Considering aspects of equity and diversity in the assessment of interventions for improving health literacy in migrants: preliminary results

Session: 

Oral session: Global health and equity (1)

Date: 

Tuesday 22 October 2019 - 14:00 to 15:30

Location: 

All authors in correct order:

Baumeister A1, Aldin A2, Chakraverty D3, Monsef I2, Jakob T2, Seven ÜS3, Anapa G3, Kalbe E3, Skoetz N4, Woopen C1
1 Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University Hospital of Cologne and Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne, Germany
2 University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological Malignancies, Germany
3 Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Germany
4 University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Cancer, Germany
Presenting author and contact person

Presenting author:

Annika Baumeister

Contact person:

Abstract text
Background: health literacy is a key concept for autonomous health decisions and behaviour, effective prevention and management of diseases, as well as for people’s overall health status. Empirical research identified migrants as a high-risk group for limited health literacy. However, female and male migrants differ in their pre-, peri- and post-migration experiences, educational background, socio-economic resources, and health status. This point should be considered in research on migrants’ health. Additionally, health literacy is a highly complex construct that is neither consistently defined nor measured.

Objective: to identify the challenges in conducting an equity- and theory-driven systematic review that aims to assess the effectiveness of complex interventions on health literacy in a highly diverse population.

Methods: to capture two highly complex themes - migration and health literacy - in one review we firstly, identified a theoretical framework of health literacy that fits our objective and addresses aspects of equity. Secondly, we defined first-generation migrants and acknowledged the heterogeneity of their ethnicities, experiences, socio-economic and educational resources in our definition. Thirdly, we developed a search strategy that covers all relevant terms of health literacy and migration. In a next step, we aim to summarise individual study results by clustering them into measurement, outcome and application field of health literacy. Lastly, this review will be linked to a qualitative evidence synthesis (QES) to address aspects of diversity and equity.

Results: our search yielded 2732 results. We preliminary included 36 references that address outcomes relevant to health literacy. Full-text screening revealed high between-study heterogeneity with regard to the definition and measurement of health literacy. Furthermore, information on generation and ethnicity of migrants is often reported unclearly. A data extraction form for such complex intervention studies is in development. The QES linked to this review is conducted in parallel by the same team of authors.

Conclusions: inconsistencies in definitions of health literacy and migration lead to high between-study heterogeneity and complicate the summary of individual study results in meta-analyses. Conducting a Cochrane Review on interventions for improving health literacy in a highly diverse population requires extended interdisciplinary and methodological exchange, as the application of a standardised review template is not feasible.

Patient or health care consumer involvement: the review will receive feedback from at least one consumer referee as part of Cochrane Consumer’s and Communication’s standard editorial process. Additionally, we interviewed healthcare providers to get an in-depth view of the health literacy-related issues in this context. The project is funded by the Federal Ministry of Education and Research in Germany (01GL1723).