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

社会经济地位(社会经济地位，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。关于持续性躯体症状(PSS)，有一些研究根据SES和迁移来调查不平等。这些研究表明，躯体症状在SES低和移民背景的个人中更常见。然而，解释PSS中社会不平等的因素在很大程度上是未知的。疾病认知、疾病信念(健康素养/污名)、疾病行为、健康焦虑等PSS的加重因素对此解释有重要作用。目前的研究将调查导致肠易激综合征(IBS)症状持续和疲劳的因素中的社会不平等(根据社会经济地位和移民)。在这方面，将探讨以下加剧因素：疾病认知、对症状的知识和信念、疾病和治疗经验、疾病行为和健康焦虑。为了检查加剧因素中的社会不平等，该项目将收集定量和定性数据。量化数据将通过在德国(N=2400)具有代表性的电话调查来收集。通过一个描述患者在性别、病情(IBS/疲劳)、职业地位(低/高)和移民(是/否)方面不同的小插曲设计，将探索公共知识和信念(例如健康素养)、态度(耻辱)和对这种疾病的个人经历(例如躯体症状负担)。在将小场景设计与调查相结合时，社会不平等将从两个角度进行审查：作为小场景中人的社会特征和受访者的社会特征。补充的纵向定性访谈将与病人(n=32在三个时间点，结果为N=96访谈)进行，这些病人也将因性别、条件、职业状况和移民而有所不同。患者将从汉堡的初级保健诊所招募。访谈将涉及疾病的起源和发展、应对和寻求帮助以及社会互动和他人对疾病的看法(例如感觉到的耻辱)。纵向设计将允许描绘症状过程中的不平等以及随着时间的推移经验的变化。我们预计，根据SES和迁移状态，导致IBS症状持久性和疲劳感的因素存在不平等。研究结果将有助于我们理解和解释PSS中的不平等现象，从而有助于我们深入了解PSS的社会背景。该项目将有助于实现总体项目目标，因为社会保障和迁移是可能对PSS编年化产生影响的诱因。可以将预期成果纳入预防和治疗PSS的概念，例如通过提高公众知识和减少耻辱。

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.