Top

International Journal of Public Health

Published in:

Open Access 01-04-2018 | Original Article

Poor health and refraining from seeking healthcare are associated with comprehensive health literacy among refugees: a Swedish cross-sectional study

Authors: Josefin Wångdahl, Per Lytsy, Lena Mårtensson, Ragnar Westerling

Published in: International Journal of Public Health | Issue 3/2018

Abstract

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. Furthermore, CHL is associated with the above-mentioned factors. Efforts are needed to promote refugees’ CHL, optimal health-seeking behavior, and health.

Available only for authorised users

Bowe A (2017) The cultural fairness of the 12-item General Health Questionnaire among diverse adolescents. Psychol Assess 29:87–97. https://doi.org/10.1037/pas0000323 CrossRefPubMed

Brach C, Keller D, Hernandez B, Bauer C, Parker R, Dreyer B, Schyve P, Lemerise JA, Schillinger D (2012) Ten attributes of Health Literate Health Care Organizations. Discussion Paper. Institute of Medicine, Washington (DC)

Carneiro IG, Rasmussen CD, Jorgensen MB, Flyvholm MA, Olesen K, Madeleine P, Ekner D, Sogaard K, Holtermann A (2013) The association between health and sickness absence among Danish and non-Western immigrant cleaners in Denmark. Int Arch Occup Environ Health 86:397–405. https://doi.org/10.1007/s00420-012-0773-5 CrossRefPubMed

Chandola T, Jenkinson C (2000) Validating self-rated health in different ethnic groups. Ethn Health 5:151–159. https://doi.org/10.1080/713667451 CrossRefPubMed

WHO Europe (2013) Health literacy—the solid facts. http://www.euro.who.int/__data/assets/pdf_file/0008/190655/e96854.pdf. Accessed 3 March 2017 2013

Eurostat Statistics Explained (2016) Minimum European Health Module (MEHM). http://ec.europa.eu/eurostat/statistics-explained/index.php/Glossary:Minimum_European_Health_Module_(MEHM). Accessed 14 September 2017

Gele AA, Pettersen KS, Torheim LE, Kumar B (2016) Health literacy: the missing link in improving the health of Somali immigrant women in Oslo. BMC Public Health 16:1134. https://doi.org/10.1186/s12889-016-3790-6 CrossRefPubMedPubMedCentral

Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 27:191–197CrossRefPubMed

Goldberg DP, Oldehinkel T, Ormel J (1998) Why GHQ threshold varies from one place to another. Psychol Med 28:915–921CrossRefPubMed

Guillemin F, Bombardier C, Beaton D (1993) Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46:1417–1432CrossRefPubMed

Hadgkiss EJ, Renzaho AM (2014) The physical health status, service utilisation and barriers to accessing care for asylum seekers residing in the community: a systematic review of the literature. Aust Health Rev 38:142–159. https://doi.org/10.1071/AH13113 PubMed

Ingleby D (2012) Acquiring health literacy as a moral task. Int J Migr Health Soc Care 8:22–31CrossRef

Jonzon R, Lindkvist P, Johansson E (2015) A state of limbo–in transition between two contexts: health assessments upon arrival in Sweden as perceived by former Eritrean asylum seekers. Scand J Public Health 43:548–558. https://doi.org/10.1177/1403494815576786 CrossRefPubMedPubMedCentral

Kimbrough Benneth J (2007) Health literacy as a contributor to immigrant health disparties. J Health Dispar Res Pract 1:93–106

Lecerof SS, Stafstrom M, Emmelin M, Westerling R, Ostergen PO (2017) Findings from a prospective cohort study evaluating the effects of International Health Advisors’ work on recently settled migrants’ health. BMC Public Health 17:369. https://doi.org/10.1186/s12889-017-4273-0 CrossRefPubMedPubMedCentral

Levin-Zamir D, Baron-Epel OB, Cohen V, Elhayany A (2016) The Association of Health Literacy with Health Behavior, Socioeconomic Indicators, and Self-Assessed Health From a National Adult Survey in Israel. J Health Commun 21:61–68. https://doi.org/10.1080/10810730.2016.1207115 CrossRefPubMed

Ng E, Omariba DWR (2014) Immigration, generational status and health literacy in Canada. Health Educ J 73:668–682CrossRef

Nielsen SS, Krasnik A (2010) Poorer self-perceived health among migrants and ethnic minorities versus the majority population in Europe: a systematic review. Int J Public Health 55:357–371. https://doi.org/10.1007/s00038-010-0145-4 CrossRefPubMed

Nutbeam D (2008) The evolving concept of health literacy. Soc Sci Med 67:2072–2078. https://doi.org/10.1016/j.socscimed.2008.09.050 (S0277-9536(08)00457-7 [pii]) CrossRefPubMed

Palumbo R, Annarumma C, Adinolfi P, Musella M, Piscopo G (2016) The Italian Health Literacy Project: insights from the assessment of health literacy skills in Italy. Health Policy 120:1087–1094. https://doi.org/10.1016/j.healthpol.2016.08.007 CrossRefPubMed

Pelikan J, Ganahl K (2017) Die europäische Gesundheitskompetenz-Studie Konzept, Instrument und ausgewählte Ergebnisse. [The European Health Literacy Study: concept, instrument and selected results]. In: Schaeffer D, Pelikan J (eds) Health Literacy Forschungsstand und Perspektiven. Hogrefe, Bern, pp 93–125

