Which criteria characterize a health literate health care organization? - a scoping review on organizational health literacy

Readability of written information for patients across 30 years: A systematic review of systematic reviews

OBJECTIVE

This study conducted a systematic review of the systematic reviews of readability assessment studies to contribute to future readability research and practice by providing a comprehensive overview of information readability for patients.

METHODS

We searched multiple databases. We included systematic reviews of studies that quantitatively assessed the readability of health information.

RESULTS

This study included 24 systematic reviews, which assessed the readability of 29,424 materials across 438 studies from 1990 to 2022. All systematic reviews reported that the readability of most materials exceeded the recommended sixth to eight-grade reading level. The readability level did not improve between 2001 and 2022, when the included systematic reviews were published.

CONCLUSIONS

We found that the required reading level of information was too high for patients in all clinical areas included in this systematic review. We also identified gaps in readability assessment research in clinical areas and across media types and languages, which should be addressed by future studies.

PRACTICE IMPLICATIONS

Health professionals should use available guidelines to make existing patient information easy to read and to write easy-to-read patient information, thereby improving readability. Such efforts are needed regardless of the organizations these professionals work at.

[Organizational health literacy in German hospitals and nursing homes: state and perspectives]

BACKGROUND

It is unclear to what extent hospitals and nursing homes in Germany make it easier for people to navigate, understand, and use information and services to take care of their health, that is, demonstrate organizational health literacy (oHL), and which aspects are essential for identifying approaches to promoting oHL.

METHODS

The basis is formed by three independently conducted research projects: (1) a survey of hospitals (HO) and nursing homes (NH) (EwiKo, 2021), (2) a survey of hospitals (GK-KH, 2022), and (3) a consensus process to reduce a detailed self-assessment tool (SAT-OHL-Hos v1.1; 2024). In (1) and (2), all German hospitals and the 1475 NH in Saxony and Thuringia were included, and the HLHO-10 (range 1 to 7, high values = high oGK) was used. The consensus process was carried out in the WHO network M‑POHL with the aim of reducing the 141 indicators by about two-thirds while maintaining the depth and breadth of the concept in three steps: prioritization of indicators at the national level, merging of national votes, consensus in the international working group.

RESULTS

Evaluable questionnaires were received from 195 NH, 62 HO, and 291 HO (response rate: 13.2%, 3.2%, and 11%, respectively). The mean values of the 10 HLHO-10 standards ranged from 3.5 to 5.7, with no substantial differences between hospitals and nursing homes. The consensus process led to a reduced instrument of 54 items. Among other things, the discussion addressed the question of what can be expected across countries.

DISCUSSION

For the first time, data on oHL in nursing homes are available. The self-assessed oHL of the surveyed institutions is in the medium to good range. The SAT-OHL-Hos V2, now shortened by about one-third, is a "short, detailed" and internationally applicable instrument ready for empirical testing.

[Development and evaluation of an assessment tool for organisational health literacy]

BACKGROUND

In research on organisational health literacy (OHL), there is a lack of standardised assessment tools for measuring and comparing the OHL of different organisations. This article therefore examines (1) which criteria for assessing OHL can be derived from research and practice, (2) how these are implemented in organisations and (3) the psychometric properties of a questionnaire developed from them.

METHODOLOGY

OHL criteria were identified by means of literature research and workshops. The criteria were agreed upon in a Delphi study and an assessment tool was developed. An online questionnaire was developed and psychometrically tested. Measures such as Cronbach's alpha, item selectivity and difficulty, and floor/ceiling effects were used for the analysis.

RESULTS

Over 500 criteria were identified and an assessment tool of 77 criteria (5 main categories and 17 sub-categories) was developed. The subject of "Barrier-free access and navigation" was best implemented in healthcare organisations. The psychometric properties showed a good to excellent internal consistency of the questionnaire structure. Only one main category showed significant floor effects; there were no ceiling effects. At the item level, ceiling effects were found for 13 items, and 39 items showed a satisfactory discriminatory power.

