Background: Migrants are at risk of worse health outcomes, especially when they have poor proficiency of the majority language [1]. Health literacy has been recognised as a determinant of health, and a factor related to health promotion, health outcomes and equitable healthcare [2]. Studies have found that self-management of chronic diseases requires advanced health literacy skills [3]. To date, people with limited Norwegian language proficiency have been excluded from almost all rheumatology studies in Norway. In order to provide equitable healthcare to this patient group, and specifically to make rheumatology healthcare responsive to their needs, a better understanding of health literacy needs and the development of appropriate health literacy interventions within the Norwegian context are required. This study is the first part of a health literacy development project, which is inspired by the Ophelia process [4].

Objectives: To explore health literacy strengths and challenges among migrant patients with inflammatory rheumatic diseases and limited Norwegian language proficiency.

Methods: In-depth interviews were conducted with 19 migrant patients with different inflammatory rheumatic diseases, who used an interpreter when communicating with health professionals. Ten women and nine men, aged over 18 years, who spoke Polish, Arabic, Tamil, Somali or Urdu were included. The interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. Codes were generated and subsequent themes then structured within the nine domains of health literacy from the Ophelia process [4]. The patterns of health literacy strengths and challenges were then analysed and health literacy profiles generated.

Results: Four health literacy profiles were generated, demonstrating a diversity of health literacy strengths and challenges among migrant patients with inflammatory rheumatic diseases. All four profiles included men and women, different inflammatory rheumatic diseases and different languages. Profile 1: Participants described extensive health literacy challenges. In particular they had very little support from their social network and healthcare providers, and often described being alone when managing their health problems. They struggled to find and understand reliable health information, as well as navigate within the healthcare system. Some of the participants did not use the internet to search for health information or services due to illiteracy or limited skills navigating the internet. Profile 2: Participants struggled to understand and critically appraise health information about their disease and how to manage it. They described varying abilities to find reliable health information and lacked sufficient information to manage their health. Participants did not always share their concerns or worries with health professionals, nor clarify information and advocate on their own behalf. Profile 3: Participants struggled to find reliable health information and navigate within the healthcare system. They often had an emotionally supportive family but described a limited social network in Norway. Although not always able to actively engage with healthcare providers, they described feeling understood and supported. Profile 4: Participants had strategies to manage most health challenges they experienced. They had trusting and supportive relationships with health professionals and used a diverse range of sources to find information about their disease and health. Some navigated digital health services independently, whilst others relied on friends or family. Challenges still remained advocating for themselves at the system and service level. Participants had a close and supportive family, providing emotional and practical support. Work, where relevant, was described as positive for their well-being. All of the participants were active in the self-management of their disease. These findings highlight the diversity of health literacy strengths and challenges among migrant patients with a rheumatic inflammatory disease and limited Norwegian language proficiency. The profiles from this study will be used to develop data-informed vignettes to facilitate idea-generating workshops. In the next phase of this project we will co-design and develop context-appropriate health literacy interventions.

Conclusion: To our knowledge, this is the first qualitative study to explore health literacy among migrant populations with inflammatory rheumatic diseases and limited Norwegian language proficiency. Four main profiles with different patterns of health literacy strengths and challenges were generated. In the next phase of this project these profiles will be used to facilitate development of health literacy interventions for this patient group.

REFERENCES: [1] Kjøllesdal MKR et al. Health risks among long-term immigrants in Norway with poor Norwegian language proficiency. Scand J Public Health. 2023;51:422-429.

[2] Sørensen K et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.

[3] Heijmans M et al. Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. Patient Educ Couns. 2015;98:41-48.

[4] Beauchamp A et al. Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia). BMC Public Health. 2017;17:230.

Acknowledgements: This study is funded by REMEDY - Center for Treatment of Rheumatic and Musculoskeletal Diseases.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.