Organizational Health Literacy Research Articles

Personal and organisational health literacy in the non-specific symptom pathway for cancer: An ethnographic study.

People being investigated for cancer face a wealth of complex information. Non-specific symptom pathways (NSS) were implemented in the United Kingdom in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue or general practitioner 'gut feeling', who did not have streamlined pathways for cancer investigation. This study aimed to explore the health literacy skills needed by patients being investigated for cancer in NSS pathways. This study employed ethnographic methods across four hospitals in England, including interviews, patient shadowingand clinical care observations, to examine NSS pathways for cancer diagnosis. We recruited 27 patients who were shadowed and interviewed during their care. We also interviewed 27 professionals. The analysis focused on patient communication and understanding, drawing on the concepts of personal and organisational health literacy. Our analysis derived six themes highlighting the considerable informational demands of the NSS pathway. Patients were required to understand complex blood tests and investigations in primary care and often did not understand why they were referred. The NSS pathway itself was difficult to understand with only a minority of patients appreciating that multiple organs were being investigated for cancer. The process of progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. The results of investigations were complex, often including incidental findings. Patients whose persistent symptoms were not explained were often unsure of what to do following discharge. We have identified several potential missed opportunities for organisations to support patient understanding of NSS pathways which could lead to inappropriate help-seeking post-discharge. Patients' difficulties in comprehending previous investigations and findings could result in delays, overtestingor inadequately targeted investigations, hindering the effective use of their medical history. Third, patients' limited understanding of their investigations and results may impede their ability to engage in patient safety by reporting potential care errors. Patient, public, clinical and policy representatives contributed to developing the research objectives through a series of meetings and individual conversations in preparation for the study. We have held several events in which patients and the public have had an opportunity to give feedback about our results, such as local interest groups in North London and academic conferences. A clinical contributor (J.-A. M.) was involved in data analysis and writing the manuscript.

Addressing Low Health Literacy in Surgical Populations

AbstractHealth literacy is defined as the ability to obtain, engage, understand, and act upon health information to make decisions about health care. Health literacy is a key determinant of health outcomes and disparities including those in surgery. Over one-third of surgical patients suffer from low health literacy, with disproportionately higher rates among older, rural, and black patients. Low health literacy has been associated with poor adherence to preoperative and discharge instructions, longer lengths-of-stay, higher readmission rates, and higher health care costs. However, health literacy is modifiable, and therefore it is uniquely positioned for meaningful interventions at the patient, provider, and system level. These interventions include using more visual aids with patients and families (patient level), communicating in more understandable ways (provider level), and improving the organizational health literacy of hospitals (system level). Through high-quality research and multilevel interventions, significant opportunities exist to address low health literacy and improve outcomes, eliminate disparities, and reduce costs for this disparity population.

Perceptions of Leadership and Culture Around Organizational Health Literacy in a Neuro ICU (P11-2.002)

Perceptions of Leadership and Culture Around Organizational Health Literacy in a Neuro ICU (P11-2.002)

The Relationship Between a Healthy People 2030 Health Literacy-Related Objective (HC/HIT02) and Cancer Prevention and Screening Behaviors

ABSTRACT Healthy People 2030 highlights the importance of both personal and organizational health literacy (HL) to improving population health. Yet, most research focuses on personal-level HL or fails to study the effect of both types of HL on health behavior. This study explored the relationships between organizational HL (Healthy People 2030 objective: decrease the proportion of adults who report poor communication with their health care provider), personal-level HL, and cancer prevention and screening behaviors. Data were collected using Qualtrics Panel. Participants who indicated they had a non-emergency room provider visit in the last 12 months were included in the analyses. Participants (n=549, Mean age = 41.44 years, SD = 15.91; 51.9% female; 54.3% White, 28.8% Hispanic/Latino/a/x) completed measures of personal and organizational HL and reported on their cancer prevention (e.g., cigarette smoking) and screening (e.g., mammogram) behaviors. Hierarchical linear and logistic regressions predicting cancer prevention and screening behaviors, respectively, from organizational HL, personal HL, and demographic covariates, were estimated. Regarding the results, higher organizational HL was related to higher fruit and vegetables consumption and physical activity after accounting for personal-level HL and demographic covariates. Higher personal-level HL was related to lower physical activity, binge-drinking, and cigarette smoking, and higher odds of pap smear screening, prostate-specific antigen testing, and completing all eligible screenings after accounting for organizational-level HL and demographic covariates. The findings support that personal-level and organizational HL may be differentially important to improving cancer prevention and screening behaviors. Policies that address improving both personal-level and organizational-level HL are needed.