DISCUSSION

OHL is a multidimensional construct that is well represented by the assessment tool. Further validation with larger samples is necessary for the use of the tool as a questionnaire for measuring OHL and for comparison between institutions. A reduction in the number of criteria can improve the consistency of the content of the main and sub-categories.

[Establishing and implementing the National Action Plan Health Literacy in Germany]

About ten years ago, studies on health literacy in Germany indicated that population health literacy was low. This prompted a group of distinguished experts to initiate the development of a National Action Plan for Health Literacy (NAP-HL) for Germany, modeled after those of other countries. This article explains the origins and development of the plan in Germany, provides an overview of the steps taken during its creation, and summarizes its content. Subsequently, the transfer strategy, including the three steps of diffusion, dissemination, and implementation, is discussed. The concluding assessment evaluates the plan's achieved impacts and critically reflects on the implementation strategy. Overall, numerous impulses were provided for agenda setting and the promotion of health literacy. The challenge remains to develop sustainable interventions for strengthening health literacy, accompanied by systematic research.

Delivering Patient-Centered Care With Respect to Patient Education and Health Literacy in Athletic Training Job Settings

CONTEXT

A patient-centered care (PCC) environment allows athletic trainers (ATs) to develop trusting relationships with patients, enabling them to make the most informed care decisions. To provide PCC, the AT should assess health literacy and deliver quality patient education.

OBJECTIVE

To explore the lived experiences of ATs from different job settings to identify how they deliver PCC specific to health literacy and patient education.

DESIGN

Qualitative.

SETTING

Virtual interviews.

PATIENTS OR OTHER PARTICIPANTS

Twenty-seven ATs (age = 34 ± 10 years; women = 15, men = 12) from the physician practice (n = 10), college (n = 9), and secondary school (n = 8) settings.

MAIN OUTCOME MEASURE(S)

We interviewed the participants using a semistructured interview protocol. Three researchers coded the transcripts after the consensual qualitative research process for each job setting. Trustworthiness was achieved through multianalyst triangulation, member checking, and internal auditing.

RESULTS

Four domains emerged from all interviews: (1) work environment, (2) essential traits and skills, (3) health literacy assessment strategies, and (4) patient education materials and delivery. In the work environment, ATs described the patient load, interprofessional relationships, and patient characteristics across settings. Essential traits and skills varied widely between settings, and ATs needed different strategies based on differing patient needs. For health literacy assessment strategies, ATs did not formally assess health literacy and relied on perceptions and assumptions. Effective digital information and health informatics strategies were described for patient education materials and delivery.

CONCLUSIONS

ATs from physician practice, college, and secondary school settings describe using various strategies to create a patient-centered environment. Participants shared their behaviors in assessing health literacy and delivering patient education from various job settings.

Health literacy and psychological wellbeing of employees working from home in Germany-online survey results

Employees' psychological wellbeing is of special interest to employers, as mental illnesses are still the second most common reason for work absences. The psychological wellbeing of employees is determined by factors at an individual, interpersonal and organizational level. Health literacy encompasses both the individual and the organizational level and thus offers a good concept against the background of employees' psychological wellbeing. Furthermore, demographic change increases skills shortages, while recently, other working models, such as increasing home office arrangements, benefit and challenge both employees and employers. Therefore, this study examines the associations between individual and organizational health literacy, work-from-home culture, and the psychological wellbeing of employees who mainly work from home. An anonymous open online survey via Facebook and Instagram advertisements was conducted in June 2023 in Germany. The questionnaire included nine thematic groups with validated and nonvalidated scales (e.g. WHO-5 Wellbeing-Index). Data from 103 participants were suitable for data analyses in IBM SPSS Statistics 23. Of the participating employees, 17% were assigned to males and 83% to females. The mean age was 49.5 years. Individual and organizational health literacy and work-from-home culture were positively associated with employees' psychological wellbeing. Organizational health literacy mediated the effect of individual health literacy on employees' psychological wellbeing. Individual and organizational health literacy totally mediated the impact of work-from-home culture. The study results highlight that individual and organizational health literacy provide useful concepts for practitioners and researchers regarding the psychological wellbeing of employees working from home and that both might play a crucial role in mediating the effect of organizational culture aspects on employees' psychological wellbeing.

