Beyond the Lines: Exploration of Health Literacy Among Inmates in a European Prison in Africa

Abstract

Migration status, belonging to ethnic or racial minorities, and low educational and socioeconomic levels are predisposing factors for low health literacy, which can be further exacerbated by incarceration. This study aimed to explore the health literacy levels of incarcerated individuals in a European enclave on the African continent and compare these findings with the Spanish population assessed in the European Health Literacy Survey. A cross-sectional study was conducted using a convenience sampling method between August and September 2023. Participants completed the short form of the Spanish version of the European Health Literacy Survey questionnaire, and relevant sociodemographic data were collected. This instrument assessed the skills of accessing, understanding, appraising, and applying health-related information. Sociodemographic variables such as age, education level, nationality, and length of incarceration were included to enable a more nuanced analysis of the factors contributing to health literacy disparities. A total of 71 inmates with a basic command of the Spanish language participated. Of these, 94.37% demonstrated inadequate or problematic health literacy levels. The most pronounced disparities, compared to the non-incarcerated population, were observed in accessing health information, particularly in the domain of disease prevention. No significant associations were identified between health literacy levels and the selected sociodemographic variables. However, being part of the incarcerated population, itself emerged as a determining factor for low health literacy when compared to the non-incarcerated population, findings reveal significant health literacy deficits among the incarcerated population, emphasizing the role of incarceration as both a challenge and an opportunity for intervention.