The Relationship of COVID-19 Vaccination Status with Health Literacy of Syrians Living in Istanbul

Abstract

Health literacy is an important determinant of health care use among refugees and migrant communities. This present study aimed to evaluate the relationship between health literacy levels, sociodemographic characteristics, and the status of receiving the COVID-19 vaccine in Syrians under “Temporary Protection” in Istanbul. This study was conducted in February, March, and May 2022 in an Extended Migrant Health Center in Istanbul, with a survey prepared in Arabic under observation. A total of 571 questionnaires were analyzed. The mean age of the participants was 31.92 ± 6.14, and 80.7% were female and 26.6% were high school graduates. A total of 55.0% of Syrians have not had any of the COVID-19 vaccines. The health literacy level of 1.1% of the immigrants was determined as “excellent”, 68.7% as “inadequate”, 20.7% as “problematic/limited”, and 9.6% as “adequate”. According to the logistic regression model, being male, of elder age, middle and above economic status, and having a chronic disease in the family were determined as the variables associated with the status of being vaccinated against COVID-19. Refugees are a group often exposed to inequalities in access to health services. Increasing health literacy in these groups will provide a significant improvement in access to and use of health services.

COVID-19 Vaccination and Predictive Factors in Immigrants to Europe: A Systematic Review and Meta-Analysis

“…Specifically, five of these were carried out in Norway, two each in France, Germany, and Italy, one each in Finland, Denmark, Sweden, and Turkey, and one multicentric study in Switzerland, France, and Italy. Three studies (19%) were published in 2021 [23,25,29], four (25%) in 2023 [16,18,21,30], and the remaining nine studies (56%) in 2022 [17,[19][20][21][22]24,[26][27][28]. The earliest data collection was compiled in the period May 2020-June 2020 in Longchamps' study [25], which investigated the hesitancy to vaccinate, as the COVID-19 vaccine was not yet available; the latest one was compiled on COVID-19 vaccination status in February, March, and May 2022 by Aysit et al [16].…”

“…The studies carried out on the largest samples were generally designed as register-based cohort studies with the data obtained from regional or national registries; the other studies were cross-sectional designed based upon data collected by web-based surveys with computer-assisted web interviews (CAWI) or computer-assisted telephone interviews (CATI). Only in one study [25], the participants (residents of French homeless shelters) were interviewed in person or by telephone, while in the multicentric study [28] and in the study on Syrians under "Temporary Protection" in Istanbul [16], the questionnaire was available at health facilities. The participants of the study of Holz et al [22] were randomly drawn from the database of a third-party online access panel provider and incentivized by earning 50 Euro cents per 10-minute interview time.…”

“…Concerning the country of origin of immigrants in European countries, the Italian studies [27,29] subdivided the sample into Italians or foreigners according to their citizenship; the others considered immigrants as born abroad of foreign-born parents. Only Kraft et al [23] considered immigrants separately by country of origin; Lajunen and Wrobel [24] and Aysit et al [16] considered immigrants from only one country (Poland and Syria, respectively); the other studies subdivided immigrants from countries grouped by regions or by language spoken.…”

“…Ten studies aimed at vaccine uptake in immigrants (and in the host population, if investigated) [16][17][18][19][20][21]23,27,29,31], three studies aimed at the vaccine hesitancy [25,28,30], one study the attitude to vaccinate [24], one other [22] the vaccine intention, and the last remaining [26] the information access to preventive measures against COVID-19.…”

“…No evidence of publication bias was observed by visual inspection of the funnel plot (Figure 2) or by using Egger's test (p = 0.73). In this elaboration, we did not consider the sample of Syrian immigrants from Turkey [16], both because of the sex imbalance (81% women) and the late period of data collection (referring to only 2022) compared to the other studies. Through the meta-analysis, we found a high heterogeneity across the studies (I 2 : 99.60%, p < 0.001), and we estimated a pooled uptake prevalence of the COVID-19 vaccine of 71.3% (9 samples, 95% CI: 70.02-72.52%) among a cumulative sample size of 1,960,724 immigrants in European countries.…”