Readability of online and offline written health information: a protocol of a systematic review of systematic reviews

INTRODUCTION

Healthcare organisations should create and disseminate readable information to citizens and patients to reduce the level of health literacy required for individuals. Several systematic reviews have reported overviews of the readability of written health information for each subject area. This systematic review of systematic reviews will synthesise evidence from existing systematic reviews to provide an overview of studies that assessed readability in diverse areas and identify gaps to be filled in future research and practice to improve the readability of health information.

METHODS AND ANALYSIS

The following databases will be searched: PubMed, MEDLINE, CINAHL, PsycINFO, Web of Science Core Collection, Scopus, Cochrane Database of Systematic Reviews, and Google Scholar. The reference lists of the eligible studies will be searched to identify additional studies. The eligible literature will be systematic reviews of published empirical studies that quantitatively assessed the readability of health information for patients and/or citizens. Two independent reviewers will screen the titles, abstracts and full texts of all identified literature. A lead researcher will extract the data, and a second reviewer will check the results. Discrepancies will be resolved through discussion, and a third reviewer will be involved if necessary. Data, such as the characteristics of the systematic review, characteristics of the reviewed literature in the systematic review, subject area, material characteristics, definition(s) of readability, readability assessment methods, main results and quality assessment, will be extracted. The findings will be synthesised in a numerical summary and a descriptive and narrative review.

ETHICS AND DISSEMINATION

This review does not involve any ethical concerns. The results and implications of this systematic review will be disseminated at conferences and in peer-reviewed journals.

The dark side of the moon: can critical health literacy offer solutions to the fundamental problems of health literacy?

This commentary is intended as a response to ongoing concerns expressed about fundamental limitations of current research, policy, and practice surrounding health literacy. These concerns emphasise the individualistic and reductionist approaches which often dominate health literacy work, as well as a neglect of broader structural factors in addressing pressing public health issues. The potential of critical health literacy as a concept and practical approach which responds to these critiques is presented. A case is made that critical health literacy, as a concept that operates at both the community and individual level, offers an opportunity to address and eventually overcome these basic limitations in current health literacy approaches.

Improving Indigenous Stroke Outcomes by Shifting Our Focus from Health to Cultural Literacy

PURPOSE OF REVIEW

Stroke incidence and outcomes are disproportionately unfavorable among Indigenous populations in Western colonized countries. These inequities are often attributed to poor health literacy. This paper summarizes recent evidence on the topic of Indigenous health literacy, describes current gaps, and proposes priorities for future work/research.

RECENT FINDINGS

Traditionally, much focus has been placed on improving health literacy for Indigenous Peoples as a key intervention to address Indigenous stroke and other health disparities. Recent literature, however, challenges this approach as it risks stigmatization and marginalization and portrays the deficiencies as sitting with Indigenous people. Increasingly, an emphasis is placed on the need for health literacy approaches to be culturally responsive for the populations of interest, for institutions to provide high quality culturally relevant stroke care, and for providers to upskill in cultural safety to better meet the needs of Indigenous patient populations. Very little evidence exists to indicate that stroke care providers are meeting these needs. To close the health gap and improve stroke care for Indigenous Peoples, the focus needs to shift from promoting health literacy among Indigenous Peoples to providing high quality culturally relevant health care. More research into this topic and monitoring of progress over time is needed.

Exploring the barriers to the development of organizational health literacy in health institutions to meet the needs of older patients from multiple perspectives: a mixed-methods study

BACKGROUND

The latest evidence on health literacy in China revealed that only 8% of individuals aged 65-69 years, a segment of the geriatric population, possess adequate health literacy levels, indicating a low level in China. Studies have demonstrated that improving the organizational health literacy of healthcare institutions is a crucial approach to addressing low health literacy among older patients.

