Health Literacy: A question of Health that Matters

Launched in 2011 under the motto “health literacy promotes more active and participatory citizens”, Saúde que Conta, currently in its ninth phase, is a long-term scientific project that has led to meaningful and measurable changes in national policy, public health planning, and citizen empowerment. It brought together researchers from fields such as medicine, education, journalism, sociology, and psychology, along with key stakeholders from government institutions and civil society, to investigate and promote health literacy in Portugal.

The project’s first major contribution was laying the foundation for the first national study on health literacy in Portugal. Through the Think Tank Capacitação do Cidadão em Saúde, it revealed two critical findings: that higher levels of health literacy are associated with better population health outcomes, and that investing in health literacy leads to a more effective use of health services and lower healthcare costs. Building on this evidence, the second phase examined shared decision-making in healthcare, demonstrating how communication between patients and professionals must improve to enable patients to participate meaningfully in decisions about their health.

One of the project’s most influential impacts came in its third phase, when it led the application of the European Health Literacy Survey in Portugal. This study revealed that 61% of the population had problematic or inadequate health literacy, particularly within the healthcare domain. These findings helped support the development of the National Health Literacy Strategy in 2016, this strategic plan marked a major national-level policy outcome rooted in the project’s research.

Saúde que Conta has continued to expand its reach in subsequent phases. In 2018, two digital books – “Decidir em conjunto sobre a nossa Saúde” and “Doentes em Segurança” – were launched to translate findings into accessible tools for the general public. In 2019, the study “Health Literacy in Chronic Illness,” developed with the partnership of Ordem Portuguesa dos Farmacêuticos, showed that individuals with chronic diseases and low health literacy have higher rates of emergency service use and poorer adherence to treatments. The seventh phase addressed health literacy among higher education students, finding that 44% had an inadequate or problematic health literacy level, with disparities tied to socioeconomic background. This evidence has highlighted the need for equity-focused approaches within the academic sector.

In 2023, the project investigated the health literacy and quality of life of informal carers in Portugal, concluding that 58.6% of caregivers had an inadequate or problematic level of health literacy, which was directly correlated with reduced quality of life and increased caregiver burden. This work underscored the broader societal implications of health literacy beyond clinical settings. The current phase of the project focuses on obesity, exploring obesity awareness, health literacy levels and public attitudes toward the condition. It also launched the podcast “Lado B da Literacia”, available on Spotify and Apple Podcasts, which brings in-depth conversations on complex and often overlooked health literacy themes – such as artificial intelligence, genomic literacy, and One Health – to a broader audience. With 12 episodes and 34 expert contributors, the podcast exemplifies how the project bridges academic research and public engagement.

The research conducted within the Saúde que Conta project has had a significant impact on academia, healthcare, and both social and public policy. Over 11,000 people have participated in its various research phases, more than 50 individuals have requested to use the Portuguese version of the European Health Literacy Survey (HLS-EU-PT), and the project’s findings have contributed to numerous postgraduate theses. Scientific publications and participation in both national and international conferences have further demonstrated the project’s wide-reaching influence. Its impact is also reflected in strategic partnerships with institutions such as Plataforma de Saúde em Diálogo, Direção-Geral da Saúde, and the Rede Académica de Literacia em Saúde, among others. The foundational data and expert insights produced by Saúde que Conta were critical in identifying needs, guiding solutions, and mobilising institutional support. This groundwork has enabled changes like national policy development, public resource creation, and raising awareness among citizens, health professionals, educators, and decision-makers about the importance of health literacy.

Ultimately, the project’s most significant contribution has been embedding health literacy as a public health priority in Portugal, influencing both practice and policy. Its sustained commitment to research, dissemination, and collaboration ensures that its impact continues to grow, as the project has influenced policies, improved practices and benefited communities and individuals.