Comprehension and usefulness of Spanish language health information about depression treatment.

US Latine adults who prefer the Spanish language for healthcare encounter communication have high risk of health disparitiesm in part from low organizational health literacy, mental health stigma and discrimination. Organizational health literacy includes the provision of culturally responsive, language concordant health information, which supports good comprehension and usefulness and could mitigate some health disparities. We conducted a pilot study to assess commonly provided patient health information handouts about depression treatment and antidepressant consumer medication information sheets. Thirty Latine adults with a Spanish language preference and a history of depression and antidepressant use participated in one phone interview. Descriptive statistics and thematic analysis were used to assess comprehension and usefulness of selected sections extracted verbatim from these documents. Overall, 83% (n = 25) participants reported that all sections were easy to understand, and 97% (n = 29) said that they were useful. Yet, responses to open-ended questions for 53% (n = 16) of participants revealed 'confusing' terminology in at least one section, and 10% (n = 3) expressed concerns about or misunderstood an idiomatic phrase as reinforcing mental health stigma. The seriousness of the organizational health literacy-based issues identified in this and previous studies require that government and health service organizations make necessary and timely revisions to address them.

Addressing Current Deficits in Patient Education Materials Through Crowdsourcing.

Patient education materials are commonly reported to be difficult to understand. We aimed to use crowdsourcing to improve patient education materials at our institution. This was a department-wide quality improvement project to increase organizational health literacy. There are 6 phases of this pilot study: (1) evaluating preexisting patient education materials, (2) evaluating online patient education materials at the society (the American Society of Plastic Surgeon) and government level (Medline Plus), (3) redesigning our patient education material and reevaluating the education material, (4) crowdsourcing to evaluate understandability of the new patient education material, (5) data analysis, and (6) incorporating crowdsourcing suggestions to the patient education material. Breast-related patient education materials are not easy to read at the institution level, the society level, and the government level. Our new implant-based breast reconstruction patient education material is easy to read as demonstrated by the crowdsourcing evaluation. More than 90% of the participants reported our material is "very easy to understand" or "easy to understand." The crowdsourcing process took 1.5 days, with 700 workers responding to the survey. The total cost was $9. After incorporating participants' feedback into the finalized material, the readability of the material is at the recommended reading level. The material also had the recommended length (between 400 and 800 words). Our study demonstrated a pathway for clinicians to efficiently obtain a large amount of feedback to improve patient education materials. Crowdsourcing is an effective tool to improve organizational health literacy.

Social determinants of health literacy among parents and caregivers in the US-Affiliated Pacific.

Health literacy is understudied in the US-Affiliated Pacific (USAP), where local populations have historically experienced social marginalization and disproportionate health inequities caused by the social determinants of health (SDOH). This cross-sectional study analyzed several SDOH indicators-acculturation, use of food assistance programs and demographic characteristics (race and ethnicity, household income, primary language spoken at home and educational attainment)-and their relationship to health literacy among 1305 parents/caregivers of young children ages 2-8 years old who participated in the Children's Healthy Living (CHL) program in Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawai'i. Significantly increased odds of low health literacy were found among parents/caregivers with households where a language other than English was the primary language compared to English-only households (OR = 1.86, 95% CI = 1.22, 2.82), household income of <$35 000 compared to ≥$35 000 (OR = 2.15, 95% CI = 1.13, 4.07), parents/caregivers of Asian children compared to parents/caregivers of White children (OR = 2.68, 95% CI = 1.05, 6.84), parent/caregivers with less than or some high school education compared to high school completion (1st- to 8th-grade OR = 4.46, 95% CI = 2.09, 9.52; 9th- to 11th-grade OR 1.87, 95% CI = 1.06, 3.30) and parent/caregivers with acculturation status defined as marginalized as compared to integrated (OR = 2.31, 95% CI = 1.09, 4.86). This study indicates that some USAP parents/caregivers may lack the capacity to acquire health information, utilize health resources, and navigate health decision making. Future efforts to understand and improve health literacy in the USAP should be population specific, thoroughly assess personal and organizational health literacy, and inventory community health care capacity.

