{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:32:48Z","timestamp":1790760768217,"version":"4.1.0"},"reference-count":54,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T00:00:00Z","timestamp":1696982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Rational drug use is a pivotal concept linked with morbidity and mortality. Immigration plays a significant role as a determinant affecting individuals\u2019 health-related attitudes, behaviors, and the pursuit of health services. Within this context, the study was initiated to assess the factors influencing health literacy and rational drug use among Syrian immigrants in Istanbul. A cross-sectional study was undertaken on 542 Syrian adults utilizing a three-part questionnaire encompassing sociodemographics, rational drug use, and the e-health literacy scale (eHEALS). With an average age of 39.19 \u00b1 13.10 years, a majority of participants believed medications should solely be doctor-prescribed (97%) and opposed keeping antibiotics at home (93.7%). Yet, 62.5% thought excessive herbal medicine use was harmless. The mean eHEALS score stood at 20.57 \u00b1 7.26, and factors like age, marital status, income, and duration of stay in Turkey influenced e-health literacy. Associations were seen between low e-health literacy and being female, being older, having a lower education level, and regular medication use. Syrian immigrants displayed proper knowledge concerning antibiotics yet exhibited gaps in their understanding of general drug usage, treatment adherence, and herbal medicines. Approximately 80.3% had limited health literacy, pointing to the need for targeted interventions for enhanced health and societal assimilation.<\/jats:p>","DOI":"10.3390\/antibiotics12101531","type":"journal-article","created":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T08:07:12Z","timestamp":1697011632000},"page":"1531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Rational Drug and Antibiotic Use Status, E-Health Literacy in Syrian Immigrants and Related Factors: A Cross-Sectional Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8862-1343","authenticated-orcid":false,"given":"Mehmet Sait","family":"De\u011fer","sequence":"first","affiliation":[{"name":"Department of Public Health, Medical Faculty, Hitit University, Corum 19030, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6744-1343","authenticated-orcid":false,"given":"Mehmet Akif","family":"Sezerol","sequence":"additional","affiliation":[{"name":"Epidemiology Program, Institute of Health Sciences, Istanbul Medipol University, Istanbul 34810, T\u00fcrkiye"},{"name":"Sultanbeyli District Health Directorate, Istanbul 34935, T\u00fcrkiye"},{"name":"Health Management Program, Graduate Education Institute, Maltepe University, Istanbul 34857, T\u00fcrkiye"},{"name":"Department of Public Health, School of Medicine, Istanbul Medipol University, Istanbul 34810, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8545-3660","authenticated-orcid":false,"given":"Muhammed","family":"Atak","sequence":"additional","affiliation":[{"name":"Department of Public Health, Istanbul Medical Faculty, Istanbul University, Istanbul 34093, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,11]]},"reference":[{"key":"ref_1","unstructured":"(2023, October 07). Available online: https:\/\/www.who.int\/about\/governance\/constitution."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Sezerol, M.A., and Alta\u015f, Z.M. (2023). Vaccine Uptake and COVID-19 Frequency in Pregnant Syrian Immigrant Women. Vaccines, 11.","DOI":"10.3390\/vaccines11020257"},{"key":"ref_3","first-page":"37","article-title":"Ak\u0131lc\u0131 ila\u00e7 kullan\u0131m \u00f6l\u00e7e\u011fi ge\u00e7erlilik ve g\u00fcvenilirli\u011fi","volume":"3","author":"Alaiye","year":"2018","journal-title":"EST\u00dcDAM Halk Sa\u011fl\u0131\u011f\u0131 Derg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e16316","DOI":"10.2196\/16316","article-title":"The Swedish version of the electronic health literacy scale: Prospective psychometric evaluation study including thresholds levels","volume":"8","author":"Jaensson","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref_5","first-page":"184","article-title":"Knowledge Gap and Digital Media: Effect of Socio Demographics and eHealth literacy on Perceived Trust in Online Health Information among Female Users","volume":"1","author":"Asgher","year":"2020","journal-title":"J. Media Commun."},{"key":"ref_6","first-page":"82","article-title":"A Research to Determine the Relationship Between EHealth Literacy and Rational Drug Use Awareness","volume":"22","author":"Tosun","year":"2021","journal-title":"Cumhur. Univ. J. Econ. Adm. