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HEALTH LITERACY IN NUTRITION AND THE PROMOTION OF
HEALTH COMMUNICATION: A SCIENTIOMETRIC STUDY
Priscila Gomes de Mello1
Abstract: Health Literacy (HL) is associated with the acquisition of knowledge, motivation and skills
to access, understand, evaluate and apply health information to make choices and decisions about
daily health care, disease prevention and health promotion to maintain or improve quality of life.
From this perspective, Nutritional Literacy (NL) and Food Literacy (FL) emerge. The objective of
this study is to analyze the scientic production through a scientometric study on Health Literacy in
Nutrition and the production of Health Communication in this eld; and to describe the production
on Health Literacy in Nutrition and the Production of Health Communication. This study is of the
qualitative and quantitative type developed through a Literature Review and Scientometric study in
which articles on the theme of Health Literacy and Health Communication were researched from
January 2012 to December 2022 in Clarivate’s Web of Science (WoS). We found 367 references that
dealt with Health Literacy and Health Communication, and out of a total of 22 articles, 10 that dealt
specically with the approach to Nutrition and Food were selected. Therefore, the insertion of LN
and LA can constitute strategies with potential for eectiveness in health promotion and prevention,
when linked to health communication processes. It is necessary to plan new studies in the Brazilian
population to analyze the benets to public health.
Keywords: Health Literacy, Social Media, Behavioral Nutrition, Health Communication
1 Master in Professional Health Education, ESPJV/FIOCRUZ, priscilamello.saude@gmail.
com , http://lattes.cnpq.br/1413128600700568, https://orcid.org/0000-0002-8373-4872
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INTRODUCTION
Literacy (HL) is associated with the acquisition of knowledge, motivation and skills to
access, understand, evaluate and apply health information to make choices and make decisions about
everyday health care, disease prevention and promotion of health to maintain or improve quality of
life, according to the World Health Organization (WHO, 2013).
A HL considered inadequate or “limited” is associated with greater chances of worsening
long-term health conditions, decreased health prevention practices, less independence in medication
management and increased mortality (TAYLOR et al., 2018) .
Adequate HL enhances the communication processes between patients and healthcare
professionals, the active and autonomous search for health information to improve understanding and
positively impact clinical results, contributing to (TAYLOR et al., 2018).
Table 1 presents the “ European Health Literacy Survey ”: with the 12 subdimensions dened
by the European Health Literacy conceptual model. This structure was based on the combination
of the four dimensions relating to health information processing with the three levels of domains,
generating a matrix with 12 dimensions of the LS (SØRENSEN et al, 2013).
From this perspective, it is essential to highlight that the complexity of the HL concept
and the multidimensionality of meanings that can be attributed in the diagnostic assessment of the
patient’s or health professional’s level of literacy and the possibilities of interventions that can be
carried out in dierent actions in health as: health care, disease prevention and health promotion (
SØRENSEN et al, 2013).
Within the scope of the Unied Health System (SUS), LS can be understood and constituted
when historically linked to the process of ghting for the democratization of access to information
and communication practices that began to be debated with broad popular participation and the
institutionalization of Health Councils by law no. 8142/90 (TEXEIRA, 1997).
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With the participation of Brazilian society and proposals for articulation in the area
of information, communication and education, the rst attempts were made to build a project on
“Information in health and population” in health by professionals in the areas of communication and
education (TEXEIRA, 1997 ). From this perspective, the dissemination of information should not be
restricted to the mere dissemination of data, but promote training in the use of this data and encourage
dialogical communication practices that allow the decoding of technical rhetoric into popular rhetoric
to build a “Health Awareness” (TEXEIRA, 1997).
When reecting on the eld of “Communication and Health”, according to a Bourdinean
conception , it is a space constituted by human relationships established historically and cumulatively
through social contexts and processes that are inserted and inuenced by positions and symbolic
material capital. This eld includes theories, methods, institutional policies and practices, interests,
tensions and negotiations ( ARAÚJO; CARDOSO; MURTINHO, 2011).
Furthermore, the eld of communication is not just about reecting on issues related to media
and ideology, but must encompass social processes that occur in this dynamic of communication that
are inuenced by the eld of ‘cultural battle’ (MARTÍN-BARBERO , 2015, p.16). The relationships
between actors in the communication process are not static, but there is a eld of disputes and tensions
between individuals.
Currently, in the eld of Nutrition and Food, there has been reection on the importance of
health information and communication processes as a possibility for disseminating knowledge and
changing eating habits to improve the health conditions and quality of life of the population. From
the LS perspective, the concept of Nutritional Literacy and Food Literacy emerges as possibilities
for health information and communication strategies and as an emerging eld of knowledge that is
proposed as a dierentiator in health promotion and disease prevention.
Nutritional Literacy (LN), which seeks as its main objective to evaluate the basic literacy and
numeracy skills necessary to acquire , process and interpret nutritional information, that is, it only
develops an understanding of information exclusively related to nutrients, but is not concerned with
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other topics about food (TORRES; REAL, 2020).
Food Literacy ( LA) is a concept used to formulate food and nutrition policies and eld
research, and considers the involvement of all individuals in the food system, nutritional and food
information, the ability to apply this information and skills for preparing foods, healthy food choices
and consider the impact of these components on health, economy and the environment (TORRES;
REAL, 2020).