Health literacy in adult patients with atopic dermatitis: A cross-sectional study

BackgroundHealth literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make appropriate health decisions. Patients with limited health literacy are less likely to manage chronic diseases appropriately. ObjectiveTo assess the prevalence of limited health literacy in patients with atopic dermatitis (AD), and its association with other patient-reported outcomes. MethodsA cross-sectional questionnaire-based study was conducted at a tertiary referral centre for AD. Patients diagnosed with AD by a dermatologist between 2019 and 2021 were identified from medical records. Perception-based health literacy was assessed by the European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16) and performance-based health literacy by the Newest Vital Sign (NVS). Patients completed the Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), and Atopic Dermatitis Control Tool (ADCT) to measure AD severity, quality of life and AD disease control, respectively. ResultsIn total, 322 patients were included (response rate 48.3%). Based on the HLS-EU-Q16, 32.4% had limited health literacy (8.4% inadequate and 24.0% problematic) which was associated with impaired quality of life. According to the NVS, 20.3% had inadequate health literacy which was associated with older age. ConclusionUp to one-third of the patients with AD showed signs of limited health literacy, which was associated with impaired health related quality of life and older age. Further research should evaluate the influence of inadequate health literacy on health outcomes and focus on strategies to improve organizational health literacy to eventually enhance patient-centered care.

Health literacy of patients with chronic diseases – quantitative results of a mixed methods study in primary healthcare / Gesundheitskompetenz von Menschen mit chronischer Erkrankung – quantitative Ergebnisse einer Mixed-Methods-Studie in der Primärversorgung

Abstract Background In research and practice to promote health literacy, people with chronic illnesses represent an important target group. They are confronted with complex demands during the course of their illness. And, they utilize healthcare services more frequently. Patients are often dependent on the support of healthcare professionals. Population-based studies in Germany conducted that the majority of people find it most difficult to assess health information. The studies emphasize the enhancement of professional‘s health literacy, e. g. in nursing profession, as a prerequisite for improving capabilities in the population. In order to achieve better access and a needs-based care for people with chronic illnesses, a project in northern Germany has developed and offered a care-led concept. Methods As part of this project, data on self-assessed health literacy of chronically ill patients from a community health center was collected and analyzed using a quantitative survey in a mixed-methods study. Results The data analysis shows that more than half of the participants, regardless of gender and age, rate their health literacy as inadequate. On every level of information requirements and areas difficulties were reported. Conclusion The involvement of patients is needed in order to establish suitable strategies to empower health literacy for people with chronic illnesses. Particularly, the promotion of professional and organizational health literacy is essential for this.

Developing organizational health literacy in primary health care: a learning network of 18 Belgian projects

