Implementation and Long-Term Outcomes of Organisational Health Literacy Interventions in Ireland and The Netherlands: A Longitudinal Mixed-Methods Study

Abstract

Organisational Health Literacy (OHL)-interventions are needed to overcome health inequality. OHL-interventions have successfully identified communication barriers at the organisational level, but evidence is limited on the extent to which this leads to sustainable organisational change. This study aims to assess the implementation fidelity, moderators (barriers and facilitators), and long-term impact of OHL-interventions in hospitals in Ireland and The Netherlands. We used a longitudinal mixed-methods approach to assess two similar OHL-interventions in one Irish and three Dutch hospitals. The OHL-interventions concerned the improvement of navigation and implementation of health literacy-friendly communication throughout organisations. Participants were 24 hospital employees and 40 older adults who use hospital services. At six, eight, and eighteen months, we assessed the level of implementation, barriers and facilitators, and impact through questionnaires and in-depth semi-structured interviews. After older adults and professionals had identified a number of communication problems, we found that professionals had successfully implemented OHL-interventions to promote navigation and comprehensible communication. Limited resources and variation in organisational structures and procedures were perceived as barriers to implementation. The participation of service users, leadership support, and a stepwise implementation of interventions were perceived to facilitate implementation. In the long term, the OHL-interventions led to system-wide improvements, as shown by better embedding of health literacy policies, enhanced patient engagement, provision of plain language training and comprehensible information. Findings were similar for the two countries. Embedded OHL-interventions resulted in sustainable and system-wide health literacy changes in all four hospitals. Following implementation, OHL-interventions have the potential to promote health equity and empowerment among health service users.

Improving Health Literacy Responsiveness: A Randomized Study on the Uptake of Brochures on Doctor-Patient Communication in Primary Health Care Waiting Rooms

“…This might, for instance, be achieved by health care professionals actively distributing such materials, or by simply placing multiple displays throughout the waiting room. In addition, other methods can be used to better tailor healthcare delivery to the needs of patients with low levels of health literacy, for instance by strengthening the skills of health care professionals to communicate with these patients [ 47 , 48 ], or by adapting the organization and design of health care services [ 49 ].…”

Interdisciplinary Perspectives on Health Literacy Research Around the World: More Important Than Ever in a Time of COVID-19

“…Trezona et al [64] provide a relevant self-assessment tool for organizational health literacy in "Field-Testing and Refinement of the Organisational Health Literacy Responsiveness Self-Assessment (Org-HLR) Tool and Process". Kaper et al [65] consider the sustainable changes and longitudinal outcomes of organizational health literacy efforts in "Implementation and Long-Term Outcomes of Organisational Health Literacy Interventions in Ireland and The Netherlands: A Longitudinal Mixed-Methods Study". As in many studies, this considers two different health contexts and the need to address health inequality.…”

Outcomes and Critical Factors for Successful Implementation of Organizational Health Literacy Interventions: A Scoping Review

“…Together with the assessment, these studies also often evaluated the feasibility of the OHL-instrument. Eleven studies reported on both the assessment and on findings regarding the planning and delivery of interventions [22,[25][26][27][28][29][30][31][32][33][41][42][43]. Fourteen studies were conducted in the United States [22][23][24]28,29,[31][32][33][34]36,[38][39][40]43]; other studies were conducted in Australia [25][26][27]30,41], New Zealand & Canada [37], and several European countries including Austria [35], Italy [17], Ireland and the Netherlands [42], and Spain [3].…”