Managing complexities of inflammatory rheumatic diseases as a migrant-a qualitative exploration of health literacy experiences.

Background: Migrants comprise over 17% of Norway's population and are at increased risk of limited health literacy, a key determinant of health. Health literacy is shaped by language, culture, social norms, discrimination, and health system responsiveness. Inflammatory rheumatic diseases are complex, chronic conditions requiring long-term, specialised care. Patients with these diseases and a migrant background, particularly those with limited proficiency in the dominant language, face additional barriers and poorer outcomes, yet their health literacy experiences remain underexplored. This study explored the experiences of patients with inflammatory rheumatic diseases, a migrant background, and limited language proficiency in accessing, understanding, appraising, and using health information and rheumatology services in Norway. Methods: Nineteen semi-structured, in-depth interviews were conducted with patients with a migrant background, and who used interpreters during consultations with health professionals. Participants were recruited from rheumatology departments at two Norwegian hospitals. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Two patient research partners were involved throughout the study. Results: Three main themes were generated. First, barriers to accessing and using health information and services were shaped by the interplay between language proficiency, digital literacy, and social support, which often compensated for system gaps. Health systems implicitly assumed a minimum level of linguistic and digital competence, creating mismatches between system demands and patients' abilities. Second, trust was foundational, shaping engagement and acceptance of treatment. Trust developed over time; length of residency did not necessarily equate to confidence in using services, and trust in health professionals often preceded trust in the wider system. Third, employment was an important factor shaping health literacy and disease management: while colleagues supported service navigation, physically demanding and precariat working conditions constrained access to care and self-management. Conclusion: Managing these conditions among migrants with limited language proficiency is shaped by interrelated individual, relational, and structural factors. Health literacy is co-constructed through social networks, trust, and contexts such as employment, while system assumptions about language and digital competence create fragmented access. Interventions should move beyond communication barriers to foster trust, support shared understanding, and address broader social and structural conditions influencing engagement with health services.