WIBEG – WE PROVIDE GUIDANCE FOR YOUR HEALTH – A good practice in Austria
The context of the practice:
Contextual factors and conditions of special importance for the good practice:
The project is developed by a consulting association (not-for-profit) and a national funding body. It was to be implemented by a subdivision of a national NGO operating in a distinct region (Lower Austria), a centre focusing on women’s health. Founded in 2012, this centre for women’s health has become an important place in the region for migrant women to go to. Services combine educational and community work, general and psychological counselling as well as medical services.
The wibeg project builds on a predecessor project that was initiated by beratungsgruppe.at in urban Vienna and aimed to access migrant women from Turkey in health workshops. Within the project, material about mental health, nutrition and physical wellbeing with a lot of pictures and stories was developed in German. The material explicitly tried to connect to the lived everyday realities of the target group. It was used in several small workshop groups with 5-8 women from Turkey to initiate change in their health behaviour. The workshops were facilitated by health tutors who are from Turkey themselves, but who speak German with the women. Before working with the participants in the small workshops, the health tutors received a training on health knowledge, didactical and communication issues, instructions how to use the project material etc. In all cases, the Turkish women were empowered to access the Austrian health care system – also in field trips and direct support finding a doctor or visiting a health care centre.
In 2015, the project was transferred to several rural areas in Austria, also targeting Afghan women as well as Turkish women. This transfer project (wibeg) was implemented until 2017 by Caritas Wiener Neustadt. It is an inclusive and functional way to attract migrant or refugee women to the health care system, focusing on the mediation role of the health tutors, who are essential for the success of the project.
The good practice concerns procedures for health care training/intermediation, facilitating Health Literacy in a specific target group.
The practice is concerned with:
- Refugees reception
Elements characterizing the context in which the practice takes place:
- External funding
- Opportunity to learn from a predecessor project that took place in a different region, involving one of the target groups, and to use existing material
- Established NGO, well-connected, already working with migrant women
- Members of the target group are trained to work with the target group (setting approach)
- Holistic approach to health
Framework conditions on an organisational/institutional level:
- The practice/effort is facilitated by policies/political incentives.
- The practice/effort reflects an institutional diversity code of conduct with overall values for diversity management in a healthcare organisation.
- The practice/effort reflects institutional rules about user-friendly / disabled-friendly access to buildings and physical environments in healthcare service.
- The practice/effort reflects an institutional and multidisciplinary collaboration with religious/spiritual/cultural stakeholders and experts.
- The practice/effort reflects an institutional policy/rule/intent to provide ethnic/cultural diversity in the healthcare staff.
Framework conditions on a competence/communication level:
- The practice/effort reflects the provision and access to treatment in other languages than the national language – for patients and relatives.
- The practice/effort reflects the provision and access to special intercultural outreach activities (like special corps or teams for homecare etc).
Categories of the good practice:
- Diversity management/Organizational perspective.
- Intercultural communication and skills/Competence perspective.
- Diversity management and intercultural skills/Organisational and competence perspective
- Local Healthcare centre
- Home nursing service
- Outpatient Treatment service
- Nursing home
- Municipal Health Authorities
- NGOs & private health project
- Hospital sector
- Emergency ward
- Medical ward
- Surgical ward
- Psychiatric ward
The target groups and actors in the practice:
The main target groups:
The target group comprises mothers and grandmothers living in Turkish and Afghan communities in Lower Austria – in particular third-country nationals -, as well as their families. The project focuses on women of a low socio-economic status. The target group is thought of as “hard-to-reach”. The women predominantly belong to a Muslim background and are especially disadvantaged both socially and in regard to health due to their specific living conditions (little formal education, little German skills, hardly any personal income, dependant on husband and family, number of children is above average etc.). Additionally, there is little informal community care for psychosocial issues, since members of the target group seldom talk about these areas of life with their peers.