Objectives:&#x0D; &#x0D; Introduce the Organisational Health Literacy approach to&#x0D; &#x0D; primary care practitioners&#x0D; &#x0D; Discuss the challenges posed by introducing OHL in primary&#x0D; &#x0D; care&#x0D; &#x0D; Share potential solutions for best practice in OHL in primary care&#x0D; Reflect on appropriate process and outcome measures for OHL in primary care&#x0D; &#x0D; Rationale: The move towards active patient participation and informed decision making in health care has raised the interest in health literacy. Informed decision making requires sufficient knowledge about the possibilities, consequences, benefits and risks of interventions to make decisions that align with one’s personal values and preferences. As such, health literacy, defined as a person’s knowledge, motivation and skills to obtain, understand, evaluate, and apply health information, plays a key role in making informed health decisions.&#x0D; While the importance of health literacy is generally recognized by primary care practitioners, to date most efforts to address it have focused on enhancing the skills of patients to understand and apply the information given by professionals, and of professionals to adjust their communication to patients with low health literacy. Yet, as the health care systems is often complex and demanding, health care organizations can also try to reduce the demands they place on patients and families by implementing policies, practices, and systems that make it easier for people to navigate, understand, and use information and services to take care of their health. This strategy is known as Organizational Health Literacy (OHL). Critical components of OHL include (1) improving access to and navigation of health care facilities and systems; (2) encouraging patient engagement in the health care process; (3) enhancing communication with patients and families; (4) establishing a workforce with OHL-related knowledge and skills; (5) creating an organizational culture and infrastructure supportive of OHL; and (6) meeting patient needs, such as provision of interpreter services and self-management support.&#x0D; Efforts to introduce OHL are increasingly implemented with success in the hospital setting and, to a lesser extent, in other health organizations such as health insurance companies, but have thus far rarely been applied in the primary care setting.&#x0D; The workshop will address the challenges posed by introducing OHL in primary care, drawing on the first-hand experience with 18 OHL projects launched in 2022 in Belgium with support of the Dr. Daniël De Coninck Fund (managed by the King Baudouin Foundation) and functioning as a learning network.&#x0D; Audience: Primary care practitioners and managers of primary care networks.&#x0D; Workshop content:&#x0D; 1.A short introduction to the concept and criteria of OHL&#x0D; and the 18 Belgian projects (10min)&#x0D; 2.Three short presentations of projects focusing on OHL in&#x0D; primary care (20min)&#x0D; 3.Discussion in breakout groups on challenges to introducing OHL in primary care (30min):&#x0D; (1)Embedding health literacy in the organizational mission,&#x0D; structure and functioning &#x0D; (2)Building relationships between health care professionals&#x0D; and service users around HL&#x0D; (3)Developing HL through language, action and experience&#x0D; (4)Co-creating with service users throughout the care&#x0D; journey&#x0D; (5)Learning and evaluating across organizational&#x0D; boundaries&#x0D; 4.A plenary debate (20min)&#x0D; 5.Conclusion and summary of the learnings (10min)&#x0D; &#x0D;

Organizational health literacy – a neglected aspect of integrated care?

Issue: Integrated care is predominantly characterized by complex value creation processes, different financing and remuneration concepts and dynamic network practices within the healthcare system. Collaborative interventions in and beyond the healthcare system are further accompanied by rapid digital transformation, quickly renewed knowledge, and a rise in overall health information. At the same time, the majority of healthcare users in Switzerland have difficulties in adequately dealing with health information. As current data show, almost half of the Swiss population have a limited level of health literacy and a corresponding need for support in dealing with health information as well as navigating the healthcare system [1]. However, sufficient health literacy is required – not only on an individual, but even more on an organizational and system level [2]. By enhancing organizational health literacy (OHL), a great step towards the successful implementation of integrated care could be taken: Embedded in dynamic and evolving contexts, healthcare organizations and professionals play a vital role in supporting people to find, understand, critically appraise, and apply health information, and thereby strengthening people’s health literacy [3]. &#x0D; Description of the problem: Despite the latest research on the promising impact of OHL, current debates in the field of integrated care provide insufficient insights into how OHL could promote integrated care transitions and support healthcare organizations to align and integrate patient-pathways. We therefore aimed to elaborate on the role of OHL in integrated care and propose that a health literacy-oriented perspective is needed to ensure that integrated care services support people in making informed and sound decisions regarding their health. &#x0D; Results: A first literature review and evaluation of selected health literacy tools and interventions on an organizational level show a promising potential of an OHL approach to improve integrated care processes and practices. OHL can improve the quality of care by strengthening communication practices between healthcare users and health professionals, promoting service delivery, and enhancing teamwork among health professionals. &#x0D; Lessons: We have learned that practice-oriented and participative health literacy initiatives can provide promising approaches to strengthen both integrated care and collaborative team processes in and beyond healthcare organizations. Thus, in particular health literacy on the organizational level provides a crucial, yet still underestimated aspect of integrated care to co-design care journeys that respond to people’s needs. &#x0D; &#x0D; Main message: Health literacy approaches offer valuable insights for work process in the field of integrated care and thus can improve our understanding, conceptualization, and implementation of integrated care in practice. &#x0D; [1] De Gani SM, Jaks R, Bieri U, Kocher JP. Health Literacy Survey Schweiz 2019-2021. Zürich; 2021.&#x0D; [2] Farmanova E, Bonneville L, Bouchard L. Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues. Inquiry. 2018;55:46958018757848. doi:10.1177/0046958018757848.&#x0D; [3] Stuermer N, Gani SM de, Beese A-S, Giovanoli Evack J, Jaks R, Nicca D. 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. IJERPH. 2022;19.&#x0D;

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

BackgroundUntil 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.MethodsThe 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.ResultsIn 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.ConclusionsWe 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.

