Background: Inflammatory rheumatic diseases require complex management strategies. Patients with a migrant background may face increased challenges due to linguistic, cultural, and systemic barriers. These patients may experience suboptimal health outcomes, especially when their proficiency in the dominant language is limited. Addressing their health literacy needs may improve these health outcomes. However, limited knowledge exists on how health services can effectively address the health literacy needs of patients with migrant backgrounds, inflammatory rheumatic diseases and limited proficiency in the dominant language. This study is part of a larger project aiming to explore the health literacy needs of migrant patients with inflammatory rheumatic diseases and limited proficiency in Norwegian, as well as develop interventions to meet these needs. Inspired by the Ophelia (Optimising Health Literacy and Access) process [1], the first phase explored the health literacy needs of this patient group, showing challenges in understanding information, actively engaging with health professionals, and navigating health services [2]. This current study focuses on the second phase, which involves developing interventions to address identified health literacy needs. To improve rheumatology services, it is important to develop effective and sustainable health literacy-informed interventions, where collaboration between stakeholders, namely patients and health professionals, is essential. Co-design is a collaborative process that may offer a robust and practical approach to developing interventions that address the health literacy needs of migrant patients with inflammatory rheumatic diseases and limited proficiency in the country’s dominant language. Interactive and participatory research methods, such as co-designing interventions, are important for groups underserved by traditional research methods.

Objectives: To describe how co-design was used to develop health literacy–informed interventions to meet the needs of patients with migrant backgrounds, inflammatory rheumatic diseases and limited Norwegian language proficiency.

Methods: Two separate idea-generating workshops were conducted: one with health professionals, another with patients with a migrant background. The empirical findings from the previous health literacy needs assessment [2] were presented in the form of four vignettes. These purposefully developed vignettes were short narratives describing fictive patients that illustrated the various health literacy needs patients with migrant backgrounds experience. These vignettes facilitated discussions in the workshops to generate solutions to address the health literacy needs. Ideas from the workshops were organised and systematically analysed, with input from two patient research partners. The list of final ideas was presented to relevant key stakeholders (health professionals, managers and patients with migrant backgrounds) for discussion, evaluation, and rating of their importance and feasibility. The outcomes of these discussions and ratings were used in co-design workshops to prioritise, choose and develop health literacy-informed interventions.

Results: Twenty-four multidisciplinary rheumatology health professionals and six linguistically and culturally diverse migrant patients with inflammatory rheumatic diseases and limited Norwegian language proficiency participated in the idea-generating workshops. A total of 27 health literacy-informed ideas were generated to address the health literacy needs of this patient group, spanning individual, health professional, and health service delivery levels. The ideas included the following themes: adapted information for patients, communication competency skills for health professionals, and reliable digital health information sources. Further analyses showed that the final intervention would consist of three main elements: 1) A film for patients that provides easy-to-understand information about inflammatory rheumatic diseases, what to expect during a consultation with their rheumatologist, how to prepare for appointments, the roles of different multidisciplinary team members, and how to access these resources. The film will be translated into various languages. 2) Train rheumatology health professionals to use the teach-back communication technique or other sensitive communication strategies with interpreters to help patients understand information about their disease and its management. 3) Establish clinic procedures to ensure that patients with migrant backgrounds, when appropriate, can meet with a nurse and other members of the multidisciplinary team immediately after their rheumatology appointment.

Conclusions: A total of 27 ideas were generated to meet the health literacy needs of patients with migrant backgrounds, inflammatory rheumatic diseases and limited Norwegian language proficiency. The final intervention will target individual, health professional, and health service delivery levels. The co-design process included participation in idea-generating workshops and subsequent ratings of ideas importance and feasibility. This allowed stakeholders - both patients and health professionals - to actively engage in generating and developing interventions to address health literacy needs. Such engagement may enhance the acceptability and sustainability of the resulting interventions. The approach used in this study could be adapted to other contexts.

REFERENCES: [1] Osborne RH, Elmer S, Hawkins M, Cheng C. The Ophelia Manual. The Optimising Health Literacy and Access (Ophelia) process to plan and implement National Health Literacy Demonstration Projects. Centre for Global Health and Equity SoHS, Swinburne University of Technology, editor. Melbourne, Australia2021.

[2] Treacy L, Alpers L-M, Azimi M, Hakim S, Zangi HA. Diversity of health literacy strengths and challenges among migrant patients with Inflammatory Rheumatic Diseases: a qualitative exploration (accepted for publication Jan 2026). Rheumatol Adv Pract.

Acknowledgments: NIL.

Disclosure of Interests: None declared.