The health literate health care organization 10 item questionnaire (HLHO-10): development and validation

Abstract

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.

A Scoping Review on How to Make Hospitals Health Literate Healthcare Organizations

“…Facing such attributes, many authors have proposed health literacy intervention toolkits for health care organizations [9,10], as well as correlated measurement tools [11][12][13]; however, to date a systematisation of the conceptual model based on the experiences described in the literature is still lacking.…”

Organizational Health Literacy in Facilities for People with Disabilities: First Results of an Explorative Qualitative and Quantitative Study

“…Various (survey) instruments have been developed in order to assess attributes and degree of OHL, as well as to detect requirements for action in relation to OHL [4,28,29]: the HLHO-10 [28], the Health Literacy Universal Precautions Toolkit [29,30], and the V-HLO [31]. These tools examined various areas and attributes of OHL (e.g., HL awareness, verbal and written communication, or target-group self-management and empowerment) in order to assess the quality and potential of OHL more deeply [29].…”

“…These tools examined various areas and attributes of OHL (e.g., HL awareness, verbal and written communication, or target-group self-management and empowerment) in order to assess the quality and potential of OHL more deeply [29]. Based on the 10 attributes of health-literate organizations [22], Kowalski et al [28] developed in 2015 a valid and reliable measurement tool in the German language, including 10 items to self-assess the level of OHL, which were also validated in the English language. The so-called HLHO-10 can be used in two ways: (1) it can be applied in research to assess the level of OHL in hospitals or other health care organizations, and (2) it can be used as a self-assessment tool to identify areas with potential for improvement, as well as to develop measures to improve OHL.…”

“…The main purpose, represented in the second part of the questionnaire, was to assess the attributes of OHL, which were surveyed using the HLHO-10 questionnaire [28]. This instrument, which addresses the ten attributes of HLO [22], was developed by Kowalski et al [28] in 2015 and has been tested as a valid and reliable measure in the German language including 10-items to self-assess the level of OHL.…”

“…The main purpose, represented in the second part of the questionnaire, was to assess the attributes of OHL, which were surveyed using the HLHO-10 questionnaire [28]. This instrument, which addresses the ten attributes of HLO [22], was developed by Kowalski et al [28] in 2015 and has been tested as a valid and reliable measure in the German language including 10-items to self-assess the level of OHL. The following items on features of OHL are included: questions on the extent to which the organization devotes itself to HL in its mission statement, quality management, or HR planning; the application and development of (individualized) health information; the navigation and provision of various media in the organization; communication standards, particularly in critical situations; and the support of clients in health-relevant topics, as well as the training of skilled staff in HL.…”