Informal Caregivers' Health Literacy and Nursing Practices Perceived as Supportive of Health Literacy in Primary Care: A Sequential Mixed-Methods Study.

BACKGROUND/OBJECTIVES: Informal caregivers support home care while having health, information and self-care needs. This study assessed general and domain-specific health literacy among informal caregivers registered with a Portuguese Family Health Unit and explored, with QUAL interpretive priority for the nursing-practice objective, perceptions of nursing practices supportive of health literacy. METHODS: A sequential mixed-methods design (quan → QUAL) was used. The quantitative phase included 30 informal caregivers who completed a sociodemographic questionnaire and the Portuguese European Health Literacy Survey (HLS-EU-PT). The QUAL phase included five informal caregivers selected from the highest recorded caregiving-intensity category and interviewed at home. Quantitative data were analysed descriptively; 95% confidence intervals were calculated for principal means and proportions. Qualitative data were analysed using Bardin's content analysis. Integration occurred through connection and aggregate interpretation; individual HLS-EU-PT scores were not linked to interviews. RESULTS: Informal caregivers were mostly women (83.3%), older than 55 years (80.0%) and cohabiting with the dependent person (83.3%). The mean general HLS-EU-PT score was 26.64 ± 8.40 (95% CI 23.50-29.78); 22/30 informal caregivers had limited health literacy (73.3%; 95% CI 55.6-85.8). Health promotion was the lowest-scoring domain (25.34 ± 8.31; 95% CI 22.24-28.44), with 28/30 informal caregivers showing limited health literacy (93.3%; 95% CI 78.7-98.2). QUAL findings highlighted personalised information, checking understanding, caregiver experience, decision support and resource guidance. CONCLUSIONS: Limited health literacy was frequent. The QUAL phase deepened understanding of perceived nursing support, but findings indicate perceived needs rather than effects.