (RU SOMACROSS)

• 批准号: 460374208
• 负责人: Professor Dr. Olaf von dem Knesebeck
• 金额: --
• 依托单位: Institut für Medizinische Soziologie
• 依托单位国家: 德国
• 项目类别: Research Units
• 资助国家: 德国
• 项目状态: 未结题
• 来源: https://gepris.dfg.de/gepris/projekt/460374208?language=en
• 关键词: Social; Inequalities; Aggravating; Factors; Somatic

Socioeconomic status (SES, i.e. education, income, and/or occupational position) and migration are important social determinants of health. Regarding persistent somatic symptoms (PSS), there are a few studies investigating inequalities according to SES and migration. These studies indicate that somatic symptoms are more prevalent among individuals with a low SES and a migration background. However, factors explaining social inequalities in PSS are largely unknown. It is expected that aggravating factors of PSS like illness perception, illness beliefs (health literacy/stigma), illness behaviour, and health anxiety play an important role for this explanation. The current study will examine social inequalities (according to SES and migration) in factors contributing to symptom persistence in Irritable Bowel Syndrome (IBS) and fatigue. In this regard, the following aggravating factors will be explored: illness perception, knowledge and beliefs about the symptoms, illness and treatment experiences, illness behaviour, and health anxiety.In order to examine social inequalities in aggravating factors, the project will collect both quantitative and qualitative data. Quantitative data will be gathered via a representative telephone survey in Germany (N=2,400). With a vignette design depicting patients varying in sex, condition (IBS/fatigue), occupational status (low/high), and migration (yes/no), public knowledge and beliefs (e.g. health literacy), attitudes (stigma), and personal experiences with the condition (e.g. somatic symptom burden) will be explored. In combining a vignette design with a survey, social inequalities will be examined from two perspectives: as a social characteristic of the person in the vignette and of the respondents. Complementary, longitudinal qualitative interviews will be conducted with patients (n=32 at three time points, resulting in N=96 interviews) who will also vary according to sex, condition, occupational status and migration. Patients will be recruited from primary care practices in Hamburg. The interviews will cover origin and development of the condition, coping and help-seeking as well as social interactions and perception of the disease by others (e.g. perceived stigma). The longitudinal design will allow to depict inequalities in the course of symptoms and in changes of experiences over time. We expect inequalities in factors contributing to symptom persistence in IBS and fatigue according to SES and migration status. The results will help us to understand and explain inequalities in PSS and thus, will provide an insight into the social context of PSS. The project will contribute to the overall project objectives since SES and migration are predisposing factors that may have an impact on the chronification of PSS. Expected results can be integrated into concepts of prevention and treatment of PSS, e.g. by improving public knowledge and reducing stigma.

社会经济地位（SES，即教育、收入和/或职业地位）和移徙是健康的重要社会决定因素。关于持续躯体症状（PSS），有一些研究调查了根据社会经济地位和移民而产生的不平等现象。这些研究表明，躯体症状在低社会经济地位和移民背景的个体中更为普遍。然而，解释PSS社会不平等的因素在很大程度上是未知的。预计加重PSS的因素，如疾病感知、疾病信念（健康素养/耻辱）、疾病行为和健康焦虑在这一解释中发挥了重要作用。目前的研究将检查社会不平等（根据SES和迁移）在促进肠易激综合征（IBS）和疲劳症状持续的因素。在这方面，将探讨下列加重因素：对疾病的认识、对症状的认识和信念、疾病和治疗经历、疾病行为和健康焦虑。为了审查加剧社会不平等的因素，该项目将收集定量和定性数据。定量数据将通过德国有代表性的电话调查收集（N= 2400）。通过一个小插图设计，描绘了不同性别、状况（肠易激综合征/疲劳）、职业状况（低/高）和迁移（是/否）的患者，将探讨公众知识和信仰（如健康素养）、态度（污名化）和个人经历（如躯体症状负担）。在将小插图设计与调查相结合时，社会不平等将从两个角度进行检查：作为小插图中的人和受访者的社会特征。将对患者进行补充性的纵向定性访谈（三个时间点n=32，共n= 96次访谈），访谈对象也会因性别、病情、职业状况和迁移而有所不同。患者将从汉堡的初级保健实践中招募。访谈将涵盖疾病的起源和发展、应对和寻求帮助以及社会互动和他人对疾病的看法（例如感知到的耻辱）。纵向设计将允许描述症状过程中的不平等和随时间变化的经验。我们预计，根据社会经济地位和移民状况，导致肠易激综合征和疲劳症状持续的因素不平等。研究结果将有助于我们理解和解释PSS中的不平等现象，从而深入了解PSS的社会背景。该项目将有助于实现整个项目目标，因为SES和迁移是可能对PSS的进度产生影响的诱发因素。可以将预期结果纳入PSS的预防和治疗概念，例如通过提高公众知识和减少耻辱感。