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Aysit, E., Ikiisik, H., Cakir, M., and Maral, I. (2023). The Relationship of COVID-19 Vaccination Status with Health Literacy of Syrians Living in Istanbul. Vaccines, 11.","DOI":"10.3390\/vaccines11091394"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sullman, M.J.M., Lajunen, T.J., Baddal, B., and Apostolou, M. (2023). Antibiotics Knowledge. Attitudes and Behaviours among the Population Living in Cyprus. Antibiotics, 12.","DOI":"10.3390\/antibiotics12050897"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e225","DOI":"10.2196\/jmir.3318","article-title":"eHealth Literacy Interventions for Older Adults: A Systematic Review of the Literature","volume":"16","author":"Watkins","year":"2014","journal-title":"J. Med. Internet Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1388102","DOI":"10.1080\/20008198.2017.1388102","article-title":"Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: Integrating scalable psychological interventions in eight countries","volume":"8","author":"Sijbrandij","year":"2017","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1016\/j.pec.2015.04.003","article-title":"Optimal health literacy measurement for the clinical setting: A systematic review","volume":"98","author":"Duell","year":"2015","journal-title":"Patient Educ. Couns."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tavousi, M., Mohammadi, S., Sadighi, J., Zarei, F., Kermani, R.M., Rostami, R., and Montazeri, A. (2022). Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0271524"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"105124","DOI":"10.1016\/j.ijmedinf.2023.105124","article-title":"Sociodemographic Determinants of Digital Health Literacy: A Systematic Review and Meta-Analysis","volume":"177","author":"Estrela","year":"2023","journal-title":"Int. J. Med. Inform."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/jonm.13175","article-title":"Effects of mHealth-based interventions on health literacy and related factors: A systematic review","volume":"29","author":"Lin","year":"2021","journal-title":"J. Nurs. Manag."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106733","DOI":"10.1016\/j.cct.2022.106733","article-title":"Towards a more patient-centered clinical trial process: A systematic review of interventions incorporating health literacy best practices","volume":"116","author":"Bader","year":"2022","journal-title":"Contemp. Clin. Trials"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1007\/s10903-008-9135-5","article-title":"The Role of Culture in Health Literacy and Chronic Disease Screening and Management","volume":"11","author":"Shaw","year":"2009","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_17","first-page":"240","article-title":"Effect of education on rational drug use and health literacy in people with diabetes mellitus","volume":"46","year":"2021","journal-title":"Cukurova Med. J."},{"key":"ref_18","unstructured":"Frederiksen, N., and W\u00e5ngdahl., J. (2022). Health literacy in the Nordic countries: Not only a determinant of health, but also a tool for health promotion."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Singh, H., Kolschen, J., Samkange-Zeeb, F., Brand, T., Zeeb, H., and Sch\u00fcz, B. (2022). Modifiable predictors of health literacy in working-age adults\u2014A rapid review and meta-analysis. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-13851-0"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bergman, L., Nilsson, U., Dahlberg, K., Jaensson, M., and W\u00e5ngdahl, J. (2021). Health literacy and e-health literacy among Arabic-speaking migrants in Sweden: A cross-sectional study. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-12187-5"},{"key":"ref_21","unstructured":"(2022, September 04). Global Report 2022|Global Focus. Available online: Unhcr.org."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1007\/s10903-020-01025-2","article-title":"Post-migration Social\u2013Environmental Factors Associated with Mental Health Problems Among Asylum Seekers: A Systematic Review","volume":"22","author":"Jannesari","year":"2020","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Niyomyart, A., Chow, S.K.Y., Bualoy, W., Butsing, N., Tao, X., and Zhu., X. (2023). Antibiotic Knowledge, Antibiotic Resistance Knowledge, and Antibiotic Use: A Cross-Sectional Study among Community Members of Bangkok in Thailand. Antibiotics, 12.","DOI":"10.3390\/antibiotics12081312"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"cky047-076","DOI":"10.1093\/eurpub\/cky047.076","article-title":"2.5-O7 Rational drug use and migration: Awareness and attitudes towards antibiotic use among adults in Turkey and Turkish migrants in Sweden, the Netherlands and Germany","volume":"28","author":"Erdsiek","year":"2018","journal-title":"Eur. J. