Abstract
BackgroundUnemployed persons are at high risk for low health literacy. Most studies addressing health literacy of unemployed persons focus on risk factors for low health literacy or correlates of health literacy, but studies on needs of unemployed persons regarding health literacy are scarce. We aimed to obtain better understanding of health literacy needs of unemployed adults by triangulating the results from a scoping review on health literacy needs in unemployed adults and additional in-depth qualitative interviews.MethodsScoping review: We searched six databases up to January 2021 as well as gray literature for relevant studies following PRISMA-ScR guidelines. Titles, abstracts, and full texts were screened independently by two researchers. Qualitative study: Ten participants of a job-reintegration program in Germany were interviewed following a guideline covering topics including health issues of interest to the participants, their sources of health-related information and the barriers/facilitators they experience when accessing health services.ResultsScoping review: After screening 2,966 titles and abstracts, 36 full texts were considered, and five articles fulfilled the inclusion criteria. Four focused on mental health literacy and outcomes, while the fifth assessed information-seeking practices. One additional report on health literacy was identified via the gray literature search. Awareness of one's condition was identified as a facilitator for mental health help-seeking, while fear of harmful effects of medication prevented help-seeking. Qualitative study: Participants were interested in and were generally well-informed about health topics such as nutrition and physical activity. The main challenge perceived was translating the knowledge into practice in daily life. GPs and the social services providers played an important role as a source of health information and advice. Regarding mental health, similar barriers, facilitators and needs were identified through triangulation of findings of the scoping review with those of the interviews.ConclusionsThere is need to address health literacy needs of long-term unemployed persons that go beyond mental health literacy. Public health interventions should not only aim at improving health literacy scores, but also focus on how to help participants translate health literacy into practice. Population groups of interest should also be involved in all processes of designing interventions.
Highlights
Health literacy is often defined as “the knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life throughout the course of life” [1]
Unemployment is generally associated with poor health and low health literacy [8, 13, 18, 19], our study participants were wellinformed about health topics and relevant information sources, partly because of their own history of illnesses
While large parts of the general population probably face similar challenges regarding engaging in healthy lifestyles, the situation for long-term unemployed persons is compounded by various factors such as low economic resources and limited supportive social networks [33, 34]
Summary
Health literacy is often defined as “the knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life throughout the course of life” [1]. The concept is evolving and continues to gain importance globally [3] It has been included in many policy programs such as the United States’ Healthy People 2030 initiative [2] or Germany’s National Action Plan Health Literacy [4]. It has been suggested that persons with low health literacy suffer from poorer overall health [5] and find it more difficult to follow doctors’ instructions, or take medication as prescribed [6] compared to those with higher health literacy scores. They have been reported to use hospital and out-patient services more and to use preventive measures less, thereby incurring more medical costs [7–9]. We aimed to obtain better understanding of health literacy needs of unemployed adults by triangulating the results from a scoping review on health literacy needs in unemployed adults and additional in-depth qualitative interviews
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