Health literacy among refugees in Sweden – a cross-sectional study

BMC Public Health

Ragnar Westerling¹  Lena Mårtensson²  Per Lytsy¹  Josefin Wångdahl¹ 

[1] Social Medicine, Department of Public Health and Caring Science, Uppsala University, Box 564, 751 22 Uppsala, Sweden;Institute of Neuroscience and Physiology/Occupational Therapy, University of Gothenburg, Box 455, SE 405 30 Göteborg, Sweden

关键词: HLS-EU-Q16;    S-FHL;    Sweden;    Health promotion;    Refugees;    Health literacy;   

Others  :  1126402
DOI  :  10.1186/1471-2458-14-1030

 received in 2013-12-17, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

Refugees have poorer health compared to indigenous populations, which may be explained by lower health literacy, i.e. not being able to access, understand, appraise or apply health information. This study aims to determine levels of functional and comprehensive health literacy, and factors associated with inadequate health literacy, in refugees coming to Sweden.

Method

A cross-sectional study was performed among 455 adult refugees speaking Arabic, Dari, Somali or English. Participants in 16 strategically selected language schools for immigrants responded to a questionnaire. Health literacy was measured using the Swedish Functional Health Literacy Scale and the HLS-EU-Q16 questionnaire. Uni- and multivariate statistical methods were used to investigate group differences.

Results

The majority of the participating refugees had inadequate or limited functional health literacy and comprehensive health literacy. About 60% of them had inadequate functional health literacy and 27% had inadequate comprehensive health literacy. Low education and/or being born in Somalia were factors associated with an increased risk of having inadequate functional health literacy. Having inadequate functional health literacy was associated with an increased risk of having inadequate comprehensive health literacy.

Conclusions

The majority of refugees in the language schools had limited or poor health literacy. Health literacy should be taken into consideration in contexts and in activities addressing migrants. More research is needed to better understand health literacy among refugees and to develop strategies and methods to increase health literacy and make life easier for those with low health literacy.

