Health literacy, the ability to obtain and comprehend health knowledge, is essential to promote health and reduce disparities. Health communication aims to improve health by ensuring an effective understanding and application of health information. Despite current challenges, there are many opportunities for improving communication in the health literacy practice. Promoting communication in health literacy is essential in empowering individuals, improving outcomes, and reducing healthcare disparities. Effective communication enables access, comprehension, and informed decision-making of individuals and communities regarding their health, strengthening their central role in promoting health literacy. This paper highlights the challenges and opportunities in today’s world, especially in a post-pandemic era, dominated by infodemic and social media influencers, while providing solutions, encompassing professional training of health professionals on communication, digital skills, and an overarching strategy across health institutions. Translating knowledge into health-promoting behaviors and well-being can only be effective by accounting for communication in health literacy.

A literacia em saúde, a capacidade de obter e compreender conhecimentos sobre saúde, é essencial para promover a saúde e reduzir as disparidades. A comunicação em saúde tem por objetivo melhorar a saúde, assegurando uma compreensão e aplicação eficazes da informação sobre saúde. Apesar dos desafios atuais, existem muitas oportunidades para melhorar a comunicação na prática da literacia em saúde. A promoção da comunicação na literacia em saúde é essencial para capacitar os indivíduos, melhorar os resultados e reduzir as disparidades nos cuidados de saúde. Uma comunicação eficaz permite o acesso, a compreensão e a tomada de decisões informadas dos indivíduos e das comunidades relativamente à sua saúde, reforçando o seu papel central na promoção da literacia em saúde. Este artigo destaca os desafios e as oportunidades no mundo atual, especialmente numa era pós-pandémica, dominada pela infodemia e pelos influenciadores nas redes sociais, ao mesmo tempo que apresenta soluções, incluindo a formação profissional dos profissionais de saúde em comunicação e competências digitais, e uma estratégia global para as instituições de saúde. A tradução do conhecimento em comportamentos promotores da saúde e do bem-estar só pode ser eficaz se a comunicação for tida em conta na literacia em saúde.

Palavras ChaveComunicação em saúde, Literacia em saúde, Infodemia

Effective communication is a cornerstone of health literacy, a concept deeply intertwined with the complex dynamics of healthcare. While it is true that language barriers, cultural differences, and low health literacy levels among individuals can pose significant communication challenges, the landscape is far more multifaceted. The complexities of the patient-provider relationship, the influence of health-promoting environments, and the pervasive impact of health literacy levels all contribute to the intricate web of health communication. In this letter, we delve into the multidimensional relevance of communication in health literacy, recognizing the profound challenges faced and exploring the numerous opportunities for enhancement.

The Interconnected Role of Communication and Health Literacy in Public Health

Health promotion, defined as “the process of enabling people to increase control over and to improve their health” [1], highlights the fundamental role of communication and health literacy as essential components in empowering individuals and populations. They serve as crucial pillars of public health, closely tied to the promotion of well-being, health protection, and the reduction of inequities [2].

Health literacy was defined in 1998 by WHO and it “implies the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions.” Thus, health literacy means more than being able to read pamphlets and make appointments. It entails the improvement of people’s access to health information, and their capacity to use it effectively, health literacy is critical to empowerment. Since its initial definition in 1998, the concept has evolved, leading to the development of various relevant definitions, as well as health promotion strategies [3‒5].

Given the Society for Health Communication’s definition, which characterizes health communication as “the science and art of using communication to advance the health and well-being of people and populations,” it becomes evident that health communication is a “multidisciplinary field of study and practice that applies communication evidence, strategy, theory, and creativity to promote behaviors, policies, and practices that advance the health and well-being of people and populations.” Taking this comprehensive perspective into account, health communication involves cognitive interventions aimed at facilitating the improvement of individuals’ and populations’ health. The ability to comprehend and apply health information is a fundamental aspect of health literacy, which can have a significant impact on health behaviors and outcomes [6, 7].