There are few studies that relate Health Literacy to the processes of Health Communication
in the eld of Nutrition and questions that can be asked about ‘How is the scientic production on
Health Literacy in Nutrition and the Promotion of Health Communication characterized? What are
the main gaps in studies on Health Literacy in Nutrition and the Promotion of Communication in
He a lt h?’.
In this sense, the objective of this study is to analyze scientic production through a
scientometric study on Health Literacy in Nutrition and the production of Health Communication in
this eld; and describe the production on Health Literacy in Nutrition and the Production of Health
Communication.
MATERIALS AND METHODS
This study is qualitative and quantitative, developed through a Bibliographic Review and
Scientometrics study in which articles were researched on the topic of Health Literacy , Health
Communication from January 2012 to December 2022 Web of Science ( WoS ) from Clarivate . The
English language descriptors “Health Literacy ” AND “Health Communication” were used. In the
search for knowledge produced in the eld of Health Literacy , Health Communication and Nutrition,
only results for the search criteria and the present theme were presented with the terms “Health
Literacy ” AND “Health Communication” AND “ Nutrition ” in the summary table.
The following variables were considered for this study: year of publication, source, impact
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factor, area of knowledge, citation and country were identied for each publication. The results were
analyzed using the WoS database and Microsoft Oce Excel and Citespace software to create the
gures.
Scientometric analysis, CiteSpace was used , a software that enables data analysis and
scientic visualization used for processing information related to databases that enables co-citation
and was developed by Chaomei Chen (2006). With several functions that enable the creation of network
prole graphs to improve the level of interpretation for the production of scientometrics studies .
This way, it is possible to determine which thematic areas are most comprehensive, identify
hot posts and label clusters related to the terms searched. It is possible to establish which main research
studies have been carried out, the most frequent terms and/or key words in journals.
Therefore, the node analysis can be represented by groups of tree rings in dierent colors,
in which it can be inferred that the purple color indicates the oldest study and the orange color the
most recent study. With the use of CiteSpace , it is possible to identify central points and nodes with
high betweenness centrality. Centrality analysis was carried out according to the variables: author,
keyword, countries using the following Equation(1):
Centrality (Nodal i) = ∑ i≠j≠k Ρik (i)/ Ρik
According to Eq.(1), quantitative analysis can be performed based on the number of paths
between the nearest nodes jek and ρjk (i) and the numbers of paths that pass through node i. Therefore,
using the centrality indicator, it is possible to visualize, through this spatial component indicator, how
scientic production is distributed and the main trends through spatial scale information.
RESULTS
367 references were found that dealt with Health Literacy and Health Communication
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and from a total of 22 articles, 10 were selected that dealt with the approach to Nutrition and Food
specically.
In table 1, the Top 10 authors cited according to the analysis in Web of Science are presented,
with an h-index of 25, the authors Fleary , Joseph; Pappagianopoulos , in the United States, obtained the
highest number of citations in 2018 (n=150) reaching the annual evaluation of 25 and this publication
was carried out in the Journal of Adolescence .
Table 1. Top 10 most cited authors, also obtained from Create Citation Report from Web of Science.
SOURCE: (Web of Science, 2022)
In this study, a systematic review was carried out on the relationship between HL and
health behaviors in adolescents to investigate the characteristics of dierent levels of HL and their
role in decision-making about adolescent health. The results demonstrated that there is a signicant
Authors Periodical
Year of
publication
Total
Citations
Annual
Assessment
FLEARY; JOSEPH;
PAPPAGI ANOPOU LOS Journal of Adolescence 2018 150 25
CHEN, X. et al.
Journal of Health Communication 2018 101 16.83
NUTBEAM, D.; LLOYD, J.E.
Annual Review of Public Health 2021 100 33.33
LI, X.; LIU, Q. Journal of Medical Internet
Research 2020 85 21.25
BAUMANN E., et al
Journal of Medical Internet
Research 2017 71 10.14
DADACZYNSKI K., et al.
Journal of Medical Internet
Research 2020 68 22.67
JOSEPH G., et al. Journal of Genetics Counseling 2019 68 9.71
RATZAN SC, et al.
Public Health Research & Practice 2018 66 16.5
MEPPELINK, CS, et al. Journal of Health Communication 2020 55 11
HAN, PKJ; et al. Journal of Health Communication 2018 50 8.33
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relationship between HL and health behaviors and health outcomes and emphasized the need for
future research to utilize an integration between theoretical frameworks of health behaviors and the
use of comprehensive LS denitions and strategies ( FLEARY; JOSEPH ; PAPPAGIANOPOULOS,
2018).
In the second study, Chen et al (2018), in the United States, were cited 101 times, reaching
an annual rating of 16.83 and the article was published in the Journal of Health Communication . In
this study, LS was analyzed and associated with people’s trust in various potential sources of health
information. They found that lower level of LS was associated with lower odds of choosing medical
websites for health information and higher odds of using other media such as television, social media,
blogs and celebrity pages. In this study, the authors recommended the need to increase the public’s
ability to evaluate the quality of health information sources and highlight the need to improve the reach
of high-quality health information among people with limited HL in order to increase eectiveness. of
health communication programs and campaigns (CHEN et al, 2018).
The third study, by authors Nutbeam and Lloyd (2021), in Australia, was cited 100 times
and reaching an annual rating of 33.33 and the article was published in the journal Annual Review
of Public Health. The study sought to portray the social determinants of health and disparities and
inequalities in health status across population groups.
