Good health is a prerequisite for migrants who are to establish themselves and integrate in a new country. It increases their opportunities to participate in various integration activities, such as language courses, other studies, job search, performing in and maintaining a job, as well as to participate in society in general (Wångdahl, 2017). Health literacy can be an important tool to help migrants achieve good health and a good integration process.
Health problems among refugees can often be explained by risk factors related to the social determinants of health, exposure to health risks in the country of origin, during the flight, and in the new country to which they have migrated and are resettling (Wångdahl, 2017; Hempler et al., 2020). Refugees may face barriers to seeking help for their health problems in the new country because it is hard for them to find and understand health information. There may also be communication problems between refugees and healthcare professionals due to limited health literacy at both individual and organisational level (Wångdahl & Sørensen, 2020; Wångdahl, 2017). Furthermore, the health of many refugees deteriorates over time, which can also be explained by the fact that it is a challenging process to establish oneself in a new country where the language, culture, and social structure is not the same as in the country of origin (Zdravkovic et al., 2016; MILSA, 2015).
However, studies in Sweden show that the deterioration of migrants’ health over time can be reduced by offering health communication to, for example, newly arrived refugees as part of the civic orientation courses available to people who have recently been granted residence in Sweden. Such health communication is based on a culturally sensitive approach using civic and health communicators who speak the refugees’ mother tongue. Culturally sensitive approaches to health communication can increase migrants’ health literacy and improve their chances of good health (Svensson et al., 2017; Al-Adhami, 2015), which can benefit the integration process as a whole.
The Nordic countries each have their own organisational structures dealing with the migrants’ and refugees’ settlement process, the content and scope of introduction programmes, and who the responsible authorities are. This does not mean that there are no similarities between the Nordic countries. For example, the introduction programmes share similar features and typically last two to three years, and are primarily targeted at adult refugees and reunified families. The overall aim of the introduction programmes is also similar across the Nordic countries, namely the transition to work or education and, in the longer term, economic independence for the individual. In order to achieve this goal, all participants must complete an individually tailored programme, including language training and social/civic orientation courses, adapted to their specific circumstances and needs (Jönsson, 2017). Health communication is now an integral part of civic orientation courses in Sweden. Given that it can help improve the whole integration process, the other Nordic countries might want to consider whether health communication should be part of their induction programmes, too.
Specific areas of action to promote health literacy among migrants
The WHO/Europe recommends four specific interventions for migrants that are relevant in disease prevention and health promotion work in the Nordic countries. The recommendations are based on American and Australian research on health literacy, and they are known to work. The recommendations cover both the community level and the healthcare sector (Wångdahl & Sørensen, 2020; Kickbusch et al., 2013).
Promising areas for action concerning health literacy for migrants, according to WHO/Europe:
Develop specific health literacy strategies for migrants. Specific migrant-friendly strategies can make systems more responsive to migrant needs. Migrant users and communities can be engaged in planning, implementing, and evaluating these strategies through patients, cultural mediators in health settings, and patients’ organisations.
Environmental interventions. Effective interventions include the use of patient navigators, translated signage or pictograms, and providing healthcare interpreters. Providing signage in minority languages not only helps ethnic minority patients find their way around hospitals but also creates a sense of belonging and inclusiveness. Although plain language is important in conveying messages, other means of communication such as images, photographs, graphic illustrations, audio, and videos should be considered in producing materials.
Health provider training can improve communication by taking into account simplified messaging and cultural sensitivity. Migrant-friendly health providers should elicit information about health literacy and language proficiency that may affect people’s ability to undertake healthcare. People should receive appropriate treatment and care sensitive to their ethnicity, sex, abilities, age, religion, and sexual orientation. Diagnosis with relevant information and explanations should be communicated to people in their preferred language. Cultural mediators who explain and make understood various perspectives on health and disease are critical for many issues such as diagnostic treatment, surgery, or treatment procedures. Professional interpreters should be used in obtaining informed consent from migrant patients.
Networking and intersectoral interventions. Healthcare organisations can catalyse migrant-friendly action with other sectoral and stakeholder organisations such as pharmacies, social work departments, schools, criminal and justice departments, voluntary organisations, and companies (Kickbusch et al., 2013).