Rosário Jorge, Pires Joana Correia, Dias Sónia, Pedro Ana Rita
Polytechnic Institute of Beja, Beja, Portugal.
Institute for Research and Advanced Training, University of Évora, Évora, Portugal.
PLoS One. 2025 Jun 27;20(6):e0326575. doi: 10.1371/journal.pone.0326575. eCollection 2025.
Health Literacy (HL), defined as the ability to access, understand, appraise and apply health information to make informed decisions, is essential for individual and public health. However, in rural regions such as Alentejo, Portugal, higher education students often encounter specific challenges that hinder the development and effective use of these skills. This study aimed to explore the perceptions of higher education students in Alentejo, Portugal, with regard to health literacy, access to and utilisation of healthcare, and to identify barriers, facilitators and interventions to inform strategies that promote equity, build student capacity and sustainably improve health outcomes.
A qualitative, exploratory, and descriptive study was conducted using three focus groups held on 11th, 13th, and 18th December 2023, with a purposive non-probability sample of 29 participants across first-year, intermediate, and final-year levels. The participants shared their experiences, challenges, and resources related to health literacy, healthcare access, and utilisation. The focus group discussions were audio-recorded, transcribed verbatim, and analysed through a systematic process of open, axial, and selective coding. Codes were organised into categories, and thematic identification was facilitated using a constant comparative method. Content analysis was conducted with MAXQDA® 22 software. Ethical approval was obtained from the Ethics Committee of the University of Évora, Portugal, and informed consent was secured from all participants.
The students' perception was that health literacy, access to and utilisation of healthcare are influenced by a dynamic interaction of barriers and facilitators. The identified barriers encompassed the presence of misinformation, financial and logistical challenges, and emotional stigma, particularly in the context of mental and sexual health. Conversely, facilitators were identified as encompassing access to digital tools, a family and peer support network, professional guidance and institutional resources such as libraries and workshops. The students recommended that interventions to improve health literacy be integrated into the higher education curriculum, that navigation support systems be improved and that structural inequalities be explored in order to improve access to and participation in healthcare.
Digital resources have the potential to improve access to health information; however, persistent challenges such as misinformation, financial constraints and stigma limit their impact. This study underscores the significance of specific interventions to enhance health literacy and healthcare navigation skills. These interventions include the integration of health literacy into academic curricula, the provision of specialised workshops, and the facilitation of access to healthcare services. The study identifies nursing interventions and institutional support as key strategies to promote equitable access to healthcare and improve student wellbeing.
健康素养（HL）被定义为获取、理解、评估和应用健康信息以做出明智决策的能力，对个人和公众健康至关重要。然而，在葡萄牙阿连特茹等农村地区，高等教育学生经常面临一些特定挑战，这些挑战阻碍了这些技能的发展和有效运用。本研究旨在探讨葡萄牙阿连特茹高等教育学生对健康素养、医疗保健的获取和利用的看法，并确定障碍、促进因素和干预措施，以为促进公平、培养学生能力和可持续改善健康结果的策略提供信息。
采用定性、探索性和描述性研究方法，于2023年12月11日、13日和18日举行了三场焦点小组讨论，以目的抽样的非概率样本选取了29名来自一年级、中级和最后一年的参与者。参与者分享了他们与健康素养、医疗保健获取和利用相关的经历、挑战和资源。焦点小组讨论进行了录音，逐字转录，并通过开放式、轴心式和选择性编码的系统过程进行分析。代码被组织成类别，并使用持续比较法促进主题识别。使用MAXQDA® 22软件进行内容分析。获得了葡萄牙埃武拉大学伦理委员会的伦理批准，并获得了所有参与者的知情同意。
学生们认为，健康素养、医疗保健的获取和利用受到障碍和促进因素动态相互作用的影响。已确定的障碍包括错误信息的存在、财务和后勤挑战以及情感污名，特别是在心理健康和性健康方面。相反，促进因素被确定为包括获取数字工具、家庭和同伴支持网络、专业指导以及图书馆和工作坊等机构资源。学生们建议，将提高健康素养的干预措施纳入高等教育课程，改善导航支持系统，并探索结构性不平等，以改善医疗保健的获取和参与。
数字资源有潜力改善健康信息的获取；然而，错误信息、经济限制和污名等持续存在的挑战限制了它们的影响。本研究强调了特定干预措施对提高健康素养和医疗保健导航技能的重要性。这些干预措施包括将健康素养纳入学术课程、提供专门的工作坊以及促进医疗保健服务的获取。该研究确定护理干预措施和机构支持是促进公平获取医疗保健和改善学生福祉的关键策略。
