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Wångdahl, Josefin
Publications (10 of 15) Show all publications
Wångdahl, J. (2017). Health literacy among newly arrived refugees in Sweden and implications for health and healthcare. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis.
Open this publication in new window or tab >>Health literacy among newly arrived refugees in Sweden and implications for health and healthcare
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to examine the distribution of health literacy (HL) levels in newly arrived Arabic-, Dari-, or Somali-speaking refugees in Sweden. Further aims were to investigate sociodemographic characteristics associated with inadequate HL in this group, and to investigate whether HL levels are associated with experiences of the health examination for asylum seekers (HEA), health seeking behaviour and health.

Three quantitative cross-sectional studies, using data from two different surveys, were conducted among Arabic-, Dari-, and Somali-speaking, newly arrived refugees taking part in courses in Swedish for immigrants or civic orientation. In addition, an explorative qualitative study, based on focus group discussions, was performed on Arabic- and Somali-speaking newly arrived refugees who had taken part in an HEA. All data were collected 2013-2016. The quantitative data were analysed using different statistical methods, foremost descriptive statistics and univariate and multivariate binary logistic regression analyses. The qualitative data were analysed using Graneheim and Lundman’s method for latent content analysis.

The main findings were that the majority of Arabic-, Dari-, or Somali-speaking refugees in Sweden have limited functional health literacy (FHL) and/or limited comprehensive health literacy (CHL). Having a low education level and/or being born in Somalia were associated with having inadequate FHL, but not with having inadequate CHL. Limited FHL was associated with inadequate CHL. Experiences of poor quality of communication and having benefited little from the HEA were more common among those with limited CHL, as compared to those with higher CHL. Experiences of communication problems and a lack of information related to the HEA were found in the qualitative studies as well. In addition, it was more common that those with limited CHL reported poor general health and impaired psychological well-being, and that they had refrained from seeking healthcare.

In conclusion: limited HL is common among newly arrived refugees in Sweden and seems to be of importance for the experience of the HEA, health-seeking behaviour and health. HL needs to be taken into consideration in the work with refugees in order to increase equity in healthcare and health. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 102 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1397
Keyword
Health literacy, S-FHL, HLS-EU-Q16, Asylum seeker, Migrant, Immigrant, Experiences, Health check-up, Communication, Information, Self-perceived health, Mental health, Health-seeking behaviour, Refrained from healthcare, Screening, Disease prevention, Health promotion, Quality of care, Equity in health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-333427 (URN)978-91-513-0159-4 (ISBN)
Public defence
2018-01-10, Polhemssalen, Ångströmlaboratoriet, Lägerhyddsvägen 1, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-12-20 Created: 2017-11-20 Last updated: 2018-01-15
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2016). Comprehensive health literacy is associated with experiences of the health examination for asylum seekers - A Swedish cross-sectional study. In: : . Paper presented at The International Forum on Quality and Safety in Healthcare, 12-15 April 2016, Gothenburg, Sweden. .
Open this publication in new window or tab >>Comprehensive health literacy is associated with experiences of the health examination for asylum seekers - A Swedish cross-sectional study
2016 (English)Conference paper, Poster (with or without abstract) (Refereed)
Keyword
Health literacy, refugees, health examination, health promotion, Sweden, S-FHL, HLS-EU-Q16
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-285192 (URN)
Conference
The International Forum on Quality and Safety in Healthcare, 12-15 April 2016, Gothenburg, Sweden
Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2017-03-15Bibliographically approved
Wångdahl, J. & Al-Adhami, M. (2016). Hälsokommunikation i samhällsorienteringen i Stockholms län 2015-2016: En utvärderingsrapport. .
Open this publication in new window or tab >>Hälsokommunikation i samhällsorienteringen i Stockholms län 2015-2016: En utvärderingsrapport
2016 (Swedish)Report (Other academic)
Publisher
75 p.
Series
Socialmedicinsk rapportserie, ISSN 1402-7070
Keyword
Folkhälsa, samhällsorientering, migration, hälsa, hälsolitteracitet
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-302510 (URN)
External cooperation:
Available from: 2016-09-05 Created: 2016-09-05 Last updated: 2016-09-07Bibliographically approved
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2015). Comprehensive health literacy and the experiences of the health examination for asylum seekers. In: : . Paper presented at 8th European Public Health Conference: Health in Europe – from global to local policies, methods and practices, 14–17 OCTOBER 2015, Milan, Italy. .
Open this publication in new window or tab >>Comprehensive health literacy and the experiences of the health examination for asylum seekers
2015 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Objective: The purposes of the study were to investigate refugees’ experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and to investigate whether health literacy is associated with those experiences.

