Background: Refugees report poorer health compared to host populations and studies indicate an underutilization of healthcare services among refugees. In Sweden, a course in civic orientation is offered to all newly arrived refugees in order to facilitate their establishment, but also to help them make rational and informed health choices. The course is given at group level and most commonly in the refugees' mother tongue. However, an evaluation of the civic orientation indicates that refugees with different health literacy levels do not benefit from it to the same extent. To address this, the "Teach-back Method" has been taught to approximately 200 cultural mediators within the EU project "MILSA training platform for civic and health communication".

Objective and method: The aim of the study was to investigate perceptions of cultural mediators in implementing a Swedish version of the “teach-back method” for improved health information recall – Förstå Mig Rätt (FMR) – in the Swedish civic orientation for newly arrived refugees. Data was collected through semi-structured interviews and analysed by content analysis. Deriving from a holistic view of health, Sørensen’s integrated model for health literacy guided the discussion in examining how FMR contributed to improved health literacy.

Findings: Three themes emerged from the data: (i) Appreciating the impact of FMR; (ii) valuing the role of a communicator and; (iii) practical challenges of implementing FMR. The findings demonstrated an overall appreciation for FMR as it empowered the communicators with the ability to discover misunderstandings easier. Nevertheless, it was sometimes perceived as challenging to ask the refugees to retell information and some refugees even expressed feelings of insult. Lack of time and struggle to adapt information to fit all also generated concerns.

Conclusion: FMR serves its purpose of ensuring recall and understanding of health information among newly arrived refugees attending the Swedish civic orientation. Specifically, FMR makes its largest contribution to health literacy improvements in the second competence outlined by Sørensen’s model (understanding). However, for optimal utilization, groups should be adjusted for participant educational level while further clarification on when the second and third phase of the teach-back concept should transpire, is recommended.