The interaction between ethnicity and health literacy for weight management among obese Arabic-speaking immigrants in Australian primary health care

Abstract

Obesity affects many Australians, particularly Arabic-speaking immigrants, who experience challenges in weight management due to a range of factors including inadequate health literacy. While there is little controversy about the importance of health literacy for weight management, there is comparatively little research exploring the influence of health literacy on weight management among culturally and linguistically diverse population groups. Using a mixed methods instrumental single case study with repeated measures at baseline, six months and 12 months, this thesis investigates the interaction between ethnicity and health literacy for weight management among obese Arabic-speaking immigrants with low health literacy in a South Western Sydney general practice.This research was nested within a cluster randomised controlled trial of weight management in general practice. The trial aimed to evaluate the implementation and effectiveness of the role of practice nurses as ‘prevention navigators’ to support obese patients with low health literacy to better manage their weight. Data collection included a self-completed questionnaire and a face-to-face qualitative interview with five health care providers who treated predominantly Arabic-speaking patients and a telephone quantitative survey and qualitative interview with twelve Arabic-speaking patients in Arabic. The triangulated data were analysed through an inductive, constructivist lens.The study found a complex relationship between ethnicity and health literacy for weight management. While many similarities existed between Arabic-speaking and non- Arabic-speaking patients and their health care providers, the effects of low health literacy on weight management were amplified by ethnicity-related factors among Arabic-speaking patients, particularly their ability to actively manage their own health and their ability to read and understand written health information. Examples of these ethnicity-related factors included the traditional Arabic diet, cultural norms of hospitality and generosity, religious celebrations, changes to the physical environment following migration, social support and depressed mood. In turn, these negatively interacted with the attitudes of primary health care providers, which they often conflated patient’s low health literacy with a lack of motivation, and the overall health system’s goals and capabilities to improve access, efficiency and integration of care. Primary health care providers need to understand how ethnicity and low health literacy among Arabic-speaking patients may interact and confound their attempts to address obesity in this population