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).