By targeting women/mothers/grandmothers who are to serve as multipliers in their families and communities, family members like partners and children serve as indirect target groups.
The practice revolves around the relationship between tutors/intermediators – who are members of the target group themselves and have been trained by project members and health care professionals – and patients (migrant women who shall serve as multipliers in their families and communities).
Other relations involved in or affected by the good practice:
Further groups of people who are involved in the project:
- Project staff
- Health care professionals/specialists who speak at workshops
- Staff working at the destinations of the excursions (i.e. health insurance carriers, centres for medical check-ups)
- Members of the carrier institution
- Local stakeholders
- Community members who are addressed/involved during recruiting
Persons indirectly affected:
- Children and grandchildren of the mothers/grandmothers attending the women’s groups
- Family members
- Community members
Aims and objectives in the practice:
The projects aims to facilitate health-related equal opportunities for women of a low socio-economic status by spreading health knowledge in a small-group setting. In order to implement measures that are attractive, realistic as well as affordable to the target group, the relation between individual aspects (health related behaviour, life style) and factors like living and working environments is considered.
- Disseminate and convey Health Literacy.
- Increase the health potential of the target groups by facilitating access to information, preventive measures and institutions of the health care system.
- Reduce medical expenses by fostering health related behaviour and prevention.
- Intercultural mediation between migrants and actors of the health care system to improve the cost-benefit-relation of activities
- Empower migrants with a low socio-economic status to foster health-related equal opportunities
The projects aims to demonstrate and explain how physical, mental and social well-being are related by taking daily situations as examples. Information on health and health-promoting behaviour shall be made accessible to the target group, thereby familiarizing participants with health care institutions (medical check-ups, GPs, health insurance carriers etc.) and services available. The project aims to facilitate Mental Health Literacy in the target group as well as communication and exchange among the participants in order to create mutual support for changing and improving their living conditions.
- Female migrants – mothers and grandmothers – of low socio-economic status participate in the programme, receive the health box and work through it with the help of the health tutors.
- The women/mothers/grandmothers are sensitized for health related issues.
- Health-related issues are addressed in the families of the participating women, ways of behaviour are reconsidered, the children engage with the materials and health promoting knowledge is transmitted.
- The women/mothers/grandmothers are able, by help of the programme activities, to use existing resources (own and public) as well as to serve as multipliers in their families and social environment, impacting behaviour and circumstances in a positive way.
- The programme is brought to the attention of female migrants with a low socio-economic status through recruiting, presentations, flyers and informational conversations taking place in their residential areas.
- The participants are familiar with a holistic approach to health and the interactions between physical, mental and social well-being.
- The participants are aware of main services for health promotion and institutions and feel able to access relevant information.
- The participants act as multipliers in their families in terms of health consciousness, behaviour and circumstances.
In 2 years, 12 groups of women (with 6-8 participants) are formed in 12 communities/regional areas; participants are supervised by 3 multilingual tutors.
The approach, activities and methods:
Since the targeted women/mothers/grandmothers feel responsible for care and sustenance of their family members, they are especially well suited to serve as multipliers, affecting behaviour in their families.
The women are being reached by activities in their residential area. Through the women, their grand-/children and their entire family is being reached. By reaching the family environment and through grand-/children, the communities are also being reached.
Thus, the participating women pass on the acquired knowledge to their grand-/children, family and community members. Word-of-mouth as important means of activating community members and raising interest for health promotion
Women who are members of the target group are chosen as health tutors, working with the target group. The health tutors are first trained on how to work with groups of women, how to use the project materials, on health knowledge and didactical questions. In a second step, the health tutors recruit potential participants in their residential environments and invite them to participate. Participation is voluntary. Each health tutor works with 6-8 women (bi-monthly meetings). Through continuing support, health tutors and participants forge a long-term and trusting relationship – slow speed based on a needs-oriented approach. This on-going support facilitates a gradual change in health-related behaviour on the side of the participants.