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Roque, F., Herdeiro, M.T., Soares, S., Rodrigues, A.T., Breitenfeld, L., and Figueiras, A. (2014). Educational interventions to improve prescription and dispensing of antibiotics: A systematic review. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-1276"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/S1473-3099(14)70071-4","article-title":"H. Antibiotic use in Eastern Europe: A cross-national database study in coordination with the WHO Regional Office for Europe","volume":"14","author":"Versporten","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1002\/pds.5311","article-title":"Evaluation of more than one billion outpatient prescriptions and eight-year trend showing a remarkable reduction in antibiotic prescription in Turkey: A success model of governmental interventions at national level","volume":"30","author":"Aksoy","year":"2021","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e13746","DOI":"10.2196\/13746","article-title":"An electronic medication module to improve health literacy in patients with type 2 diabetes mellitus: Pilot randomized controlled trial","volume":"4","author":"Seidling","year":"2020","journal-title":"JMIR Form. Res."},{"key":"ref_29","first-page":"108","article-title":"Birinci Basamak Sa\u011fl\u0131k Kurulu\u015funa Ba\u015fvuranlarda Sa\u011fl\u0131k Okuryazarl\u0131\u011f\u0131 ile Kanser Bilgi Y\u00fck\u00fc \u0130li\u015fkisi","volume":"26","year":"2021","journal-title":"Anatol. Clin. J. Med. Sci."},{"key":"ref_30","unstructured":"World Health Organization (2015). Antibiotic Resistance: Multi-Country Public Awareness Survey, World Health Organization."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1093\/eurpub\/ckv043","article-title":"Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU)","volume":"25","author":"Pelikan","year":"2015","journal-title":"Eur. J. Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Pedro, A.R., Raposo, B., Lu\u00eds, L., Amaral, O., Escoval, A., and Sim\u00f5es Dias, S. (2023). Portuguese Version of the HLS-EU-Q6 and HLS-EU-Q16 Questionnaire: Psychometric Properties. Int. J. Environ. Res. Public Health, 20.","DOI":"10.21203\/rs.3.rs-1894949\/v2"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.2196\/jmir.8.4.e27","article-title":"eHEALS: The eHealth Literacy Scale","volume":"8","author":"Norman","year":"2006","journal-title":"J. Med. Internet Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e24466","DOI":"10.2196\/24466","article-title":"Arabic version of the electronic health literacy scale in Arabic-speaking individuals in Sweden: Prospective psychometric evaluation study","volume":"23","author":"Dahlberg","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_35","first-page":"576","article-title":"How is eHealth literacy measured and what do the measurements tell us? A systematic review","volume":"7","author":"Karnoe","year":"2015","journal-title":"Knowl. Manag. E-Learn."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2600","DOI":"10.1002\/nop2.1520","article-title":"Assessment of health literacy among migrant populations in Southern Spain: A cross-sectional study","volume":"10","author":"Erahmouni","year":"2023","journal-title":"Nurs. Open"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Bas-Sarmiento, P., Poza-M\u00e9ndez, M., Fern\u00e1ndez-Guti\u00e9rrez, M., Gonz\u00e1lez-Caballero, J.L., and Falc\u00f3n Romero, M. (2020). Psychometric Assessment of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) for Arabic\/French-Speaking Migrants in Southern Europe. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17218181"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1080\/10810730.2016.1207115","article-title":"The Association of Health Literacy with health behavior socioeconomic indicators, and self-assessed health from a National Adult Survey in Israel","volume":"21","author":"Cohen","year":"2016","journal-title":"J. Health Commun."},{"key":"ref_39","unstructured":"(2023, September 09). Available online: https:\/\/multeciler.org.tr\/turkiyedeki-suriyeli-sayisi\/."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1037\/pro0000434","article-title":"Mental health of Iranian immigrants and their descendants: A review","volume":"53","author":"Amini","year":"2022","journal-title":"Prof. Psychol. Res. