Health literacy with a focus on knowledge and use of antibiotics amongst refugees and asylum seekers in Germany – a cross-sectional, single center quantitative study

Aims Health literacy (HL) enables individuals to make informed health decisions, including regarding infectious diseases. Refugees are at heightened risk of low HL due to language barriers, cultural differences, and limited access to reliable health information. They also face higher risk of infectious diseases, including antibiotic-resistant infections. We aimed to assess HL, antibiotic knowledge and use, and relationships between them among adults residing in the initial reception center (Landeserstaufnahmeeinrichtung, LEA) for refugees and asylum seekers in Freiburg, Germany. Methods We conducted a cross-sectional study with 107 adult LEA residents, who completed questionnaires in Arabic, Persian, Pashto, Turkish, and English. HL was measured using the HLS-EU-16; antibiotic knowledge and use were assessed using ad hoc questions, based on existing literature. Data were analyzed using descriptive and inferential statistics. Results Around half of participants had adequate self-reported HL, while the remainder reported problematic or inadequate HL. Nearly half reported having used antibiotics within the last 6 months; however, knowledge regarding antibiotics was patchy and many participants reported inappropriate antibiotic use (e.g., stopping when symptoms improve; storing leftover antibiotics for later use). Lower HL and lower antibiotic knowledge were associated with increased likelihood of inappropriate antibiotic use. Differences between language subgroups were apparent, both in HL and in problematic antibiotic use. Conclusions The study demonstrates that HL among LEA residents in Freiburg is heterogeneous and shaped by multiple demographic and contextual factors. The findings underscore the importance of culturally and linguistically tailored health education strategies to improve infection prevention and health outcomes in refugee populations, particularly regarding knowledge about and use of antibiotics.