Strategic Communication for Local Public Health Services in Portugal: A Delphi Study


  • Duarte Vital Brito Public Health Unit Cascais. Western Lisbon Local Health Unit. Lisbon.



Delphi Technique, Health Communication, Portugal, Public Health Administration, Strategic Planning


Introduction: Strategic communication plays a decisive role in public health planning and project implementation. However, Portuguese Local Public Health Units, which are responsible for community interventions, still lack guidance models, tools, specialized resources, and training in health communication. The aim of this study was to develop a conceptual model of strategic organizational communication for local public health services, in Portugal.
Methods: This study presents a conceptual model of strategic organizational communication for Local Public Health Units, which was developed through a three-round, modified Delphi online panel. Thirty-seven Portuguese specialists in public health, communication, and community members were invited to analyse a proposed framework, based on an up-to-date literature review. High retention rates were observed in all rounds (first = 22 valid participations;
second = 21 valid participations; third = 18 valid participations).
Results: Most participants believed that Portuguese Public Health Units were not prepared to communicate effectively and that they would benefit from adequate planning and identification of a communication lead or team. Websites and social media were also identified as essential for effective communication. The validated conceptual model integrated different partners in health and in the community, with emphasis on the relationships with the national network of health authorities, other Public Health Units, primary health care units, municipalities, and schools. The preferred channels identified for communicating with these partners included interpersonal relationships, email, and mobile phone. No consensus was obtained for preferred communication channels between Local Public Health Units and the media.
Conclusion: Strategic planning based on the proposed conceptual model involving different stakeholders, has potential to improve the effectiveness of internal and external communication and facilitate the implementation of public health programs and projects. The proposed model needs to be validated in Local Public Health Units, considering the potential human, material, and financial constraints.


Download data is not yet available.


Neal H. Better communications for better health. New York: The National Health Council; 1962.

Schiavo R. Health communication - from theory to practice. 2nd ed. San Francisco: Jossey-Bass; 2014.

Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.

Khorram-Manesh A, Dulebenets M, Goniewicz K. Implementing public health strategies - the need for educational initiatives: a systematic review. Int J Environ Res Public Health. 2021;18:5888.

Carey R, Connell L, Johnston M, Rothman A, de Bruin M, Kelly M, et al. Behavior change techniques and their mechanisms of action: a synthesis of links described in published intervention literature. Ann Behav Med. 2019;53:693-707.

Lee N. Reducing the spread of COVID-19: a social marketing perspective. Soc Mark Q. 2020;26:259-65.

World Health Organization - Regional Office for Europe. European action plan for strengthening public health capacities and services. Copenhagen: WHO Regional Office for Europe; 2012.

Lammers J, Barbour J. An institutional theory of organizational communication. Commun Theory. 2006;16:356-77.

Kunsch M. Comunicação organizacional integrada na perspetiva estratégica. In: Felix J, editor. Comunicação estratégica e integrada: a visão de 23 renomados autores de 5 países. São Paulo: Editora Rede Integrada; 2020. p.87-104.

Postmes T, Tanis M, Wit B. Communication and commitment in organizations: a social identity approach. Group Process Intergr Relat. 2001;4:227-46.

Hallahan K, Holtzhausen D, van Ruler B, Vercic D, Sriramesh K. Defining strategic communication. Int J Strateg Commun. 2007;1:3-35.

Pereira M. Comunicação estratégica no contexto organizacional strategic communication in organizational context. Rev Int Cienc. 2014;4:37-50.

Parvanta C, Nelson D, Parvanta S, Harner R. Essentials of public health communication. Massachusetts: Jones & Bartlett Learning; 2011.

Ruão T, Lopes F, Marinho S. Comunicação e saúde, dois campos em intersecção. Comun Soc. 2012:5-7.

Kunsch M. Planejamento e gestão estratégica de relações públicas nas organizações contemporâneas. Anàlisi. 2006;34:125-39.

Clampitt P, Downs C. Employee perceptions of the relationship between communication and productivity: a field study. Int J Bus Commun. 1993;30:5-28.

Yates K. Internal communication effectiveness enhances bottom-line results. J Organ Excell. 2016;25:71-9.

Robson P, Tourish D. Managing internal communication: an organizational case study. Corp Commun. 2006;10:213-22.

Martins M. Internal communication plan of the Hospital do Espírito Santo de Évora, EPE.. Évora: Universidade de Évora; 2014.

Serapioni M, Ferreira P, Antunes P. Participação em saúde: conceitos e conteúdos. Notas Económicas. 2014;40:26-41.

Parvanta C, Bass S. Health communication - strategies and skills for a new era. Massachusetts: Jones & Bartlett Learning; 2018.