Methods: A cross-sectional study was performed in 2013, among 455 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional health literacy scale and the short European health literacy questionnaire. Experiences of communication and the usefulness of health examination for asylum seekers were measured in several questions.  Uni- and multivariate statistical methods were used to investigate group differences.

Results: A considerable proportion of refugees in Sweden had bad experiences of the communication and the usefulness of the health examination for asylum seekers. Refugees with inadequate comprehensive health literacy experienced more communication problems and the examination as less useful, compared to those with non-inadequate comprehensive health literacy. No differences in those experiences could be seen between refugees with different levels of functional health literacy.

Conclusion: Refugees’ own experiences indicate that a low level of comprehensive health literacy could act as a barrier to fulfilling the purposes of the health examination for asylum seekers. Comprehensive health literacy seems to be of greater importance in that context than functional health literacy

Practical Implications: Health literacy must be highlighted and acted upon in clinical praxis to increase the quality of the health examination for asylum seekers.

Keyword
Health literacy, refugees, health examination, health promotion, Sweden, S-FHL, HLS-EU-Q16
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-284969 (URN)
Conference
8th European Public Health Conference: Health in Europe – from global to local policies, methods and practices, 14–17 OCTOBER 2015, Milan, Italy
Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2017-03-15Bibliographically approved
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2015). Comprehensive health literacy is associated with experiences of the health examination for asylum seekers - A Swedish cross-sectional study. In: The 3rd European Health Literacy Conference: Developing Health Literacy During the Life Course. Paper presented at The 3rd European Health Literacy Conference, 17 - 19 November 2015, Brussels, Belgium. .
Open this publication in new window or tab >>Comprehensive health literacy is associated with experiences of the health examination for asylum seekers - A Swedish cross-sectional study
2015 (English)In: The 3rd European Health Literacy Conference: Developing Health Literacy During the Life Course, 2015Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Introduction: Little is known about refugees’ health literacy (HL) and their experiences of the health examination for asylum seekers (HEA).  Communication problems and difficulties with HL are common in clinical care targeted to migrants. Limited language skills, different cultural views of health, and health care knowledge about health and health literacy may explain some of the communication problems.  From a public health perspective, communication problems are serious as they limit access to health care and information. One vulnerable group of migrants in terms of health is refugees, i.e. persons who have fled from and/or cannot return to their country for a well-founded fear of persecution, including war or civil conflict. Many refugees come into contact with health information when they participate in an HEA, provided in most countries that accept refugees.  The overall purpose of HEA is to identify poor health in order to secure the well-being of seekers of asylum and to guarantee the safety of the population in the host country.  Refugees´ experiences of communication during the HEA and about its usefulness are thus far not known. However, important information and good communication and interpersonal relations between health care receivers and providers are viewed as being important to the quality of health care.  In the context of HEA, limited HL may result in failure to identify health problems and in participants not getting treatments and information their medical situation calls for. The purposes of the study were to investigate refugees’ experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and to investigate whether health literacy is associated with those experiences.

Methods: A cross-sectional study was performed in 2013, among 455 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional HL Scale (S-FHL) and the short European HL Questionnaire (HLS-EU-Q16). Experiences of communication and the usefulness of HEA were measured in several questions.  Uni- and multivariate statistical methods were used to investigate group differences.

Results: A considerable proportion of refugees in Sweden had bad experiences of the communication and the usefulness of HEA. Refugees with inadequate comprehensive HL experienced more communication problems and the examination as less useful, compared to those with non-inadequate comprehensive HL. No differences in those experiences could be seen between refugees with different levels of functional HL.

