Health Literate Healthcare Research Articles

Organizational health literacy in hospitals and primary health care - developing innovative tools

Abstract Background Organizational health literacy (OHL), particularly in health systems, is vital for supporting public health. Self-assessment tools (SAT), critical for quality assessment/improvement and for empowering relevant stakeholders, could support hospitals and primary healthcare services to promote their role in health literacy responsiveness, and support organizations in identifying strengths and areas of improvement. Methods The SAT for OHL in hospitals (OHL-Hos) and in primary healthcare (OHL-PHC) were developed via a participatory process, based on the “Vienna Concept of a Health Literate Healthcare Organization”. Piloting of the tools in European countries shed light on the tools’ depth and the need for revision. The development of short versions followed a Delphi process with experts from ten to thirteen European countries, respectively, from December 2023 - April 2024. Healthcare service diversity within and between countries was taken into consideration as well as cultural/language adaptation. Shortening OHL-Hos followed four steps: 1) prioritization of the most relevant indicators, 2) considering additional resources, 3) consensus process, 4) refinement of the tool and wording. Results The SATs for both healthcare settings are now established. The SAT for OHL-Hos includes a matrix model of eight standards, 21 sub-standards and 75 indicators. The SAT for OHL-PHC includes seven standards, 19 sub-standards and 69 indicators, covering OHL in organizational structures and processes for staff, patients and the community served with specific focus on navigation, communication, and participation. Both SATs are accompanied by a guide to direct organizations through in the self-assessment process. Conclusions The process of identifying OHL needs and opportunities in the health system, facilitated by participatory methods for tool development, led to innovative SATs for OHL which are currently ready for piloting and implementation in European countries.

Italian translation and cultural adaptation of health literate organisation self-assessment tool

Abstract Background The International Working Group Health Promoting Hospitals and Health Literate Healthcare Organizations has developed an English-language self-assessment tool for Organizational Health Literacy of Hospitals, designed to quality managers of healthcare organizations. It aims to diagnose strengths and weaknesses of the organization's health literacy, and our goal is to translate and culturally adapt it for Italy. Methods We have been following the Translation, Review, Adjudication, Pretesting, and Documentation team model for cross-cultural translation of questionnaires. Initially, two separate teams of translators worked independently to translate the tool from English to Italian. Next, the national coordinator organised six meetings to discuss, integrate, and unify the two versions, and any translation difficulties and suggested solutions were reported in the supporting tool that will be sent along with final agreed version of the tool to the International Coordination Centre. Finally, two experts will review the translation for the cultural adaptation. Results Difficulties related to comprehension in translation can arise from ambiguity in word choice, the need for contextual precision, and a lack of cultural appropriateness. The translation of English words that have become part of Italian language (e.g. ‘feedback', ‘stakeholder', ‘management', ‘standard') was also hugely discussed between the teams. Finally, to categorize the information entered into the supporting tool, 50% pertains to adaptation to context, 30% to simplification or clarification, and 20% to non-applicable items. Conclusions Cultural adaptation will improve the translation by reducing ambiguities, providing contextual clarifications, and rephrasing items to make them more appropriate for Italy. The Italian version of the tool will be piloted in local hospitals to support healthcare operators, patients, and the community in better managing the complexities of healthcare organizations. Key messages • Translation of health literacy self-assessment tool for Italian hospitals, aiming to reduce ambiguity and increase appropriateness for local context. • Culturally adapted tool to diagnose organizational health literacy in Italian hospitals will help healthcare organizations deal with complexity of healthcare and improve patient outcomes.

Navigational health literacy of the population in Germany

Many health care systems are characterized by their high complexity and intransparency. Finding one's way through the multitude of services and finding the right place requires high navigational health literacy (NHL). NHL is defined as the ability to manoeuvre through the health care system and deal with the information required to do so. However, so far, there has been a lack of data on the population's NHL. The objective of this article is to analyse empirically the NHL in Germany and its association with socio-demographic and economic factors. NHL was surveyed with an instrument (HLS19-NAV) newly developed by an international working group, measuring the self-assessed difficulties in relation to 12 navigation-related information tasks. The HLS19-NAV has already been used in 8 countries, including Germany. In Germany, data on NHL was collected from 2,151 adult residents in a representative cross-sectional study. The relationship between socio-demographic and economic factors, and NHL was examined by using methods of analysis of variance and multivariate linear regression analysis. Approximately 80% of the respondents showed low NHL with a mean score of 41.5 out of a possible 100 points. Those with low socio-economic resources, people of advanced age, people who had migrated to Germany or who were limited by health issues had a particularly low NHL. However, even people with good resources had a relatively low NHL. In contrast, the mean score was significantly higher among health professionals. In recent years, numerous efforts have been made to reduce navigational difficulties and to better guide patients through the German health care system. However, according to the results of the study, there is still need for further action. Above all, structural measures are required: this includes the creation of sufficient, reliable information on the health care system and its organizations as well as the implementation of navigation aids, health care pathways and the creation of a health-literate health care system including organizations and health professionals that contribute to strengthening NHL in general.