Capacity building among the target groups and the communities they belong to; the programme activities are based upon an appreciation of the participants and intercultural understanding.
Holistic approach to health:
Project material illustrates the complex relationships between behaviour and environmental conditions and the interactions of physical, mental and social elements of health. Thus, the areas covered are extensive, i.e. movement, child development, communication, vaccination, sexuality or dental hygiene.
The wibeg project works with written material about health, which is easily understandable and illustrated with stories, graphs and pictures. The project builds upon existing material (health box, picture books, texts, guides etc.) that was developed in a previous project involving Turkish women. Most of the material is available in Turkish and it is to be translated for Afghan women. The material deals with matters that are relevant for the everyday life of the participants.
The main contact person for migrant women are the health tutors, who are themselves from a migrant community, but are trained in leading health workshops. Their role is strenuous and requires a lot of time, empathy, compassion and understanding of their professional role as tutors. Excursions and workshops in small groups (at participants’ homes or in neutral places like community centres) are made, in order for participants to get to know health care institutions (medical check-ups, GPs, health insurance carriers etc.) and services available. Additionally, there are group meetings with specialists (i.e. on nutrition or women’s health), in which sound knowledge on health is communicated in a target group specific way, trying to integrate health promotion into everyday life.
Other activities comprise process management and documentation procedures, instruction of staff as well as guidance and monitoring conversations with staff members, which are to be held on a regular basis. The project is being evaluated, i.e. on reach of target groups, the work as health tutors, communication within the project team and sustainability (integration into carrier institution, networking with relevant stakeholders, long-term securing of resources, extension to additional regions).
3 months: preparatory phase – choosing of staff; recruiting of participants; training of health tutors.
16 months: working with the groups of women – information activities and excursions; guidance, project monitoring with staff; documentation of project activities (mid-term reports); disseminating project activities, networking with stakeholders; external evaluation.
1 month: roll-out phase – processing documentation; final report; external evaluation.
Intended and achieved results:
The intended results:
The project aims at empowerment, by informing, educating, sensitizing and activating the participating mothers/grandmothers, and motivating them to share know how with their children and family members. Through the low-threshold activities, that are suited for the target group at hand, which is typically hard to reach:
- Health Literacy is to be built-up among the target group.
- Awareness is to be raised.
- Access to health services is to be facilitated.
Additionally, the project shall be developed further and extended to more regions in Austria.
The success indicators for the good practice results:
- Reaching of target group: 90 participants in 12 women’s groups
- Reaching of indirect target group: 300 family members of the participants
Reaching 300-350 people in total
The results so far (at a certain time):
11 women’s groups in 7 rural communities have been formed. The groups are permanent, once established, reaching out to app. 80 women at the moment. The Afghan women have low educational background (22 out of 30 have no primary education). Turkish women are mostly housewives and have no own income. Women between 21 and 30 were reached especially well. Thus, the project reached its target group: Turkish and Afghan women of a low socio-economic status. Yet, the project was not successful in reaching grandmothers (women 50+ are generally not being reached as participants in the women’s groups).
Intended and achieved effect:
The intended effect:
Change of behaviour among the target group:
- Increased knowledge about health
- Establishing trusted relationships
- Improving health related behaviour, i.e. in relation to nutrition, prevention, mental well-being etc.
- Getting to know their residential area, increased movement and social activity outside of the home
Institutional change/system change:
- Finding regional partners, establishing relationships of cooperation
- Creating infrastructure (i.e. rooms for the groups to come together)
- Forming of groups, facilitating self-reliance
The success indicators for the good practice effect:
- Changed behaviour among the target group (Health Literacy, access to health care system)
- Involvement of stakeholders
- Integration of project into carrier institution (existing departments and structures); sustainability (resources, transfer)
The effect so far of the good practice (at a certain time):
A questionnaire administered to participants of the workshops with specialists (response n=41) shows that knowledge about health promotion was increased in all thematic areas (what is health, family life, children’s health etc.). The participants’ volition to change was increased after the workshops as well as their willingness to learn.