These authors highlighted the conceptual dierences regarding health inequalities, for
example, in the United States the term “health disparity” is used to refer to the worst state of health
between dierent social, racial and ethnic groups. On the other hand, in other countries the terms
used such as “health inequalities” and “health inequity” are used to describe dierences in health
conditions highlighting the importance of equity and social justice. They highlighted the potential
role of HL as a social determinant of health and as a possible public health intervention for health
inequities (NUTBEAM; LLOYD, 2021).
In this way, LS would contribute to mediating the causes and eects of social problems
established by health determinants. With existing interventions, it was possible to demonstrate the
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feasibility of improving LS in high-risk populations and the need for research that tests the eects
of health inequalities on LS. The authors pointed to themes about HL that should be developed: (1)
improving the quality of health communication that reaches a diversity of populations, especially
improving front-line professional skills and support; (2) enabling people to develop transferable skills
in accessing, understanding, analyzing, and applying health information; and (3) ensure that priority
is proportionate to need, reaching and engaging population groups that are disproportionately aected
by low LS (NUTBEAM; LLOYD, 2021).
The production of publications by countries carried out by spatial analysis in which countries
with larger circles and more orange colors have more recent publications with a total of 54 nodes in
the network, according to the g-Index index (k=25), modularity (Q= 0.497), cluster (S=0.704) and
Harmonic Mean ( Q,S =0.497). According to degree of centrality (d), countries such as the United
States (d=17), Australia (d=10), France (d=10), Ireland (d=8) and England (d=7) have higher numbers
of publications with more eects on the network, more recent publications and greater degree of
centrality related to the topic (Figure 1). The countries with the most cited articles were: the United
States with 177, Australia with 31, China with 16, Ireland with 15 and England with 13.
The network consisted of 4 clusters: 0# cross-sectional study, health literacy and disparities;
1#health communication, in European countries and validation study; 2# health communication,
revisiting COVID-19 and health literacy ; #3 and cross-sectional and meta-analysis study. No “ burst
” of publications were found in the years analyzed, which refers to an ‘explosion’ of citations in one
year. The centrality value was zero.
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Figure 1. Geolocation of published scientic articles and grouping by countries in relation to the
frequency and centrality of the theme Health Literacy and Health Communication
SOURCE: ( CiteSpace , 2022)
According to gure 2, the network of key terms in the publications found on Health Literacy
and Health Communication, considering the g-index (k=25) presented 253 terms with a density
(d)=0.415, modularity (Q =0.3641) and cluster (S=0.7054) and Harmonic mean (Q,S=0.4973). The
largest cluster #0 was about ‘Randomized Clinical Trial” and the most cited terms were: 158 terms ‘
health literacy ‘ , 113 terms ‘ health communication’ and 48 terms ‘ care ‘. The second largest cluster
#1 was ‘ Health Literacy in Genetics ‘ and the most cited terms were: 40 terms ‘ information ‘, 28
terms ‘ health communication ‘ and 9 terms ‘ breast cancer ‘. The third largest cluster #2 was about
‘ Information Overload ‘ and the most cited terms were: 20 terms ‘ internet ‘, 15 terms ‘ perception ‘
and 12 terms about ‘social media’ . The bursts found refer to cluster 7#, air pollution, with a score of
2.26 on LS in the COVID-19 scenario in 2020; and cluster 8#, ‘ the course ‘ score 2.26 on a qualitative
study that portrayed the immigrant’s perception of health guidelines in Sweden, in 2020.
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Figure 2. Network of key terms in publications on Health Literacy and Health Communication
SOURCE: ( CiteSpace , 2022)
In gure 3, the distribution of publications on Health Literacy and Health Communication by
area of knowledge in the period from 2017 to 2022 shows that the three areas with the highest number
of publications were: 122 articles were published in the area of Environmental and Occupational
Public Health , 106 articles in the area of Communication and 72 articles in the area of Health Policies
and Services.
Figure 3. Distribution of Publications on Health Literacy and Health Communication by area of
knowledge in the period from 2017 to 2022
SOURCE: (Web of Science, 2022)
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Author Ye a r Quotes Annual
Assessment
Goals Outcome
HUNTER-ADAMS;
ROTHER
2017
37 5.29
Explore the complexity of health and
communication from the perspective of
cross-border migrants seeking prenatal care
in Cape Town, South Africa in a study of
maternal and infant nutrition.
Communication and Health was considered
the prerequisite for quality care and reducing
border barriers and xenophobia. Free
professional medical interpretation for the
patient would not only benet immigrant
populations, but would benet the broader
community where LS language are barriers
to accessing healthcare.
UEMURA; YAMADA;
OKAMOTO
2021 71.75
To examine the eects of an active learning
program on LS, lifestyle behaviors,
physical function, and mental health among
community-dwelling older adults with low
LS.
Active learning can be used to educate
not only in schools, but in healthcare, and
programs can be used to promote a healthy
lifestyle (i.e., physical activity, dietary
variety, mobility in living space, and social
network size) among older adults who lack
the condence or motivation to engage in
healthy communication and behaviors.
BISSELL et al. 2019 61.2
socioecological perspective in determining
the eectiveness of a longitudinal LS
program/health intervention on children’s
nutritional knowledge, attitudes toward
healthy eating and exercise, food preferences,
and eating behavior
socioecological model perspective , the results
suggest that children’s eating behaviors
need to be considered at the intersection of
children’s HL/health attitudes, community
eorts, and media use/screen time.
