Background
“…links to literacy and entails people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course” (page 3).
Purpose
-
Refugees with inadequate and problematic HL experience more communication problems during HEA as compared to those with sufficient HL.
-
Refugees with inadequate and problematic HL experience HEA as less useful as compared to those with sufficient HL.
Method
Study design and setting
Study population
Data collection
Material and analysis
Characteristics
Experiences of communication and the usefulness of HEA
Statistical analysis
Sensitivity analyses
Results
Characteristics
Variables (n = 360) | Number | Total distribution (%) |
---|---|---|
Gender (number = 354) | ||
Men | 184 | 52.0 |
Women | 170 | 48.0 |
Age (n = 325) | ||
18–24 | 61 | 18.8 |
25–44 | 201 | 61.8 |
45 years or older | 63 | 19.4 |
Country (n = 310) | ||
Afghanistan | 30 | 9.7 |
Iraq | 63 | 20.3 |
Somalia | 94 | 30.3 |
Syria | 66 | 21.3 |
Other country | 57 | 18.4 |
Education (n = 355) | ||
None | 47 | 13.2 |
1–6 years | 84 | 23.7 |
7–12 years | 122 | 34.4 |
More than 12 years | 102 | 28.7 |
Functional health literacy (n = 315) | ||
Inadequate | 190 | 60.3 |
Problematic | 59 | 18.7 |
Sufficient | 66 | 21.0 |
Comprehensive health literacy (n = 237) | ||
Inadequate | 66 | 27.8 |
Problematic | 77 | 32.5 |
Sufficient | 94 | 39.7 |
Comprehensive health literacym (n = 360) | ||
Inadequate | 151 | 41.9 |
Problematic | 110 | 30.6 |
Sufficient | 99 | 27.5 |
Self-assessed health (n = 351) | ||
Very poor | 12 | 3.4 |
Poor | 36 | 10.3 |
Fair | 107 | 30.5 |
Good | 94 | 26.8 |
Very good | 102 | 29.1 |
Years of residential permit (n = 321) | ||
Less than 1 year | 21 | 6.5 |
1–2 years | 209 | 65.1 |
More than 2 years | 91 | 28.3 |
Time since participating in a health examination for asylum seekers (n =354) | ||
Less than a year ago | 178 | 50.3 |
1–2 years ago | 87 | 24.6 |
More than 2 years ago | 89 | 25.1 |
Support of interpreter (n = 318) | ||
Yes | 241 | 75.8 |
No | 77 | 24.2 |
Experiences of HEA
Total study population | Comprehensive health literacyab | ||||
---|---|---|---|---|---|
Respondents/ response category | Inadequate | Problematic | Sufficient | p-value | |
Response categories | Number (%) | 199 Number (%) | 141 Number (%) | 115 Number (%) | |
Understood what was being told (n = 329) |
<0.001
c
| ||||
No | 20 (6.1) |
16 (11.9)
|
3 (2.9)
|
1 (1.1)
| |
Partly | 69 (21.0) |
34 (25.2)
|
18 (17.5)
|
17 (18.2)
| |
Yes | 240 (72.9) |
85 (63.0)
|
82 (79.5)
|
73(80.2)
| |
Could talk about health problems (n = 321) |
<0.001
c
| ||||
No | 49 (15.3) |
32 (24.1)
|
12 (12.2)
|
5 (5.6)
| |
Partly | 22 (6.9) |
16 (12.0)
|
4 (4.1)
|
2 (2.2)
| |
Yes | 250 (77.9) |
85 (63.9)
|
82 (83.7)
|
83 (92.2)
| |
Could ask questions (n = 318) |
<0.001
c
| ||||
No | 55 (17.3) |
33 (26.2)
|
12 (12.0)
|
10 (10.9)
| |
Partly | 53 (16.7) |
28 (22.2)
|
16 (16.0)
|
9 (9.8)
| |
Yes | 210 (66.0) |
65 (51.6)
|
72 (72.0)
|
73 (79.3)
| |
Received answers to questions asked (n = 299) |
