Health Literacy and Colorectal Cancer Screening: A Community-Based Programme

BackgroundColorectal cancer (CRC) remains a major cause of morbidity and mortality in Portugal. Limited health literacy (HL) is a determinant of unequal access to colorectal cancer screening (CRCS), influencing knowledge, beliefs, and adherence. Promoting HL at the community level may enhance informed decision-making and participation in CRCS.ObjectiveTo describe and evaluate a community-based nursing intervention, grounded in the Health Planning methodology, aimed at improving HL related to colorectal cancer screening among individuals without access to a family health team in a Public Health Unit (PHU) in the Lisbon region.MethodsA community-based intervention study was conducted between October 2022 and March 2023, following the Health Planning methodology. Baseline HL was assessed using the validated HLS19-Q12 questionnaire, complemented by sociodemographic data, in a convenience sample of 54 individuals aged 50-74 years. Based on the situational diagnosis, educational strategies were developed, including a nursing-led video, posters with QR-code access, and health professional guidance. A separate anonymous post-intervention questionnaire was administered between January 6 and February 15, 2023. Thirty responses were received; 28 respondents were eligible for CRCS and included in the post-intervention descriptive analysis. Because post-intervention responses were not individually linked to baseline HLS19-Q12 responses, paired pre-post analysis was not performed.ResultsAt baseline, 29% of participants had excellent HL, 44% sufficient, 23% problematic, and 4% inadequate. The most critical domain was Disease Prevention, particularly access to information. In the post-intervention evaluation (n = 28 eligible respondents), 22 participants (78.6%) reported improved knowledge about CRCS, 27 (96.4%) reported increased awareness of the importance of CRCS, 23 (82.1%) reported improved knowledge about access pathways, and 25 (89.3%) expressed willingness to maintain or initiate participation in CRCS. The most commonly reported contact routes were posters displayed in health centres/QR-code pathway (13/28, 46.4%) and health professionals (11/28, 39.3%).ConclusionThis community-based nursing intervention, grounded in a baseline HL diagnosis, was feasible to implement in a primary care/public health context and was followed by favourable short-term self-reported outcomes regarding CRCS awareness, knowledge of access pathways, perceived clarity of educational materials, and intention to participate in screening. However, due to the descriptive design, small convenience sample, and absence of individual-level longitudinal follow-up, causal effects on HL or screening uptake cannot be inferred.