College of Health, Massey University, Wellington, New Zealand.
School of Medicine, University of Tasmania, Hobart, Australia.
Health Promot J Austr. 2022 Apr;33(2):403-411. doi: 10.1002/hpja.501. Epub 2021 Jun 6.
Tasmania, Australia is home to a population of Bhutanese former refugees who have resettled since 2007. Their refugee journey and disrupted education opportunities have resulted in gaps in literacy in their primary language (Nepali), and many suffer one or more chronic conditions (ongoing communicable or noncommunicable diseases (NCDs)). This research explored how this community perceives chronic conditions and managed their medication using the concept of distributed health literacy.
A longitudinal qualitative method was used whereby 15 former refugees and their carers were interviewed 3-4 times over 9 months. Data were thematically analysed using a hybrid approach of inductive and deductive coding and theme development.
Four themes related to distributed health literacy were identified. These were "barriers to medication literacy and adherence," "support people as health literacy mediators," "understandings of chronic disease" and "strengthening distributed health literacy." Participants described managing relatively low levels of knowledge about their chronic conditions and medications by appointing support people who acted as health literacy mediators. This resulted in interactions with health professionals, information gathering and medication use being enacted collectively between family members. Carers felt responsible for supporting others who were new to the Australian health system to learn new skills in addition to assisting with tasks such as informal interpreting. SO WHAT?: Interventions to improve the health literacy of former refugees should focus on collective critical health literacy action rather than just the functional health literacy of individuals. Health literacy mediators are a vital form of support for former refugees managing chronic conditions, so must be included in education and support programs.
澳大利亚塔斯马尼亚州是 2007 年以来安置的不丹前难民的家园。他们的难民之旅和中断的教育机会导致他们的母语（尼泊尔语）读写能力出现差距，许多人患有一种或多种慢性疾病（持续的传染病或非传染性疾病（NCDs））。这项研究探讨了该社区如何看待慢性疾病，并利用分布式健康素养的概念来管理他们的药物。
采用纵向定性方法，对 15 名前难民及其照顾者进行了 3-4 次访谈，时间跨度为 9 个月。使用归纳和演绎编码以及主题开发的混合方法对数据进行主题分析。
确定了与分布式健康素养相关的四个主题。这些主题是“药物读写和依从性障碍”、“支持人员作为健康素养中介”、“对慢性疾病的理解”和“加强分布式健康素养”。参与者描述了通过指定支持人员作为健康素养中介来管理相对较低的慢性疾病和药物知识水平。这导致家庭成员之间共同进行与卫生专业人员的互动、信息收集和药物使用。照顾者除了协助非正式翻译等任务外，还负责支持那些刚接触澳大利亚卫生系统的人学习新技能。
提高前难民健康素养的干预措施应侧重于集体批判性健康素养行动，而不仅仅是个人的功能性健康素养。健康素养中介是管理慢性疾病的前难民的重要支持形式，因此必须纳入教育和支持计划。
