Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland

Sarah Mantwill, Peter J. Schulz

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Objective This study aimed at investigating the association between functional health literacy and knowledge on when to seek medical help for potentially harmless (overutilization) or serious (underutilization) situations among immigrants and non-immigrants in Switzerland. Methods Data was collected among three immigrant groups and the native population (N = 1146) in the German- and Italian-speaking part of Switzerland. Health literacy was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) and three Brief Health Literacy Screeners. Over- and underutilization of healthcare services was assessed with items asking participants about when to seek medical help for minor, respectively major, physical symptoms. Results Immigrants were more likely to seek medical help when unwarranted (overutilization). Health literacy, when assessed with the S-TOFHLA, was significantly associated with over- and underutilization. Yet, once controlled for covariates, the association between health literacy and overutilization was negative. Immigration background and micro-cultural differences emerged as important predictors of utilization. Conclusions Results suggest that functional health literacy is directly related to healthcare utilization. The effects might be amplified by (micro-)cultural differences. Practice implications Healthcare providers should be aware of differences in health literacy and utilization patterns among different population groups. Communication between patients and providers should be literacy and culturally sensitive.

Original languageEnglish
Pages (from-to)2020-2027
Number of pages8
JournalPatient Education and Counseling
Issue number11
StatePublished - Nov 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier B.V.


  • Health literacy
  • Healthcare utilization
  • Immigrant health
  • Immigrants
  • Switzerland


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