Papers by Christopher Kofahl
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
Zusammenfassung Hintergrund Mundgesundheit ist ein wesentlicher Bestandteil der allgemeinen Gesun... more Zusammenfassung Hintergrund Mundgesundheit ist ein wesentlicher Bestandteil der allgemeinen Gesundheit und des Wohlbefindens. Sie wird von vielen Faktoren beeinflusst. Dazu zählen insbesondere individuelle Aspekte wie Mundgesundheitskompetenz und -verhalten. Ziel der Studie war die Bestimmung des konkreten Zusammenhangs zwischen Mundgesundheitskompetenz und -verhalten mit physischer Mundgesundheit. Methoden In dieser bevölkerungsbasierten Querschnittsstudie wurden Daten von insgesamt 5510 Personen, welche von 2016 bis 2018 in die Hamburg City Health Study (HCHS) eingeschlossen wurden, mit einem durchschnittlichen Alter von 62,1 Jahren und einem Frauenanteil von 50,7 % ausgewertet. Die physische Mundgesundheit wurde mit den 14 Items des Physical Oral Health Index (PhOX) erhoben. Zur Bestimmung von Mundgesundheitskompetenz und -verhalten wurde ein neu entwickelter Fragebogen mit 10 Aspekten basierend auf dem Oral Health Literacy Adult Questionnaire und der 5. Deutschen Mundgesundheits...
Gesundheitswesen, Aug 1, 2022
Research Square (Research Square), Mar 31, 2022
BACKGROUND Studies in Germany have shown that susceptible groups, such as people with a migration... more BACKGROUND Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app. OBJECTIVE This study aims to describe the development process of the MuMi app. METHODS For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation. RESULTS On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group. CONCLUSIONS The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background.
Health Expectations, Sep 21, 2022
BMC Public Health, Sep 2, 2022
Objective: Large-scale population-based studies regarding the role of education in periodontitis ... more Objective: Large-scale population-based studies regarding the role of education in periodontitis are lacking. Thus, the aim of the current study was to analyze the potential association between education and periodontitis with state of the art measured clinical phenotypes within a large population-based sample from northern Germany. Material & methods: The Hamburg City Health Study (HCHS) is a population-based cohort study registered at Clini-calTrial.gov (NCT03934957). Oral health was assessed via plaque-index, probing depth, gingival recession and gingival bleeding. Periodontitis was classified according to Eke & Page. Education level was determined using the International Standard Classification of Education (ISCED-97) further categorized in "low, medium or high" education. Analyses for descriptive models were stratified by periodontitis severity. Ordinal logistic regression models were stepwise constructed to test for hypotheses. Results: Within the first cohort of 10,000 participants, we identified 1,453 with none/mild, 3,580 with moderate, and 1,176 with severe periodontitis. Ordinal regression analyses adjusted for co-variables (age, sex, smoking, diabetes, hypertension and migration) showed that the education level (low vs. high) was significantly associated with periodontitis (OR: 1.33, 95% CI: 1.18;1.47). Conclusion: In conclusion, the current study revealed a significant association between the education level and periodontitis after adjustments for a set of confounders. Further research is needed to develop strategies to overcome education related deficits in oral and periodontal health.
Cancer Causes & Control, Jul 12, 2022
Purpose This study aims to introduce the development and psychometric properties of a brief gener... more Purpose This study aims to introduce the development and psychometric properties of a brief generic cancer knowledge scale for patients (BCKS-10) that includes different elements of knowledge and skills (terminology, diagnosis, treatment, prevention, and numeracy). Although cancer knowledge is a central dimension of cancer literacy, most previous studies either investigated cancer knowledge among the general population, or among patients with a specific cancer diagnosis. Methods Qualitative interviews (n = 11) and a quantitative survey (n = 267) among peer support group leaders were conducted to further develop the BCKS-10 after literature screening. n = 500 patients with cancer were recruited across Germany between October 2020 and February 2021. Construct validity, item discrimination and reliability were tested. Results ANOVA revealed no significant differences of the knowledge score between various cancer sites, a significant positive association with education, and a negative association with migration background by trend supporting construct validity. In terms of item discrimination, the corrected item-total correlation of 8 out of 10 items were above the threshold of 0.3. Cronbach's alpha of about 0.68 revealed an acceptable internal consistency as the tool is brief and consists of different dimensions. Conclusion Overall, the findings show that the BCKS-10 is a suitable tool to briefly assess cancer knowledge among patients independent of cancer site. However, further surveys have to be conducted to validate the psychometric properties and enhance the BCKS-10.
