Health literacy (HL) is about acquiring competences, confidence, and motivation to take action in health improvement. Health communication is key in promoting HL. Information leaflets are a tool that grants autonomy, thereby empowering self-management of health. Qualitative and content analysis of two original leaflets was made by a group of medical doctors, targeting pregnant women and the elderly, who represent different stages of the life cycle. The content was written in an assertive, clear, and positive language, and was adjusted to the target public. A question-answer system was used, making it easier for the reader to gather specific information. Structural aspects underlying both leaflets were similar. Health leaflets are widely used for the proper transmission of information. It is therefore essential that they are appropriate to the recipients' HL throughout the life cycle. The critical and systematised analysis of their information content contributes to quality assurance, leading to better HL and healthcare in general.
TopTheoretical Framework
According to the World Health Organization (WHO, 1998), Health Literacy (HL) is about achieving a level of knowledge, skills, and confidence to take action in the improvement of personal and community health by changing lifestyles and living conditions. This concept is a dynamic construct (Vaz de Almeida, 2018; Telo de Arriaga et al., 2019), as it has been updated over time, to encompass an increasingly larger set of dimensions. For Sørensen et al. (2012), HL involves knowledge, motivation and skills to access, understand, evaluate, and apply health information to make judgements and decisions in everyday life regarding health care, disease prevention, and health promotion in order to maintain or improve quality of life, throughout the individual's life cycle. Nutbeam's (2000) model for classifying HL, considered original, conceptualized three aspects: the functional aspect, which refers to obtaining information about the use of services and health risks; the interactive aspect, which refers to the development of personal skills that boost the motivation and self-confidence necessary for making health decisions; and the critical aspect, which aims to increase the individual's influence, power, and resilience to changes that improve health through the knowledge acquired of its determinants.
One of the most important main Europe-wide studies on HL — the European Health Literacy Survey (HLS-EU, 2015) — found that in a universe of 8,000 respondents spread across 8 countries (Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland, and Spain), at least 1 out of 10 (12%) of the respondents revealed an insufficient level of HL and almost 1 in 2 (47%) had a limited level of HL. In Portugal (Pedro, Amaral & Escoval, 2016), the validation and application of the same survey revealed that 61% of the surveyed population showed a problematic or inadequate level of general HL, with the average for the 9 countries standing at 49.2%. The same study found that only 44.2% show sufficient or excellent level of HL in the health care dimension, and that compared to the average of the 9 countries (54.5%), about 45% show a sufficient or excellent level of HL in the disease prevention dimension. As for health promotion, 60.2% show a problematic or adequate level of HL, compared to an average of 52.1%. That being said, it is determined that HL is a field to invest in and that, as pointed out by Spain, Ávila & Mendes (2016), its low level among the Portuguese population results in individual and social costs, and is usually associated with low levels of education and access to information, which in turn decrease the individual's autonomy in using and navigating the health system.
The concept of health communication is inherent to HL. According to Zarcadoolas, Pleasant & Greer (2006, p. 196), communicating goes beyond informing, and health communication has its own specificities, as it is tailored to the parties and the relationship between them. In a broader sense, it enables the sharing of health-related information with the goal of influencing, engaging and supporting individuals, communities and health professionals to introduce, adopt or support a behaviour, practice or policy that aims to improve health outcomes (Schiavo, 2013, p.7). Given these assumptions, it can be understood that health communication is a key element in promoting HL, not only in terms of improving individual health, but also the efficiency and quality of care provided. In this sense, it becomes relevant to assess and provide tools to patients in order to stimulate self-efficacy in managing their own health. One of the contexts where this practice can be applied is in Primary Health Care (PHC), particularly in the context of the relationship between the family doctor and the patient.