Co-created health literacy actions for migrants: pilot in Portugal

Background

Migrants in Europe face structural, linguistic and cultural barriers limiting access to health information and preventive care, with elevated risk of type 2 diabetes and cardiovascular disease (CVD) in several migrant subgroups. Limited health literacy exacerbates these inequities. Within the JACARDI Joint Action, we piloted a co-created, community-based health literacy action for migrants in Portugal.

Methods

This mixed-methods pilot study was conducted as a pre-test phase prior to scale-up, guided by the Ophelia (Optimising Health Literacy and Access) approach. The health literacy action emerged from a needs assessment with over 1,100 migrants using the Health Literacy Questionnaire (HLQ) and qualitative methods, followed by ideas generation workshops with migrants and stakeholders. Participants attended seven culturally adapted, participatory sessions. Pre–post outcomes included HLQ domains and CVD/diabetes knowledge, complemented by qualitative feedback. Changes were assessed using paired t-tests; effect sizes as Cohen’s dz.

Results

Thirty-two migrants with complete pre–post data were included (mainly South Asian and African; majority women; mean stay 1.8 years). Significant improvements were observed in navigating the healthcare system (2.57 to 3.32; Δ + 0.75, p = .002; dz = 0.61), having sufficient information to manage health (2.52 to 3.04; Δ + 0.52; p = .012; dz = 0.47), appraisal of health information (2.69 to 3.08; Δ + 0.39; p < .020; dz = 0.43), and CVD/diabetes knowledge (0.67 to 0.77; Δ + 0.10; p < .001; dz = 0.67). Participants reported high engagement: “I now feel more confident talking to doctors and understanding what to do.”

Conclusions

This co-created, community-based action was feasible, well accepted, and improved health literacy and disease-specific knowledge among migrants. Findings support the scale-up of culturally responsive prevention strategies to reduce health inequities.

Key messages

• Co-created actions can strengthen people’s ability to access, understand and use health information and services.

• Improving health literacy in migrant populations supports more equitable access to care and better prevention of chronic diseases.