Health literacy, resilience and perceived stress of migrants in Israel during the COVID-19 pandemic

Objective To examine perceived stress in migrants guided by Bornstein's Specificity Principle in Acculturation Science (BSPAS) theoretical framework. Design Using a cross-sectional study, we recruited English-language migrants (n = 411) living in Israel to respond to an online questionnaire during the COVID-19 pandemic, from 3 April to 16 May 2020. Main Outcome Measures The dependent variable comprised the Perceived Stress Scale (PSS) scores, which attained an internal consistency of 0.91 in this sample. Results PSS scores were related to lower age (p < 0.0001), being single (p = 0.0095), not possessing high (p = 0.0069) or medium resilience (p = 0.0002), reporting below average SES (p = 0.0196), being "extremely" worried about getting COVID-19 (p < 0.0001), and having high health literacy (p = 0.0007). Additionally, the interaction between health literacy and resilience (p < 0.0001) showed that migrants with high resilience and high health literacy had the lowest perceived stress; and migrants with low resilience and high health literacy had the highest perceived stress. Conclusions Interventions are needed to assist migrants during the COVID-19 pandemic. The optimal intervention will aim to address the psychological distress while increasing both health literacy and resilience.