2.K. Round table: Navigational health literacy. Perspectives from Austria, Germany and Switzerland

Abstract Background Theoretical and empirical studies indicate that a lack of transparency and highly complexity makes it difficult for patients to navigate healthcare systems. This requires the competence to access, understand, appraise, and apply information about the healthcare system, its organizations and proceedings, i.e., navigational health literacy. Since little is known about navigational health literacy, partly due to a lack of measurement tools, a new instrument measuring navigational health literacy was developed as part of the Health Literacy Population Survey Project 2019-2021 (HLS19). It was applied in national health literacy surveys of the three German-speaking countries Austria, Germany and Switzerland among others. The empirical findings obtained in the three German-speaking countries and further perspectives on the topic will be presented and discussed in the workshop. Objectives of the workshop The workshop on navigational health literacy has three key objectives: 1) It gives an overview on the newly developed instrument for measuring navigational health literacy in HLS19, its development and validation; 2) it aims to discuss the distribution of navigational health literacy among the Austrian, German, and Swiss population and to highlight barriers and challenges for patients regarding navigation health literacy; and finally 3) it proposes steps to promote and strengthen navigational health literacy. Added value of the workshop The workshop is designed to enhance the understanding of navigational health literacy and to propose future scenarios and steps for action to develop and implement better health literacy outcomes. By the end of the workshop, participants – will have discussed the methodological approach for measuring navigational health literacy; – will have heard of current data and developments regarding navigation health literacy in Austria, Germany and Switzerland; – will have exchanged ideas and sustainable strategies to strengthen healthcare systems by developing navigational health literacy. The four panelists will give short presentations on: HLS19, navigational health literacy research, the newly developed instrument measuring navigational health literacy in HLS19, key findings of their respective national health literacy surveys, and recommendations and current navigational health literacy initiatives in their countries. In a panel discussion, the panelists and workshop participants will discuss the presented findings and recommendations as well as the need for action regarding implementation strategies, hands-on initiatives, and sustainable solution approaches. Key messages • Navigating healthcare systems and related information proves difficult for major parts of the general population. • There is a need of health literate healthcare systems and organizations reducing the demands placed on patients by providing guidance and support. Speakers/Panellists Doris Schaeffer Bielefeld University, Bielefeld, Germany Lennert Griese Bielefeld University, Bielefeld, Germany Saskia De Gani Careum Center for Health Literacy, Zürich, Switzerland Robert Griebler Austrian National Public Health Institute, Vienna, Austria

A Psychometric Analysis of the Health Literate Health Care Organization-10 Item Questionnaire.

The concept of a Health Literate Healthcare Organization (HLHO) is a relatively new approach to health literacy that moves the focus from the individual patient to the overarching health care system. The HLHO-10 questionnaire was developed internationally to assess the 10 Attributes of HLHOs as described by participants of the Institute of Medicine Roundtable on Health Literacy. The purpose of this study was to establish reliability and validity of the HLHO-10 among a sample of United States hospitals. Reliability and validity were established through assessing the factor structure for the HLHO-10 and psychometric evaluation. The HLHO-10 was found to be reliable with a Cronbach's alpha of .855 and a two-factor structure was revealed through exploratory factor analysis. Additional research is needed to further validate use of the HLHO-10 in the U.S., but initial findings of this emerging tool are promising and timely as the issue of health literacy comes to the forefront of U.S. health care systems and associated regulatory agencies. [HLRP: Health Literacy Research and Practice. 2022;6(2):e137–e141.]