<0.001
c
| ||||
No | 52 (17.4) |
31 (26.3)
|
10 (11.0)
|
11 (12.2)
| |
Partly | 54 (18.1) |
30 (25.4)
|
19 (20.9)
|
5 (5.6)
| |
Yes | 193 (64.5) |
57 (48.3)
|
62 (68.1)
|
74 (82.2)
| |
Quality of communication (n = 275) | |||||
Low quality | 100 (27.8) |
60 (56.6)
|
25 (28.7)
|
15 (18.3)
|
<0.001
c
|
High quality | 175 (63.6) |
46 (43.3)
|
62 (71.3)
|
67 (8.7)
| |
Received information about
| |||||
… asylum seekers’ rights to health (n = 306) | |||||
No | 137 (44.8) |
78 (61.4)
|
40 (44.0)
|
19 (21.6)
|
<0.001
c
|
Yes | 169 (55.2) |
49 (38.6)
|
51 (56.0)
|
69 (78.4)
| |
…where to go if one becomes sick in Sweden (n = 324) | |||||
No | 76 (23.5) |
49 (36.6)
|
14 (14.3)
|
13 (14.1)
|
<0.001
c
|
Yes | 248 (76.5) |
85 (63.4)
|
84 (85.7)
|
79 (85.9)
| |
…where to go in Sweden if one feels mentally unwell (n = 306) | |||||
No | 169 (55.2) |
85 (70.2)
|
52 (53.1)
|
32 (36.8)
|
<0.001
c
|
Yes | 137 (44.8) |
36 (29.8)
|
46 (46.9)
|
55 (63.2)
| |
Received little health care information (n = 206) | |||||
Little | 113 (31.4) |
67 (63.2)
|
30 (37.0)
|
16 (20.3)
|
<0.001
c
|
Much | 153 (57.5) |
39 (36.8)
|
51 (63.0)
|
63 (79.7)
| |
Received new knowledge (n = 301) |
<0.001
c
| ||||
No | 124 (34.4) |
73 (60.8)
|
35 (36.5)
|
16 (18.8)
| |
Partly | 63 (20.9) |
21 (17.5)
|
24 (25.0)
|
18 (21.2)
| |
Yes | 114 (37.9) | 26 (21.7) | 37 (38.5) | 51 (60.0) | |
Received help (n = 316) |
<0.001
c
| ||||
No | 83 (23.1) |
52(41.3)
|
22 (21.8)
|
9 (10.1)
| |
Partly | 99 (31.3) |
44 (34.9)
|
36 (35.6)
|
19 (21.2)
| |
Yes | 134 (42.4) |
30 (23.8)
|
43 (42.6)
|
61(68.5)
|
Associations between HL and experiences of HEA
Factors associated with the experiences of HEA
ORs of having experienced poor quality of communication | ORs of having received little health care information | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Variables | Crudea OR (95 % CI) | ORb (95 % CI) | Crudea OR (95 % CI) | ORb (95 % CI) | ||||||
Number of respondents/ analysis | Number of respondents/ analysis:168 | Number of respondents/ analysis | Number of respondents/ analysis:164 | |||||||
Sex | 270 | 262 | ||||||||
Men | 1 | 1 | 1 | 1 | ||||||
Women | 1.06 | (0.65–1.74) | 1.34 | (0.61–2.92) | 0.87 | (0.53–1.42) | 0.57 | (0.26–1.25) | ||
Age | 247 | 240 | ||||||||
18–24 | 1 | 1 | 1 | 1 | ||||||
25–44 | 1.25 | (0.62–2.51) | 1.08 | (0.43–2.74) | 1.02 | (0.51–2.01) | 0.81 | (0.33–2.00) | ||
44- | 0.98 | (0.42–2.29) | 1.14 | (0.35–3.70) | 0.61 | (0.27–1.39) | 0.74 | (0.24–2.23) | ||
Education | 271 | 263 | ||||||||
0–6 years | 0.71 | (0.42–1.21) | 1.11 | (0.47–2.63) | 0.78 | (0.47–1.30) | 1.14 | (0.51–2.58) | ||
≤ 7 years | 1 | 1 | 1 | 1 | ||||||
Country | 235 | 222 | ||||||||
Iraq | 1 | 1 | 1 | 1 | ||||||
Other country | 1.27 | (0.53–3.02) | 1.40 | (0.40–4.95) | 2.03 | (0.85–4.83) | 3.03 | (0.85–10.71) | ||
Syria | 0.72 | (0.30–1.73) | 0.60 | (0.19–1.91) | 1.03 | (0.44–2.42) | 0.72 | (0.24–2.15) | ||
Afghanistan | 1.33 | (0.47–3.78) | 0.66 | (0.15–2.88) | 2.10 | (0.74–5.94) | 0.90 | (0.22–3.69) | ||