OBJECTIVE

To explore the obstacles hindering the advancement of organizational health literacy in healthcare institutions in meeting the needs of older patients.

DESIGN

A mixed-methods approach was employed to investigate both the status and barriers to the establishment of organizational health literacy within two healthcare institutions.

PARTICIPANTS

Participants included older individuals aged over 60, clinical staff, and managerial personnel from these two health institutions.

METHODS

This research utilized the social-ecological model as its theoretical foundation and utilized a mixed-methods approach to examine the current status and challenges in developing organizational health literacy within healthcare institutions. Initially, a survey using a questionnaire (n = 178) was conducted among older patients to evaluate the establishment of organizational health literacy from their perspective. Following this, interviews (n = 22) were carried out with administrators, clinical personnel, and elderly patients to identify the barriers hindering the development of organizational health literacy within healthcare institutions.

RESULTS

Quantitative research indicates that health institutions have been less accommodating to the requirements of older patients, with health information dissemination and communication emerging as the weakest areas. Qualitative investigations revealed three key influencing factors: patient-related factors, including physiological and cognitive decline, as well as low educational attainment among older patients; organizational factors, including inadequate clinical staff numbers, deficient long-term systematic training, and a digital divide resulting from health institutions' digital advancements; and policy-related factors indicating a lack of regulations governing the establishment of organizational health literacy within healthcare institutions.

CONCLUSION

The two most vulnerable aspects of OHL in medical institutions regarding the needs of older patients are health information and communication. The factors influencing the construction of OHL in medical institutions are multifaceted, encompassing micro, meso, and macro levels. At the macro level, it is essential for medical institutions to enhance leadership awareness of OHL and to incorporate its development into institutional strategic plans. At the meso-level, medical institutions should be made to optimize the medical environment for elderly patients and to prioritize health literacy training for medical staff. At the micro level, attention must be given to the characteristics and needs of elderly patients. Ultimately, by implementing a comprehensive construction of intervention strategies, the response ability of medical institutions to the needs of elderly patients can be enhanced.

When great responsibility comes with limited options: experiences and needs of older community-dwelling adults regarding accessing, understanding, appraising and using health-related information

BACKGROUND

In previous research, older adults have been associated with reduced levels of health literacy (HL) influenced by a range of contextual factors. To optimise HL, it is essential to better understand the interactions between the ageing process and both personal and environmental factors as perceived by older adults. This study aimed to explore the experiences and needs of older community-dwelling adults when accessing, understanding, appraising and using health-related information.

METHODS

An explorative, qualitative design was used within the social constructivism framework. Semi-structured individual interviews were conducted with 20 adults aged 70-96 living at home in three areas in Northern Iceland. The transcribed interviews were constructed into categories and subcategories using qualitative content analysis.

FINDINGS

Four categories emerged. "Expectations for responsibility" describes the experience that individuals are responsible for taking care of their health, including accessing, understanding, appraising and using information and services, showing initiative and keeping needed communications active. "A gap between expectancy and ability/context" includes experiences while taking responsibility for expectations not aligning with skills/situations, creating information gaps. "Finding one's own ways" comprises various adapted ways to access, understand, and use information and services. "Bridging the gap" describes experiences of needing shared responsibility and more manageable options to enable reasoned health-related decisions and navigation in the healthcare system.

CONCLUSIONS

The participants valued and took full responsibility for accessing, understanding, appraising and using information and services as part of a social norm; however, they experience information gaps. They request shared responsibility by being provided with fundamental health-related information as a vital step in making reasoned health-related decisions and navigating the healthcare system. They also request more inclusive and accessible service opportunities to bridge the gaps and facilitate HL. It is necessary to critically address, at a systematic level, the conflict between expected individual responsibility and the existence of options to act upon this responsibility. In matters of health, health services and HL, the need to analyse and confront structural disadvantages experienced by older adults is highlighted.

The Influence of Dr. Rima Rudd's Organizational Health Literacy Scholarship in Maryland

BACKGROUND

This article analyzes and reflects on Dr. Rima Rudd's organizational health literacy ideas and tools and their influence on the field generally and on four projects over 12 years in Maryland specifically.

