Janßen Christian, Sauter Stefanie, Kowalski Christoph
Department of Applied Social Sciences, Munich University of Applied Sciences, Munich, Germany.
Psychosoc Med. 2012;9:Doc07. doi: 10.3205/psm000085. Epub 2012 Oct 25.
The following analysis aims to determine whether differences in the use of prevention and health promotion services in Germany can be attributed to health inequality between different social status groups measured by education, occupation and income and where certain improvements can be made in health promotion and prevention efforts and research to reduce those differences.
A systematic literature search was conducted using MedPilot to identify relevant articles published between 1998 and 2010 in the Medline, Medizinische Gesundheit, CC Med, Deutsches Ärzteblatt and Sozialmedizin (SOMED) databases, the Hogrefe, Karger, Krause and Pachermegg and Thieme publisher databases, the Cochrane Database of Systematic Reviews (CDSR), the Cochrane Database of Abstracts of Reviews of Effectiveness (DARE), and the Cochrane Central Register of Controlled Trials.
A total of 23 empirical studies on the topic of "prevention, health prevention and social inequality" met the criteria for inclusion in the review. 20 of the 23 reviewed studies provided relatively clear evidence of a significant association between higher social status and greater use of prevention and health promotion services. According to the reviewed studies, gender tends to have a greater effect on the use of prevention and health promotion services than characteristics of vertical social inequality. No studies were found dealing with tertiary prevention or using qualitative methods to explore their research questions.
Overall, the review shows that there is sufficient evidence for the relationship between social status and the use of prevention and health promotion services and that this association is both significant and relevant. There are, however, a few "blind spots" in research on this topic, such as a lack of studies on tertiary prevention, especially with regards to prevention and health promotion services use among men, as well as general studies on health promotion among men and women. There is also a lack of published intervention studies demonstrating how to better reach the socially disadvantaged.
以下分析旨在确定德国预防和健康促进服务使用方面的差异是否可归因于以教育、职业和收入衡量的不同社会地位群体之间的健康不平等，以及在健康促进、预防工作和研究中可以在哪些方面做出某些改进以减少这些差异。
使用MedPilot进行系统的文献检索，以识别1998年至2010年间发表在Medline、Medizinische Gesundheit、CC Med、Deutsches Ärzteblatt和Sozialmedizin（SOMED）数据库、Hogrefe、Karger、Krause和Pachermegg以及Thieme出版商数据库、Cochrane系统评价数据库（CDSR）、Cochrane有效性评价摘要数据库（DARE）和Cochrane对照试验中心注册库中的相关文章。
共有23项关于“预防、健康预防与社会不平等”主题的实证研究符合纳入该综述的标准。23项综述研究中的20项提供了相对明确的证据，表明较高的社会地位与更多地使用预防和健康促进服务之间存在显著关联。根据综述研究，性别对预防和健康促进服务使用的影响往往大于纵向社会不平等特征的影响。未发现涉及三级预防或使用定性方法探索其研究问题的研究。
总体而言，该综述表明，有充分证据证明社会地位与预防和健康促进服务使用之间的关系，且这种关联既显著又相关。然而，该主题的研究存在一些“盲点”，例如缺乏关于三级预防的研究，特别是关于男性预防和健康促进服务使用情况的研究，以及关于男性和女性健康促进的一般研究。也缺乏已发表的干预研究来证明如何更好地覆盖社会弱势群体。
