Health Literacy: Understanding the concept

According to the World Health Organization (WHO), Health Literacy is defined as the human capacity to obtain, process and understand elementary Health information, to adequately use healthcare services and take the right decisions in Health. It is influenced by individual and community factors, namely: 

  • Quality of information and respective dissemination strategies; 
  • Competency of social communication professionals; 
  • Goals designed by the education system; 
  • Surrounding culture and beliefs. 

Health Literacy: an emergent social need

According to Literacy and Learning in Healthcare and several other studies, low Health Literacy levels contribute to fewer prevention attitudes among citizens and, consequently,to lower quality of life of the population. On the healthcare services’ perspective, this translates into a higher number of hospital emergency episodes and stays, thus, a higher economic burden. Also, territorial heterogeneity regarding Health Literacy Levels intensifies the regional inequalities in Health, a shared concern amongst European governments. 

The current science and technology (r)evolution, the social burden of comorbidities, the challenges raised by chronic diseases and the increasing budget constraints of healthcare systems are rising a political pressure to implement strategies of sustainability. As a result, Health Literacy initiatives respond to an emergent social need for improving citizens’ engagement in their own health care 

Digital Literacy can help reducing regional inequalities

In the scope of Health, digital literacy refers to the capacity to use, explore, understand and critically evaluate Health information provided by any digital tool to adequately face a specific Health situation (Direção Geral de Saúde, 2019). 

Considering the wide range of possibilities raised by digital technologies, as well as the increasing social importance of IT tools, actions for improving Digital Health Literacy appear as an unparalleled opportunity not only to protect and promote Public Health through disease prevention and Health promotion, but also to tackle regional inequalities related to Health. 

However, two main concerns of accessibility must be taken into account with regard to the design of Digital Health Literacy tools: 

  • Accessibility to the digital world may be limited, especially for the elderly population and those with disabilities, the most vulnerable and the socioeconomic deprived ones; 
  • Accessibility to trustful and relevant information may be compromised; owing to the significant amount of digital contents, it is becoming harder to distinguish reliable digital sources. As reported by OECD in Caring for quality in health: Lessons learnt from 15 reviews of health care quality, not so long ago, information was considered a success measure for Health quality; however, now, quality relies on the capacity to choose the relevant information. 

Dissemination is not always social activation

Although access to reliable Health information is considered one basic human right, spreading information is not enough: it is crucial to empower people to use that information when in critical decision moments.  

Behavioral change is typically known as one critical human hurdle. eHealth solutions, however, can help disrupting that resistance by raising the level of citizens’ engagement. In fact, if initiatives of Literacy in Digital Health train and motivate physicians to understand the benefits of a correct use of digital tools and to be willing to decrease the social digital gap, they co-create trustful and user-friendly solutions, which facilitate the interaction between citizens and healthcare services, while ensuring human and safe relations. Therefore, citizens are not only more informed about their Health but also pushed towards better Health self-management skills – social activation. (Direção Geral de Saúde, 2019) 

The activation phenomenon translates, then, into an autonomous participation of the population in topics related to Public Health and Social Well-being, as global adoption of prevention attitudes, better choices in Health and a consequent better use of healthcare services. 

The value of cooperative Health Literacy initiatives

As claimed by Judith Myers and many other authors, after characterizing health literacy levels and identifying local needs, Health Literacy initiatives should have their approach adapted to the different targets – the so-called plain language – according to demographic, economic and education factors. 

A well-known example of these initiatives is Ophelia (OPtimizing HEalth LIterAcy), a co-creation approach which seeks to improve health and equity by developing grounded health literacy interventions. In this project, a wide range of patients, practitioners and policy makers work together in real-world settings to build sustainable responses for: 

  • Availability of health services,  
  • Access to health information,  
  • Improvement of individual health outcomes and  
  • Reduction of health inequalities.  

In 2013, the Ophelia team launched a tool for better measurement of Health Literacy levels called Health Literacy Questionnaire (HLQ), which has already been translated into different languages, such as English, Danish, Dutch and German. By assessing the nine domains of Health Literacy, this questionnaire provides a detailed profile of the health literacy challenges one might experience, thus, guiding intervention elaboration, promoting citizens’ empowerment and improving healthcare systems’ response to local needs. 

Ophelia’s worldwide success emphasizes the key role of cooperation: healthcare professionals, the primary responsible ones for improving Health Literacy, will barely accomplish Literacy goals until they realize the value of collaboration with other clinicians, patients, social communication entities, decision-makers and citizens. In fact, in Manual de Boas Práticas, Literacia em Saúde, DGS suggests that integrated approaches are essential in effective Health Literacy initiatives, to guarantee a clear understanding of the main social needs, a transparent and successful dissemination of clinical evidence to citizens and, lastly, a correct Health decision-making. 

This vision is aligned with the WHO Agenda 2030, which highlights the following stakeholders as the key partners for advanced and sustainable Health Literacy programs: 

  • Government, 
  • Media (including social media), 
  • Civil society, 
  • Community leaders and 
  • Research and academic institutions.

— About the author —

As Technical Manager, Carolina works directly with healthcare providers, patients and researchers, and analyzes health and socioeconomic data to monitor and support VOH.CoLAB’s technical team in the development and implementation of digital health projects.


Organização Mundial da Saúde. (2013). Health literacy: The Solid Facts. Copenhagen: OMS

Carvalho, G. (2009). Literacia científica: conceitos e dimensões. In F. Azevedo & M. G. Sardinha (Eds.), Modelos e práticas em literacia (pp. 179-194)

Norris, S.P & Phillips, L.M. (2002) How literacy in its fundamental sense is central to scientific literacy. Science education, 87, 224-240.

Espanha, R., Ávila, P. & Mendes, R.V. (2016). Literacia em Saúde em Portugal: Relatório síntese. Lisboa: Fundação Calouste Gulbenkian

Manual de Boas Práticas, Literacia em Saúde – Capacitação dos Profissionais de Saúde, Direção Geral de Saúde (2019)

OECD. Caring for Quality in Health. Lessons Learn from 15 Rev Heal Care Qual, 2017

Plain Language Action and Information Network. What is Plain Language?

Goeman, Dianne & Conway, Sue & Norman, Ralph & Morley, Jo & Weerasuriya, Rona & Osborne, Richard & Beauchamp, Alison. (2016). Optimising Health Literacy and Access (OPHELIA) of service provision to community dwelling older people with diabetes receiving home nursing support. Journal of Diabetes Research. 2016. 10.1155/2016/2483263.