Health-related television communication and navigational health literacy among older adults in Portugal: an analysis of televised narratives

Background Health literacy (HL) is a key determinant of health, with inadequate levels linked to inappropriate use of services, adverse outcomes, and increased costs for individuals and health systems. Television is a widely accessed source of health information in Europe, yet its role in supporting audiences’ navigational health literacy (HL-NAV) – competences essential for effective use of health care systems (HCS) – remains underexplored. This study examines how Portuguese television contributes to older adults’ HL-NAV by analysing how televised health-related contents address health care and the HCS, and the conceptual resources conveyed for understanding and navigating care. Methods We conducted a 13-week qualitative media analysis of purposively sampled daytime talk shows and primetime newscasts most watched by older adults on four national television channels in Portugal (November 2022–January 2023). The corpus comprised 112 programmes featuring narratives addressing 280 health-related topics. Data underwent multilevel qualitative content analysis combining deductive and inductive coding, thematic framing, and discourse analysis, guided by the WHO-European Region HL-NAV framework and study research questions, assessing contributions to HL-NAV-related conceptual resources and their distribution across systemic, organisational, and interactional levels. Results Health-related segments appeared regularly in the sampled TV programmes, but information relevant to HL-NAV was poor, partial, and fragmented. Health-related contents prioritized health promotion, disease prevention, and individual responsibility over health care, while seldom providing information on navigating the HCS. Important gaps were identified across HL-NAV levels, alongside persistent representational biases affecting the visibility of health care sectors, services, actors, and expertise. These patterns limited the diversity and scope of health care knowledge and navigation-related information conveyed through television. Conclusions Portuguese daily TV programmes most watched by older adults provide limited support for HL-NAV, reinforcing an emphasis on individual responsibility while neglecting the complexities of navigating the HCS and accessing adequate care. Although communication on preventive dimensions is valuable, HL-NAV remains the most challenging HL dimension across European populations, making it a priority for reducing health inequalities. These findings suggest opportunities to provide clearer navigation-related information. Integrating media studies perspectives into HL research is key to designing effective, inclusive communication strategies.