A qualitative study to explore health literacy skills in older people from a disadvantaged community in Brazil

We aim to describe older peoples' experiences of accessing, understanding, communicating and appraising health information in the context of primary care in a disadvantaged community in North-East Brazil. A qualitative interview study was conducted with 42 older people at two primary healthcare units in the city of Arapiraca, Brazil. Semi-structured interviews were guided by a qualitative health literacy instrument, translated and adapted for use in Brazil. Of the 42 participants, 30 were women and the majority (n = 32) were 60-69 years of age. Qualitative analysis identified that participants had difficulties accessing, understanding and communicating health information, often in the context of chronic disease. Few participants demonstrated an understanding about their specific health concerns, and most had difficulty explaining and interpreting health conditions more generally. Most participants indicated that they did not actively seek health information and this was compounded by physicians who were reported to provide limited information about diagnosis and treatment of health conditions. More than half of the participants reported that they did not understand medical terms included in health information, but most reported that they took no action to clarify understanding. In conclusion, we observed that conventional health literacy skills are very poor in this population of older Brazilians living in a disadvantaged community, with many resigned to not receiving health information or relying on sources other than health professionals. The findings from this study speak to the need for health literacy interventions targeting older adults in Brazil. A two-tiered approach which seeks to reduce the demands and complexities placed upon patients within the healthcare system but also targets interventions toward building the skills and capacities of individuals is likely to be most effective.