OBJECTIVE

We present four organizational health literacy projects - two from oral health and two from COVID-19 vaccination - that used or were influenced by Dr. Rudd's the Health Literacy Environment of Hospitals and Health Centers.

METHODS

In the oral health projects, we describe the organizational assessments we conducted, the assessment results, and the actions organizations took in response. In a Frederick, Maryland, COVID-19 project, we worked with multiple organizations in a single city to train them in the organizational assessment process, and we report the activities and results of this training. In the Baltimore, Maryland COVID-19 project, we provided general information about organizational health literacy and trained key health professionals in local organizations.

KEY RESULTS

Our results confirm that Dr. Rudd's tools work mainly as intended because they help organizations or third-party evaluators identify health literacy barriers and create health literacy insights. Also, we observed that organizational health literacy tools can support organizations' interest in equity goals and increase their willingness to spend time on health literacy projects.

CONCLUSIONS

Translating knowledge and skills to actions can require more time than organizations can commit or be more difficult than they can handle. In our projects, the four most positive examples were driven by a collaboration between our team and a change champion who had the power to institute new ideas and actions. While it can take time and money to gain traction, our Maryland work shows that organizational assessments are accessible, practical and tangible. We conclude that Dr. Rudd's influence extends beyond specific tools and is reflected in the field's acceptance of organizational and professional responsibility for health literacy as an equity and justice issue. [HLRP: Health Literacy Research and Practice. 2024;8(3):e151-e158.].

A systematic scoping review and content analysis of organizational health literacy responsiveness assessment tools

The characteristics of health literate organizations have been variously described in recognition that it is important for organizations to respond to the diversity of people's health literacy strengths and challenges. A systematic scoping review was conducted to identify, assess and classify international self-assessment tools aimed at measuring the capability of organizations to embody health literate characteristics. Following the JBI Scoping Manual, a search was conducted in six databases and identified 2693 articles. After screening, 16 studies published between 2007 and 2023 across eight countries were eligible for inclusion. Results were summarized and a finite list of items from existing tools was generated. Content analysis was performed to classify these items. Whilst most assessment tools in the included studies were healthcare-focused, other settings included schools and government departments. The 16 assessment tools included a total of 661 items, and 647 items were retained that met the definition of health literacy responsiveness. Items were classified into six domains (communication; navigation of resources; culture; policies and practice; involvement or engagement and workforce development), with high agreement between two researchers (91.5%). The 647 items were reviewed to exclude items that were too contextually specific, focused solely on service users, were too broad or had suitable alternatives; 210 items were finally retained. This research is two-fold: provides a synthesis of existing organizational health literacy responsiveness assessment tools across settings; and provides a list of items, which will be essential to developing context specific assessment tools through Delphi methods in the future.

Multi-staged development and pilot testing of a self-assessment tool for organizational health literacy

BACKGROUND

Until now a comprehensive, consensus-based tool that can be used by a variety of health care organizations for assessing their organizational health literacy (OHL) is not available. Therefore, we aimed to develop and test a literature- and consensus-based self-assessment tool.

METHODS

The study is based on a scoping review that was previously published by the authors. For the development of the self-assessment tool, the criteria identified in the literature were synthesized with criteria gained through group discussions with representatives of different types of health care organizations (N = 27) all based in Hamburg (Germany). Consensus on the criteria was reached by conducting a Delphi process (N = 22). A review by the project's patient advisory council was included in the process. The self-assessment tool was converted into an online tool and refined by a pretest. Finally, the online survey was piloted (N = 53) and the reliability and item loadings for each scale were analyzed.

RESULTS

In total, 77 criteria (items) characterizing a health literate health care organization were developed and grouped into five main categories (scales): (1) "easy access and navigation", (2) "integration, prioritization, and dissemination of OHL", (3) "qualification, quality management, evaluation, and needs assessment", (4) "communication with target groups", and (5) "involvement and support of target groups". The results of the online survey showed that the tool is suitable for assessing an organization's status quo on OHL. The psychometric analysis showed good to excellent internal consistency. Item analyses of the developed self-assessment tool was satisfactory.