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.cmi.2021.10.017","article-title":"Non-biomedical factors affecting antibiotic use in the community: A mixed-methods systematic review and meta-analysis","volume":"28","author":"Sun","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"McCracken, C.M., Tucker, K.J., Tallman, G.B., Holmer, H.K., Noble, B.N., and McGregor, J.C. (2023). General Perceptions and Knowledge of Antibiotic Resistance and Antibiotic Use Behavior: A Cross-Sectional Survey of US Adults. Antibiotics, 12.","DOI":"10.3390\/antibiotics12040672"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Gradl, G., Kieble, M., Nagaba, J., and Schulz, M. (2022). Assessment of the Prescriptions of Systemic Antibiotics in Primary Dental Care in Germany from 2017 to 2021: A Longitudinal Drug Utilization Study. Antibiotics, 11.","DOI":"10.3390\/antibiotics11121723"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1007\/s10903-010-9367-z","article-title":"Sexual and Reproductive Health Behaviors of Undocumented Migrants in Geneva: A Cross Sectional Study","volume":"13","author":"Sebo","year":"2011","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1993066","DOI":"10.1155\/2022\/1993066","article-title":"Medicine Adherence and Associated Factors in Immigrants and Refugees: A Systematic Review","volume":"2022","author":"Patel","year":"2022","journal-title":"Int. J. Clin. Pract."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"315","DOI":"10.33457\/ijhsrp.793342","article-title":"Examination of pregnant women\u2019s konwledge level and attitudes towards rational drug use applying to healthcare facility in Mardin","volume":"5","author":"Utli","year":"2020","journal-title":"Int. J. Health Serv. Res. Policy"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"126","DOI":"10.46413\/boneyusbad.859525","article-title":"Yeti\u015fkin Bireylerde Ak\u0131lc\u0131 \u0130la\u00e7 Kullan\u0131m\u0131 ve Etkileyen Fakt\u00f6rlerin Belirlenmesi","volume":"3","author":"Uysal","year":"2021","journal-title":"Band\u0131rma Onyedi Eyl\u00fcl \u00dcniversitesi Sa\u011fl\u0131k Bilim. Ve Ara\u015ft\u0131rmalar\u0131 Derg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"62","DOI":"10.35232\/estudamhsd.553156","article-title":"Bir Sosyal Bilimler Meslek Y\u00fcksekokulu \u00d6\u011frencilerinin Ak\u0131lc\u0131 \u0130la\u00e7 Kullan\u0131m\u0131 Konusunda Bilgi ve Davran\u0131\u015flar\u0131n\u0131n De\u011ferlendirilmesi","volume":"5","author":"Kurt","year":"2020","journal-title":"EST\u00dcDAM Halk Sa\u011fl\u0131\u011f\u0131 Derg."},{"key":"ref_49","first-page":"273","article-title":"Ak\u0131lc\u0131 ila\u00e7 kullan\u0131m\u0131nda sa\u011fl\u0131kl\u0131 ya\u015fam becerilerinin etkisi","volume":"10","author":"Zeynep","year":"2020","journal-title":"SGD-Sos. G\u00fcvenlik Derg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.5455\/medscience.2022.08.185","article-title":"Determination of rational drug use knowledge levels of adult Syrians under temporary protection applying to immigrant health centers in Malatya province and related factors","volume":"11","author":"Baskiran","year":"2022","journal-title":"Med. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.sapharm.2023.03.009","article-title":"Determinants of antibiotic self-medication: A systematic review and meta-analysis","volume":"19","author":"Ahmed","year":"2023","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Lescure, D.L.A., van der Velden, A.W., van Reenen, N.H., Richardus, J.H., and Voeten, H.A.C.M. (2022). Perspectives of Immigrants and Native Dutch on Antibiotic Use: A Qualitative Study. Antibiotics, 11.","DOI":"10.3390\/antibiotics11091179"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1590\/S0103-21002012000900012","article-title":"Self-medication in adult Latin American immigrants in Seville","volume":"25","year":"2012","journal-title":"Acta Paul. Enferm."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Lajunen, T.J., Sullman, M.J.M., Baddal, B., Teke\u015f, B., and Apostolou, M. (2023). Antibiotics Knowledge, Attitudes and Behaviours among the Population Living in Greece and Turkey. Antibiotics, 12.","DOI":"10.3390\/antibiotics12081279"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/10\/1531\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:04:58Z","timestamp":1760130298000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/10\/1531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,11]]},"references-count":54,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["antibiotics12101531"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12101531","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,11]]}}}