\u201cThe system has to be health literate, too\u201d - perspectives among healthcare professionals on health literacy in transcultural treatment settings

BackgroundEffective communication is a central aspect of organizational health literacy. Healthcare professionals are expected to ensure an effective and satisfactory flow of information and to support their patients in accessing, understanding, appraising, and applying health information. This qualitative study aimed to examine the health literacy-related challenges, needs, and applied solutions of healthcare professionals when engaging with persons with a migrant background. Based on the integrated model of health literacy (Sørensen et al., BMC Public Health 12:80, 2012), we focused on environmental, personal, and situational factors that shape health literacy in transcultural treatment settings.MethodsWe conducted five focus group discussions with healthcare professionals (N = 31) who are in regular contact with persons with a migrant background. Discussions were transcribed verbatim and analyzed using qualitative content analysis by applying a deductive–inductive categorization procedure. Deductive categories were derived from the integrated model of health literacy.ResultsChallenges included a mismatch in the provision and use of health services. Participants regarded easily accessible services and outreach counselling as helpful solutions. Further challenges were the migrant patients’ distrust in healthcare professionals and the German healthcare system, the participants’ uncertainty in dealing with patients’ expectations and needs, and the patients’ non-compliance with appointments. Environmental factors included systemic lack of time and economic pressure. Both were reported as impeding the flow of information in all treatment settings. Participants with a migrant background themselves (n = 16) regarded this personal factor as an opportunity that increased patients’ trust in them. They also reported challenges such as high levels of responsibility felt when ad hoc interpreting for colleagues.ConclusionsKnown issues observed in the delivery of healthcare for the majority population (i.e., systemic lack of time, economic pressure) appear to be intensified in the context of migration. An increasingly diverse patient clientele indicates a growing need for culture-sensitive, health-literate healthcare organizations. A corresponding diversity of the health workforce is desirable and should be strengthened by national finance and educational programs. Healthcare professionals who interpret for colleagues should be given the necessary time. Further studies are needed to develop appropriate interventions for improving health literacy at individual and organizational levels. Funding for interpreting services should be expanded.

Health-Literate Healthcare Organizations and Quality of Care in Hospitals: A Cross-Sectional Study Conducted in Tuscany.

The concept of Health-Literate Healthcare Organization (HLHO) concerns the strategies by which healthcare organizations make it easier for people to navigate, understand, and use information and services to take care of their health. The aims of this study were to validate the HLHO-10 questionnaire in the Italian language; to measure the degree of implementation of the 10 attributes of HLHOs in a sample of hospitals placed in Tuscany; and to assess the association between the degree of implementation of the 10 attributes of HLHOs and the perceived quality of care. This was a cross-sectional study where data were collected using a self-administered questionnaire including three sections: a descriptive section, a section focused on the perceived quality, and the Italian version of the HLHO-10 questionnaire. A total amount of 405 healthcare managers answered the questionnaire (54.9%). The analysis shows that the HLHO score is significantly associated with the type of hospitals: accredited private hospitals have higher HLHO scores. Moreover, the perceived quality increases with the increasing of the HLHO score, with the highest coefficient for local public hospitals. In conclusion, Organizational Health Literacy culture should be an integral element for the management to improve the quality of care.

A Scoping Review on How to Make Hospitals health Literate Healthcare Organizations.

The concept of health literacy is increasingly being recognised as not just an individual trait, but also as a characteristic related to families, communities, and organisations providing health and social services. The aim of this study is to identify and describe, through a scoping review approach, the characteristics and the interventions that make a hospital a health literate health care organisation (HLHO), in order to develop an integrated conceptual model. We followed Arksey and O’Malley’s five-stage scoping review framework, refined with the Joanna Briggs Institute methodology, to identify the research questions, identify relevant studies, select studies, chart the data, and collate and summarize the data. Of the 1532 titles and abstracts screened, 106 were included. Few studies have explored the effect of environmental support on health professionals, and few outcomes related to staff satisfaction/perception of helpfulness have been reported. The most common types of interventions and outcomes were related to the patients. The logical framework developed can be an effective tool to define and understand priorities and related consequences, thereby helping researchers and policymakers to have a wider vision and a more homogeneous approach to health literacy and its use and promotion in healthcare organizations.