CONCLUSIONS

We were able to define a set of 77 items to characterize OHL, which were integrated into a new, comprehensive, and consensus-based self-assessment tool to identify areas for improvement. We found evidence that the self-assessment tool, based on the identified criteria, consists of the assumed five scales. Further research should analyze the validity of the self-assessment tool on a higher detail level.

Lessons on Health Literacy and Communication in Post-Stroke Rehabilitation:: A Primer and Proposal

Health literacy, or the ability to find, understand, and use information to make well-informed health decisions, has been linked to post-stroke rehabilitation outcomes. Importantly, barriers to health literacy stem from stroke survivor characteristics, clinician practices, institutional norms, as well as systemic variables. These barriers impact recovery and rehabilitation outcomes. To address these obstacles, clinicians can learn from the evidence-based practices used by speech-language pathologists in their work with stroke survivors with aphasia, a language impairment that can follow stroke. These methods to overcome communication barriers are appropriate and recommended for patients and family members regardless of stroke impairment, and include a transdisciplinary care model, multimodal approaches to patient education, along with consistent engagement with patients and their care partners. These strategies may be adopted for both personal and organizational health literacy efforts and help optimize the rehabilitation and recovery outcomes of stroke survivors with and without aphasia.

Organizational Health Literacy and Health Among New York State Medicaid Members

BACKGROUND

The definition of health literacy has recently expanded beyond the idea of individual skills to include the system and environment the individual interacts with to receive care, known as organizational health literacy (OHL). However, neither the prevalence of OHL nor the impact of OHL on individuals' perceptions of their health and healthcare have been examined in New York's Medicaid managed care population.

OBJECTIVE

This study aimed to estimate the prevalence of organizational health literacy in the New York State (NYS) Medicaid Managed Care (MMC) program.

METHODS

A brief measure to assess organizational health literacy was developed from responses to two questions in the 2018 NYS Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Generalized Estimating Equation models were developed to analyze the association between organizational health literacy and three aspects of perceptions of health and health care, controlling for demographic differences and clustering effects from health insurance plans. Missing data were handled using multiple imputation.

KEY RESULTS

Among 3,598 members included in the study, 20% of the MMC members reported inadequate organizational health literacy. These members were more likely to be older, less educated, from racial and ethnic minority groups, and less fluent with English. They are more likely to have poorer self-reported health (odds ratio [OR] 1.49), lower perceived access to health care (OR 6.97), and lower satisfaction with their health care (OR 6.49) than members who did not report inadequate organizational health literacy.

CONCLUSIONS

Our results suggest that a proportion of the NYS MMC population faces inadequate organizational health literacy, which can present a barrier to health care access and result in patients having a significantly poorer health care experience. Using an existing data source that is part of existing data collection allows for routine assessment of organizational health literacy, which can help inform health plans about areas for potential improvement. [HLRP: Health Literacy Research and Practice. 2023;7(3):e154-e164.].

Development and validation of the health literacy environment scale for Chinese hospitals from patients' perspective

Introduction

While the research on improving individual health literacy by promoting individual skills and abilities is increasing, less attention has been paid to the complexities of the healthcare environment that may influence patients' ability to access, understand, and apply health information and health services to make health decisions. This study aimed to develop and validate a Health Literacy Environment Scale (HLES) that is suitable for Chinese culture.

Methods

This study was conducted in two phases. First, using the Person-Centered Care (PCC) framework as a theoretical framework, initial items were developed by using the existing health literacy environment (HLE) related measurement tools, literature review, qualitative interviews, and the researcher's clinical experience. Second, scale development was based on two rounds of Delphi expert consultation and a pre-test conducted with 20 hospitalized patients. Using 697 hospitalized patients from three sample hospitals, the initial scale was developed after item screening and its reliability and validity were evaluated.

