Project Details
Projekt
Natural experiment on contextual effects on health and health care among refugees (NEXUS)
Applicant
Professor Dr. Kayvan Bozorgmehr
Subject Area
Empirical Social Research
Public Health, Healthcare Research, Social and Occupational Medicine
Public Health, Healthcare Research, Social and Occupational Medicine
Term
from 2019 to 2023
Project identifier
Deutsche Forschungsgemeinschaft (DFG) - Project number 409654512
Many studies on contextual health effects suffer from compositional bias and selective migration into neighbourhoods. Longitudinal natural experiments have the potential to overcome these limitations, but these are rare phenomena and underused in public health. Migrant dispersal policies qualify as a natural experiment as the assignment to neighbourhoods occurs by administrative reasons in quasi-random fashion. This sub-project of the research unit PH-LENS aims to study the relationships between health inequalities and contextual characteristics of the place of residence, such as accommodation, neighbourhood, and regional deprivation, in a marginalised migrant population by exploiting dispersal policies as a natural experiment. Further aims are to assess how health systems contribute to, mitigate, or reduce inequalities in health and health care of marginalised populations using resilience and responsiveness frameworks. NEXUS comprises four work packages (WP): A systematic review on contextual effects on health and social outcomes derived from studies on migrant dispersal programs (WP1); a secondary analysis of survey data from a pseudo-panel with independent cross-sections used to approximate a longitudinal natural experiment among 560 refugees from 60 accommodation centres and six reception centres (WP2); a prospective natural experiment study with primary data collection and measurement of both contextual and individual factors among 1,200 asylum seekers and 300 pregnant women who will be recruited in a state reception centre and followed-up for 12 months after dispersal between 44 districts (WP3); and a comparison between results of the pseudo-panel and the prospective study by meta-analytic approaches to advance methodological knowledge on contextual health research (WP4). Additionally, as part of WP3, qualitative interviews with key stakeholders in regional health systems will be performed to develop a quantitative survey of regional health system actors, aimed at measuring resilience in all 44 districts. The analytical approaches applied comprise propensity score matching, difference in difference analysis, as well as Bayesian and multi-level regression. NEXUS applies innovative research designs to address these objectives, and contributes to the research unit by generating empirical knowledge on mechanisms and consequences of ‘othering’ processes and their interaction with context, which may be transferable to other marginalised social groups in society. The sub-project will also generate knowledge on the role of regional health system factors in reducing or increasing health inequalities and enhance methodological knowledge on natural experiments and measurements of resilience. NEXUS uses a synergistic approach to data collection jointly with the sub-projects ENSURE and TREAT, and closely collaborates with the sub-projects OTHER, DEPRIV, PROREF and LARGE to contribute to the overall goals of the Research Unit PH-LENS.
DFG Programme
Research Units