Evaluating Health Literacy Environments in Australian Health Services

The term ‘health literacy’ refers to the knowledge and skills used by an individual to make decisions about his or her own health. However, the environment in which health decisions are made is increasingly recognised as a critical component of health literacy. The health literacy environment can help to moderate the typical relationship between low individual health literacy and poor health. Becoming a more health literate healthcare organisation may require only meager financial investment for relatively large effectiveness gains. In this article, a review of Australian government health policies identifies three major foci relevant to the health literacy environment: the complexity of health services, the content of health information, and the physical environment. An overarching theme identified in this review is the importance of consumer input in evaluating all aspects of the health literacy environment. Despite major policy imperatives and the ongoing need to ensure health investments are socially equitable and cost-effective, there is little published evidence of Australian healthcare services evaluating their own health literacy environment. This article establishes the importance of evaluating the health literacy of Australian healthcare services and reviews four potentially useful evaluation tools.

An Assessment of Organizational Health Literacy Practices at an Academic Health Center.

Organizational health literacy is the degree to which an organization considers and promotes the health literacy of patients. Addressing health literacy at an organizational level has the potential to have a greater impact on more health consumers in a health system than individual-level approaches. The purpose of this study was to assess health care practices at an academic health center using the 10 attributes of a health-literate health care organization. Using a survey research design, the Health Literate Healthcare Organization 10-Item Questionnaire was administered online using total population sampling. Employees (N = 10 300) rated the extent that their organization's health care practices consider and promote patients' health literacy. Differences in responses were assessed using factorial analysis of variance. The mean response was 4.7 on a 7-point Likert scale. Employee training and communication about costs received the lowest ratings. Univariate analyses revealed that there were no statistically significant differences (P = .05) by employees' health profession, years of service, or level of patient contact. There were statistically significant differences by highest education obtained with lowest ratings from employees with college degrees. Survey responses indicate a need for improvements in health care practices to better assist patients with inadequate health literacy.

Screening for Type 2 Diabetes Risk Factors in a Greek Municipality towards Health-literate Healthcare

Diabetes prevention is possible and a lot of strategies have been implemented worldwide. Unfortunately, we lack systematic efforts of combined Type 2 Diabetes risk factors screening with the concept for patients knowledge and evaluation of health information. This is true in semi-urban Greek areas stricken by the socio-economy crisis. We used the FINDRISK questionnaire and a knowledge attitude and perceptions questionnaire for cardiovascular risk factors. Totally 358 people were recruited from March to June 2014. Young doctors examined the patients and filled in the questionnaires after their fully informed consent. We have found 75 people (20,95%) with score >15. Mean age: 52,14 years and mean BMI: 27,43kg/m 2 Accordingly their knowledge about health risk factors >90% knew the significance of high blood cholesterol, Diabetes, bad diet, exercise, smoking, obesity and hypertension, but over 60% underestimated their exact mortality impact on cardiovascular events. In our area pilot study, the burden of the problem for future development of T2D is probably heavy. Although health risk factors knowledge is growing, there are gaps in the field of person oriented methodology approach for enhanced health literacy. We need the development of targeted intervention programmes towards interdisciplinary working, transparent decision-making and active health-literated involvement of patients.

Systematically Addressing Hospital Patient Education

ABSTRACTThis study evaluated patient education materials at a large hospital. In this online field survey study, subjective plain language quality of patient materials was determined by health professionals’ perceptions of patients’ understanding of materials; objective quality was assessed using Fry and Flesch-Kincaid readability assessments. Subjectively, 74% of surveyed employees rated patient understanding of resources identified as very good or good. Objective plain language quality assessment revealed between 9th and 10th grade readability levels of materials. Improving patient education with attention to readability can help hospitals address the ten attributes of health literate healthcare organizations and improve patient experiences.

The Next Frontier in Communication and the ECLIPPSE Study: Bridging the Linguistic Divide in Secure Messaging.

Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients' literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from patients and match patients' literacy level. This paper describes the Employing Computational Linguistics to Improve Patient-Provider Secure Email (ECLIPPSE) study, an interdisciplinary effort bringing together scientists in communication, computational linguistics, and health services to employ computational linguistic methods to (1) create a novel Linguistic Complexity Profile (LCP) to characterize communications of patients and clinicians and demonstrate its validity and (2) examine whether providers accommodate communication needs of patients with limited HL by tailoring their SM responses. We will study >5 million SMs generated by >150,000 ethnically diverse type 2 diabetes patients and >9000 clinicians from two settings: an integrated delivery system and a public (safety net) system. Finally, we will then create an LCP-based automated aid that delivers real-time feedback to clinicians to reduce the linguistic complexity of their SMs. This research will support health systems' journeys to become health literate healthcare organizations and reduce HL-related disparities in diabetes care.

