The adaptation of Turkish health literacy scale for literate Syrian adult refugees living in Turkey: a reliability–validity study

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Evaluation of Nutritional Status with Healthy Eating Index (HEI-2010) of Syrian Refugees Living Outside the Refugee Camps

“…5 : Beans and peas are included here (and not with vegetables) when the Total Protein Foods standard is not otherwise met. 6 : Includes seafood, nuts, seeds, soy products (other than beverages), as well as beans and peas, which are counted as Total Protein Foods. 7 : Ratio of poly-and mono-unsaturated fatty acids (PUFAs and MUFAs) to saturated fatty acids (SFAs).…”

“…Immigrants with legal status may access migrant health clinics and units for free primary healthcare services provided by the Turkish government. By August 2020, there were 2520 Syrian healthcare professionals working in these clinics and units around the country and 966 trained referral guides/translators serving patients (for linguistic problems) [6]. In addition to the more than 3.7 million Syrian refugees who are officially registered in Turkey, there are also an estimated tens of thousands to one million Syrian refugees who are not officially registered and do not have access to public health services.…”