Development of a health literacy framework for primary health care service users in Qatar: a mixed methods study

Health literacy (HL) has increasingly been recognized as a key factor influencing health outcomes and performance of health systems. Evidence suggests enhancing HL can improve access to care, self-management, and overall health outcomes. Despite Qatar’s well-established primary health care system, the country faces a high prevalence of non-communicable diseases. This study aimed to develop a health literacy framework tailored for primary health care service users (PHCSUs) in Qatar. A mixed methods study design which included a quantitative and qualitative component was employed. The quantitative component consisted of administering a validated Health Literacy Questionnaire (HLQ) to establish HL levels in PHCSUs. The qualitative component included interviews with PHCSUs and focus group discussion (FGD) with PHCC health care providers (HCPs). They were designed to identify preferred HL channels and gain an in-depth understanding of barriers and facilitators pertaining to HL strategies. The findings from the HLQ survey, HCP FGD and PHCSUs interviews along with strategies identified from literature were triangulated to develop a HL framework utilising the Socioecological Model structure as a foundation. A total of 3124 HLQ survey responses were received. 26 HCPs and 16 PHCSUs participated in the FGD and interviews respectively. The study found HL in PHCSUs was influenced by expectations of HL, tailoring of messages, existing chronic conditions, language barriers, peer support, duration of clinical consultations, access to preventive services, regulation of health information sources, societal and cultural factors and community outreach. The study proposes a HL framework with HL determinants nested within the SEM in its entirety. It provides comprehensive view of HL and the many factors that influence it. The HL framework acknowledges the role of individuals and organizations, as well as the strong influence of overarching societal and cultural factors. This information can be utilized to devise interventions to improve HL through effective and innovative learning strategies. Implementation of these evidence-informed interventions and future research in this area can enhance patient centered care and improve the health outcomes.