Strengthening health literacy among urban marginalised populations through a tailored primary care model: a mixed-methods study.

Abstract

BACKGROUND: Urban marginalised populations face intersecting barriers, such as poverty, unstable housing and discrimination, that erode health literacy in primary-care contexts. We examined whether an inter-professional, low-barrier primary care model improves health literacy competencies compared with usual care. METHODS: A convergent mixed-methods study took place at Centretown Community Health Centre (CCHC), Ottawa (2019–2023). Phase 1 compared Health Literacy Questionnaire (HLQ) scores between clients receiving tailored care (n = 37) and matched community members using usual services (n = 36). Phase 2 explored experiences through four focus groups and semi-structured interviews (n = 23). Independent samples t-tests and inductive thematic analysis were used. RESULTS: Overall health literacy was moderate in both groups; however, the tailored-care group scored higher on appraisal of health information (M = 3.03 ± 0.57 vs. 2.76 ± 0.46, p = 0.025, d = 0.53). Qualitatively, tailored-care participants described clearer chronic-disease self-management, strategic navigation of appointments, and fewer inappropriate emergency department visits. Persistently low social support scores highlighted systemic isolation. CONCLUSIONS: Embedding social supports, outreach, and client-centred education within primary care can strengthen critical appraisal skills in marginalised settings. Scaling such models should pair literacy interventions with broader community-support strategies. TRIAL REGISTRATION: Not applicable (observational study).