RIESMEYER;
HAUSWALD; MERGEN
2019 5 1
Analyze the relationship between media
and LS, self-representation and nutritional
behavior of girls who receive nutrition-related
content on Instagram
The results show the relevance of the media
and LS for nutritional behavior. However,
these images inspire them for their self-
representation and nutritional behavior.
Young people adopted the images into
their own eating habits, adopting trends
and thus acting against their knowledge of
the negative consequences to achieve the
socially expected body image.
Table 1. Studies that associated Health Literacy, Communication and Health and Nutrition
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ROBINSON; COVELESKI 2018 50.83
To evaluate reactions through messages from
college-aged women related to the email
received from the University inviting them
to a free program for physical tness and
nutritional intervention against obesity.
LS, feminist identication, body
dissatisfaction and body size discrepancy
inuenced evaluations of the oensiveness
and eectiveness of the message and
adherence to the weight loss program.
JO; JUNG 2019 30.6
Investigate the use of food labels among
Koreans and the demographic dierences
between food label users and non-users,
presenting key data for strategies to improve
dietary lifestyles by facilitating the use of
food labeling
The level of education is associated with the
use of food labeling. Educational level is a
typical socioeconomic index, and if people
who are less educated tend not to use food
labeling, this can lead to health inequality.
Therefore, nutritional labeling must take
into account LS among the less educated
social classes. From a health communication
perspective, images and photos can increase
consumers’ understanding, which should be
considered to improve understanding of food
labeling.
DE ROSSO et al. 2022 two 1
Explore parents’ perceptions, search for
practical information and needs regarding
infant and young child feeding to design an
ecient communication strategy.
Parents receive information from multiple
sources, which can lead to confusion when
deciding which advice to follow. In public
health communication, the strategy adapted
to the current needs of parents should target
these various sources.
CHOI; NORTHUP; REID 2021 two 0.67
To determine how two individual factors,
health consciousness and LS, dierentially
inuence evaluations of claimed nutrient
content messages for an unhealthy food and
whether such evaluations are moderated
by reading the food’s nutrition facts label
displaying dierent portion sizes.
The results reveal understanding of the
processing of unhealthy food information
with nutrient claims and suggest implications
for health communication about food,
marketing and public health policy.
HASSIM et al. 2021 10.33
Analyze parents’ perceptions regarding health
communication, how parents ensure their
children follow healthy eating habits, and
how they seek information about childhood
obesity intervention during the COVID-19
pandemic.
The T20 groups were more ecient in
managing and applying knowledge due to
their greater LS and communication within
their social groups making healthy food
choices compared to other groups. This
describes the gap in eective communication
strategies to improve the public’s health
literacy.
PILGRIM, K.; BOHNET-
JOSCHKO
2022 10.33
To describe an overview of the visual
language of German tness inuencers on
Instagram and the body image portrayed for
implications for policies and institutions for
health promotion and prevention.
The need for construction at a political
level of uniform guidelines or adaptation to
existing laws, so that users and inuencers
have a clear attribution on the labeling of
contributions and, in this way, an increase
in information transparency is possible in
digital media.
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CHOI; NORTHUP; REID 2021 two 0.67
To determine how two individual factors,
health consciousness and LS, dierentially
inuence evaluations of claimed nutrient
content messages for an unhealthy food and
whether such evaluations are moderated
by reading the food’s nutrition facts label
displaying dierent portion sizes.
The results reveal understanding of the
processing of unhealthy food information
with nutrient claims and suggest implications
for health communication about food,
marketing and public health policy.
HASSIM et al. 2021 10.33
Analyze parents’ perceptions regarding health
communication, how parents ensure their
children follow healthy eating habits, and
how they seek information about childhood
obesity intervention during the COVID-19
pandemic.
The T20 groups were more ecient in
managing and applying knowledge due to
their greater LS and communication within
their social groups making healthy food
choices compared to other groups. This
describes the gap in eective communication
strategies to improve the public’s health
literacy.
PILGRIM, K.; BOHNET-
JOSCHKO
2022 10.33
To describe an overview of the visual
language of German tness inuencers on
Instagram and the body image portrayed for
implications for policies and institutions for
health promotion and prevention.
The need for construction at a political
level of uniform guidelines or adaptation to
existing laws, so that users and inuencers
have a clear attribution on the labeling of
contributions and, in this way, an increase
in information transparency is possible in
digital media.
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In Table 1, the results of 10 studies that associated Health Communication, Health Literacy
and Nutrition were presented in relation to the year of publication, number of citations, annual
evaluation and objectives and the outcome.
The contribution of the health professional is essential to improve health communication to
reduce language barriers, in the case of immigrant care, which may not be eective in reducing deeply
rooted xenophobic attitudes. In interpreting language about maternal and child nutrition, the authors
highlighted that condence in the interpretation must be shared on both the part of the migrant patient
and the health care provider. Health professional training and health policies must include the health
communication agenda to resolve issues of cultural dierences among immigrants in maternal and
child nutrition. (HUNTER-ADAMS; ROTHER, 2017).
In the study in which patients participated in a 24-week active learning program (90 min
on 1 day/week) in which the teaching themes were: exercise, diet/nutrition and cognitive activity to
promote the health of the elderly, changes were observed behavioral behaviors in daily life and self-
management according to the individual’s health status with the promotion of a healthy lifestyle and
preventing functional decline among older people who do not have the condence to engage in health
communication. ( UEMURA; YAMADA; OKAMOTO, 2021).
