Background: As compared to the German host population, migrants differ in many aspects of their
health that are relevant for health care provision. Current explanatory models of
migrant health neglect the importance of cultural and religious factors. Using recent
empirical data from the field of medical rehabilitation as an example, we point out
the potential role of these factors in clinical practice. We discuss explanatory mechanisms
of how these factors can create barriers to health care access and to the effectiveness
of therapeutic regimens. Methods: Data from the German Socio-Economic Panel (n=19,521), quantitative routine data from
the German Statutory Pension Insurance Scheme (n=634,529) and qualitative interview
data on migrants undergoing medical rehabilitation in Germany was used to illustrate
the potential role of culture and religion. A literature review was conducted to identify
explanatory mechanisms. Results: Migrants utilize medical rehabilitation less often than non-migrants (OR=0.68; 95%-CI=0.50;0.91).
For those who do, medical rehabilitation is less effective (OR for low occupational
performance after rehabilitation=1.50; 95%-CI=1.46;1.55)-despite adjusting for divergence
in socio-demographic and disease patterns. Partially, differences may be the result
of cultural and religious factors. This assumption is supported by qualitative focus
group discussions. Different explanatory mechanisms for this influence can be identified
in literature. Most important are illness perceptions, religious coping strategies,
family and religious bonds as well as culturally defined food, body and personal hygiene
perceptions. Conclusion: Culture and religion may have an impact on the perceived meaning and the appraisal
of a disease as well as on the choice of coping strategies. They can affect interaction
and communication in the health care system and may create barriers to health care
access and to the effectiveness of therapeutic regimens. Consequently, they have to
be considered in clinical practice as part of a diversity management in order to provide
health care according to patients' subjective and objective needs.
