Health literacy plays a decisive role in reaching old age in good health. Low health literacy contributes to behaviors like being sedentary and not exercising, eating a less nutritious diet, taking more medications, and using healthcare services more often. Even though individuals with a migration background now comprise almost a quarter of the entire population of Germany, there has not previously been comprehensive research on their health literacy. Researchers from Bielefeld University and the University of Cologne are now, for the first time, analyzing the health literacy of people with a migration background. The key finding: contrary to the prevailing view, health literacy among people with a migration background is similar to that of the general German population – and even tends to be slightly higher.
Based on their findings, the research team has concluded that when it comes to health literacy, people with migration background should not be categorically labelled as a vulnerable group, but instead viewed with greater nuance.
First survey specifically on individuals with a migration background and their health literacy
Researchers at Bielefeld University have been regularly collecting data on the status of health literacy among residents of Germany. The new study, entitled “Health literacy among people with migration background in Germany” (HLS-MIG), has a new focus. “With this study, we have, for the first time, been able to collect detailed data on the extent, causes, and consequences of health literacy among people with a migration background in Germany,” explains Bielefeld University’s Prof. Dr. Doris Schaeffer, who heads the study together with Dr. Eva-Maria Berens, also of Bielefeld University.
The study surveyed the two largest migrant groups in Germany: individuals with a migration background in Turkey and in the states of the former Soviet Union. Together, these two groups represent 30 percent of all individuals with a migration background in Germany.
Few differences to the general population
The study, which was funded by the Robert Bosch Stiftung, demonstrates that more than half (52 percent) of individuals with a Turkish or former Soviet migration background have low health literacy; the other half (48 percent), however, have high health literacy. Levels of health literacy in people with a migration background are thus similarly aligned to those of the general population. The researchers explain this finding with the fact that many migrants have lived in Germany for a long time: “the group of ‘people with a migration background’ includes both those who have migrated to Germany in the first generation, but also their children. They have often been living in Germany for decades,” says Eva-Maria Berens.
One important point to keep in mind, as Berens notes, is that health literacy among people with a migration background is unevenly distributed in social terms. In the study, low educational attainment, low socioeconomic status, older age, and chronic disease were all factors found to be associated with lower health literacy – similar to the situation in the general population. Their own migrant experience and limited German language skills can also impact health literacy.
“The study’s findings suggest that migration status, unlike socioeconomic status or low educational attainment, is not closely correlated with health literacy. This is good news for our multicultural society and underscores the importance of developing interventions,” says Dr. Ingrid Wünning Tschol, who serves as the director of the division of health at the Robert Bosch Stiftung GmbH.
Widespread use of health information in foreign languages
According to the study, people with a migration background have a great deal of interest in health information. A large share of the individuals surveyed rely on health information in multiple languages. More than half (64 percent) of those surveyed with a migration background in the former Soviet states obtain health information partially or exclusively in Russian. 45 percent of the survey respondents with a Turkish migration background also get their health information in Turkish. “First-generation migrants and those with limited German skills in particular are the ones who frequently turn to health information in the language of their country of origin. But even second-generation survey respondents with strong German language skills also make use of multilingual resources,” says Eva-Maria Berens.
Being listened to is not a given at the doctor’s office
One significant difference to the general population that the researchers were able to ascertain deals with communicating with doctors. The study demonstrated that people with a migration background find it especially difficult to get doctors to listen to them without being interrupted. Approximately one third of the survey respondents from both the former Soviet states and Turkey found this to be challenging – and this rate is considerably higher than in the general population. Specialized health terminology is another challenge.
The researchers see this as an urgent call to action in both policy and public life. “As a society, we need to invest more in the promotion of health literacy among the entire population,” says Doris Schaeffer. “In addition to this, the general image of people with a migration background as a homogenous category needs to be revised – this group must be viewed in a more differentiated manner.” According to the researchers, different approaches could be used to facilitate and promote health literacy. Improving the quality and accessibility of health information is essential, along with placing a greater focus on low health literacy and diversity. Specific measures aimed at target groups to strengthen health literacy are also very important.
Background of the Study
This study was conceptualized based on the model set forth in “Health Literacy Survey Germany” (HLS-GER), a representative study conducted in 2014 and 2020 to determine health literacy of the general German population. For this survey, questionnaires were modified with respect to the special characteristics of individuals with a migration background. Some 1,000 interviews were carried out and analyzed. The project, which will run through September 2022, has been provided with 650,000 Euro in funding from the Robert Bosch Stiftung. Health literacy encompasses the ability to locate, understand, evaluate, and apply information on health topics. Previous studies have shown that the lower a person’s health literacy, the more likely they are to go to the doctor or hospital, and use emergency medical services.
Original publication (in German):
Eva-Maria Berens, Julia Klinger, Monika Mensing, Sarah Carol, Doris Schaeffer: Gesundheitskompetenz von Menschen mit Migrationshintergrund in Deutschland: Ergebnisse des HLS-MI. Bielefeld: Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Universität Bielefeld, https://doi.org/10.4119/unibi/2960131, published on 17 January 2022.