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      Health literacy of forcibly displaced (migrant) women during the COVID-19 pandemic: a grounded theory study

      research-article
      Jana Tempes , Uwe Bittlingmayer , Eva-Maria Bitzer , Ines Himmelsbach
      International Journal of Migration, Health and Social Care
      Emerald Publishing
      Women, Health care, Forcibly displaced (migrants), COVID-19 pandemic, Health literacy, Women, Health care, Qualitative study

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          Abstract

          Purpose

          The unexpected and rapid outbreak of the COVID-19 pandemic increased the vulnerability of forcibly displaced (migrant) women, who were a social group already at risk of health inequities and poorer health outcomes. This study aims to examine the health literacy of forcibly displaced (migrant) women during the COVID-19 pandemic in Germany using a multidimensional health literacy model as a framework.

          Design/methodology/approach

          A grounded theory methodology was implemented including interviews with 33 forcibly displaced (migrant) women from July to September 2021. An experienced female researcher interviewed all forcibly displaced (migrant) women, and apart from one telephone interview, all interviews were conducted in person.

          Findings

          Following data analysis, the category, “Use of health information in the context of the COVID-19 pandemic of forcibly displaced (migrant) women”, was identified as a core category. The findings provide valuable insight into the health literacy of forcibly displaced (migrant) women during the COVID-19 pandemic. Societal and environmental determinants, personal determinants and situational determinants were identified as factors impacting health literacy. Furthermore, health literacy was distinguished as competence to make informed decisions in the health domains “health care” and “disease prevention”.

          Originality/value

          Although previous research often focuses on the deficits of forcibly displaced (migrants), this study highlights the resources forcibly displaced (migrant) women use to deal with health-related difficulties, especially during a crisis such as the COVID-19 pandemic. Importantly, such resources were available even if the study participants did not speak the language of the immigration country.

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          Most cited references66

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          Is Open Access

          Health literacy and public health: A systematic review and integration of definitions and models

          Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. Methods A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. Results The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Conclusions Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.
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            How to fight an infodemic

            WHO's newly launched platform aims to combat misinformation around COVID-19. John Zarocostas reports from Geneva. WHO is leading the effort to slow the spread of the 2019 coronavirus disease (COVID-19) outbreak. But a global epidemic of misinformation—spreading rapidly through social media platforms and other outlets—poses a serious problem for public health. “We’re not just fighting an epidemic; we’re fighting an infodemic”, said WHO Director-General Tedros Adhanom Ghebreyesus at the Munich Security Conference on Feb 15. Immediately after COVID-19 was declared a Public Health Emergency of International Concern, WHO's risk communication team launched a new information platform called WHO Information Network for Epidemics (EPI-WIN), with the aim of using a series of amplifiers to share tailored information with specific target groups. Sylvie Briand, director of Infectious Hazards Management at WHO's Health Emergencies Programme and architect of WHO's strategy to counter the infodemic risk, told The Lancet, “We know that every outbreak will be accompanied by a kind of tsunami of information, but also within this information you always have misinformation, rumours, etc. We know that even in the Middle Ages there was this phenomenon”. “But the difference now with social media is that this phenomenon is amplified, it goes faster and further, like the viruses that travel with people and go faster and further. So it is a new challenge, and the challenge is the [timing] because you need to be faster if you want to fill the void…What is at stake during an outbreak is making sure people will do the right thing to control the disease or to mitigate its impact. So it is not only information to make sure people are informed; it is also making sure people are informed to act appropriately.” About 20 staff and some consultants are involved in WHO's communications teams globally, at any given time. This includes social media personnel at each of WHO's six regional offices, risk communications consultants, and WHO communications officers. Aleksandra Kuzmanovic, social media manager with WHO's department of communications, told The Lancet that “fighting infodemics and misinformation is a joint effort between our technical risk communications [team] and colleagues who are working on the EPI-WIN platform, where they communicate with different…professionals providing them with advice and guidelines and also receiving information”. Kuzmanovic said, “In my role, I am in touch with Facebook, Twitter, Tencent, Pinterest, TikTok, and also my colleagues in the China office who are working closely with Chinese social media platforms…So when we see some questions or rumours spreading, we write it down, we go back to our risk communications colleagues and then they help us find evidence-based answers”. “Another thing we are doing with social media platforms, and that is something we are putting our strongest efforts in, is to ensure no matter where people live….when they’re on Facebook, Twitter, or Google, when they search for ‘coronavirus’ or ‘COVID-19’ or [a] related term, they have a box that…directs them to a reliable source: either to [the] WHO website to their ministry of health or public health institute or centre for disease control”, she said. Google, Kuzmanovic noted, has created an SOS Alert on COVID-19 for the six official UN languages, and is also expanding in some other languages. The idea is to make the first information that the public receive be from the WHO website and the social media accounts of WHO and Dr Tedros. WHO also uses social media for real-time updates. WHO is also working closely with UNICEF and other international agencies that have extensive experience in risk communications, such as the International Federation of Red Cross and Red Crescent Societies. Carlos Navarro, head of Public Health Emergencies at UNICEF, the children's agency, told The Lancet that while a lot of incorrect information is spreading through social media, a lot is also coming from traditional mass media. “Often, they pick the most extreme pictures they can find…There is overkill on the use of [personal protective equipment] and that tends to be the photos that are published everywhere, in all major newspapers and TV…that is, in fact, sending the wrong message”, Navarro said. David Heymann, professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, told The Lancet that the traditional media has a key role in providing evidence-based information to the general public, which will then hopefully be picked up on social media. He also observed that for both social and conventional media, it is important that the public health community help the media to “better understand what they should be looking for, because the media sometimes gets ahead of the evidence”.
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              Low health literacy and health outcomes: an updated systematic review.

