Unpacking Health Literacy Disparities in Migrant and Ethnic Minority Communities in England.

Abstract

Health literacy is essential for navigating healthcare systems and making informed decisions. Migrant and minority ethnic populations often face barriers that impact their health literacy and access to care. This study explored the health literacy profiles and lived experiences of African and Latin American communities in England. A mixed-methods study was conducted using Phase 1 of the Ophelia (Optimising Health Literacy and Access) process. Sixty-five participants completed the Health Literacy Questionnaire (HLQ), and hierarchical cluster analysis identified distinct health literacy profiles. Two focus groups (n = 7 each) were held to explore participants' experiences in greater depth. Qualitative data were analysed using thematic analysis. While participants demonstrated strengths in accessing and understanding health information, significant disparities emerged in areas requiring institutional engagement, trust in healthcare providers, and emotional support. Key barriers included digital exclusion, limited interpreter availability, fear of immigration consequences, and experiences of being dismissed or misunderstood in clinical settings. These challenges disproportionately affected asylum seekers and those with insecure immigration status, reflecting structural vulnerability and institutional racism. The study highlights the limitations of individual-level interventions and calls for system-wide changes to address the relational and structural barriers that undermine health equity. Improving health literacy among migrant populations requires more than accessible information. Equity-focused, co-designed interventions that confront institutional racism, invest in culturally safe communication, and prioritise emotional safety are essential to reducing racial and ethnic health disparities.