Roach KE (2001) A clinician’s guide to specification and sampling. J Orthop Sports Phys Ther 31:753–758. https://doi.org/10.2519/jospt.2001.31.12.753 CrossRefPubMed

Rowlands G, Shaw A, Jaswal S, Smith S, Harpham T (2017) Health literacy and the social determinants of health: a qualitative model from adult learners. Health Promot Int 32:130–138. https://doi.org/10.1093/heapro/dav093 PubMed

Sorensen K, Broucke SV, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H, HLS-EU Consortium EH (2012) Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 12:80. https://doi.org/10.1186/1471-2458-12-80 CrossRefPubMedPubMedCentral

Sorensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, Kondilis B, Stoffels V, Osborne RH, Brand H (2013) Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health 13:948. https://doi.org/10.1186/1471-2458-13-948 CrossRefPubMedPubMedCentral

Sorensen K, Pelikan JM, Rothlin F, Ganahl K, Slonska Z, Doyle G, Fullam J, Kondilis B, Agrafiotis D, Uiters E, Falcon M, Mensing M, Tchamov K, Broucke S, Brand H, Consortium H-E (2015) Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health 25:1053–1058. https://doi.org/10.1093/eurpub/ckv043 CrossRefPubMedPubMedCentral

Sun X, Shi Y, Zeng Q, Wang Y, Du W, Wei N, Xie R, Chang C (2013) Determinants of health literacy and health behavior regarding infectious respiratory diseases: a pathway model. BMC Public Health 13:261. https://doi.org/10.1186/1471-2458-13-261 CrossRefPubMedPubMedCentral

Suphanchaimat R, Kantamaturapoj K, Putthasri W, Prakongsai P (2015) Challenges in the provision of healthcare services for migrants: a systematic review through providers’ lens. BMC Health Serv Res 15:390. https://doi.org/10.1186/s12913-015-1065-z CrossRefPubMedPubMedCentral

The Public Health Agency of Sweden (2014) Syfte och bakgrund till frågorna i nationella folkhälsoenkäten—Hälsa på lika villkor [Purpose and background to questions in the national public health survey—Health on equ al terms]. https://www.folkhalsomyndigheten.se/globalassets/statistik-uppfoljning/enkaterundersokningar/nationella-folkhalsoenkaten/syfte-bakgrund-fragorna-hlv.pdf. Accessed 23 Feb 2018

Thomas F (2016) Handbook of migration and health. Cheltenham, United KingdomCrossRef

Tinghög P, Arwidsson C, Sigvardsotter E, Malm A, Saboonchi F (2016) Nyanlända och asylsökande i Sverige. En studie om psykisk ohälsa, trauma och levnadsvillkor. Röda korsets Högskolas rapportserie 20016:1 [New arrivals and asylum seekers in Sweden. A study of mental illness, trauma and living conditions. Red Cross University’s Report Serie 2016:1.]. Röda korsets högskola., Stockholm

UNHCR (2015) Global trends Forced displacement in 2015. http://www.unhcr.org/576408cd7.pdf. Accessed 8 December 2016

Wamala S, Merlo J, Bostrom G, Hogstedt C (2007) Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Commun Health 61:409–415. https://doi.org/10.1136/jech.2006.049999 CrossRef

Wångdahl J, Lytsy P, Mårtensson L, Westerling R (2014) Health literacy among refugees in Sweden—a cross-sectional study. BMC Public Health 14:1030. https://doi.org/10.1186/1471-2458-14-1030 CrossRefPubMedPubMedCentral

Wångdahl J, Lytsy P, Mårtensson L, Westerling R (2015) Health literacy and refugees’ experiences of the health examination for asylum seekers—a Swedish cross-sectional study. BMC Public Health 15:1162. https://doi.org/10.1186/s12889-015-2513-8 CrossRefPubMedPubMedCentral

Yaser A, Slewa-Younan S, Smith CA, Olson RE, Guajardo MG, Mond J (2016) Beliefs and knowledge about post-traumatic stress disorder amongst resettled Afghan refugees in Australia. Int J Ment Health Syst 10:31. https://doi.org/10.1186/s13033-016-0065-7 CrossRefPubMedPubMedCentral

Title: Poor health and refraining from seeking healthcare are associated with comprehensive health literacy among refugees: a Swedish cross-sectional study
Authors: Josefin Wångdahl
Per Lytsy
Lena Mårtensson
Ragnar Westerling
Publication date: 01-04-2018
Publisher: Springer International Publishing
Published in: International Journal of Public Health / Issue 3/2018
Print ISSN: 1661-8556
Electronic ISSN: 1661-8564
DOI: https://doi.org/10.1007/s00038-017-1074-2

At a glance: The STEP trials

Springer Medicine

Poor health and refraining from seeking healthcare are associated with comprehensive health literacy among refugees: a Swedish cross-sectional study

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Parental transmission of smoking among middle-aged and older populations in Russia and Belarus

Effect of the national screening program on malignancy status of cervical cancer in Northern Thailand

The contribution of behavioural and metabolic risk factors to socioeconomic inequalities in mortality: the Italian Longitudinal Study

Spirituality as a protective health asset for young people: an international comparative analysis from three countries

Blended learning is an effective strategy for acquiring competence in public health biostatistics

The relaunch of IJPH’s knowledge synthesis, translation, and exchange section