Barriers and facilitators of implementing a health literacy-based intervention in Portugal

Abstract Background Despite the effectiveness of cervical cancer screening (CCS) in reducing mortality rates, disparities persist in access to screening among women with low health literacy, often termed ‘hard-to-reach women’. Health literacy-based interventions can help promote screening uptake. Based on a health literacy-based intervention for CCS implemented in Lisbon with the support of community workers, this study explores barriers and facilitators of the implementation process as perceived by these actors. Methods The intervention consisted of educational sessions on cervical cancer and CCS aimed at 246 women, implemented in community settings in 2023-2024. Within a mixed-methods approach, a pre-and post-intervention survey was applied to assess willingness to screen, and two focus groups were conducted with 10 community workers on their implementation experiences. Descriptive analysis and content analysis were performed where appropriate. Results Of the 665 women invited, 37% were enrolled in the sessions; 91% completed the follow-up. Community workers valued the informative content as adequate to raise awareness. Implementation facilitators included women’s trust in collaborating organisations and a complement of peer recruitment. Challenges included the additional workload of community workers, finding creative strategies to engage women, scheduling the sessions that best suited women’s time demands, and limited spaces to accommodate several group sessions. Proposed solutions to overcome barriers included increasing the time availability of community workers to support participants’ recruitment and session delivery, conducting itinerant and open sessions, and integrating the sessions within the organisation’s health-promoting activities. Conclusions Health literacy-based interventions are helpful in raising CCS awareness. Tailored interventions sensitive to context demands may contribute to successful actions. Key messages • Health literacy interventions can be key to promoting cervical cancer screening among hard-to-reach women. • Tailored community-based interventions may help address barriers to cervical cancer screening.