Improving refugees’ health literacy: An assessment of the Swedish ‘teach-back’ method at group level

Abstract

Abstract Background Refugees report lower levels of self-assessed health and underutilize healthcare services compared to host populations. In Sweden, a course in civic orientation is offered to all refugees to facilitate their establishment and help them make informed health choices. However, an evaluation of the civic orientation indicates that refugees with lower health literacy levels do not benefit from the orientation to the same extent. To address this, the ‘teach-back' method has been taught to about 200 cultural mediators participating in the EU project ‘MILSA training platform for civic and health communication'. This study investigated perceptions of the communicators in implementing a Swedish version of the ‘teach-back' method at group level for improved health information recall called Förstå Mig Rätt (FMR). Methods The data was collected through semi-structured interviews and analyzed by content analysis. Deriving from a holistic view of health, Sørensen's integrated model for health literacy guided the discussion in examining how FMR contributed to health literacy. Results Three themes emerged: (i) Appreciating the impact of FMR; (ii) valuing the role of a communicator and; (iii) practical challenges of implementing FMR. The findings demonstrated an overall appreciation for FMR as it empowered the communicators with the ability to discover misunderstandings easier. Nevertheless, it was sometimes perceived as challenging to ask the refugees to retell information and some refugees even expressed feelings of insult. Lack of time and struggle to adapt the information to fit all also generated concerns. Conclusions FMR makes its largest contribution to health literacy improvements in the second competence outlined by Sørensen's model (understanding). However, for optimal utilization, groups should be adjusted for participant educational level while further clarification on when the second and third phase of the teach-back concept should transpire, is recommended. Key messages FMR (a Swedish version of the method ‘teach-back’) can be used for health communication on group level. The use of FMR makes it easier to detect misunderstandings when communicating.