Embedding health literacy into health systems: a case study of a regional health service.

Objective The aim of the present study was to describe how one regional health service the Illawarra Shoalhaven Local Health District embedded health literacy principles into health systems over a 3-year period. Methods Using a case study approach, this article describes the development of key programs and the manner in which clinical incidents were used to create a health environment that allows consumers the right to equitably access quality health services and to participate in their own health care. Results The key outcomes demonstrating successful embedding of health literacy into health systems in this regional health service include the creation of a governance structure and web-based platform for developing and testing plain English consumer health information, a clearly defined process to engage with consumers, development of the health literacy ambassador training program and integrating health literacy into clinical quality improvement processes via a formal program with consumers to guide processes such as improvements to access and navigation around hospital sites. Conclusions The Illawarra Shoalhaven Local Health District has developed an evidence-based health literacy framework, guided by the core principles of universal precaution and organisational responsibility. Health literacy was also viewed as both an outcome and a process. The approach taken by the Illawarra Shoalhaven Local Health District to address poor health literacy in a coordinated way has been recognised by the Australian Commission on Safety and Quality in Health Care as an exemplar of a coordinated approach to embed health literacy into health systems. What is known about the topic? Poor health literacy is a significant national concern in Australia. The leadership, governance and consumer partnership culture of a health organisation can have considerable effects on an individual's ability to access, understand and apply the health-related information and services available to them. Currently, only 40% of consumers in Australia have the health literacy skills needed to understand everyday health information to effectively access and use health services. What does this paper add? Addressing health literacy in a coordinated way has the potential to increase safety and quality of care. This paper outlines the practical and sustainable actions the Illawarra Shoalhaven Local Health District took to partner with consumers to address health literacy and to improve the health experience and health outcomes of consumers. Embedding health literacy into public health services requires a coordinated whole-of-organisation approach; it requires the integration of leadership and governance, revision of consumer health information and revision of consumer and staff processes to effect change and support the delivery of health-literate healthcare services. What are the implications for practitioners? Embedding health literacy into health systems promotes equitable, safe and quality healthcare. Practitioners in a health-literate environment adopt consumer-centred communication and care strategies, provide information in a way that is easy to understand and follow and involve consumers and their families in decisions regarding and management of the consumer's care.

Designing health-literate health care organization: A literature review

Health literacy is usually described as a silent epidemic, which is challenging the sustainability of health care systems all over the world. The scientific literature has discussed the drawbacks of marginal health literacy on the functioning of the health care organizations. In particular, limited health literacy has been associated with: poorer ability of patients to comprehend health information, deficient medication adherence, insufficient use of prevention services, higher hospitalization rates, and greater health service utilization. In most of the cases, health literacy has been understood as an individual trait, which ultimately concerns the patients’ ability to obtain, process, and understand health information to navigate the health system. Alternatively, poor attention has been paid to the health literacy of the organizations operating within the health system, that is to say “organizational health literacy”. Indeed, neither the scholars nor the practitioners have adequately addressed the role played by the health care organizations to meet the needs of patients who live with limited health literacy. To contribute in filling such a gap, this study discusses the design and the structure of health-literate health care organizations. For this purpose, a systematic literature review was performed, involving 69 articles indexed in Scopus-Elsevier, Pub-Med, and Google Scholar to point out how the health care organizations face health literacy issues and to discuss what tools are used by the health care organizations to meet the information needs of people living with limited health literacy. Health-literate health care organizations turn out to be crucial to enhance patient engagement and improve health outcomes.

Why should and how can hospitals improve their organizational health literacy?

In late modern "multi-option" and "health" societies, health literacy (HL), understood as a specific competence, is considered necessary to successfully deal with the multitude of health relevant decisions and tasks to be taken every day. The concept has been used in the US, primarily in healthcare, to research the consequences of HL on the outcome of treatment specifically in patients with limited HL. In this context, it became evident that HL has to be understood as a relational or contextual concept. That is, the adequacy of HL does not only depend on personal HL, but equally on the demands organizations put on their users. This understanding of HL opened the road to measure not only individual HL, but also the HL sensitivity of organizations, i.e. organizational HL, and to use targeted measures to improve it. The ten attributes of a health-literate healthcare organization, as defined by the US Institute of Medicine, are a first systematic attempt to use this strategy in healthcare. In the meantime, the strategy has been used in other settings as well. Using experiences from health-promoting hospitals and the quality movement in healthcare, the authors develop this approach further into the comprehensive Vienna concept of the health-literate hospital, which considers all stakeholders and tasks of the hospital which are relevant for HL. A self-assessment tool was developed and tested as a basic instrument for developing a health-literate hospital. By doing so, hospitals are empowered to make a contribution to the promotion of HL as an important societal task.

