Correlates of Basic Health Literacy Among Karen Refugees from Burma

Background and Purpose: Refugees face many challenges once they resettle in the United States, including inadequate access to healthcare services (Derose, et al., 2007). Accessing healthcare services in a timely manner is essential to achieve the best health outcome for many refugees, which is necessary for achieving self-sufficiency. One of the critical skills needed to understand and navigate the complex healthcare system is health literacy. Health literacy is the ability to access, understand, appraise, and use information and services to make an informed health-related decision, leading to a better health outcome (Sorensen, et al., 2012). The purpose of this study is to explore the correlates of health literacy among the Karen refugees.

Method: Data were collected from face-to-face interviews with 201 Karen-speaking refugees (73 men; 128 women) between the ages 18-96 in their native language by bilingual interviewers. Health literacy was measured by a 9-item health literacy assessment (range: 0-9) that was constructed based on feedback from a series of focus groups with the community leaders. We examined the number of chronic health conditions, the frequency of PCP visits, and various demographic variables (gender, age, age at U.S. arrival, marital status, employment, religious participation, English proficiency, education, & having kids under 18). We initially conducted a linear regression analysis, followed by two separate analyses by gender (men and women) using SPSS.

Results: The mean age for the overall sample was 40.62 (SD=13.29); men 42.27 (SD=13.60) and women 39.67 (SD=13.07). The health literacy scores for women (M=4.20; SD=1.65) were not statistically different from men (M=3.86; SD=1.66). Linear regression analysis showed a variety of factors associated with higher health literacy scores: older age (b=.122; p<0.01), arriving to the U.S. at a younger age (b=-.147; p<0.001), participating in more religious services (b=.189; p<.05), and having more frequent PCP visits (b=.376; p<0.05) were all associated with higher health literacy scores. The model explained about 12% of the variance (adjusted R² =12.1%).

In a follow-up analysis of the Karen men subsample, the only factor significantly associated with higher health literacy scores was more frequent PCP visits (b=.620; p<0.05). For a follow-up analysis on the subsample of Karen women, however, the results showed that older age (b=.156; p<0.01), arriving to the U.S. at a younger age (b=-.167; p<0.05), and greater religious service participation (b=.269; p<.05) were all associated with health literacy scores. The regression model for Karen men and women explained approximately 6.6% and 12.4% of the variance of the model, respectively.

Conclusion and Implication: The study results revealed that Karen men and women have different factors associated with their basic health literacy. For men, frequent visit to their doctors was the only significant predictor for health literacy scores, while older age, arriving to the U.S. at a younger age, and more frequent participation in religious services were all significant contributors of health literacy scores for women. The study results suggest that gender-specific intervention strategies should be considered when working to improve the basic health literacy among Karen men and women.