【 授权许可】

   
2014 Wångdahl et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]The United Nations Refugee Agency, Malaysia: Frequently asked questions (FAQs). [http://www.unhcr.org.my/Resources-@-Frequently_Asked_Questions(FAQs).aspx webcite]
• [2]The United Nations Refugee Agency: UNHCR statistical yearbook 2011, 11th edition. [http://www.unhcr.org/516282cf5.html webcite]
• [3]Migrationsverket: Asylsökande 2012 [Swedish Migration board: Asylum seeker 2012] [http://www.migrationsverket.se/info/5646.html webcite]
• [4]McKay L, Macintyre S, Ellaway A: Migration and Health: A Review of the International Literature. Glasgow: Medical and Public Helath Science Unit; 2003.
• [5]Mladovsky P: Migration and Health in the EU. London: Employment, Social Affairs and Equal Opportunities; 2007.
• [6]Socialstyrelsen: Folkhälsorapport 2009. [The National Board of Health and Welfare: The Swedish Public Health Report 2009] [http://sjp.sagepub.com/content/40/9_suppl.toc webcite]
• [7]Kreps GL, Sparks L: Meeting the health literacy needs of immigrant populations. Patient Educ Couns 2008, 71(3):328-332.
• [8]Eckstein B: Primary care for refugees. Am Fam Phys 2011, 83(4):429-436.
• [9]Gerritsen AA, Bramsen I, Deville W, van Willigen LH, Hovens JE, van der Ploeg HM: Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 2006, 41(1):18-26.
• [10]Hollander A-C: Social Inequalities in Mental Health and Mortality Among Refugees and Other Immigrants to Sweden. Stockholm: Karolinska Institutet; 2013. [PhD Thesis]
• [11]Davies A, Basten A, Frattini C: Migration: A Social Determinant of the Health of Migrants. Geneva: International Organization for Migration; 2006.
• [12]Commission on Social Determinants of Health: “Closing the gap in a Generation: Health Equity Action on the Social Determinants of Health” Final Report of the Commission on the Social Determinants of Health. Geneva: World Health Organization; 2008.
• [13]Ingleby D: Acquiring health literacy as a moral task. Int J Migration Health Soc Care 2012, 8(1):22-31.
• [14]Hjelm K, Bard K, Nyberg P, Apelqvist J: Religious and cultural distance in beliefs about health and illness in women with diabetes mellitus of different origin living in Sweden. Int J Nurs Stud 2003, 40(6):627-643.
• [15]Young N, Mortensen A: Refugees and asylum seekers: implications for ED care in Auckland, New Zealand. J Emerg Nurs 2003, 29(4):337-341.
• [16]Smith LS: Health of America's newcomers. J Community Health Nurs 2001, 18(1):53-68.
• [17]Gerritsen AA, Bramsen I, Deville W, van Willigen LH, Hovens JE, van der Ploeg HM: Use of health care services by Afghan, Iranian, and Somali refugees and asylum seekers living in The Netherlands. Eur J Public Health 2006, 16(4):394-399.
• [18]Kickbusch IS: Health literacy: addressing the health and education divide. Health Promot Int 2001, 16(3):289-297.
• [19]Nutbeam D: Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 2000, 15(3):259-267.
• [20]Hill L: Health literacy is a social justice issue that affects us all. Adult Learning 2007, 15:4-6.
• [21]Nutbeam D: The evolving concept of health literacy. Soc Sci Med 2008, 67(12):2072-2078.
• [22]Rowlands G: Health literacy and public health: a framework for developing skills and empowering citizens. Perspect Public Health 2012, 132(1):23-24.
• [23]Sorensen K, Broucke SV, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H, Hls-Eu Consortium EH: Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 2012, 12(1):80. BioMed Central Full Text
• [24]Ishikawa H, Kiuchi T: Health literacy and health communication. Biopsychosoc Med 2010, 4:18. BioMed Central Full Text
• [25]Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K: Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 2011, 155(2):97-107.
• [26]Easton P, Entwistle VA, Williams B: Health in the 'hidden population' of people with low literacy. A systematic review of the literature. BMC Public Health 2010, 10:459.
• [27]Bevelander P: In the Picture - Resettled Refugees in Sweden. In Resettled and Included? The Employment Integration of Resettled Refugees in Sweden. Edited by Bevelander P, Hagström M, Rönnqvist S. Malmö: Malmö University; 2009. [http://www.mah.se/upload/Forskningscentrum/MIM/MIM/Resettled%20and%20Included%20MUEP.pdf webcite]
• [28]Taguma M, Moonhee K, Brink S, Teltemann J: OECD Reviews of Migrant Education Sweden. France: Organisation for economic co-operation and development (OECD); 2010. [http://www.oecd.org/sweden/44862803.pdf webcite]
• [29]HLS-EU consortium: Comparative report on health literacy in eight EU member states. The European health literacy survey HLS-EU. [http://www.healthliteracy.ie/wp-content/uploads/2012/09/HLS-EU_report_Final_April_2012.pdf webcite]
• [30]NG E, Walter Rasugu Ombaria D: Health literacy and immigrants in Canada: determinants and effects on health outcomes. [http://www.ccl-cca.ca/pdfs/OtherReports/NgOmaribaHealthLiteracyImmigrantsFullReport.pdf webcite]
• [31]Morrison AK, Myrvik MP, Brousseau DC, Hoffmann RG, Stanley RM: The relationship between parent health literacy and pediatric emergency department utilization: a systematic review. Acad Pediatr 2013, 13(5):421-429.
• [32]Herndon JB, Chaney M, Carden D: Health literacy and emergency department outcomes: a systematic review. Ann Emerg Med 2011, 57(4):334-345.