              Approximately 80 million Americans have limited health literacy, which puts them at greater risk for poorer access to care and poorer health outcomes. To update a 2004 systematic review and determine whether low health literacy is related to poorer use of health care, outcomes, costs, and disparities in health outcomes among persons of all ages. English-language articles identified through MEDLINE, CINAHL, PsycINFO, ERIC, and Cochrane Library databases and hand-searching (search dates for articles on health literacy, 2003 to 22 February 2011; for articles on numeracy, 1966 to 22 February 2011). Two reviewers independently selected studies that compared outcomes by differences in directly measured health literacy or numeracy levels. One reviewer abstracted article information into evidence tables; a second reviewer checked information for accuracy. Two reviewers independently rated study quality by using predefined criteria, and the investigative team jointly graded the overall strength of evidence. 96 relevant good- or fair-quality studies in 111 articles were identified: 98 articles on health literacy, 22 on numeracy, and 9 on both. Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer ability to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Poor health literacy partially explains racial disparities in some outcomes. Reviewers could not reach firm conclusions about the relationship between numeracy and health outcomes because of few studies or inconsistent results among studies. Searches were limited to articles published in English. No Medical Subject Heading terms exist for identifying relevant studies. No evidence concerning oral health literacy (speaking and listening skills) and outcomes was found. Low health literacy is associated with poorer health outcomes and poorer use of health care services. Agency for Healthcare Research and Quality.
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                Author and article information

                Contributors
                Journal
                IJMHSC
                10.1108/IJMHSC
                International Journal of Migration, Health and Social Care
                IJMHSC
                Emerald Publishing
                1747-9894
                1747-9894
                16 November 2023
                27 November 2023
                : 19
                : 3/4
                : 451-469
                Affiliations
                [1]Department of Sociology, University of Education Freiburg; , Freiburg im Breisgau, Germany
                [2]Department of Public Health and Health Education, University of Education Freiburg; , Freiburg im Breisgau, Germany
                [3]Institute of Applied Science, Catholic University of Applied Sciences Freiburg; , Freiburg im Breisgau, Germany
                Author notes
                Jana Tempes can be contacted at: jana.tempes@ph-freiburg.de
                Article
                712280 IJMHSC-08-2022-0088.pdf IJMHSC-08-2022-0088
                10.1108/IJMHSC-08-2022-0088
                a9f4cf91-b860-45d1-a1ad-dad52648460a
                © Emerald Publishing Limited
                History
                : 30 August 2022
                : 21 July 2023
                : 29 August 2023
                : 12 October 2023
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 63, Pages: 19, Words: 11093
                Categories
                research-article, Research paper
                cat-HSC, Health & social care
                cat-VG, Vulnerable groups
                cat-IDMG, Inequalities & diverse/minority groups
                cat-SOCY, Sociology
                cat-RES, Race & ethnic studies
                cat-MIN, Minorities
                cat-SOCY, Sociology
                cat-RES, Race & ethnic studies
                cat-MLT, Multiculturalism
                cat-SOCY, Sociology
                cat-RES, Race & ethnic studies
                cat-RIL, Racial identity
                cat-SOCY, Sociology
                , Work
                , economy & organizations
                cat-LMOV, Labour movements
                Custom metadata
                M
                Web-ready article package
                Yes
                Yes
                JOURNAL
                included

                Qualitative study,Health care,Women,Health literacy,COVID-19 pandemic,Forcibly displaced (migrants)

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