Results

The HLES comprised 30 items classified into three dimensions as follows: interpersonal (11 items), clinical (9 items), and structural (10 items) dimensions. The Cronbach's α coefficient of the HLES was 0.960 and the intra-class correlation coefficient was 0.844. The confirmatory factor analysis verified the three-factor model after allowing for the correlation of five pairs of error terms. The goodness-of-fit indices signified a good fit for the model (χ²/df = 2.766, RMSEA = 0.069, RMR = 0.053, CFI = 0.902, IFI = 0.903, TLI = 0.893, GFI = 0.826, PNFI = 0.781, PCFI = 0.823, PGFI = 0.705). The item-content validity index ranged from 0.91 to 1.00, and the scale-content validity index was 0.90.

Conclusion

The HLES had good reliability and validity and provides a patient perspective tool for evaluating HLE and a new perspective for improving health literacy in China. That is, healthcare organizations make it easier for patients to access, understand, and use health information and service. Further studies about the validity and reliability of HLE should include other districts and different tiers or types of healthcare organizations.

Shifts in Diabetes Health Literacy Policy and Practice in Australia-Promoting Organisational Health Literacy

Improving organisational health literacy ensures people can navigate, understand and use essential health information and services. However, systematic reviews have identified limited evidence for practical approaches to implementing such organisational change, particularly at a national level. This study aimed to (a) investigate the approach taken by an Australian national diabetes organisation-Diabetes Australia, as the administrator of the National Diabetes Services Scheme (NDSS)-to improve organisational health literacy over a 15-year-period and (b) examine the impact of organisational changes on the health literacy demands of health information. We performed an environmental scan, examining the websites of the NDSS, Diabetes Australia and the Australian government for reports and position statements describing organisational health literacy policies and practices between 2006 and 2021. The Patient Education Materials Assessment Tool (PEMAT) was applied to consecutively published NDSS diabetes self-care fact sheets (n = 20) to assess changes in the health literacy demands (understandability and actionability) of these fact sheets over the same period. We identified nine policies resulting in 24 health literacy practice changes or projects between 2006 and 2021, applied using a streamlined incremental approach and group reflexivity. The incremental approach focused on (1) increasing audience reach, (2) consistency and branding, (3) person-centred language and (4) the understandability and actionability of health information. The PEMAT scores of fact sheets improved between 2006 and 2021 for understandability (53% to 79%) and actionability (43% to 82%). Diabetes Australia's information development process leveraging national policies, employing an incremental approach and group reflexivity has improved the health literacy demands of diabetes information and serves as a template for other organisations seeking to improve their organisational health literacy.

High-Risk Infant Follow-Up After NICU Discharge: Current Care Models and Future Considerations

Preterm infants are at heightened risk for chronic health problems and developmental delays compared with term-born peers. High-risk infant follow-up programs provide surveillance and support for problems that may emerge during infancy and early childhood. Although considered standard of care, program structure, content, and timing are highly variable. Families face challenges accessing recommended follow-up services. Here, the authors review common models of high-risk infant follow-up, describe novel approaches, and outline considerations for improving the quality, value, and equity of follow-up care.

Health Professionals' Experience with the First Implementation of the Organizational Health Literacy Self-Assessment Tool for Primary Care (OHL Self-AsseT)-A Qualitative Reflexive Thematic Analysis

Organizational health literacy (OHL) is crucial for public health, in turn health care organizations play vital roles in improving populations' health literacy. Therefore, the aim of this qualitative study was to explore how the organizational health literacy self-assessment tool (OHL Self-AsseT) was implemented, used, and understood by primary care teams from a network of general practices and a Home Care Service Organization in Zurich, Switzerland. Reflexive thematic analysis with a constructivist orientation was used to analyze data from 19 interviews pre- and post-OHL Self-AsseT use. Normalization Process Theory supported structuring of inductively developed themes. Findings show that the participants experienced working with the OHL Self-AsseT meaningful, as it helped with "Addressing OHL construction sites" so that they could "build momentum for change". The experience of "Succeeding together in construction" led to a "feeling of team-efficacy during change". Practical use of the tool and/or discussions about OHL led to a growing conceptual understanding, which was described as "Using a construction plan-making sense of ongoing OHL activities". To conclude, the OHL Self-AsseT encouraged teams to initiate change, led to greater team-efficacy and supported the construction of OHL. Improved implementation strategies will support this intervention's scale-up as a base for effectiveness testing.