Conclusion: Refugees’ own experiences indicate that a low level of comprehensive HL could act as a barrier to fulfilling the purposes of HEA. Comprehensive HL seems to be of greater importance in that context than functional HL. Health literacy must be highlighted and acted upon in clinical praxis to increase the quality of HEA.

Keyword
Health literacy, refugees, health examination, health promotion, Sweden, S-FHL, HLS-EU-Q16
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-285188 (URN)
Conference
The 3rd European Health Literacy Conference, 17 - 19 November 2015, Brussels, Belgium
Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2017-03-15Bibliographically approved
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2015). Health literacy and refugees' experiences of the health examination for asylum seekers: a Swedish cross-sectional study. BMC Public Health, 15, Article ID 1162.
Open this publication in new window or tab >>Health literacy and refugees' experiences of the health examination for asylum seekers: a Swedish cross-sectional study
2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, 1162Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The purpose of the health examination for asylum seekers in most countries is to identify poor health in order to secure the well-being of seekers of asylum and to guarantee the safety of the population in the host country. Functional health literacy is an individual's ability to read information and instructions about health and to function effectively as a patient in the health system, and comprehensive health literacy is an individual's competence in accessing, understanding, appraising and applying health information. Little is known about refugees' health literacy and their experiences of the health examination for asylum seekers. The purposes of the study were to investigate refugees' experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and whether health literacy is associated with those experiences.

METHODS: A cross-sectional study was made among 360 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional Health Literacy Scale and the short European Health Literacy Questionnaire. Experiences of communication and the usefulness of the health examination were measured in several questions. Associations were sought using univariate and multivariate statistical models.

RESULTS: In the health examination for asylum seekers, a poor quality of communication was experienced by 36 %, receiving little information about health care by 55 %, and receiving little new knowledge by 41 % and/or help by 26 %. Having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of a poorer quality of communication (OR: 9.64, CI 95 %: 3.25-28.58) and the experience of receiving little valuable health care information (OR: 6.54, CI 95 %: 2.45-17.47). Furthermore, having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of not receiving new knowledge (OR: 7.94, CI 95 %: 3.00-21.06) or receiving help with health problems (OR: 8.07, 95 % CI: 2.50-26.07. Functional healthy literacy was not associated with experiences of HEA.

CONCLUSION: Refugees' experiences indicate that a low level of comprehensive health literacy can act as a barrier to fulfilling the purposes of the health examination for asylum seekers. Comprehensive health literacy seems to be of greater importance in that context than functional health literacy.

Keyword
Health literacy, Refugess, Health examination, Health promotion, Sweden, S-FHL, HLS-EU-Q16
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-268009 (URN)10.1186/s12889-015-2513-8 (DOI)000365311300008 ()26596793 (PubMedID)
Funder
Public Health Agency of Sweden
Available from: 2015-12-01 Created: 2015-12-01 Last updated: 2017-12-01Bibliographically approved
Wångdahl, J. & Mårtensson, L. (2015). Measuring health literacy: the Swedish Functional Health Literacy scale. Scandinavian Journal of Caring Sciences, 29(1), 165-172.
Open this publication in new window or tab >>Measuring health literacy: the Swedish Functional Health Literacy scale
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 1, 165-172 p.Article in journal (Refereed) Published
Abstract [en]

Background:

The benefits of health promotions efforts vary due to a complexity of reasons. One possible reason for absence of effects is the level of functional health literacy among the individuals that participate in the interventions. Thus valid and reliable instruments that capture these kinds of skills are needed. The aim of this study was to develop a Swedish Functional Health Literacy scale to use in health promotion and health prevention by translating the Japanese Functional Health Literacy scale into Swedish and testing some aspects of its validity and test-retest reliability.

Methods: The research project comprised six phases including translation and back-translation, validity tests on the two first versions of the instrument based on interviews of professionals and representatives for the target group of the instrument, and a test-retest of the first version on target groups.  

