Health literacy and healthcare services use among migrants and non-migrants: national Italian data

Abstract Background Health Literacy (HL) is the ability to access, understand, evaluate, and apply health information. This study examines its association with health care services (HCS) use in the general Italian adult population, with a focus on migrants. Methods A national survey was conducted in Italy in 2021, in the framework of the WHO network Measuring Population and Organizational Health Literacy (M-POHL). A validated questionnaire was administered to a representative sample of the resident population aged 18+ years (N = 3,500), including 75 individuals born abroad with foreign-born parents. HL score was based on a 4-point Likert scale (very easy to very difficult), categorized as Inadequate (0-50%), Problematic (51-66%), Sufficient (67-80%), Excellent (81-100%), and combined into ‘Limiting’ (Inadequate/Problematic) and ‘Not limiting’ (Sufficient/Excellent). A multivariate logistic regression analysis, adjusted by sex, age, geographical area, education, financial deprivation, migrant status-MS was used to explore the associations between HL and the use of general practitioners, medical or surgical specialist services-MSS, inpatient hospital services, day-patient hospital services-DPS, and emergency services. Self-perceived health-SPH was included as ‘bad/fair’ vs ‘good’. Results Migrants showed a higher rate of limited HL (73.7%) than non-migrants-NM (64.4%). Among migrants, never using MSS was less common in Limiting HL vs Not limiting HL (34.6% vs 78.9%); likewise, among NM for MSS (46.6% vs 51.8%) and DPS (91.0% vs 94.0%). Bad/fair SPH was more frequent in Limiting HL among NM (59.2% vs 42.9%). Significant association with Limiting HL was found for MSS use twice or more (OR = 1.43) and bad/fair SPH (OR = 1.45). MS was also associated with Limiting HL, though not significantly (OR = 1.45). Conclusions Limited HL, more frequent among migrants, was associated with lower MSS use and bad/fair SPH; this may indicate issues for access to HCS and calls for further studies. Key messages • Limited Health Literacy is more frequent among migrants, highlighting a key vulnerability in access to health services. • Limited Health Literacy is associated with higher medical or surgical specialist service use and poorer self-perceived health.