Figuring Out Life After Covid-19: a Qualitative Study From Sweden.

To obtain a deeper understanding of the daily life experiences of working aged people during the year following hospitalization due to SARS-CoV-2 (COVID-19), with a focus on function-ing in daily life and return to work. An explorative qualitative study using individual interviews. A purposive sample was selected of persons who had received inpatient hospital care, had been discharged approximately 1 year previously and were of working age. Semi-structured interviews were conducted with 11 participants (9 men, 2 women). The interviews were transcribed and analysed with inductive thematic analysis. Four themes were identified. Navigating health, with or without support from healthcare, was described as challenging when managing consequences of COVID-19. Participants struggled with a lack of energy that interfered with daily life. It was a trial-and-error process trying to use familiar strategies in new ways to manage. The return to work process was facilitated by own strategies and support. This study contributes increased knowledge of everyday life experiences of people 1 year following hospitalization due to COVID-19. The lack of energy and a struggle to manage health while navigating the healthcare system emphasize the importance of strengthening personal and organizational health literacy to facilitate the recovery process after severe COVID-19.

Organizational health literacy of schools in Germany: a cross-sectional study in schools

Abstract Background Organizational health literacy facilitates health literacy by creating health-literate settings. The school setting is an important venue for the promotion of health literacy of children and adolescents. Within the Health-Literate Schools project (HeLit-Schools), a concept for organizational health literacy of schools was developed, with eight standards informing a questionnaire. This study aims at assessing the implementation status of organizational health literacy of schools in Germany. Methods School principals from primary and secondary schools in Germany were invited to take part in an online survey that was launched in winter 2022/23. The implementation status of organizational health literacy was measured using a 48-item self-report questionnaire (OHLS-Q), based on the HeLit-schools concept. Sociodemographics of principals and schools, as well as other health-related variables were assessed. Descriptive statistics were conducted using SPSS. Results The preliminary sample from two federal states comprises N = 482 principals (71% female, Ø 52.3 years old). Of the schools, 44% were primary, 41% secondary, and 15% special education schools. Overall, two-thirds of the items reflecting organizational health literacy were rated as partly or fully implemented while across the individual standards a great variance was found. Schools already participating in school promotion programs or networks (28%) reported a higher implementation status of organizational health literacy. Conclusions This was the first ever assessment of organizational health literacy of schools based on a novel concept and questionnaire. The findings provide insights into resources and barriers for the implementation of school health literacy. German schools show a relatively high overall implementation status of organizational health literacy. Nevertheless, potential for improvement could be identified. The survey is currently ongoing and more states will provide useful data to be analysed.

Organizational Health Literacy in cancer care: the patients’ perspective

Abstract Introduction While earlier views of health literacy focused on patients’ skills, recent conceptualizations put the emphasis on matching individuals’ functional, communicative and critical skills to the information requirements of the health system. This paradigm shift has given rise to the concept of health-literate organizations. Yet while this concept is becoming better known, the barriers and facilitators to its implementation remain understudied. This study aims at understanding patients’ perspective of how their health literacy levels are being attended to by the healthcare system and enable their decision-making process. Methods The study took place at the oncology-hematology departments in two sites of a Brussels-based hospital, serving two different patient populations. The perceptions of 20 patients on existing health literacy policies and procedures were evaluated through semi-structured interviews based on the Enliven Organisational Health Literacy Self-Assessment Resource, CDC's attributes of a health-literate organization, and the International Self-Assessment Tool for Organizational Health Literacy Responsiveness of Hospitals. The models underlying these tools were used for the analysis of the results alongside the WHO health literacy policy model. Results Preliminary results revealed a weak understanding of the term health literacy and poor comprehension of the impact and importance of health literacy. The information given through oral or written measures was considered sufficient but poorly adapted to cultural and linguistic needs. Little or no involvement was perceived in patient-related approach strategies. Coordinating nurses were considered as the main source of information. Conclusions The weak ability of patients to understand the importance of health literacy and its impact calls for a health literate organization approach that allows the patient an accessible and level-adapted environment that caters to all HL levels. Key messages • Weak ability for patients to understand HL and it's importance shows how perception of adapted Health Literate approaches are impacted. • The need for health literate organizations through the creation of interventions that cater the needs of patients, health care staff and the organization.

