Background <p>There is a growing literature on the influences of cultural knowledge and practices on health literacy, as well as how people’s specific communities and backgrounds affect their health literacy in new environments. Although this literature is growing, little is known about how the health knowledge of African refugees influences their experiences with Australian health care, how their health literacy changes as they learn more about Australian systems, and how they use their health literacy to support and improve their health when health systems do not meet their knowledge and needs. This qualitative study explored health literacy among African refugees by highlighting their knowledge, culturally and religiously creative health practices in Australia.</p> Methods <p>This study draws on 19 semi-structured face-to-face interviews conducted with a culturally and linguistically diverse sample of African refugees from nine countries living in southwestern Sydney, Australia, between March and December 2022. Audio-recorded, semi-structured interviews were transcribed verbatim and coded into QSR NVivo 12. A constant comparative and thematic analysis method-guided data analysis.</p> Results <p>Three themes were identified, demonstrating the multifaceted connections between health literacy, culture, religion, experiences, and language. First, African refugees’ knowledge of health systems could not be easily used in Australia because systems were different, and Australian health systems were not set up to support other groups/various types of health literacy. The second theme was that health knowledge is multidimensional, with heterogeneous determinants and information sources influencing diverse culturally and religiously conditioned, constructed, and bound health practices. In theme three, African refugees’ complex thoughts, decisions, and actions to enhance their health and health literacy after resettling in Australia demonstrated that health information meaning, and knowledge are created and distributed across social networks and relationships.</p> Conclusion <p>The findings offer a needed social-cultural re-framing of health literacy to describe and capture health care practices and beliefs of cultural groups such as African refugees in Australia. Expanding health literacy to include social and cultural dimensions could strengthen African refugee patients’ knowledge about the health system and empower health care services and providers to adapt their processes, structures and procedures to different health literacy states and levels.</p>