Structured review communication strategies of Portuguese local health plans since 2024

Background

Local Health Plans (LHP) identify local health needs, select health strategies and set goals, to guide multisectoral context-specific local action for sustainable health, in alignment with the National Health Plan (NHP). In Portugal, the 2024 reorganisation of the National Health Service required Local Health Units to develop new LHP. In 2020, 56,9% lacked a communication strategy and none reported evaluation indicators. We assessed and compared strategic communication components in Portuguese LHP produced since 2024.

Methods

Cross-sectional documentary review of seven LHP produced from 2024 onwards, identified from institutional websites or shared with Directorate-General of Health’s NHP national team. We included all LHP identified by March 2026 (n = 7; N = 39). A structured 17-item evaluation matrix aligned with key stages of strategic health communication was applied to assess compliance. Two researchers assessed all plans independently; disagreements were resolved by consensus. Descriptive analysis used absolute/relative frequencies, target audiences and online retrievability.

Results

Overall compliance ranged from 8% to 80%, showing heterogeneity across LHP. Communication diagnosis and evaluation were addressed in two plans and none linked indicators to objectives. Identification of target audiences and communication channels was present in five plans but inconsistently specified. Six plans appeared in the top two Google search results (query: plan title + institution), but only one was available on municipal websites.

Conclusions

Recent Portuguese LHP showed uneven preparedness for strategic communication. Despite improved identification of audiences/channels, persistent gaps in diagnosis and evaluation may limit implementation and accountability. These findings highlight the need for training local health planning teams in strategic health communication. This matrix can support structured quality improvement in Portugal and other settings.

Key messages

• Portuguese LHP vary considerably regarding communication strategies: most list channels and audiences (5/7), but few include diagnosis or evaluation (2/7), limiting accountability for communication.

• There is a need to strengthen health communication skills in local planning teams to improve LHP implementation, community engagement, effectiveness, evaluation and capacity to support change.