In the approach to general and childhood obesity carried out in the United States, it was
observed that information about the importance of adhering to healthier eating habits, reducing the
consumption of foods with low nutritional content to increase LS at school, can enhance changes in
food choices in dierent environmental contexts such as at home or in other contexts and positive
changes in health behaviors (BISSELL et al, 2019).
In the context of social networks such as Instagram , in a qualitative study carried out with
female adolescents aged between 13 and 19 years old, which sought to analyze the use of this platform
and its potential inuence on nutritional behavior and personality expression in interaction with other
users in relation to Media Literacy . The authors highlighted that the transfer of Media Literacy to
the eld of Health Communication allows these associations to be inferred through more evident
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intersections ( RIESMEYER; HAUSWALD; MERGEN, 2019).
In the context of obesity in the female college population, public health strategies must
consider the importance of health communication to avoid embarrassment or feelings of bullying
or fatphobia when you have a low LS. The authors highlighted that in a free university program to
improve physical conditioning and nutritional support, young women who had low HL considered the
email approach as an institutional oense and reacted negatively, having identication characteristics
such as feminist, body dissatisfaction and body size discrepancy. and assessed the eectiveness of
the message as oensive and the intervention to promote weight loss was not eective (ROBINSON;
COVELESKI, 2018).
In the LN approach, a study considered that the positive association between the level of
education and LS may reect on social inequity in health. The authors identied that food labels
that are dicult to understand make food use and choices dicult and recommend the creation of
community educational programs and measures to increase the level of LN education for interpreting
food labels ( JO; JUNG, 2019).
The authors De Rosso et al (2022) carried out a study on the use of dierent guidelines on
infant feeding by French parents in which the dierent perceptions of parents on the information-
seeking practices and feeding needs of babies and young children were assessed. Therefore, they found
that the use of dierent sources can confuse counseling, a similarity in search strategies according
to the child’s age. They recommended that the content must be adequate to avoid inequalities in LS
and socioeconomic status, the importance of developing dierent communication strategies for the
use of infant feeding guidelines, creation of an ocial website and adequately indexed in digital and
automated tools, such as use of applications on smartphones , which contributed to the construction of
a new communication strategy in French public health regarding child nutrition from 0 to 3 years old.
In another study, the population segment that seeks to determine their food preferences was
evaluated with the theoretical bases of the so-called ‘ health halo eect’ which refers to the act of
overestimating a single functional claim of the food, for example, ‘ I prefer to choose only low-fat
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foods ‘, without taking into account other macronutrients and nutrients, choices may not contribute to
an expected result. In this research, we sought to determine individual factors, health awareness, LS
level, the inuences of dierent evaluations of messages linked to the nutrient content for a healthy
and unhealthy food and whether these evaluations are mediated by reading nutritional information in
labeling (CHOI; NORTHUP; REID, 2021).
The results demonstrated that LS had a positive inuence on the interpretation of nutritional
information labeling and the recognition of unhealthy amounts per serving. In contrast , LS negatively
inuenced purchase intention. In situations where the nutritional label communicated the larger
portion size, it indicated the importance of subjective and objective knowledge, promoting dierent
reactions from consumers (CHOI; NORTHUP; REID, 2021).
According to Pereira Neto (2021), when an individual adopts the habit of carrying out an
in-depth search about their health condition through the main digital platforms , such as websites
and virtual communities, they have the ability to become an expert in a specic area. subject. In this
sense, the search for recognition on nutritional labeling increases consumers’ critical ability to choose
foods that have a better nutritional composition, becoming an expert patient .
The expert patient is associated with a condition of acquisition of empowerment , in which
individuals or groups can overcome by transforming a situation of ‘vulnerability’, ‘inequality’ or
‘impotence’ into a new condition of life with a state of greater autonomy, self-determination and
political awareness (PEREIRA NETO, 2021) in relation to their role in society with greater access to
information and knowledge. This change in behavior means that individuals have a more participatory
development in sharing their experiences in health-disease processes in virtual communities
(PEREIRA NETO, 2021).
In Malaysia, a study sought to evaluate aspects of childhood obesity in the pandemic related
to parents’ perceptions regarding health communication and how parents ensure that their children
have healthy eating habits and how they seek information about intervention in childhood obesity. It
was found that knowledge management and application are more ecient due to their greater LS and
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communication within their social groups. The authors highlighted the importance of implementing
eective health communication strategies to improve the population’s HL (HASSIM et al., 2021).
The spread of misleading content and disinformation campaigns became known as “
infodemic ”, with strong repercussions in Brazil throughout the pandemic period. Misinformation was
not created and disseminated only by unknown agents and underground circuits on digital platforms,
but by political authorities in Brazil (VALENTE, 2022) and this contributed to the dissemination and
adoption of foods that would not be benecial for the treatment of COVID-19 , in addition to problems
of food insecurity and a greater propensity to increase the consumption of ultra-processed foods .
In a study carried out in Germany on the inuence of social networks on the behavior of
young people in relation to the development of diseases due to uncontrolled behavior, the visual
language of German tness inuencers on Instagram and the body image portrayed were evaluated.
The authors found that the followers were not a public with sucient information and there was
a lack of transparency in the communication processes. Furthermore, a lack of clarity regarding
labeling requirements for commercial products or editorial posts on social media contribute to a
lack of clarication; Broadcasting legislation and the ‘ Telemedia Law ‘ are not sucient to regulate
digital communication. Therefore, there is a need to formulate political and uniform guidelines to
adapt existing laws so that users and inuencers understand the contributions of labeling to health
promotion and prevention for this vulnerable group ( PILGRIM, K.; BOHNET-JOSCHKO, 2022).
