Bahar Özvarış Şevkat, Güçiz Doğan Bahar, Konşuk Ünlü Hande, Aktuna Gamze, İnandı Tacettin, Kurt A Öner, Aydın Neriman, Kutluk M Tezer
Public Health Institute, Hacettepe University, Ankara, Turkey.
Research for Health in Conflict in the Middle East and North Africa (R4HC-MENA), and the Conflict and Health Research Group (CHRG), King's College, London, UK.
Confl Health. 2021 Aug 28;15(1):65. doi: 10.1186/s13031-021-00401-5.
Turkey hosts the world's largest refugee population of whom 3.5 million are Syrians and this population has been continuously growing since the year 2011. This situation causes various problems, mainly while receiving health-care services. In planning the migrant health-care services, for the policy makers of host countries, health literacy level of migrants is an important measure. Determination of health literacy level of Syrian refugees in Turkey would be supportive for planning some interventions to increase health-care service utilization, as well as health education and health communication programs. An "original health literacy scale" for 18-60 years of age Turkish literate adults (Hacettepe University Health Literacy Scale-HLS) was developed to be used as a reference scale in 2018. Since it would be useful to compare the health literacy levels of Turkish adults with Syrian adult refugees living in Turkey with an originally developed scale, in this study, it was aimed to adapt the HLS-Short Form for Syrian refugees.
This methodological study was carried out between the years 2019-2020 in three provinces of Turkey where the majority of Syrians reside. The data was collected by pre-trained, Arabic speaking 12 interviewers and three supervisors via a questionnaire on household basis. At first, the original Scale and questionnaire were translated into Arabic and back translated into the original language. The questionnaire and the Scale were pre-tested among 30 Syrian refugees in Ankara province. A total of 1254 refugees were participated into the main part of the study; 47 health-worker participants were excluded from the validity-reliability analysis. Confirmatory factor analysis (CFA) was performed. Cronbach's alpha and Spearman-Brown coefficients were calculated.
Of the participants, 52.9% was male; 26.1% had secondary education level or less; almost half of them had moderate economic level; 27.5% could not speak Turkish. The Cronbach's Alpha was 0.75, Spearman-Brown Coefficient was 0.76; RMSEA = 0.073, CFI = 0.93, TLI = 0.92 and GFI = 0.95 for the Scale. The Cronbach's Alpha was 0.76, Spearman-Brown Coefficient was 0.77; RMSEA = 0.085, CFI = 0.93, TLI = 0.91 and GFI = 0.95 for self-efficacy part.
In conclusion, the adapted HLS would be a reliable instrument to evaluate the health-literacy level of Syrian refugees living in Turkey and could allow for a comparison of the host country's health literacy level to that of the refugees using the same scale.
土耳其接纳了全球数量最多的难民，其中350万是叙利亚人，自2011年以来这一群体数量持续增长。这种情况引发了各种问题，尤其是在接受医疗服务方面。在规划移民医疗服务时，对于东道国的政策制定者而言，移民的健康素养水平是一项重要指标。确定土耳其叙利亚难民的健康素养水平，将有助于规划一些干预措施，以提高医疗服务利用率，以及开展健康教育和健康传播项目。2018年开发了一种适用于18至60岁土耳其识字成年人的“原始健康素养量表”（哈杰泰佩大学健康素养量表 - HLS），用作参考量表。由于使用最初开发的量表比较土耳其成年人与居住在土耳其的叙利亚成年难民的健康素养水平会很有用，因此在本研究中，旨在将HLS简表改编用于叙利亚难民。
这项方法学研究于2019年至2020年在土耳其叙利亚人居住最为集中的三个省份开展。数据由12名经过预培训、会说阿拉伯语的访谈员和3名监督员通过家庭问卷调查收集。首先，将原始量表和问卷翻译成阿拉伯语，然后再回译成原语言。问卷和量表在安卡拉省的30名叙利亚难民中进行了预测试。共有1254名难民参与了研究的主要部分；47名卫生工作者参与者被排除在效度 - 信度分析之外。进行了验证性因素分析（CFA）。计算了克朗巴哈系数和斯皮尔曼 - 布朗系数。
参与者中，52.9%为男性；26.1%具有中学及以下教育水平；几乎一半人的经济水平中等；27.5%不会说土耳其语。该量表的克朗巴哈系数为0.75，斯皮尔曼 - 布朗系数为0.76；RMSEA = 0.073，CFI = 0.93，TLI = 0.92，GFI = 0.95。自我效能量表的克朗巴哈系数为0.76，斯皮尔曼 - 布朗系数为0.77；RMSEA = 0.085，CFI = 0.93，TLI = 0.91，GFI = 0.95。
总之，改编后的HLS将是评估居住在土耳其的叙利亚难民健康素养水平的可靠工具，并且能够使用相同量表比较东道国与难民之间的健康素养水平。