Ihm J, Lee CJ. Toward more effective public health interventions during the COVID-19 pandemic: suggesting audience segmentation based on social and media resources. Health Commun. 2021;36:98-108.

Portugal. Ministério da Saúde. Decreto-Lei n.º 137/2013. Diário da República, I Série, n.º 193 (2013/10/07).

Colégio de Saúde Pública – Ordem dos Médicos. Competências essenciais ao exercício do médico especialista em Saúde Pública. Lisboa: Ordem dos Médicos; 2013.

Arriaga M, Santos B, Costa A, Francisco R, Nogueira P, Oliveira J, et al. Health literacy survey 2019 - Portugal - levels of health literacy. Lisboa: Direção-Geral da Saúde; 2021.

Comissão para a Reforma da Saúde Pública Nacional. Modelo de uma rede de serviços de Saúde Pública – proposta de desenvolvimento e implementação. Lisboa: CRSPN; 2017.

Alpuim N. The role of strategic communication in healthcare institutions: the case of the Braga hospital. Braga: Universidade do Minho; 2015.

Creswell J. Research design: qualitative, quantitative and mixed methods approaches. 4th ed. London: Sage Publications Inc; 2013.

Yates, K. Internal communication effectiveness enhances bottom-line results. J Organ Excell. 2006;25:71-9.

Longest BB Jr, Rohrer WM. Communication between public health agencies and their external stakeholders. J Health Hum Serv Adm. 2005:28:189-217.

Lammers J, Barbour J. An institutional theory of organizational communication. Commun Theory. 2006:16:356-77.

Hsu C, Sandford B. The delphi technique: making sense of consensus. Pract Assess Res. 2007:12:1-8.

Powell C. The Delphi technique: myths and realities. J Adv Nurs. 2003;41:376-82.

Monguet J, Trejo A, Marti T, Escarrabill J. Health consensus: a digital adapted Delphi for healthcare. IJUDH. 2017;7:27-43.

Avella J. Delphi panels: research design, procedures, advantages, and challenges. Int J Dr Stud. 2016;11:305-21.

Rozados H. O uso da técnica Delphi como alternativa metodológica para a área da Ciência de Informação. Em Questão. 2015;21:64-86.

Diamond I, Grant R, Feldman B, Pencharz P, Ling S, Moore A, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014;67:401-9.

Bhandari S, Hallowell M. Identifying and controlling biases in expertopinion research: guidelines for variations of delphi, nominal group technique, and focus groups. J Manag Eng. 2021;37:04021015.

Beiderbeck D, Frevel N, von der Gracht H, Schmidt S, Schweitzer V. Preparing, conducting, and analyzing delphi surveys: crossdisciplinary practices, new directions, and advancements. MethodsX. 2021;8:101401.

Heath R, O’Hair D. Handbook of risk and crisis communication. 1st ed. New York: Routledge; 2010.

Santos A. Gestão da mudança na saúde: do planeamento à governança em saúde. Um contributo para a governança local em saúde. Lisboa: Universidade Nova de Lisboa; 2018.

Tangcharoensathien V, Calleja N, Nguyen T, Purnat T, D’Agostino M, Garcia-Saiso S, et al. Framework for managing the COVID-19 infodemic: methods and results of an online, crowdsourced WHO technical consultation. J Med Internet Res. 2020;22:e19659.

Mehrizi M, Ghasemzadeh F, Molas-Gallart J. Stakeholder mapping as an assessment framework for policy implementation. Evaluation. 2009;15:427-44.

Reynolds B, Seeger M. Chapter 5 – The spokesperson. Washington: Centers for Disease Control and Prevention; 2014.

Weaver S, Dy S, Rosen M. Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf. 2014;23:359-72.

Brito D, Garcia A. Posicionamento digital das unidades de Saúde Pública em Portugal Continental em 2019. Comunicação Pública. 2019;15.

Szostek A. ‘Dealing with my emails’: latent user needs in email management. Comput Hum Behav. 2011;27:723-9.

Duggan A. Understanding interpersonal communication processes across health contexts: advances in the last decade and challenges for the next decade. J Health Commun. 2006;11:93-108.

Smeraglio A, DiVeronica M, Terndrup C, McGhee B, Hunsaker S. Videoconferencing: a steep learning curve for medical educators. J Grad Med Educ. 2020;12:553-6.

Sousa R, Trindade R. O impacto da saúde escolar na comunidade educativa. Educ Soc Culturas. 2013;38:99-116.




How to Cite

Vital Brito D. Strategic Communication for Local Public Health Services in Portugal: A Delphi Study. Acta Med Port [Internet]. 2024 Apr. 1 [cited 2024 Apr. 23];37(4):251-6. Available from: