Multivariable regression modelling of structural, intermediary and demographic determinants of health literacy: evidence from unaccompanied migrants and statelessness-prone individuals in Ghana

BACKGROUND: Health literacy is acknowledged as a critical determinant of equitable health outcomes. However, its social patterning among populations experiencing legal precarity, irregular mobility, and administrative exclusion remains insufficiently examined in the sub-Saharan African context, particularly in Ghana. This study addresses this gap by examining health literacy among unaccompanied migrants and persons prone to statelessness in Ghana. METHODS: Data were derived from a cross-sectional survey conducted in two purposively selected districts in Ghana, characterized by mobile and heterogeneous populations. Health literacy was assessed using the HLS19-Q12 instrument and analyzed in SPSS (version 27). Analyses comprised descriptive statistics and binary logistic regression modelling. Statistical significance was set at p < 0.05, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported. RESULTS: Health literacy was predominantly low, with 62.6% of respondents reporting inadequate literacy, while 37.4% demonstrated sufficient literacy. In the multivariable binary logistic regression analyses, sufficient health literacy was significantly associated with formal employment (AOR = 4.05, p < 0.001, CI: 2.21-7.42), ease of healthcare access (AOR = 2.52, p < 0.01, CI: 1.47-4.34) and language proficiency particularly in Akan/Twi (AOR = 3.49, p < 0.01, CI: 1.43-8.48), Ga/Dangme (AOR = 4.76, p < 0.001, CI: 1.61-14.13), and Gonja/Dagbani (AOR = 4.28, p < 0.001, CI: 1.63-11.21). Other factors including social network, place of residence, health information sources, age, and access to basic amenities equally demonstrated significant associations but with comparatively modest effects. CONCLUSION: These findings suggest that health literacy among mobile and documentation-insecure populations in Ghana is structured less by demographic factors than by structural and intermediary conditions. While employment, language proficiency, and healthcare access are key determinants, other factors also contribute. Effective interventions therefore require coordinated policy responses that move beyond individual barriers and group identity to address these intersecting constraints that condition access to enabling resources.