Considering that digital platforms are not neutral systems, as they seek to expand their active
mediation in spheres, in order to control the data, information ows, interactions and transactions
operated by the dierent types of users who participate in the ecosystem that it shapes, being above
all, mediators of communicational interactions (VALENTE, 2020).
Furthermore, these communication processes are linked to marketing interests, the
accumulation of capital through monetization and stimulation of followers’ consumption of ideological
and intentional content.
From the perspective of the technological paradigm, we do not understand this process in
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a deterministic way, but when we reect on the Marxian conception , it is possible to identify the
contradictions of productive forces and social relations of production, through the critical theory
of technology as a dialectical relationship between the general determinations of the system and
technological systems that can be called “technological regulation” (VALENTE, 2020).
Discussion
Scientometric evaluation, it was possible to observe that the theme about HL and Health
Communication, in the general context, and especially when related to the context of LA or LN, there
are few publications and geolocation networks are concentrated in developed countries such as the
United States and Australia . There are few studies related to epistemological issues in the eld of
LA and LN and there is a wide eld of possibilities regarding both clinical and socio-cultural issues
that can be formulated regarding the interactive processes of health communication in adherence to
healthy eating habits.
In the process of research into communication processes and reception practices, it is important
to encompass theoretical issues in the increasingly inextricable and strategic communication/culture
relationships, which constitute the basis of transformations in the mode of social production. With this,
it is possible to understand the communication processes and reception practices encompass these
theoretical-methodological issues together with the ethical and political issue (MARTÍN-BARBERO,
2011).
From this perspective, the themes addressed in the eld of LS and LN in the eld of
communication and health portrayed the link between the problems of low LS or inadequacies
regarding behaviors and eating habits, in general, are related to theoretical-methodological issues in
the production of content and communication strategies, as well as a lack of public policy formulation
in the regulation of digital platforms.
There are distinctions and articulations between communication relations and the context,
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the choice of the interactional device and the occurrences of communication processes with the
participation of dierent social elements, they are above all heterogeneous, in the form of articulations
and tensions , even when there is the same communication objective of society and its sectors and the
need for organization in the ow of communication circulation, to highlight diversity and minimize
the eects of dispersion (BRAGA, 2011) . In this sense, in interactional processes it must be taken into
account that when choosing the interactional device, it must be used to provide opportunities for the
democratic insertion of all participants involved in relation to the content of the interactions. In the
studies evaluated, nutritional information content was introduced in a prescriptive manner, but there
was no interactional communication process to promote participants’ adherence to health promotion
and prevention processes.
In the eld of LS and LA, the need to consider the awareness of the multidimensionality of
communicative processes in society and their growing importance for the production of modernity in
countries such as those in Latin America. Considering that there are many advances in LS, and mainly
in LA and its epistemiological emergence , it is important to consider aspects of transdisciplinarity
that contribute to the reection of object-problems in the eld of communication in those of other
social disciplines and in the construction of articulations of intertextualities with the media , cultural
industries as matrices of disorganization and reorganization of social experience and the new web of
actors and power strategies in the historical process of globalization in the eld of communication and
in modern society (DE LOPES, 2006).
From the perspective of Health Communication scenarios and trends from the perspective
of the SUS, there is a clash between centrifugal forces, which drive the movement for renewal and
expansion of the right to communication, and centripetal forces that act in the conservative sense of
what is already crystallized and for the naturalization of current models ( ARAÚJO; CARDOSO;
MURTINHO, 2011). In the eld of LN and LA, there is conformity with the reproduction of marketing
models that are disseminated on digital platforms, mainly with engagement content on Instagram
following trends from other countries, as presented in table 1, mainly linked to the reduction of
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obesity , functional foods and nutrition and aesthetics, but often disconnected from the guidelines or
the Food Guide for the Brazilian Population . (BRAZIL, 2014).
In Brazil, the diculties of implementing communication in line with SUS reect the
tensions in the eld of political, ideological, economic and cultural disputes that spread on dierent
scales and through phenomena of dierent orders, moving and building the possibilities for change
in society . To strengthen the SUS, it is important to consider connections in the domains of the
SUS itself, based on the consideration of its principles, although without losing sight of the links
and relationships of interdependence that health and its communicative practices maintain with the
broader social formation in the which they are located ( ARAÚJO; CARDOSO; MURTINHO, 2011).
It is important to reect on contemporary challenges regarding the promotion of public
policies, knowledge and practices around guaranteeing the right to communication as a dimension
of the right to health (STEVANIM; MURTINHO, 2021). The rst challenge is about strengthening
democratic experiences and struggles amid the dismantling of democratic references built in the 1988
Constitution. The second challenge refers to confronting inequalities in the exercise of the right to
communication that threaten the guarantee of universal health and integral to the population. The
third challenge is a reection of the interaction between the elds of communication and health: it
translates into the need to reconcile the promotion of public policies and the development of projects
and initiatives aimed at the dialogue between communication and health with everyday experiences
that are not reduced institutional limits (STEVANIM; MURTINHO, 2021).
