MIXED METHODS EXPLORATION OF HEALTH LITERACY AMONG FORMER SOVIET UNION IMMIGRANTS

Abstract

The purpose of this dissertation was to assess the health literacy in Russian-speakingimmigrants from the former Soviet Union (FSU) and identify factors relevant to their health literacy. Immigrants have been shown to have lower health literacy than native-born population and experience challenges navigating healthcare systems of their host countries, but little is known about health literacy of FSU immigrants. This dissertation aims to fill this knowledge gap. Among the world’s 272 million international migrants, more than 25 million are from FSU. Large diasporas of FSU immigrants reside in the United States (US), Germany, and Israel. As a three manuscripts approach, this dissertation examined healthcare system factors that may influence FSU immigrants’ health literacy across the US, Germany, Israel, and two FSU countries (manuscript 1), performed a multilingual literature review (manuscript 2), and conducted a mixed methods research study to assess the health literacy of FSU immigrants in the US (manuscript 3). As a scoping review with a broad search and a narrative commentary, manuscript 1 provided an overview of FSU immigrants’ sociodemographic data, historical background, migration context, and depicted a landscape of healthcare system factors relevant to health literacy, including departed countries (Russia and Kazakhstan) and receiving countries (US, Germany, Israel) within the Integrated Health Literacy Model framework. Manuscript 1 examined multiple distinct healthcare systems and described system-level factors that may influence individual health literacy. As an integrative review with a focused search, manuscript 2 synthesized any available research literature relevant to health literacy and health insurance literacy among FSU immigrants in four languages, identifying just seven articles. Only two articles measured health literacy of FSU immigrants, which was lower than the general population. Also, manuscript 2 provided a model and possible methodology for other multilingual literature searches. Manuscript 3 conducted quantitative analyses and found that 40% of a sample of FSU immigrants living across the US had inadequate or problematic levels of health literacy based on HLS-EU-Q12. Manuscript 3 discovered that social status, social support, and English proficiency were significantly associated with health literacy in this sample, while age, gender, and education were not. Qualitative analysis identified major themes of health insurance, access to health information, experience with health care, healthcare system differences, and health beliefs as relevant to the health literacy of respondents from their own perspectives. When studying health literacy of FSU immigrants, it is important to consider personal factors as well as healthcare system and organizational factors.