While there is a substantial body of evidence underscoring the significance of communication and health literacy in healthcare [2, 6, 8], it is imperative to emphasize their practical applications in both individual and population-based healthcare approaches. The practical implications are far-reaching, encompassing the need for tailored patient education, culturally sensitive communication, and strategies that address health disparities. Additionally, it is crucial to recognize the challenges that can limit individuals’ health literacy, such as access to information, provider-patient dynamics, and the influence of social determinants of health. This was further shown in two studies that utilized the European Health Literacy Questionnaire, validated for the Portuguese population, which allowed us to understand the specific vulnerable groups with the most limited health literacy in Portugal: those with lower incomes; lower educational levels; greater self-perception of their health as bad; those that utilize healthcare services multiple times, hospitalized patients, premature deaths, or the most illiterate populations [9, 10].

Importance of Health Literacy Promotion

Health literacy is crucial in empowering citizens and providing them with autonomy regarding their own health. It does so by providing individuals with new knowledge, greater self-efficacy, and positive health attitudes and behaviors, all of which contribute to better health outcomes [6, 8]. Low health literacy, on the other hand, can directly affect an individual’s health, limiting personal and social development, as well as education, income, housing, transportation, and many other factors, accounting for a biopsychosocial view. It is closely related to negative health outcomes, worse disease management, lower adherence to medication, and overutilization of health services. This, in turn, can lead to rising hospitalization rates, morbidity, and premature death [8, 11]. Low health literacy is also associated with lower comprehension of how health services operate, disregard for disease prevention, and a higher risk of chronic diseases, such as cardiovascular diseases and cancer [12]. Conversely, higher levels of health literacy are associated with better health outcomes, higher levels of well-being, better utilization of health services, active and informed participation in healthcare, lower healthcare expenditures, and a reduction of health inequities [2, 10].

Recent data have shown a positive trend in health literacy levels in Portugal [13], which is attributed to investments in health planning, policies, and customized communication strategies [14]. Despite this, the same studies show that the navigability within Portugal’s health system has also been shown to be one of the worst in Europe. The inability of individuals with low health literacy to navigate the health system reinforces the importance of health communication in health literacy strategies. The COVID-19 pandemic also underscored the need for clear, accessible, and trustworthy health information. It highlighted the significance of adapting communication strategies to rapidly changing circumstances and addressing misinformation. Moreover, it demonstrated the pivotal role that health literacy plays in promoting public health and informed decision-making [15, 16]. The lessons from the pandemic emphasize the urgency of sustained efforts to enhance health literacy and communication in healthcare, both in Portugal and worldwide. As such, it is of utmost importance to promote health literacy in both national and local health plans, as well as invest in capacity building among health professionals to be agents for public health literacy.

Communication in Health: Boosting Health Literacy

Considered a key factor in promoting health literacy, communication is an instrument that empowers individuals to access, understand, and utilize health information for making informed decisions about their well-being. However, it is essential to note that health communication extends beyond its association with health literacy to inform, influence, and enhance health-related knowledge and decisions. While person-centered care is often viewed as individual interactions between healthcare professionals and patients, health institutions have a responsibility to facilitate person-centered communication, using communication strategies to inform and influence individual and community decisions that enhance health [17, 18]. This includes creating health messages and campaigns, developing educational materials, and improving organizational culture, while engaging with the audience or stakeholders through communication, to help understand and sustain newly adopted behaviors and practices, with the goal of increasing knowledge and understanding of health-related issues and improving the health status of the intended audience [19]. It is also important to educate the population about how to access and use health information, which requires healthcare professionals to have strong communication skills, emphasizing people interaction [18, 20], as these are essential in promoting health literacy among the population [1].

When it comes to risk communication, it is of utmost importance to disseminate information about individual and population-based health risks [21]. Effective communication is key to improving the health of a population, particularly when health information is difficult to understand or not tailored to the needs of the population. In such situations, confusion and hopelessness can arise, hindering informed decision-making [16].

Citizens are increasingly expected to take an active role in managing their own health [2, 15]. Making informed decisions about health requires access to understandable, accessible, and relevant information that is tailored to their needs and sociocultural context. Although healthcare professionals are often seen as reliable sources of health information [8], the proliferation of health information on social media and the internet means that other sources are now widely available. In this digital era, the competencies needed to engage with health and wellbeing are becoming increasingly complex, including not only health literacy and digital literacy but also social determinants of health [22]. Social determinants of health refer to the social, economic, and environmental conditions in which people live that can have a significant impact on their health and well-being. These determinants can include factors such as income, education, employment, housing, access to healthcare, social support networks, and exposure to environmental hazards. By addressing social determinants of health and promoting health literacy and effective health communication, we can work toward reducing health disparities and improving health outcomes for all individuals, regardless of their background or circumstances [23].

