Exploring health literacy in relation to noncommunicable diseases in Samoa: a qualitative study

Caroline Bollars*, Kristine Sorensen, Nanne de Vries, Ree Meertens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background Samoa is suffering from alarming rates of noncommunicable diseases (NCDs). To address this epidemic, tackling health literacy is important. A qualitative study was conducted with the aim to explore health literacy in Samoa in relation to NCDs. Methods Six focus groups were conducted, with a total sample size of 73 participants aged over 18 years. The semi-structured interview guide was based on the conceptual model of the European Health Literacy project (HLS-EU). Data was translated, transcribed, coded, and categorized as part of the qualitative analysis. Results The analysis resulted in one overarching category and seven sub-categories based on 19 themes. It revealed that health literacy in Samoa is strongly influenced by the culture. Personal responsibility is lacking. The family circle is central to health in a community where support is provided through the church and local groupings. Basic knowledge of NCDs was present in the population, but a deeper understanding of chronic disease implications was lacking. Difficulties with regards to medication adherence for chronic diseases arose as a topic, and traditional healers are still strongly embedded in the local society. Finally, the health system's performance, especially primary care services at the local level, is suffering from the high burden of NCDs and has been challenged to respond to the needs of the community it serves. Conclusion The findings of this study show how health literacy in Samoa is influenced by culture and suggest employing participatory, culture-sensitive, public health interventions which address the family as a whole, building on health literacy to address major public health problems like NCDs and remove barriers in the health system.

Original languageEnglish
Article number1151
Number of pages12
JournalBMC Public Health
Issue number1
Publication statusPublished - 22 Aug 2019


  • Health literacy
  • Public health
  • Health promotion
  • Focus groups
  • Medication adherence
  • Noncommunicable diseases
  • Risk factors
  • Obesity
  • Diabetes mellitus
  • Qualitative research
  • Primary health care
  • Samoa

Cite this