The impact was further measured in a qualitative evaluation. The health workshops led to: deep conversations, participants having their first contact to Austrian women, empowerment, reducing social isolation, getting to know the place they live in etc. Participants responded well to the work of the health tutors, in many cases klose-knit, trusted relationships were built between the tutors and the participants. The tutors felt their work was meaningful and reported changes in health-related behaviour of the participants, i.e. in regard to diet and style of cooking. The participants also socialised with specialists and other external actors during workshops.
In some groups, participants were able to improve their German skills, which in turn facilitates social inclusion.
While the project has been successful in almost reaching the numbers of participants envisioned in the application, health tutors report difficulties in ensuring regular participation of group members. The tutors have to spend a lot of time on ensuring participation, calling the participants, reminding and motivating them. This contributes to an overextension of the health tutors. Aside from their main work (recruiting, leading the meetings and documenting the activities), they have to spend a lot of time on auxiliary activities (i.e. being invited by partipants and returning the invitation, doing tasks for them, translating).
Many of the targeted women have little German skills or are illiterate. Thus, it does not suffice to make available information material in multiple languages. Especially when it concerns delicate health matters, the women are very thankful to have confidantes, like the health tutors, accompanying them to see a doctor. Otherwise they remain dependent on their children’s help when seeking medical attention.
Some of the participants hardly ever leave their immediate residential area on their own. Thus, they are being picked-up at a meeting place near their homes by their health tutors and accompanied to the group meetings, excursions etc. Afterwards, they are brought back to this meeting place. After a while it is more likely for the participants to leave their immediate living areas on their own.
The tutors are met with high expectations on the side of the participants which leads to a very high personal involvement of the health tutors. A need for professional boundary drawing and professional support for the tutors has been identified to strengthen them in doing their work. Yet, their personal engagement and the forging of trusted relationships by spending so much time and effort seems to be key for the success of their work.
The integration of the project into the carrier institution has taken place to a medium extent only. Its sustainability hinges on the health tutors, who are the ones working with the participants, generating knowledge and know-how.
Impact and effective mechanisms:
Effective mechanisms supporting the achievement of results and effect:
The work of the health tutors (migrants themselves), who are very engaged and spend a lot of time building trusted relationships with the participants, is the core element ensuring the success of the practice. Building up trust with the group members is an essential foundation for starting processes of learning, behaviour change and participant empowerment. The work of the health tutors is based on a training (on how to work, what to expect, how to handle difficulties), but also requires on-going guidance and supervision.
The availability of the target group was important for the possibility of transfering the predecessor pilot to a new region (and ideally spreading it further). Yet the project experiences show that in different places different strategies of reaching the target group and recruiting participants may work. In some cases it was successful to work with community gate-keepers and approach existing groups of women. In other cases personal contacts of the health tutors, who are members of the communities themselves, proved more successful. In most cases word of mouth and trying to reach potential participants in their home, by phoning them, was an important means of reaching the target group. Thus, trying out different recruiting strategies and adapting them to the community at hand was core for successfully building lasting participant groups.
Lastly, not having to develop all the material within the project, but being able to use existing resources contributed to the project’s success.
Awareness points by transfer:
Awareness points may include:
- Institutional framework/funding
- Strategies of recruiting/reaching the target group
- Availability of project material
- Training of health tutors
- Support for health tutors
- How to create sustainability?
Factors that especially contributed to the success of this practice:
- Health tutors’ familiarity with residential area of participants to make regional or local transfer
- Participants living close by
- Spending time on building trust
- Existing infrastructure
- Gate-keepers or existing previous relationships between health tutors and participants
- Fixed group of participants; little efforts for health tutors ensuring participation
- Support for health tutors: how to organise the beginning of meetings; what to do when participants stop showing up; how to deal with overly high expectations etc.