Conclusion
From this perspective, considering the transdisciplinarity of these challenges and their
important concepts for producing knowledge about communication processes in the eld of Nutrition
and Food, the need to build a theoretical-methodological model on LN and LA that considers regional,
social and cultural diversities , as well as epidemiological issues in the context of public health such as
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chronic non-communicable diseases. The need to formulate Communication and Health policies and
health communication strategies for health promotion and prevention in line with the strengthening
of the SUS.
Therefore, the insertion of LN and LA can constitute strategies with potential eectiveness
in health promotion and prevention, when linked to health communication processes. It is necessary
to plan new studies in the Brazilian population to analyze the benets on public health.
References
ARAÚJO, Inesita Soares; CARDOSO, Janine. Comunicação e Poder. in: Comunicação e saúde. Rio
de Janeiro: Editora Fiocruz, 2007, p. 19 a 85.
ARAÚJO, Inesita Soares; CARDOSO, Janine Miranda; MURTINHO, Rodri-
go. A comunicação no Sistema Único de Saúde: cenário e tendências. Revis-
ta Latinoamericana de Ciencias de la Comunicación. 2011. v. 6, n. 10, pp. 104-115.
Disponível em: <http://revista.pubalaic.org/index.php/alaic/article/view/22>.
BAUMANN, E.; CZERWINSKI ,F.; REIFEGERSTE D. Gender-Specic Determinants and Patterns
of Online Health Information Seeking: Results From a Representative German Health Survey J Med
Internet Res, 2017;19(4):e92 URL: https://www.jmir.org/2017/4/e92 DOI: 10.2196/jmir.6668
BISSELL, K et al. Changing the Face of Health Education via Health Interventions: Social Ecologi-
cal Perspectives on New Media Technologies and Elementary Nutrition Education, Health Commu-
nication, 34:13, p. 1575-1584, 2019. DOI: 10.1080/10410236.2018.1507659
BRAGA, José Luiz. Constituição do Campo da Comunicação. Verso e Reverso. v.25, n.58, jan-abr
2011, p. 62-77. Disponível em: Acesso em 1 jul. 2022.
BRASIL. Ministério da Saúde (MS). Guia Alimentar para a População Brasileira. Brasília: MS;2014.
CHEN X., et al. Health Literacy and Use and Trust in Health Information. Journal of Health Commu-
nication, (), 1–11, 2018. doi:10.1080/10810730.2018.1511658
114
ISSN: 2763-5724 / Vol. 04 - n 04 - ano 2024
CHOI, H; NORTHUP, T; REID, LN. How Health Consciousness and Health Literacy Inuence
Evaluative Responses to Nutrient-Content Claimed Messaging for an Unhealthy Food, Journal of
Health Communication, v.26, n.5, p. 350-359, 2021. DOI: 10.1080/10810730.2021.1946217
DADACZYNSKI K, et al. Digital Health Literacy and Web-Based Information-Seeking Behaviors
of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Stu-
dy. J Med Internet Res. 2021 Jan 15;23(1):e24097. doi: 10.2196/24097. PMID: 33395396; PMCID:
PMC7813561.
DE ROSSO S, et al. Information seeking of French parents regarding infant and young child fee-
ding: practices, needs and determinants. Public Health Nutr. 2022 Apr;25(4):879-892. doi: 10.1017/
S1368980021003086. Epub 2021 Jul 29. PMID: 34321131.
DE LOPES, Maria Immaculata. O campo da Comunicação: sua constituição,
desaos e dilemas. Revista Famecos: mídia, cultura e tecnologia. n. 30, ago 2006,
p. 16-30. Disponível em: <https://www.redalyc.org/pdf/4955/495550186002.pdf>.
Acesso em 1 jul. 2022.
FLEARY, A.; JOSEPH, P.; PAPPAGIANOPOULOS, J. E. Adolescent health literacy and health
behaviors: A systematic review. Journal of Adolescence, 62(), 116–127. 2018. doi:10.1016/j.adoles-
cence.2017.11.010
HAN, P.K.J, et al. Communication of Scientic Uncertainty about a Novel Pandemic Health Thre-
at: Ambiguity Aversion and Its Mechanisms. J Health Commun. 2018;v.23, n.5, p.435-444. doi:
10.1080/10810730.2018.1461961
HASSIM, N.; FERNANDEZ, P. R.; HOONG, N. K.; RAJARATNAM, U. D.; KOON, J. H. G.; CHING,
S. Y.; QIAN, W. Search-Journal of Media and Communication Research ; 13(3):141-156, 2021.
HUNTER-ADAMS, J.; ROTHER, HA. A Qualitative study of language barriers between South Afri-
can health care providers and cross-border migrants. BMC Health Serv Res 17,p. 97, 2017. https://
doi.org/10.1186/s12913-017-2042-5
LI X, LIU Q. Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in
115
ISSN: 2763-5724 / Vol. 04 - n 04 - ano 2024
the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens. J Med Internet Res. 2020 Oct
9;22(10):e19684. doi: 10.2196/19684. PMID: 33006940; PMCID: PMC7581310.