Aging Clinical and Experimental Research, Apr 9, 2020
Background There is a lack of studies investigating the impact of postponed dental visits due to ... more Background There is a lack of studies investigating the impact of postponed dental visits due to financial constraints on quality of life. Aims The aim of this study was to identify whether these factors are associated longitudinally. Methods Data were derived from waves 5 and 6 of the "Survey of Health Ageing and Retirement in Europe" (SHARE). The analysis focused on Germany (n = 7506). The widely used CASP-12 was used to quantify the quality of life. Postponed dental visits for financial reasons in the preceding 12 months (no, yes) were used as the main explanatory variable. Socioeconomic and health-related covariates were included in regression analysis. Results Gender stratified regression analysis showed that quality of life decreased with the presence of postponed dental visits due to financial reasons in men. Furthermore, quality of life decreased with the worsening of self-rated health in both men and women. The outcome measure was not associated with age, marital status, income, and chronic diseases in both sexes. Discussion Study findings suggest that postponing dental visits due to financial constraints contributes to a decreased quality of life among older men. Conclusion Efforts to avoid these circumstances might help to maintain the quality of life in older men.
Quality of Life Research, Jun 13, 2018
Background: Rare diseases affecting the teeth, the oral cavity and the face are numerous, each of... more Background: Rare diseases affecting the teeth, the oral cavity and the face are numerous, each of them present specific characteristics, and is a lifelong condition. The aim of the study was to assess the association between Oral health-related quality of life (OHRQoL), and demographic characteristics, clinical and dental factors, and psycho-social characteristics to investigate that oral symptoms are not the main factors underlying a decrease in OHRQoL. Material and methods: We conducted a national cohort study in French centres for rare diseases (RD) specialized in orofacial diseases. The inclusion criteria were: to have received care in RD centres over the last 5 years (2012-2017) and to have been between 6 and 17 years of age on September 1, 2017. Patients were invited to answer a questionnaire composed of socio-demographic, clinical and dental questions, psychosocial questions and then fill in the Child-OIDP Index. At the end of the questionnaire, a free space was left for the patient to add a verbatim comment to provide qualitative data. Thematic analysis was used to analyze the verbatim answers. Results: Complete data were available for 110 patients. The sample included 44.5% boys and 55.5% girls. Ages ranged from 6 to 17 years old and 68.2% were between 6 to 12 years old and 31.8% were between 13 and 17 years old. Factor associated with a lower OHRQoL were: being a girl (p = 0.03), renouncement to dental care for financial reasons (p = 0.01), having syndromic disease (p = 0.01), having a problem with tooth shape and color (p = 0.03), feeling isolated, alone and different from other children (p = 0.003 and p = 0.02). Qualitative analysis highlighted very little recourse to psychological care and patients reported great anxiety and fear about the future. Conclusion: OHRQoL of children suffering from these diseases is impaired, especially from the psychosocial point of view but also from that of the course of treatment and access to care. There is a need to improve the legibility of care pathways and the financial coverage of treatments.
Acta Neurologica Scandinavica, Oct 3, 2017
The importance of health‐related quality of life (HRQoL) in multiple sclerosis (MS) is widely ack... more The importance of health‐related quality of life (HRQoL) in multiple sclerosis (MS) is widely acknowledged. In 2015, a multicenter study was launched to assess the HRQoL and coping styles of chronically ill persons in Germany. The aims of this paper were (i) to describe how persons affected by MS assess their HRQoL and (ii) find out sociodemographic and disease‐specific determinants of HRQoL.
BMC Health Services Research, Aug 20, 2019
Background: The first aim was to present descriptive data on the frequency of dental visits among... more Background: The first aim was to present descriptive data on the frequency of dental visits among older adults in Germany. The second aim was to identify the determinants of the number of dental visits using a longitudinal approach. Methods: Longitudinal data were derived from the German Ageing Survey, which is a nationally representative sample of community-dwelling individuals ≥40 years in Germany. The frequency of dental visits in the past 12 months was recorded in the years 2002, 2008 and 2011. In order to control for time-constant unobserved heterogeneity, Poisson fixed effects regressions were used. Results: While the mean number of dental visits was 2.3 (SD: 2.0) in 2002, it was 2.0 (SD: 1.7) in 2008 and 2.1 (SD: 1.7) in 2011. The frequency of dental visits declined with age (total sample and women), transitions from normal weight to overweight (total sample), changes from divorced/widowed/single/married, living separated from spouse to 'married, living together with spouse' in women and with a decrease in the number of physical illnesses (total sample and men). Conclusions: The frequency of dental visits declines with age in older adults. While some of the determinants of frequency are non-modifiable (e.g., ageing and worsening of general health), others are modifiable (e.g., change in weight category).
