Factors associated with health literacy in sexual and reproductive health: a cross-sectional study among south Sudanese refugee women in Rhino camp refugee settlement, West Nile, Uganda

Abstract

Introduction: Refugee women in Uganda experience poorer sexual and reproductive health (SRH) outcomes than women in the host community. Previous studies have shown that refugee women face several significant barriers to accessing and utilising SRH services. The World Health Organization (WHO) are promoting self-care to improve SRH outcomes in low-income or humanitarian settings, but this places significant responsibility on individuals and requires a certain level of health literacy. Health literacy (HL) describes a person’s ability to engage with health information and services and is linked to other social determinants of health, such as level of education. Objectives: The overall objective of this research was to assess the level of health literacy and its associated factors, and to examine its relationship with the utilisation of SRH services among South Sudanese refugee women aged 15-49 years in Rhino Camp refugee settlement, Uganda. The specific objectives were to validate the Health Literacy Questionnaire (HLQ) for use in Juba Arabic-speaking communities; to use the HLQ to examine the level of health literacy among South Sudanese refugee women aged 15-49 years in Rhino Camp; to examine the factors associated with health literacy among the same population; and to examine the association between their level of health literacy and utilisation of SRH services. Methods: A cross-sectional survey design was employed, utilising a quantitative questionnaire to collect data on SRH service use and HL through a newly translated and validated Juba Arabic version of the Health Literacy Questionnaire (HLQ-JA) alongside SRH-related items. Results: The HLQ-JA demonstrated strong reliability and validity, proving robust for assessing HL among Juba Arabic-speaking South Sudanese women. The study found low HL levels overall, with significant associations between HL and factors such as level of education, household income and self-rated health status. There was a significant positive association between higher levels of HL and greater utilisation of SRH services. Conclusions/Recommendations: Efforts to improve SRH service utilisation should include targeted interventions that support low HL individuals to understand health information and navigate the healthcare system. Training healthcare providers to communicate effectively with patients with lower HL is recommended to increase SRH engagement among refugee women.