Organizational Health Literacy in the Context of Employee Health: An Expert-Panel-Guided Scoping Review Protocol

Health literacy (HL) is an interplay of individual and organizational health literacy (OHL). While individual HL has been intensively studied, the importance of OHL has become a greater focus of research attention. The National Action Plan Health Literacy in Germany emphasizes the promotion of HL in all areas of everyday life, including occupation and the workplace. The proposed scoping review aims at identifying and evaluating definitions, empirical studies and instruments on OHL targeting employee recipients. The search will be conducted in two consecutive steps and guided by expert-panel discussions in accordance to the method of Consensus Development Panels. The search will be conducted in Web of Science, PubMed and Google Scholar according to the methodological framework of Arksey and O'Malley and supplemented by the snowball principle and a hand search. All records will be included that were published until the final search date. To define eligibility criteria, the PCC framework of the Joanna Briggs Institute is used. The scoping review will critically discuss whether a new definition of OHL in the context of employee health is of purpose for future research and practice. Nonetheless, it will provide orientation in the context of employee health, also facing the consequences of SARS-CoV-2.

Measuring COVID-19 Related Health Literacy in Healthcare Professionals-Psychometric Evaluation of the HL-COV-HP Instrument

BACKGROUND

Thus far, there is no instrument available measuring COVID-19 related health literacy of healthcare professionals. Therefore, the aim of this study was to develop an instrument assessing COVID-19 related health literacy in healthcare professionals (HL-COV-HP) and evaluate its psychometric properties.

METHODS

An exploratory factor analysis, a confirmatory factor analysis, and descriptive analyses were conducted using data from n = 965 healthcare professionals. Health literacy related to COVID-19 was measured with 12 items, which were adapted from the validated HLS-EU-Q16 instrument measuring general health literacy.

RESULTS

Exploratory factor analysis demonstrated that 12 items loaded on one component. After removing one item due to its high standardized residual covariance, the confirmatory factor analysis of a one-factor model with 11 items showed satisfactory model fit (χ² = 199.340, df = 41, χ²/df = 4.862, p < 0.001, RMSEA = 0.063, CFI = 0.963 and TLI = 0.951). The HL-COV-HP instrument showed good internal consistency (Cronbach's alpha 0.87) and acceptable construct reliability.

CONCLUSIONS

The HL-COV-HP is a reliable, valid, and feasible instrument to assess the COVID-19 related health literacy in healthcare professionals. It can be used in hospitals or other healt hcare settings to assess the motivation and ability of healthcare professionals to find, understand, evaluate, and use COVID-19 information.

Patient Satisfaction Determinants of Inpatient Healthcare

The aim of the study was to analyse and evaluate the determinants influencing the overall satisfaction of patients with inpatient healthcare in the conditions of the Czech Republic. A total of the 1425 patients, who experienced hospitalisation and agreed to participate, were questioned in the study. A research questionnaire was used to obtain data on satisfaction with hospitalisation. The subject of the research consisted of the indicators related to the following factors: (i) satisfaction with the hospital, clinic, room and meals; (ii) satisfaction with medical staff-nurses, physician expertise and other staff; (iii) the quality of the treatment provided; (iv) satisfaction with leaving the hospital. The formulated statistical hypotheses were evaluated through structural equation modelling. The results of the analyses brought interesting findings. Satisfaction with medical staff is the most significant factor which has a positive effect on satisfaction with hospitalisation. Physician expertise (with trust and good communication skills) is more important for patients than satisfaction with nurses or other staff. The results obtained from the study represent valuable information for policymakers, regional healthcare plans, as well as for managers of hospitals.