JO, H.S; JUNG, S.M. Evaluation of Food Labeling Policy in Korea: Analyzing the Community
Health Survey 2014–2017. J Korean Med Sci. 2019 Aug;34(32):e211. https://doi.org/10.3346/
jkms.2019.34.e211
JOSEPH, G., PASICK, R.J., SCHILLINGER, D. et al. Information Mismatch: Cancer Risk Cou-
nseling with Diverse Underserved Patients. J Genet Counsel v.26, 1090–1104 (2017). https://doi.
org/10.1007/s10897-017-0089-4
MARTÍN-BARBERO, Jesús. ¿Desde donde pensamos la comunicación hoy? Chasqui, Quito, n. 128,
p. 13-29, abr./jun. 2015. Link: https://www.redalyc.org/articulo.oa?id=16057400003
_______. “Reubicando el campo de las audiencias en el descampado de la mutación cultural”, en
Jacks, Nilda (coord.) Análisis de recepción en América Latina: un recuento histórico con perspectivas
al futuro. Quito: Quipus-CIESPAL, 2011. Link: https://biblio.acsoandes.edu.ec/libros/127940-opac.
MEPPELINK C.S, et al. “I was Right about Vaccination”: Conrmation Bias and Health Literacy in
Online Health Information Seeking, Journal of Health Communication, v. 24, n. 2, p.129-140, 2019.
DOI: 10.1080/10810730.2019.1583701
NUTBEAM, DON; LLOYD, JANE E. Understanding and Responding to Health Literacy as a Social
Determinant of Health. Annual Review of Public Health, n. 42, v.1, 2021. doi:10.1146/annurev-pub-
lhealth-090419-102529
PEREIRA NETO, ANDRÉ; FELIPETTE, J. ; BARBOSA, L. ; SCHWARTZ, E. . Internet expert pa-
tient e empoderamento: pers de atuação em comunidadesvirtuais de renais crônicos 146. In: Pereira
Neto, Andre; Flynn, Matthew.(Org.). Internet e saúde no Brasil: desaos e tendências. 1ed. São Paulo
Cultura Acadêmica, 2021, v. 1, p. 146-176. Disponível em.
PILGRIM, K.; BOHNET-JOSCHKO, S. Inuencer und das Problem mit dem Sixpack. Präv Gesun-
dheitsf, 17, 113–118 (2022). https://doi.org/10.1007/s11553-021-00845-w
RATZAN, S.C.; SOMMARIVA, S.; RAUH, L. Enhancing global health communication during a
116
ISSN: 2763-5724 / Vol. 04 - n 04 - ano 2024
crisis: lessons from the COVID-19 pandemic. Public Health Res Pract. 2020, v.30, n., 2020. doi:
10.17061/phrp3022010. PMID: 32601655.
RESMEYER, C., HAUSWALD, J., & MERGEN, M. (Un)Healthy Behavior? The Relationship
between Media Literacy, Nutritional Behavior, and Self-Representation on Instagram. Media and
Communication, 7(2), p. 160-168, 2019. doi:https://doi.org/10.17645/mac.v7i2.1871
ROBINSON, B; COVELESKI, S. Don’t Say That to ME: Opposition to Targeting in Weight-Centric
Intervention Messages, Health Communication, 33:2, 139-147, 2018. DOI: 10.1080/10410236.2016
.1250189
SØRENSEN, K., VAN DEN BROUCKE, S., FULLAM, J. et al. Health literacy and public health:
A systematic review and integration of denitions and models. BMC Public Health 12, 80 (2012).
https://doi.org/10.1186/1471-2458-12-80
TAYLOR, D.M et al. Health literacy and patient outcomes in chronic kidney disease: a systema-
tic review. Nephrol Dial Transplant. 2018 Sep 1;33(9):1545-1558. doi: 10.1093/ndt/gfx293. PMID:
29165627.
TEIXEIRA, R. R. Modelos comunicacionais e práticas de saúde. Interfa-
ce - Comunicação, Saúde, Educação [online]. 1997, v. 1, n. 1 , pp. 7-40. Dis-
ponível em: <https://doi.org/10.1590/S1414-32831997000200002>. Acesso
em: 10 jul. 2022.
TORRES, R; REAL H. Literacia Nutricional e Literacia Alimentar: Uma Revisão narrativa sobre
Denição, Domínios e Ferramentas de Avaliação, Acta Portuguesa de Nutrição, Issue 24, 2021, Pages
56-63, https://dx.doi.org/10.21011/apn.2021.2411,
UEMURA K, YAMADA M, OKAMOTO H. The Eectiveness of an Active Learning Program in
Promoting a Healthy Lifestyle among Older Adults with Low Health Literacy: A Randomized Con-
trolled Trial. Gerontology. 2021;67(1):25-35. doi: 10.1159/000511357. Epub 2020 Dec 3. PMID:
33271536.
VALENTE, Jonas. A disputa pela regulação da desinformação e das plataformas
digitais no Brasil: o avanço do PL das Fake News na Câmara dos Deputados, P. 11 -
117
ISSN: 2763-5724 / Vol. 04 - n 04 - ano 2024
27. In: CARVALHO, Mariana Martins de; DUTRA, Luma Poletti (Orgs.). Cadernos de
conjuntura das comunicações LaPCom-Ulepicc-Brasil 2022: desinformação, crise
democrática e políticas de comunicação e cultura. Brasília:: Ulepicc-Brasil, 2022.
VALENTE, J. Plataformas digitais, economia e poder: apresentação do dossiê temático da Revista
Eptic 2020. Disponível em: https://www.researchgate.net/publication/339271177_Plataformas_digi-
tais_economia_e_pode r_apresentacao_do_dossie_tematico_da_Revista_Eptic_2020-1.
WORLD HEALTH ORGANIZATION (WHO). Health literacy: the solid facts. Denmark: WHO;
2013. Available from: http://www.euro.who.int/__data/ assets/pdf_le/0008/190655/e96854.pdf