Health Literacy and patient education in medical rehabilitation

Medical rehabilitation in Germany has a long tradition. It is covered by the statutory sickness funds and pension schemes, and is aimed at the prevention of work disability and need for nursing care due to chronic conditions. Chronically ill but health-literate patients - patients capable of making good health-related decisions, or of participating strongly in this decision making - have better health outcomes. To enhance health literacy and participation, medical rehabilitation relies heavily on patient education. This article describes health literacy from the perspective of educational research, outlines the basics of learning principles, and draws conclusions for developing patient education programmes in medical rehabilitation. Implementing a constructivist learning paradigm promotes changes within the trainer team and within the rehabilitation institution - turning it into a health-literate health care organisation. Health literacy in medical rehabilitation is aimed at neither turning the patient into a physician nor replacing evidence-based recommendations through subjective preferences. Medical rehabilitation reaches patients best by using modern health education programmes based on findings from education research, theoretically founded and directed towards building competencies. Furthermore, an educationally qualified training team and a rehabilitation institution are essential in enabling formal and informal learning processes.

Health Literate Healthcare Organizations and their Role in Future Healthcare

There is a growing need for a system change towards more patient-centred and health literate healthcare systems. One valuable approach for change on the system-level is the redesign of health organizations to health literate healthcare organizations (HLHO). This process requires sufficient efforts in teamwork, committed leadership and outcome monitoring. Nurses could make major contributions to the overall system change by integrating their expertise in the redesign of health care organizations in health literate ones.

Health literacy practices of physicians and patient care personnel in a hospital setting

Objective: Health literacy is a serious public health issue, and there are significant barriers to effective health communication among patients, physicians, and patient care personnel. We developed and implemented a hospital-wide health literacy survey to better determine the knowledge and practices of physicians and patient care personnel concerning health literacy in a hospital setting. Methods: In this cross-sectional study, we invited physicians and patient care personnel from a pediatric hospital in the Midwest to participate in a health literacy survey. The survey combined open-ended questions and Likert-type items consisting of four domains: communication, decision-making, interpersonal skills, and health literacy knowledge. Quantitative data were analyzed - using SPSS software (descriptive statistics, Cronbach’s alpha, and t-test). Open-ended responses were analyzed thematically. Results: A total of 145 physicians and 891 patient care personnel completed the surveys. The results of Cronbach’s alpha, which was used to estimate the internal consistency of the scale, were 0.7 or greater for all domains. Most of the respondents had a general idea of what health literacy means, but only 37% of patient care personnel and 65% of physicians were able to define health literacy adequately. This study revealed several differences in health literacy perceptions between physicians and patient care personnel, but most respondents agreed that there is a need for health literacy training for health care professionals. Conclusion: The results of our study revealed insights and suggest that there is an obvious need to dedicate further efforts toward promoting health literacy. Health literacy training for all healthcare professionals is crucial to create health literate healthcare organizations. The findings are also useful for the health literacy group to plan health literacy initiatives and educational programs for healthcare providers to improve communication about health with patient and families.

Motivation for a Health-Literate Health Care System—Does Socioeconomic Status Play a Substantial Role? Implications for an Irish Health Policymaker

In this article, the authors argue that the association between socioeconomic status and motivation for a health-literate health care system has implications for health policymakers. As Ireland now undergoes health care reform, the authors pose the question, “Should policymakers invest in health literacy as predominately a health inequalities or a public health issue?” Data from 2 cohorts of the Survey of Lifestyle, Attitudes and Nutrition (1998 and 2002) were used to construct a motivation for a health-literate health care system variable. Multivariate logistic regressions and concentration curves were used in the analyses of this variable. Of the 12,513 pooled respondents, 46% sought at least 1 attribute on a health-literate health care system. No discernible trend emerged from the main independent variables—social class grouping, medical card eligibility, level of education, and employment—in the regression analyses. The concentration curve, for 2002 data, graphically showed that the motivation for a health-literate health care system is spread equally across the income distribution. This analysis and more recent data suggest that health literacy in Ireland should be viewed predominately as a public health issue with a policy focus at a system level.