Background

Refugees and migrants experience health inequalities resulting from multiple barriers to access and engagement with services. For most migrants, the transition to unfamiliar environments is difficult, especially without culturally and linguistically sensitive services. Health literacy development approaches can be used to support diverse communities to have greater agency to manage their own health and the health of their families. The Ophelia (Optimising Health Literacy and Access) process uses health literacy thinking to co-design, prioritise, and implement locally designed actions that respond to the identified specific health literacy strengths, needs and preferences. This project aims to strengthen the Ophelia process for application within diverse migrant/refugee groups and organisations.

Methods

A qualitative participatory action research design will be employed to identify and respond to the diverse health literacy needs of refugees and migrants. Semi-structured interviews will be conducted using the Conversational Health Literacy and Assessment Tool (CHAT) to identify the health literacy needs and strengths of refugees and migrants. The qualitative data will be thematically analysed. Themes and subthemes will be grouped under the nine domains of the Health Literacy Questionnaire (HLQ). The data will be synthesised to generate vignettes (short stories) of the typical groups of people. The vignettes will be presented to community members and direct service providers in ideas generation workshops, which allow them to co-design ideas to improve health and services.

Impacts

The study is identifying factors from migrant/refugee and service provider perspectives that affect the ability of these communities to equitably and successfully engage in health services. Culturally and linguistically appropriate interventions will be co-designed to respond to identified health needs. The widely applied Ophelia process, including with migrants, currently relies on the HLQ. This study provides early evidence that Ophelia can be more rapidly and equitably applied using a structured qualitative approach to generating vignettes.

Conclusions

Health literacy is contextually specific. Different individuals and communities have different ways, beliefs, abilities, and motivations to make health choices. The Ophelia process creates a platform for refugees and migrants to voice their health literacy needs, be heard and acknowledged by others, and be active co-designers of solutions.

1. Research and new measures for health literacy