Somalia | 0.92 | (0.42–2.03) | 0.61 | (0.19–1.98) | 1.27 | (0.58–2.76) | 0.99 | (0.34–2.91) | ||
Support by interpreter | 250 | 243 | ||||||||
Yes | 1 | 1 | 1 | 1 | ||||||
No | 0.36 | (0.20–0.66)** | 2.35 | (1.00–5.48)* | 3.16 | (1.71–5.83)*** | 2.49 | (1.08–5.75)* | ||
FHL | 250 | 244 | ||||||||
Inadeqate | 1.50 | (0.78–2.89) | 0.81 | 0.25–2.67) | 1.36 | (0.71–2.61) | 0.74 | (0.25–2.22) | ||
Problematic | 1.14 | (0.50–2.50 | 0.86 | (0.22–3.29) | 1.20 | (0.53–2.74) | 0.60 | (0.17–2.17) | ||
Sufficient | 1 | 1 | 1 | 1 | ||||||
CHLm | 275 | 266 | ||||||||
Inadequate | 5.83 | (2.96–11.49)*** | 9.64 | (3.25–28.58)*** | 6.76 | (3.44–13.30)*** | 6.54 | (2.45–17.47)*** | ||
Problematic | 1.80 | (0.87–3.73) | 1.84 | (0.63–5.37) | 2.32 | (1.14–4.72)* | 3.39 | (1.27–9.05)* | ||
Sufficient | 1 | 1 | 1 | 1 |
ORs of not having received any new knowledge | ORs of not having received any help | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Variables | Crudea OR (95 % CI) | ORb (95 % CI) | Crudea OR (95 % CI) | ORb (95 % CI) | ||||||
Number of respondents/analysis | Number of respondents/analysis: 190 | Number of respondents/analysis | Number of respondents/analysis: 196 | |||||||
Sex | 295 | 310 | ||||||||
Men | 1 | 1 | 1 | 1 | ||||||
Women | 0.66 | (0.41–1.05) | 0.33 | (0.16–0.68)** | 0.67 | (0.40–1.12) | 0.58 | (0.27–1.25) | ||
Age | 270 | 284 | ||||||||
18–24 | 1 | 1 | 1 | 1 | ||||||
25–44 | 1.40 | (0.73–2.68) | 1.30 | (0.55–3.06) | 1.33 | (0.65–2.75) | 1.39 | (0.55–3.52) | ||
44- | 0.89 | (0.40–2.00) | 0.82 | (0.28–2.40) | 0.96 | (0.39–2.36) | 0.91 | (0.26–3.16) | ||
Education | 296 | 311 | ||||||||
0–6 years | 1.45 | (0.83–2.19) | 1.42 | (0.66–3.06) | 1.54 | (0.91–2.62) | 2.28 | (0.98–5.33) | ||
≤ 7 years | 1 | 1 | 1 | 1 | ||||||
Country | 256 | 270 | ||||||||
Iraq | 1 | 1 | 1 | 1 | ||||||
Other country | 1.46 | (0.65–3.31) | 1.28 | (0.41–3.95) | 1.80 | (0.71–4 0.58) | 1.55 | (0.45–5.34) | ||
Syria | 1.14 | (0.52–2.47) | 0.64 | (0.23–1.76) | 1.31 | (0.53–3.25) | 1.37 | (0.43–4.33) | ||
Afghanistan | 1.73 | (0.68–4.41) | 0.82 | (0.21–3.10) | 5.06 | (1.83–14.01)** | 2.37 | (0.57–9.92) | ||
Somalia | 1.84 | (0.88–3.82) | 2.41 | (0.85–6.80) | 1.38 | (0.58–3.29) | 1.30 | (0.40–4.27) | ||
Support by interpreter | 272 | 283 | ||||||||
Yes | 1 | 1 | 1 | 1 | ||||||
No | 1.60 | (0.92–2.81) | 1.73 | (0.81–3.69) | 1.25 | (0.68–2.32) | 1.55 | (0.69–3.48) | ||
FHL | 277 | 287 | ||||||||
Inadeqate | 1.43 | (0.77–2.68) | 0.55 | (0.20–1.54) | 2.21 | (1.01–4.84)* | 0.80 | (0.25–2.54) | ||
Problematic | 1.24 | (0.57–2.67) | 0.86 | (0.27–2.74) | 2.27 | (0.91–5.66) | 0.86 | (0.24–3.14) | ||
Sufficient | 1 | 1 | 1 | 1 | ||||||
CHLm | 301 | 316 | ||||||||
Inadequate | 6.70 | (3.48–12.91)*** | 7.94 | (3.00–21.06)*** | 6.25 | (2.88–13.56)*** | 8.07 | (2.50–26.07)*** | ||
Problematic | 2.47 | (1.25–4.91)** | 3.71 | (1.45–9.50)** | 2.48 | (1.07–5.71)* | 3.33 | (1.02–10.86)* | ||
Sufficient | 1 | 1 | 1 | 1 |