Results: The items in the first two versions were experienced as unclear, which led to improvements of the next version.  The final version of the translated instrument (The Swedish Functional Literacy scale) showed evidence of content validity and the test- retest confirmed that instrument had stability over time with a percentage agreements for the items ranging from 63% to 92% (M = 77,2%).  

Conclusion: The items in the Swedish version of the scale is equivalent to the original Japanese scale in terms of language and content and covers the major aspects of functional health literacy as it is defined in the literature. The translated instrument shows stability over time, i.e. reliability, at least for a part of the Swedish population. More validity tests of the Swedish Functional Health Literacy scale based on a broader population are needed.

Keyword
health literacy, health promotion, health education, prevention, measurement
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-228393 (URN)10.1111/scs.12125 (DOI)000350285500017 ()24628048 (PubMedID)
Available from: 2014-07-11 Created: 2014-07-11 Last updated: 2017-12-05
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2014). Functional and complex health literacy levels among refugees in Sweden; and examination of socio-demographic and health related factors associated with inadequate health literacy. In: : . Paper presented at The 2nd European Health Literacy Conference, 10 – 11 April 2014, Aarhus, Denmark. .
Open this publication in new window or tab >>Functional and complex health literacy levels among refugees in Sweden; and examination of socio-demographic and health related factors associated with inadequate health literacy
2014 (English)Conference paper, Oral presentation only (Refereed)
Abstract [en]

Background: Worldwide there are more than 10 million refugees; of which many have poorer health compared with indigenous populations. Not being able to access, understand, appraise or apply health information; i.e. low health literacy; could be one explanatory factor. The main purposes of this study were to determine functional and complex health literacy levels among refugees in different subgroups in Sweden; and to investigate socio-demographic and health related factors associated with inadequate health literacy.

Method: A cross-sectional study with 455 adult refugees speaking Arabic, Dari, Somali or English; was performed. Data were collected among participants in 16 strategically selected language schools for immigrants. Health literacy was measured by translated versions of The Swedish Functional Health Literacy Scale and The HLS-EU-Q16 questionnaire. Group differences were investigated by using uni- and multivariate statistical methods.

Results: About 60 % of the refugees had inadequate functional health literacy and about 80 % had limited functional health literacy. Regarding complex health literacy; about 27 % had inadequate complex health literacy and about 62 % had limited complex health literacy. Those having low education and/or were born in Somalia had a statistical significant increased risk of having inadequate functional health literacy. Those with inadequate functional health literacy had a statistical significant increased risk of having inadequate complex health literacy.

Conclusions: The majority of refugees participating in the language schools had limited or poor health literacy. Compared with health literacy levels in many indigenous populations; functional as well as complex health literacy showed to be lower among the refugees in the study. Therefore health literacy should be taken into consideration in context and activities affect those. However, more research is needed for a deeper understanding of health literacy among refugees and for development of strategies and methods increasing health literacy as well as facilitating life for those with low health literacy.

Keyword
Health literacy, refugees, Sweden, S-FHL, HLS-EU-Q16
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-284985 (URN)
Conference
The 2nd European Health Literacy Conference, 10 – 11 April 2014, Aarhus, Denmark
Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2017-03-15Bibliographically approved
Wångdahl, J., Lytsy, P., Mårtensson, L. & Wetserling, R. (2014). Functional and comprehensive health literacy levels among refugees in Sweden, and examination of socio-demographic and health related factors associated with inadequate health literacy. In: : . Paper presented at 7th European Public Health Conference Mind the gap: Reducing inequalities in health and health care (pp. 117). Oxford: Oxford University Press, 24.
Open this publication in new window or tab >>Functional and comprehensive health literacy levels among refugees in Sweden, and examination of socio-demographic and health related factors associated with inadequate health literacy
2014 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Worldwide there are more than 10 million refugees; of which many have poorer health compared with indigenous populations. Not being able to access, understand, appraise or apply health information; i.e. low health literacy; could be one explanatory factor. The main purposes of this study were to determine functional and complex health literacy levels among refugees in different subgroups in Sweden; and to investigate socio-demographic and health related factors associated with inadequate health literacy.

