School of Clinical Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
Primary Care and Population Health / Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London, London, UK.
BMJ Glob Health. 2024 Nov 28;9(11):e017277. doi: 10.1136/bmjgh-2024-017277.
Gypsies, Roma and Travellers (GRT) frequently experience poorer health outcomes than the general population and represent the most socially and economically disadvantaged individuals in many countries. In general, GRT in OECD (Organisation for Economic Co-operation and Development) countries have lower rates of literacy than the general population. Although 'health literacy' has been examined before, the link between low functional literacy and its effects on health has not yet been explored.
Searches were conducted on five large English-language databases for research papers since 2008. Grey literature was included as the number of eligible papers was small. This was complimented by citation 'chaining'. Study findings of qualitative papers were extracted, codes were devised and then analysed thematically. A narrative synthesis was reported, supplemented by the quantitative findings.
15 studies (and two substudies) were analysed. Four strongly overlapping themes were developed: (1) The context of culturally inadequate healthcare systems, (2) psychological impact and disempowerment, (3) intersectional, contextual factors and the unique needs of GRT and (4) considerations for health information resources for GRT patients with low literacy.
Although low literacy in GRT groups is a well-recognised issue, this is the first systematic review to analyse the link between low literacy and its effects on health outcomes for GRT. The wide range of socioeconomic and cultural factors present in GRT communities, combined with low literacy, act synergistically to worsen the physical and mental health of GRT groups in different ways than that seen in members of the general population with similar low literacy levels. National intervention is required to improve the literacy of GRT children and adults. There is a clear need to develop policies and processes that facilitate a better understanding of literacy levels and how they interact with other social determinants of GRT health among healthcare professionals.
CRD42023468449.
吉普赛人、罗姆人和游民（GRT）的健康状况往往不如一般人群，在许多国家，他们是社会和经济上最弱势群体。总的来说，OECD（经济合作与发展组织）国家的 GRT 群体的识字率低于一般人群。尽管之前已经研究过“健康素养”，但低功能性识字率及其对健康的影响之间的联系尚未得到探索。
自 2008 年以来，在五个大型英语数据库中搜索了研究论文。由于符合条件的论文数量较少，因此也包括灰色文献。这与引文“连锁”相辅相成。对定性论文的研究结果进行了提取、编码，然后进行了主题分析。报告了叙述性综合，补充了定量发现。
分析了 15 项研究（和两项子研究）。得出了四个紧密重叠的主题：（1）文化上不适当的医疗保健系统背景，（2）心理影响和权力丧失，（3）交叉、背景因素和 GRT 的独特需求，（4）为低识字率的 GRT 患者提供健康信息资源的考虑因素。
尽管 GRT 群体的低识字率是一个众所周知的问题，但这是第一项系统评价，分析了低识字率与其对 GRT 健康结果的影响之间的联系。GRT 社区中存在的广泛的社会经济和文化因素，加上低识字率，以不同于一般人群中具有类似低识字率的人群的方式协同作用，以不同的方式恶化 GRT 群体的身心健康。需要国家干预来提高 GRT 儿童和成人的识字率。显然需要制定政策和流程，以更好地理解识字水平，并了解它们如何与 GRT 健康的其他社会决定因素相互作用，这对于医疗保健专业人员来说非常必要。
CRD42023468449。
