Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Patient understanding can be key to the successful use of many of the interventions for which there are Cochrane Reviews and, in November 2023, we published a review that might help with this. Here are two of the authors, Angela Aldin from Cochrane Haematology and Annika Baumeister from the University of Bonn, both in Germany, to talk about the findings of that review looking at interventions for improving health literacy in migrants.

Angela: Hello Annika, thank you for being here. Let's start by defining health literacy and its importance for migrants. It's more than just understanding medical terminology, right?

Annika: Exactly. Health literacy encompasses not only understanding health information but also the knowledge, motivation and competencies to access, appraise, and apply it in order to make self-determined decisions about one's health. For migrants, this can be particularly challenging, for example, because of language barriers or unfamiliarity with the health system. 

Angela: That makes sense. So, what did the review focus on specifically?

Annika: We wanted to assess whether interventions aimed at improving health literacy in migrants are effective and whether there are any differences between the effects for migrant men and women.

Angela: Thinking about the interventions in the review, can you provide some examples of the types of thing that were compared?

Annika: We had nine comparisons in the review, because of the variability in the types of study that have been done, the interventions they compared and the participants. For example, we looked at inter alia structured self-management programmes, group-based health literacy skills building courses, telephone education and audio-visual education without personal feedback. Each intervention was adapted to participant's culture, language and literacy levels and comparators included, for example, standard care which was categorised as 'no health literacy intervention', 'written information on the same health topic' or an 'unrelated health literacy intervention' in which the participants received a similar intervention but dealing with a different health topic. 

Angela: And what about the results? What does the review say about the effectiveness of the interventions?

Annika: Overall, we have moderate to low confidence that certain intervention types, such as self-management programmes, but also group-based course to build health literacy skills and audio-/visual education without personal feedback, such as videos or interactive touchscreens, had small to moderate positive effects on migrants' health literacy. For example, they improved knowledge and understanding of medical terminology, as well as the participant's use of health information.

Angela: That's promising. Returning to the analysis of migrant men and women: were there any differences?

Annika: We found limited evidence that migrant women may experience slightly greater improvements in diabetes health literacy compared to men when they received audio-/visual education. However, was no conclusive evidence for any other comparisons or outcomes and more studies will be needed to investigate this fully. 

Angela: Alongside these gaps, are there other limitations to the review?

Annika: Yes, there are several. I've already mentioned the variations in migrant populations and health conditions that were studied, and potential biases and small sample sizes in some studies are also a problem. These will need to be addressed by larger, well-designed studies to assess the long-term effects of health literacy interventions on both migrant women and men.

Angela: Thank you, Annika, for sharing your insights with us today. All comparisons and outcomes are reported in the full text, right. 

Annika: You're welcome, Angela. Yes, listeners can find all this information in the review, which is available online at Cochrane Library dot com with a simple search for 'health literacy in migrants'.