Background: There has been an increase in the number and diversity of migrants using rheumatology care in Norway. Management strategies for inflammatory rheumatic diseases are complex, involving both pharmacological and non-pharmacological treatments. For migrants, managing these diseases can be further complicated by cultural, linguistic, and systemic barriers. Patients with migrant backgrounds and inflammatory rheumatic diseases are at risk of suboptimal health outcomes and health-related inequities, especially when they lack proficiency in the country’s dominant language [1]. Health literacy encompasses how individuals access, understand, appraise and use health information and services [2]. It is considered to be a modifiable factor related to health inequities and health outcomes in rheumatology care [3,4]. However, knowledge regarding the health literacy needs of patients with migrant backgrounds, inflammatory rheumatic diseases and limited proficiency in the host country’s dominant language is scarce.

Objectives: To explore the health literacy needs of patients with migrant backgrounds, inflammatory rheumatic diseases and limited Norwegian language proficiency.

Methods: Nineteen individual in-depth interviews were conducted with patients with migrant backgrounds who have inflammatory rheumatic diseases and limited Norwegian language proficiency. Participants were over 18 years old, and spoke Arabic, Polish, Somali, Tamil or Urdu; ten were women, nine were men. The interviews were audio-recorded, transcribed verbatim, and data were analysed using reflexive thematic analysis [5].

Results: Three main themes with sub-themes were generated: Theme 1) Communication and understanding rely on more than language. This theme demonstrates how accessing and comprehending information about inflammatory rheumatic diseases can be particularly challenging for migrants with limited proficiency in the country’s dominant language. While the use of interpreters is vital for improving understanding, communication, and use of health information and services, it is not enough to guarantee adequate comprehension and effective communication in all situations. Theme 2) Trust as a foundation for care. This theme illuminates the importance of trust in healthcare for migrants with inflammatory rheumatic diseases and emphasises that learning to navigate and trust a new healthcare system takes time. Building trusting relationships is a two-way process, with continuity of care being essential. Once established, many patients with migrant backgrounds will follow treatment plans, even if they do not fully understand the information and decision-making processes. However, challenges, such as poor communication and unmet expectations, can damage trust in both health professionals and the healthcare system. Theme 3) The connection between employment and health literacy. This theme demonstrates how interactions with colleagues can positively influence patients’ ability to find, access and use health information and services, which is particularly important for patients with migrant backgrounds and limited experience within the Norwegian healthcare system. It also addresses the positive and negative impact work can have on both mental and physical well-being, as well as on patient’s financial situations and access to services.

Conclusions: Managing inflammatory rheumatic diseases as a patient with a migrant background and limited proficiency in the country’s dominant language is complex. Health literacy in this context is influenced by various interrelated factors including language, trust and work. The intersection of migrant-specific aspects of a patient’s situation, such as linguistic proficiency, social networks, time in the country, and experience with the healthcare system, should be considered when developing health literacy-informed interventions for these patients.

REFERENCES: [1] Adas MA, Norton S, Balachandran S, Alveyn E, Russell MD, Esterine T, et al. Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study. Rheumatology. 2022;62(1):169-80.

[2] World Health Organization. Health promotion glossary of terms 2021. Geneva: World Health Organization; 2021. Report No.: 978-92-4-003834-9.

[3] Kumar K, Bakker MM, Pergens J, Carmona L, Guillemin F, Boström C, et al. Addressing health literacy and equity in European rheumatology practice: a call for action. Rheumatology Advances in Practice. 2025;9(3).

[4] Dey M, Nikiphorou E. Health equity and causes of disparities in rheumatological management. Joint Bone Spine. 2025;92(5):105902.

[5] Braun V, Clarke V. Thematic Analysis. A practical guide. Los Angeles: SAGE; 2022.

Acknowledgments: NIL.

Disclosure of Interests: None declared.