The role of culture and religion in health care provision for migrants. Experiences from medical rehabilitation and explanatory mechanisms

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.