Evaluating the health literacy demand and cultural appropriateness of online immunisation information available to refugee and migrant communities in Australia

Background: The internet is a source of health information for many consumers. However, little is known about the availability of online resources about immunisation (for children and adults) directed at refugee and migrant populations. The aim of this study was to evaluate the health literacy demand (under-standability, actionability & readability) and cultural appropriateness of immunisation resources in Australia for these communities. Methods: Our study involved two search approaches. Firstly, Google trends was used to identify the most common search terms used in Australia. Search terms used included 'immunisation', 'vaccine' and 'refugee immunisation' amongst others. These search terms were entered into: Google, Bing, Duck Duck Go and Yahoo and the first 5 pages of results for each search were examined. Searches were conducted from November 2018 to June 2019. Secondly, requests were sent out directly to key stakeholders in local health districts and state/territory health departments. Understandability and actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT). The Simple Measure of Gobbledygook (SMOG) and the Flesch readability ease tools were used to assess readability. Cultural appropriateness was assessed using additional criteria developed by the Centre for Culture, Ethnicity and Health (CEH), Victoria, Australia. Results: 27/33 resources were included in the analysis. The overall mean understandability score was 70% (range: 50-100%). The overall mean actionability score of the resources was 47% (range: 0-83%). In terms of readability, the mean score was a 10.5, which was indicative of an eleventh grade reading level. The average Flesch-Kincaid readability score was 47.7. The average score for cultural appropriateness was 79% (range: 29-100%). Conclusions: Our findings suggest that there are currently not many refugee-specific resources on immunisation. Future work needs to better improve the health literacy demand of online immunisation information. Engaging with members from migrant communities is also recommended so that appropriately tailored resources are co-developed. (C) 2020 Elsevier Ltd. All rights reserved.