BackgroundWhile research on individual health literacy is steadily increasing, less attention has been paid to the context of care that may help to increase the patient’s ability to navigate health care or to compensate for their limited health literacy. In 2012, Brach et al. introduced the concept of health literate health care organizations (HLHOs) to describe the organizational context of care. This paper presents our effort in developing and validating an HLHO instrument.MethodTen items were developed to represent the ten attributes of HLHO (HLHO-10) based on a literature review, an expert workshop, a focus group discussion, and qualitative interviews. The instrument was applied in a key informant survey in 51 German hospitals as part of a larger study on patient information and training needs (PIAT-study). Item properties were analyzed and a confirmatory factor analysis (CFA) was conducted to test the instrument’s unidimensionality. To investigate the instrument’s predictive validity, a multilevel analysis was performed that used the HLHO-10 score to predict the adequacy of information provided to 1,224 newly-diagnosed breast cancer patients treated at the sample hospitals.ResultsCronbach’s α of the resulting scale was 0.89. CFA verified the one-factor structure after allowing for the correlation for four pairs of error terms. In the multilevel model, HLHO-10 significantly predicted the adequacy of information as perceived by patients.ConclusionThe instrument has satisfactory reliability and validity. It provides a useful tool to assess the degree to which health care organizations help patients to navigate, understand, and use information and services. Further validation should include participant observation in health care organizations and a sample that is not limited to breast cancer care.

Breast cancer outpatients have numerous information needs. In addition to provide information at the right time regarding a specific disease phase, it is important that health professionals' support affected breast cancer patients in coping with the new situation.

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The aim of this study was to develop active packaging materials covered in active coatings (offering antibacterial and antiviral properties) that contain selected plant extracts. In addition, the synergistic effect of the active substances in these extracts was also analysed. The results of the study demonstrated that Scutellaria baicalensis and Glycyrrhiza L. extracts (two of six analysed plant extracts) were the most active agents against selected Gram-positive and Gram-negative bacterial strains. Additionally, the synergistic effect of S. baicalensis and Glycyrrhiza L. extracts was noted, meaning that the effect of these two plant extract mixtures on Bacillus subtilis, Staphylococcus aureus, Escherichia coli and Pseudomonas syringae growth was higher than the activity of individual pure extracts. Mixtures of the extracts were introduced into the coating carrier. A polyethylene (PE) foil was then coated with active layers containing mixtures of S. baicalensis and Glycyrrhiza L. extracts as antimicrobial agents. The results of this research showed that all of the active coatings had a bacteriolytic effect on B. subtilis and a bacteriostatic effect on S. aureus cells. The coatings were found to be inactive against E. coli and P. syringae cells. This means that the coatings could be used as internal coatings to preserve food products against Gram-positive bacteria that may be responsible for food spoilage. The results of this study also demonstrated that the coatings were highly active against phage phi 6 phage particles, used as SARS-CoV-2 surrogate. This means that the coatings could be used as external coatings to limit the spread of SARS-CoV-2 and pathogenic Gram-positive bacteria via human hands.

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