Qualitative exploration of critical health literacy among Afghan and Congolese refugees resettled in the USA

Previous research that revealed a high prevalence of low health literacy among immigrants and refugees tended to over emphasise functional health literacy as a risk factor for low health status and poor disease management. Despite a significant knowledge gap, little has been investigated regarding critical health literacy (CHL) in refugee populations whose culture deeply interweaves individual and contextual capacity to promote health. This study adopted a qualitative approach to explore CHL that is built through community health workshops (CHWs) with Afghan and Congolese refugee communities in US resettlement. As part of a community-based participatory research project, the study was conducted with Afghan and Congolese refugees resettled in the USA. A series of open-ended questions for focus group interviews were embedded in each workshop session explore health literacy skills and capacity over time. This study adopted a hybrid thematic design whereby the conceptual framework of CHL was applied to emergent themes from the data. Thematic analysis revealed four major CHL thematic domains, as experienced and demonstrated by Afghan and Congolese refugee participants: (1) critical appraisal, (2) self-efficacy and confidence, (3) empowerment, and (4) collective problem solving. Study findings underline the importance of health education validating existing cultural knowledge and practices in a group setting so as to facilitate the building and enhancement of social support systems and community action for health promotion