• [33]Sanders LM, Federico S, Klass P, Abrams MA, Dreyer B: Literacy and child health: a systematic review. Arch Pediatr Adolesc Med 2009, 163(2):131-140.
• [34]Geltman PL, Hunter Adams J, Penrose KL, Cochran J, Rybin D, Doros G, Henshaw M, Paasche-Orlow M: Health literacy, acculturation, and the use of preventive oral health care by Somali refugees living in Massachusetts. J Immigr Minor Health 2013.
• [35]Rudd R, Kirsch I, Yamamoto K: Literacy and Health in America. Princeton, N.J: Policy Information center, Education testing service; 2004.
• [36]Sentell T, Braun KL: Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. J Health Commun 2012, 17(Suppl 3):82-99.
• [37]Pleasent A: Health Literacy Around the World: Part 1 Health Literacy Efforts outside of United States. Tucson: The Institute of Medicine, Round Table of Health Literacy; 2012.
• [38]Kondilis BK, Kiriaze IJ, Athanasoulia AP, Falagas ME: Mapping health literacy research in the European Union: a bibliometric analysis. PLoS One 2008, 3(6):e2519.
• [39]Sorensen K: Health Literacy: The Neglected European Health Literacy Disparity. Maastricht: Maastricht University; 2013.
• [40]Mårtensson L, Hensing G: Health literacy - a heterogeneous phenomenon: a literature review. Scand J Caring Sci 2012, 26(1):151-160.
• [41]Guillemin F, Bombardier C, Beaton D: Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 1993, 46(12):1417-1432.
• [42]Lecerof SS, Westerling R, Moghaddassi M, Ostergren PO: Health information for migrants: the role of educational level in prevention of overweight. Scand J Public Health 2011, 39(2):172-178.
• [43]Folkhälsomyndigheten: Syfte och Bakgrund Till Frågorna i Nationella Folkhälsoenkäten - Hälsa på Lika Villkor. Stockholm; 2014. [Public Health Agency of Sweden: Purpose and background to the questions in the national survey of health and living conditions in Sweden 2012 - Health on equal terms]
• [44]Daryani A: Olika Villkor - Olika hälsa. Hälsan bland irakier folkbokförda i Malmö 2005–2007. Malmö: Malmö Institute for Studies of Migration, Diversity and Welfare; 2010. [Different conditions – Various Health. Health among Iraqis registered in Malmö 2005–2007]
• [45]Wångdahl JM, Mårtensson LI: Measuring health literacy - the Swedish functional health literacy scale. Scand J Caring Sci 2014. doi:10:111/scs.12125 [Epub ahead of print]
• [46]Mancuso JM: Assessment and measurement of health literacy: an integrative review of the literature. Nurs Health Sci 2009, 11(1):77-89.
• [47]Röthlin F, Pelikan JM, Ganahl K: Die Gesundheitskompetenz der 15-jährigen Jugendlichen in Österreich. Abschlussbericht der österreichischen Gesundheitskompetenz Jugendstudie im Auftrag des Hauptverbands der österreichischen Sozialversicherungsträger (HVSV). Wien: Ludwig Boltzmann Institut Health Promotion Research; 2013. [Health Literacy of 15 year old adolescents in Austria. Final report of the Austrian Health Literacy youth study contracted by the Federation of Austrian Social Insurance Institutions (HVSV)]
• [48]Carlin JB, Wolfe R, Coffey C, Patton GC: Analysis of binary outcomes in longitudinal studies using weighted estimating equations and discrete-time survival methods: prevalence and incidence of smoking in an adolescent cohort. Stat Med 1999, 18(19):2655-2679.
• [49]Kennerberg L: Hur försörjer sig nyanlända invandrare som inte deltar i SFI? Rapport 2009:9. Uppsala; 2009. [Institutet för arbetsmarknads- och utbildningspolitisk utvärdering] [How do newly arrive refugees not participating in SFI, earning a living? Report 2009:9.The institute for Evaluation of Labour and Education] [http://www.ifau.se/upload/pdf/se/2009/r09-09.pdf webcite]
• [50]Eriksson-Sjöö T, Ekblad S: FoU Rapport 2009:5. Stress, sömn och livskvalitét. En studie bland flyktingar i SFI-utbildning, lärare och handläggare i Fosie stadsdel, Malmö. [Malmö; 2009 [Report on Research and Education 2009:5. Stress, sleep and quallity of life. A study among refugess in SFI education, teachers and administrators in Fosie a municipality in Malmö] [http://dspace.mah.se/bitstream/handle/2043/9219/Omslag%20FoU%202009.5.pdf?sequence=1 webcite]
• [51]Shaw SJ, Armin J, Torres CH, Orzech KM, Vivian J: Chronic disease self-management and health literacy in four ethnic groups. J Health Commun 2012, 17(Suppl 3):67-81.
• [52]Coffman JM, Norton CK: Demands of immigration, health literacy, and depression in recent Latino immigrants. Home Health Care Manage Pract 2010, 22(2):116-122.
• [53]Olden A: Somali refugees in London: oral culture in a western information society. Int J Libraries Info Services 1999, 49:212-224.
• [54]Schouten BC, Meeuwesen L: Cultural differences in medical communication: a review of the literature. Patient Educ Couns 2006, 64(1–3):21-34.
• [55]Svennberg K: Mötet mellan patienten och läkaren: Erfarenheter hos Somaliska flyktingar och läkare under utbildning [The meeting between the patient and the doctor: Experiences among Somali refugees and doctors in training]. Gothenburg: Gothenburg University, The Sahlgrenska Academy, Institute of Health and Care Sciences; 2011. [PhD Thesis]
• [56]Eurostat: News release 98/2014. Asylum decisions in the EU28. [http://europa.eu/rapid/press-release_STAT-14-98_en.htm webcite]