Communication in Health: New Challenges

The COVID-19 pandemic has highlighted the importance of health communication and presented new challenges for health professionals and institutions, making it increasingly necessary to create transparent and effective health communication strategies [24]. One of the main challenges is the infodemic, which includes misinformation, disinformation, and fake news, exacerbated by the current digital era, especially social media. Even opinions expressed by influential individuals or opinion makers may require clarification as they must be based on scientific evidence. These challenges make it crucial for health professionals to act and communicate efficiently, clarifying and aligning scientific messages with the best evidence for the population [6, 13, 24].

Therefore, the health sector needs to adapt to the new digital reality by equipping multidisciplinary teams with new competencies and strategies that not only consider the current situation but also incorporate monitoring and adaptation of conveyed information [21]. This ensures equitable information transmission for everyone and leaves no one behind. Finally, the most challenging task is to achieve person-centered health communication by actively listening to individuals’ real needs and searching for effective solutions that empower both individuals and populations [17]. Communication emerges as a central element in the dimensions of health literacy, playing a crucial role in translating knowledge into health-promoting behaviors and well-being. Table 1 provides a summary of these new challenges and points to some opportunities to improve communication in health literacy.

Table 1.

Summary of challenges and opportunities of communication in health literacy

ChallengesOpportunities
Improving specific communication competencies in health professionals Inclusion of health communication topics in undergraduate training 
Provision of graduate training on health communication 
Invest in health literacy promotion within the population Development of campaigns to promote health literacy 
Investment in digital health literacy competencies 
Providing accessible information sources on the internet and in social media for citizens Investment in health communication platforms that are accessible to the population 
Fight infodemic, disinformation, misinformation, and fake news Development of institutional communication plans with strategies that clarify and disseminate the best available evidence 
Promote person-centered health communication Soliciting community feedback about concerns and questions 
Monitoring information and public opinion to adapt official information 
Make communication accessible to all Translating scientific language into accessible language and actionable practices for citizens 
Customizing information for individuals and populations 
Define national guidelines to promote communication in health literacy Strengthen the action plan for the promotion of communication in health literacy 
ChallengesOpportunities
Improving specific communication competencies in health professionals Inclusion of health communication topics in undergraduate training 
Provision of graduate training on health communication 
Invest in health literacy promotion within the population Development of campaigns to promote health literacy 
Investment in digital health literacy competencies 
Providing accessible information sources on the internet and in social media for citizens Investment in health communication platforms that are accessible to the population 
Fight infodemic, disinformation, misinformation, and fake news Development of institutional communication plans with strategies that clarify and disseminate the best available evidence 
Promote person-centered health communication Soliciting community feedback about concerns and questions 
Monitoring information and public opinion to adapt official information 
Make communication accessible to all Translating scientific language into accessible language and actionable practices for citizens 
Customizing information for individuals and populations 
Define national guidelines to promote communication in health literacy Strengthen the action plan for the promotion of communication in health literacy 

The need to improve health literacy has become increasingly evident in recent years, with the proliferation of health information sources, particularly during the COVID-19 pandemic. This reinforces the importance of having the skills to evaluate the quality of online health information [22]. Health communication is a crucial component in improving health literacy levels, not just among health professionals but also among the general population. Investing in undergraduate and graduate training in communication competencies and health literacy for health professionals is essential in providing the tools for health promotion and protection [2, 14].

Health literacy must be taken into account in the interactions between individuals and their health and social contexts. Improving health literacy can enhance an individual’s capacity and motivation to find solutions to public or individual health issues, which are crucial competencies in addressing health problems throughout the life cycle [6, 11]. Therefore, health communication is fundamental as a catalyst for health literacy, by empowering people and communities and contributing to ensuring that health literacy is integrated into all policies.

The authors have no conflicts of interest to declare.

This paper was funded by Católica Research Centre for Psychological, Family and Social Wellbeing (CRC-W), Universidade Católica Portuguesa.

All authors had a substantial contribution for this manuscript and approved the final manuscript.

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