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Health literacy among newly arrived refugees in Sweden and implications for health and healthcare
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to examine the distribution of health literacy (HL) levels in newly arrived Arabic-, Dari-, or Somali-speaking refugees in Sweden. Further aims were to investigate sociodemographic characteristics associated with inadequate HL in this group, and to investigate whether HL levels are associated with experiences of the health examination for asylum seekers (HEA), health seeking behaviour and health.

Three quantitative cross-sectional studies, using data from two different surveys, were conducted among Arabic-, Dari-, and Somali-speaking, newly arrived refugees taking part in courses in Swedish for immigrants or civic orientation. In addition, an explorative qualitative study, based on focus group discussions, was performed on Arabic- and Somali-speaking newly arrived refugees who had taken part in an HEA. All data were collected 2013-2016. The quantitative data were analysed using different statistical methods, foremost descriptive statistics and univariate and multivariate binary logistic regression analyses. The qualitative data were analysed using Graneheim and Lundman’s method for latent content analysis.

The main findings were that the majority of Arabic-, Dari-, or Somali-speaking refugees in Sweden have limited functional health literacy (FHL) and/or limited comprehensive health literacy (CHL). Having a low education level and/or being born in Somalia were associated with having inadequate FHL, but not with having inadequate CHL. Limited FHL was associated with inadequate CHL. Experiences of poor quality of communication and having benefited little from the HEA were more common among those with limited CHL, as compared to those with higher CHL. Experiences of communication problems and a lack of information related to the HEA were found in the qualitative studies as well. In addition, it was more common that those with limited CHL reported poor general health and impaired psychological well-being, and that they had refrained from seeking healthcare.

In conclusion: limited HL is common among newly arrived refugees in Sweden and seems to be of importance for the experience of the HEA, health-seeking behaviour and health. HL needs to be taken into consideration in the work with refugees in order to increase equity in healthcare and health. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , p. 102
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1397
Keyword [en]
Health literacy, S-FHL, HLS-EU-Q16, Asylum seeker, Migrant, Immigrant, Experiences, Health check-up, Communication, Information, Self-perceived health, Mental health, Health-seeking behaviour, Refrained from healthcare, Screening, Disease prevention, Health promotion, Quality of care, Equity in health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
URN: urn:nbn:se:uu:diva-333427ISBN: 978-91-513-0159-4 (print)OAI: oai:DiVA.org:uu-333427DiVA, id: diva2:1158668
Public defence
2018-01-10, Polhemssalen, Ångströmlaboratoriet, Lägerhyddsvägen 1, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-12-20 Created: 2017-11-20 Last updated: 2018-03-08
List of papers
1. Health literacy among refugees in Sweden: a cross-sectional study
Open this publication in new window or tab >>Health literacy among refugees in Sweden: a cross-sectional study
2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, no 1, p. 1030-Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Hälsolitteracitet, migration, hälsa
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-234032 (URN)10.1186/1471-2458-14-1030 (DOI)000343284400001 ()25278109 (PubMedID)
Available from: 2014-10-13 Created: 2014-10-13 Last updated: 2017-12-05Bibliographically approved
2. Health literacy and refugees' experiences of the health examination for asylum seekers: a Swedish cross-sectional study
Open this publication in new window or tab >>Health literacy and refugees' experiences of the health examination for asylum seekers: a Swedish cross-sectional study
2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 1162Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The purpose of the health examination for asylum seekers in most countries is to identify poor health in order to secure the well-being of seekers of asylum and to guarantee the safety of the population in the host country. Functional health literacy is an individual's ability to read information and instructions about health and to function effectively as a patient in the health system, and comprehensive health literacy is an individual's competence in accessing, understanding, appraising and applying health information. Little is known about refugees' health literacy and their experiences of the health examination for asylum seekers. The purposes of the study were to investigate refugees' experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and whether health literacy is associated with those experiences.

METHODS: A cross-sectional study was made among 360 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional Health Literacy Scale and the short European Health Literacy Questionnaire. Experiences of communication and the usefulness of the health examination were measured in several questions. Associations were sought using univariate and multivariate statistical models.

RESULTS: In the health examination for asylum seekers, a poor quality of communication was experienced by 36 %, receiving little information about health care by 55 %, and receiving little new knowledge by 41 % and/or help by 26 %. Having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of a poorer quality of communication (OR: 9.64, CI 95 %: 3.25-28.58) and the experience of receiving little valuable health care information (OR: 6.54, CI 95 %: 2.45-17.47). Furthermore, having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of not receiving new knowledge (OR: 7.94, CI 95 %: 3.00-21.06) or receiving help with health problems (OR: 8.07, 95 % CI: 2.50-26.07. Functional healthy literacy was not associated with experiences of HEA.

CONCLUSION: Refugees' experiences indicate that a low level of comprehensive health literacy can act as a barrier to fulfilling the purposes of the health examination for asylum seekers. Comprehensive health literacy seems to be of greater importance in that context than functional health literacy.

Keyword
Health literacy, Refugess, Health examination, Health promotion, Sweden, S-FHL, HLS-EU-Q16
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-268009 (URN)10.1186/s12889-015-2513-8 (DOI)000365311300008 ()26596793 (PubMedID)
Funder
Public Health Agency of Sweden
Available from: 2015-12-01 Created: 2015-12-01 Last updated: 2017-12-01Bibliographically approved
3. Experiences of the Health Examination for Asylum Seekers: Focus Group Discussions with Arabic and Somali Speaking Refugees in Sweden
Open this publication in new window or tab >>Experiences of the Health Examination for Asylum Seekers: Focus Group Discussions with Arabic and Somali Speaking Refugees in Sweden
(English)In: Article in journal (Refereed) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine; Social Medicine
Identifiers
urn:nbn:se:uu:diva-333396 (URN)
Note

This work were supported by the European Refugee Fund (ERF), under Grant number E 85-292:51-211-12792, and Foundation Olle Engkvist Byggmästare.

Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-02-23
4. Poor health and refraining from seeking healthcare are associated with limited comprehensive health literacy among refugees: a Swedish cross-sectional study
Open this publication in new window or tab >>Poor health and refraining from seeking healthcare are associated with limited comprehensive health literacy among refugees: a Swedish cross-sectional study
2018 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: The objectives of the study were to explore the distributions of comprehensive health literacy (CHL), general health, psychological well-being and having refrained from seeking healthcare among refugees in Sweden. Further objectives were to examine associations between CHL and the above mentioned factors.

Methods: A cross-sectional study was conducted among 513 refugees speaking Arabic, Dari and Somali. Participants in the civic orientation course in Sweden responded to a questionnaire. CHL was measured using the HLS-EU-Q16 questionnaire. Uni- and multivariate logistic regression was used to investigate potential associations.

Results: The majority of the respondents had limited CHL, and about four of ten had reported poor health and/or having refrained from seeking healthcare. Limited CHL was associated with having reported poor health and having refrained from seeking healthcare. 

Conclusions: A considerable proportion of the refugees in Sweden have limited CHL, and report less than good health and impaired well-being, or that they have refrained from seeking healthcare. Further, CHL is associated with the above mentioned factors. Efforts are needed to promote refugees' CHL, optimal health seeking behavior, and health.

Keyword
health literacy, general health, psychological well-being, refrained from healthcare, refugees
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-333397 (URN)10.1007/s00038-017-1074-2 (DOI)
Note

The study was co-financed by the County Administrative Board in Stockholm.

Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-03-02Bibliographically approved

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