Social Psychiatry and Psychiatric Epidemiology, Jan 8, 2013
It has been assumed that biogenetic causal models may improve public attitudes toward people with... more It has been assumed that biogenetic causal models may improve public attitudes toward people with mental illnesses. The present study examines whether biogenetic attributions are positively associated with acceptance of people suffering from these disorders. Population surveys were conducted in two large German cities. Respondents were presented with a vignette depicting a young female suffering from either anorexia nervosa (N = 680) or bulimia nervosa (N = 667), followed by a fully structured interview including questions on causal attributions, emotional reactions and desire for social distance. Attribution to hereditary factors showed hardly any relationship with attitudes toward people with symptoms of eating disorders. Respondents who endorsed brain disease as a cause tended more to hold those afflicted responsible for their condition, they also expressed more negative emotions and a stronger preference for social distance. Our results do not support the notion that promulgating biogenetic causal models of eating disorders helps decrease the stigma surrounding these illnesses; it may even entail the risk of increasing it.
Springer Reference Pflege, Therapie, Gesundheit, 2023
Digital health, 2022
Background Nowadays, much hope and expectations are associated with digitization in the health se... more Background Nowadays, much hope and expectations are associated with digitization in the health sector. The digital change also affects health-related self-help. A nationwide survey of self-help organizations (SHOs) aimed to show chances and limitations in the use of interactive IT tools like webforums, online meetings or social media as well as digital infrastructures for their organizational management. In this survey, we also determined whether SHO staff themselves have support and qualification needs with regard to this topic. Design The online survey was conducted between 14 November and 8 December 2019, i.e., immediately before the outbreak of the Covid-19 pandemic. The questionnaire consisted of 50 questions consisting of 180 single items which could be answered in 30–40 min. After two reminder letters, 119 questionnaires of the SHOs were gathered and analysed. Results SHOs already have a lot of experience with digital media/tools (e.g., own homepage, social media, cloud computing). Some tools are attested a “high” or “very high” benefit by more than 80% of users. Perceived benefits, however, are also facing a number of problems, ranging from lack of resources to data protection issues. Despite, or even because of the limits of digitization, there is great desire and need for support and further training in SHOs (and self-help groups). Conclusions At many points in the survey it was shown that digital media can be a useful extension of “traditional” collective self-help. Taking into account the risks and limitations associated with digital tools, SHOs can be central stakeholders in digitization in health-related self-help. Patient or Public Contribution The study was financially supported by the Federal Ministry of Health, Germany. A detailed representation of the results is publicly available at: https://www.uke.de/dish .
Zeitschrift Fur Gerontologie Und Geriatrie, Jul 14, 2021
BMC Health Services Research, Jun 11, 2022
Background: Managing multiple sclerosis (MS) includes different treatment approaches. Rehabilitat... more Background: Managing multiple sclerosis (MS) includes different treatment approaches. Rehabilitation is a key strategy in MS for improving functioning, activity and participation. As part of a larger study on overall patient experiences with different treatment approaches, this study aims to give an overview of different patients' experiences and perspectives on inpatient rehabilitation in MS. Methods: We conducted problem-centered interviews in 50 persons with MS in Germany, of whom most had relapsing-remitting MS. We used the maximum variation sampling method during recruitment. Data were analyzed thematically. Results: As a result of the analysis, three major themes were identified: 1) factors contributing to the decision-making concerning rehabilitation, 2) experience with the rehabilitation setting, 3) benefits of rehabilitation treatments. The treating physicians' attitude had a major impact on the decision to either opt for rehabilitation or not. Setting goals prior to rehabilitation was given a high priority. Exchanging experiences with other persons with MS presented a major benefit from rehabilitation while for some being separated from regular daily life resulted in a more ambiguous attitude ranging from appreciation of escaping daily hassles to substantial behavioral change management. Conclusion: Patients reported various experiences in the process of decision-making with regard to rehabilitation. Physicians´ advice, goal setting and the selection of the most suitable rehabilitation clinic were considered most relevant.
Prävention Und Gesundheitsförderung, Nov 3, 2021
PLOS ONE
Background Persons with Multiple Sclerosis (pwMS) follow individual strategies to cope with this ... more Background Persons with Multiple Sclerosis (pwMS) follow individual strategies to cope with this highly heterogeneous disease. As surveys show, lifestyle habits play an important role in pwMS. However, little is known about individual experiences of pwMS with different lifestyle adjustment strategies. Objective This study aims to describe and understand individual experiences of pwMS with lifestyle adjustments. Methods Semi-structured interviews were conducted with 50 pwMS in Germany. Criteria for inclusion were age ≥ 18 years and a diagnosis of relapsing-remitting Multiple Sclerosis. Data were analyzed inductively and deductively according to a six-step thematic analysis. Results The three main themes for experience-based lifestyle adjustments were: 1) nutrition and supplements, 2) exercise and physical activity, and 3) stress management. Influencing factors on the decision-making process such as active disease management, information and advice, desire for mental health and social...
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Papers by Christopher Kofahl