Method: A cross-sectional study with 455 adult refugees speaking Arabic, Dari, Somali or English; was performed. Data were collected among participants in 16 strategically selected language schools for immigrants. Health literacy was measured by translated versions of The Swedish Functional Health Literacy Scale and The HLS-EU-Q16 questionnaire. Group differences were investigated by using uni- and multivariate statistical methods.

Results: About 60 % of the refugees had inadequate functional health literacy and about 80 % had limited functional health literacy. Regarding complex health literacy; about 27 % had inadequate complex health literacy and about 62 % had limited complex health literacy. Those having low education and/or were born in Somalia had a statistical significant increased risk of having inadequate functional health literacy. Those with inadequate functional health literacy had a statistical significant increased risk of having inadequate complex health literacy.

Conclusions: The majority of refugees participating in the language schools had limited or poor health literacy. Compared with health literacy levels in many indigenous populations; functional as well as complex health literacy showed to be lower among the refugees in the study. Therefore health literacy should be taken into consideration in context and activities affect those. However, more research is needed for a deeper understanding of health literacy among refugees and for development of strategies and methods increasing health literacy as well as facilitating life for those with low health literacy.

Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2014
Keyword
Functional health literacy, complex health literacy, refugees, sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-284925 (URN)10.1093/eurpub/cku162.017 (DOI)
Conference
7th European Public Health Conference Mind the gap: Reducing inequalities in health and health care
Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2016-04-19
Wångdahl, J., Lytsy, P., Mårtensson, L. & Westerling, R. (2014). Functional and comprehensive health literacy levels among refugees in Sweden, and examination of socio-demographic and health related factors associated with inadequate health literacy. In: Jany Rademarkers (Ed.), : . Paper presented at The pre-conference ‘Patient participation and involvement in health care’ organized before the European Public health conference 2014. .
Open this publication in new window or tab >>Functional and comprehensive health literacy levels among refugees in Sweden, and examination of socio-demographic and health related factors associated with inadequate health literacy
2014 (English)In: / [ed] Jany Rademarkers, 2014Conference paper, Oral presentation only (Other academic)
Abstract [en]

Background: Worldwide there are more than 10 million refugees; of which many have poorer health compared with indigenous populations. Not being able to access, understand, appraise or apply health information; i.e. low health literacy; could be one explanatory factor. The main purposes of this study were to determine functional and complex health literacy levels among refugees in different subgroups in Sweden; and to investigate socio-demographic and health related factors associated with inadequate health literacy.

Method: A cross-sectional study with 455 adult refugees speaking Arabic, Dari, Somali or English; was performed. Data were collected among participants in 16 strategically selected language schools for immigrants. Health literacy was measured by translated versions of The Swedish Functional Health Literacy Scale and The HLS-EU-Q16 questionnaire. Group differences were investigated by using uni- and multivariate statistical methods.

Results: About 60 % of the refugees had inadequate functional health literacy and about 80 % had limited functional health literacy. Regarding complex health literacy; about 27 % had inadequate complex health literacy and about 62 % had limited complex health literacy. Those having low education and/or were born in Somalia had a statistical significant increased risk of having inadequate functional health literacy. Those with inadequate functional health literacy had a statistical significant increased risk of having inadequate complex health literacy.

Conclusions: The majority of refugees participating in the language schools had limited or poor health literacy. Compared with health literacy levels in many indigenous populations; functional as well as complex health literacy showed to be lower among the refugees in the study. Therefore health literacy should be taken into consideration in context and activities affect those. However, more research is needed for a deeper understanding of health literacy among refugees and for development of strategies and methods increasing health literacy as well as facilitating life for those with low health literacy.

Keyword
functional health literacy, complex health literacy, refugees, sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-284954 (URN)
Conference
The pre-conference ‘Patient participation and involvement in health care’ organized before the European Public health conference 2014
Available from: 2016-04-19 Created: 2016-04-19 Last updated: 2017-03-15Bibliographically approved
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