title: Health literacy among refugees in Sweden - a cross-sectional study.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Social Medicine, Department of Public Health and Caring Science, Uppsala University, Box 564, 751 22 Uppsala, Sweden. josefin.wangdahl@pubcare.uu.se.
authors.forename: Josefin
authors.initials: J
authors.lastname: Wångdahl
authors.forename: Per
authors.initials: P
authors.lastname: Lytsy
authors.forename: Lena
authors.initials: L
authors.lastname: Mårtensson
authors.forename: Ragnar
authors.initials: R
authors.lastname: Westerling
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005006:Ethnicity; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007802:Language; D008297:Male; D012036:Refugees / Q000706:statistics & numerical data*; D012998:Somalia / Q000208:ethnology; D011795:Surveys and Questionnaires; D013548:Sweden; D014171:Transients and Migrants