Exploring health literacy in developing economies: Perspectives and practices of health communication professionals in rural Nigeria

Background Health literacy is widely recognised as a social determinant of health and a key factor in health communication and education, with low health literacy correlated with poor health outcomes and socioeconomic inequalities. Health literacy is recognised as a core knowledge domain and competency required of health professionals, but there are limited empirical studies providing insights into professional understanding and practices, particularly in non-clinical public health communication and education roles. Whilst a global issue, health literacy is reported to be lower in developing economies and questions have been raised regarding professional health literacy perspectives and practices.Aims This paper provides insights into the health literacy perspectives and practices of health communication professionals involved in public health communication and education in a rural region of Nigeria, providing new empirical insights into professional practices and challenges in a developing economy.Methods Exploratory research design. Our data collection method was semi-structured interviews with 38 state and third-sector professionals in public health communication management, dissemination, and education roles. Data analysis was conducted via iterative cycles of pattern coding and thematic analysis.Results Our professional participants all recognised health literacy as an important consideration in public health communication and demonstrated general awareness of key issues when communicating with rural populations in Nigeria. However, the depth of perspectives and practices appears limited. All discussed health literacy in general layman’s terms with no referral to any health literacy policy, frameworks, models or specific competencies. Professional practices appear largely focused on issues of population illiteracy, linguistic diversity, and message complexity and reach, with no evidence of attention to acknowledged issues of mistrust and misinformation. Many participants also appeared to overestimate population health information seeking capabilities and none indicated any need for health literacy education for either themselves or their rural populations.Discussion Findings suggest our professional participants’ understanding of health literacy and associated practices are focused on and/or limited to basic communicative and functional aspects. Recommendations are made for action-oriented research to review health literacy educational provision for practising professionals in the region, and to develop contextually appropriate and scalable methods of health literacy education for impoverished illiterate populations.