5.L. Workshop: School health literacy as a means to achieve European public health goals

Abstract Background In recent years, health literacy has been acknowledged as crucial in context of school health promotion, prevention, and education. In 2020, the Schools for Health in Europe Network, linking the 53 WHO European Region Member States to collaborate on school health, released a milestone fact sheet on health literacy in schools, including an evidence synthesis on how health literacy impacts not only health goals but educational outcomes. In 2021, the World Health Organization Regional Office for Europe produced an evidence informed report, recommending the way forward regarding school health literacy in the realm of European public health. Organizational health literacy of schools is named a key responsibility for educational establishments alongside activities to address digitalization in education, climate and planetary health, the commercial determinants of health, the role of social media, and the aftermath of the Covid-19 pandemic. Achieving health literacy development throughout childhood and adolescence requires an early and systematic approach, ideally implemented in schools. Classroom learning and instruction by teachers qualified in health education are key to strengthen skills, behaviours, knowledge, and attitudes that schoolchildren will need to appropriately manage health information from various sources and form health decisions to promote their health in everyday life. Schools are widely accepted as the ideal setting for children to learn about and take responsibility for their own health and self-directed learning, bringing together all elements of health literacy including digital, mental, and organizational health literacy. Teaching materials and targeted sessions on health literacy, either embedded into a subject or as a cross-cutting topic, have several benefits: they reach all children regardless of their social, cultural or development background, they can be delivered over the course of a decade and longer, they can be repeated to enhance learning effects, with increasing grades the complexity and content can be expanded, and in schools it is possible to swiftly respond to contemporary health concerns of children. Objectives This workshop will present empirical findings and intervention research results from various school health literacy studies. (i) The first presentation will discuss findings of school principal's health literacy. (ii) The second presentation will provide key findings from the first ever study on organizational health literacy in schools. (iii) The third presentation will present the evaluation of a mental health literacy programme for students and teachers. (iv) The fourth presentation will introduce a digital health literacy intervention for schoolchildren. The format of this workshop will be 4x7-minute presentations followed by a 20-minute panel discussion, reflecting the relevance of the results to public health research, practice and policy. Key messages • School health literacy is an important topic within the context of school health promotion, prevention, and education. • Addressing health literacy as early as in schools will enable children and adolescent to become health literate, enabling them to face health challenges over the life-course.

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.

Building Community Health Literacy with a Social Network Perspective

Abstract Background The COVID-19 pandemic underscored the vital importance of health literacy to combat misinformation, increase trust, and ensure health equity. Health literacy is a collective responsibility, including for organizations to “equitably enable individuals to find, understand, and use information and services.” This presentation will share key insights concerning health literacy in a social context. from a 2-year regional effort to build a sustainable, health literate community by growing trusted, multi-sectorial partnerships, relationships, and networks. Methods Advancing Health Literacy Franklin County is a 2-year project initiated in June 2021 with a goal of building a sustainable, health literate community in Franklin County, Ohio, USA. The project is a collaboration among public health departments, health care organizations, an academic institution, and community organizations. Evaluations include social network analysis of organizational relationships over time, training outcomes, validated organizational health literacy (OHL) measures, and key informant interviews. Results Social network analysis show growth in the number of engaged organizations and stronger ties in these relationships. Training outcomes reveal increased knowledge, skills, and recognition of the importance of health literacy. OHL measures show engagement and improved capacity. Key informant interviews highlight the importance of the social perspective for health literacy. Conclusions Considering health literacy in a social context is important to building community-level health literacy in a sustainable way, including networks of organizations working together and the engagement of community leaders to share trusted, community relevant health information in their professional and personal social networks. Insights from this real-world implementation can inform future practice, policy, and research.

