Background and Objective:
Migrants generally reported low levels of health literacy (HL) thus increasing their difficulties in accessing and interacting with the healthcare system. This study aims to assess the HL level of 2 samples of asylum seekers and refugees residing in Tuscany, and to examine the relationship among HL, educational interventions, COVID-19 risk perception and preventive behaviours.

Methods:
Questionnaires were administered to a voluntary sample of refugees and asylum seekers (group A) between June and September 2021 and to another sample between April and September 2022 (group B) who participated at least in one out of four health-related educational intervention. HL has been measured by the Italian version of HLS-EU-Q16.

Results:
Among 171 subjects belonging to group A 25% had an inadequate HL level. Group B consisted of 102 respondents of whom 37% had an inadequate HL level. Group B compared with group A had higher percentages of respondents who considered COVID-19 a serious health problem (58.8% vs 41.1%), very likely to be infected by SARS-COV-2 (58.2% vs 29.6%) and who thought quarantine (89.7% vs 75.9%), nasopharyngeal swabs (78.4% vs 61.2%), and to get COVID-19 vaccination (89.4% vs 66.1%) were important preventive measures. HL level was found to be significantly associated (p<0.05) with COVID-19 risk perception and propensity for handwashing, face mask use, and social distancing. At multivariate logistic analysis, low educational level and residing in Italy for less than 2 years were found to be predictors of inadequate HL level (OR 2.7 CI 95% 1.22-6.13; OR 3.9 CI 95% 1.93-7.79, respectively).

Conclusions:
Findings suggest that HL and educational interventions are key to improve healthy behaviours. Structured educational interventions to increase HL levels will give contribution in the process of inclusion and integration of migrants thus reducing health related inequalities.