Measuring Digital Health Literacy in Europe – Scope, determinants and consequences

Abstract Background Increasing access to health-related digital information/resources of varied quality warrants sufficient Digital Health Literacy (DHL) in the population. Public health researchers, practitioners, and policy makers need to consider DHL for improving people's ability to use digital resources. The M-POHL HLS19 study objectives were to construct and validate a DHL measure, and identify its determinants and consequences. Methods A scale was constructed with 8 items on dealing with digital health resources. Two additional items examined interactive use of resources. The scale was applied among a sample of 29,060 respondents in 13 countries using CAPI, CATI, CAWI, PAPI and mixed methods. A standardized score was calculated for DHL, range: 0-100. Results Appraising the reliability of digital resources was perceived particularly difficult. The scale showed acceptable reliability (Cronbach's α 0.7-0.87/country). A confirmatory factor model loading onto a single latent variable indicated an acceptable fit for all countries. The DHL scale was sufficiently unidimensional based on principal component analysis of Rasch model residuals combined with dependent t-tests. Linear regression models with 5 DHL predictors showed a social gradient with explained variance of 6% (2-23%/country). The highest predictor was financial deprivation: ß=−0.15 (0.08--0.27), then age: ß=−0.13 (0.15--0.26); self-assessed social status: ß=0.08 (0.05-0.13). General health literacy was a strong predictor: ß=0.51 (0.43-0.67). In linear regressions to explain variance in self-assessed health, the DHL coefficient was significantly different from zero in 9 countries (ß=−0.05-0.10). Conclusions The new DHL scale had acceptable psychometric properties. The relevance of DHL is reflected in the high proportions with lower DHL, a social gradient, and health consequences in most countries. The study offers an evidence base for tailoring DHL intervention strategies and organizational health literacy policy. Key messages • Digital Health Literacy of populations in Europe was estimated through a validated measure with associations that predict public health and healthcare consequences in most countries. • Public health practitioners and policy makers should be aware of populations with lower Digital Health Literacy (DHL), and both promote DHL while also adjusting interventions/services to DHL needs.

Health Literacy, lifestyles, and socio-economic factors in the Italian population: a national survey

Abstract Introduction Health literacy (HL) entails people's knowledge and abilities to find, understand and use health information to make health-related decisions. This study aims to evaluate HL association with lifestyles in the Italian adult population. Methods In 2021, in the framework of the Italian participation in the WHO network Measuring Population and Organizational Health Literacy M-POHL, a survey was conducted on a representative sample of the Italian population aged 18+ years (n = 3,500). A validated 47-item questionnaire was used to collect core HL information, plus 31 items for correlate information, including lifestyles. For each HL-item, a 4-point Likert scale was applied: very easy/easy/difficult/very difficult. The HL index (percentage of very easy/easy), was stratified in Inadequate (0%−50%), Problematic (51%−66%), Sufficient (67%−80%), Excellent (81%−100%). Inadequate/Problematic were merged into “Limiting”, Sufficient/Excellent in “Not limiting”. Multivariate logistic regression analysis was implemented to assess the association between dichotomous HL and obesity (BMI &amp;gt; =30 Kg/m2), physical activity-PA (intense (5-7 days a week)/not intense (0-4 days a week)), fruit and vegetable diet-FVD (daily/not daily), smoking habit (yes/no), adjusted by sex, age, region, education-ED, financial deprivation-FD. Results Prevalence of Limiting HL is 64.6%. In Limiting HL, obesity is significantly higher than in Not limiting HL (14.6% vs 12.0%), similarly not intense PA (82.3% vs 75.7%), not daily FVD (54.0% vs 47.7%), low ED (22.3% vs 18.0%), severe FD (20.8% vs 9.1%); the opposite for smokers (30.2% vs 34.7%). Significant association with Limiting HL was found for not intense PA (Odds Ratio-OR=1.48), not daily FVD (OR = 1.24), low ED (OR = 1.39), severe FD (OR = 3.33). Conclusions Results show that persons with not intense PA and those with not daily FVD need targeted support to improve HL, as well as those with a lower level of education and problematic financial situation. Key messages • This study aims to evaluate Health literacy association with lifestyles and socio-economic factors in the Italian adult population. • Intense physical activity and a regular fruit and vegetable diet lifestyles are associated with ‘Not limiting’ Health Literacy, as well as high educational level and low financial deprivation.