BackgroundHealth literacy (HL) is seen as an increasingly relevant issue for global public health and requires a reliable and comprehensive operationalization. By now, there is limited evidence on how the development of tools measuring HL proceeded in recent years and if scholars considered existing methodological guidance when developing an instrument.MethodsWe performed a systematic review of generic measurement tools developed to assess HL by searching PubMed, ERIC, CINAHL and Web of Knowledge (2009 forward). Two reviewers independently reviewed abstracts/ full text articles for inclusion according to predefined criteria. Additionally we conducted a reporting quality appraisal according to the survey reporting guideline SURGE.ResultsWe identified 17 articles reporting on the development and validation of 17 instruments measuring health literacy. More than two thirds of all instruments are based on a multidimensional construct of health literacy. Moreover, there is a trend towards a mixed measurement (self-report and direct test) of health literacy with 41% of instruments applying it, though results strongly indicate a weakness of coherence between the underlying constructs measured. Overall, almost every third instrument is based on assessment formats modeled on already existing functional literacy screeners such as the REALM or the TOFHLA and 30% of the included articles do not report on significant reporting features specified in the SURGE guideline.ConclusionsScholars recently developing instruments that measure health literacy mainly comply with recommendations of the academic circle by applying multidimensional constructs and mixing up measurement approaches to capture health literacy comprehensively. Nonetheless, there is still a dependence on assessment formats, rooted in functional literacy measurement contradicting the widespread call for new instruments. All things considered, there is no clear “consensus” on HL measurement but a convergence to more comprehensive tools. Giving attention to this finding can help to offer direction towards the development of comparable and reliable health literacy assessment tools that effectively respond to the informational needs of populations.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1207) contains supplementary material, which is available to authorized users.

BackgroundFindings on the association between health literacy skills and patient-reported outcomes such as satisfaction with health care delivery are scarce. We explored the extent to which subjective health literacy skills and the perception of the application of patient-centered communication and shared decision-making are associated with patient’s satisfaction with care received by their general practitioner (GP).MethodsA nationwide cross sectional survey was administered in a random sample of 1125 German adults. A binary logistic regression model controlling for demographics and health status was used to examine the independent contributions of predictor variables (i.e. subjective health literacy, shared decision-making, patient-centered communication) on satisfaction with care received by the GP.ResultsRespondents with sufficient health literacy skills were 2.06 times as likely (95 % [CI]: 1.002–4.264) and those who were involved in shared decision-making by their GP were 4.02 times as likely (95 % [CI]: 1.849–8.744) to be satisfied with care received by their GP. Respondents who experienced that their GP explained things in an easy to understand way (OR: 4.44; 95 % [CI]: 1.817–10.869), knew important things about their medical history (OR: 3.46; 95 % [CI]: 1.502–7.994) and spent enough time with them, also reported to be more satisfied (OR: 3.12; 95 % [CI]: 1.410–6.905).ConclusionGerman adults having sufficient subjective health literacy skills and experiencing a more patient-centered relationship with their GP are more likely to be satisfied with care. These findings are important for health care organizations aiming to respond to health literacy needs of patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1693-y) contains supplementary material, which is available to authorized users.

BackgroundInsufficient communication and coordination is one of the most problematic issues in German health care delivery leading to detrimental effects on health care outcomes. As a consequence interprofessional continuing education (CIPE) is gathering momentum in German health policy and health care practice aiming to enhance service quality and patient safety. Nevertheless, there is limited evidence on the course of implementation and the perceived effectiveness/acceptance of CIPE in German health care. This paper describes the objectives and formal characteristics of CIPE trainings and maps important determinants influencing the success of CIPE implementation from the perspective of providers offering CIPE trainings for German health care professionals.MethodsForty-nine training institutions offering CIPE for health care professionals were identified by a structured web search including the websites of German medical education associations and public/private training institutions. Directors and managers of the identified institutions were invited to participate in a semi-structured interview. The interview guideline was developed using the SPSS method by Helferich and colleges. Interviews were analyzed using the summarizing content analysis developed by Mayring resulting in a paradigm that contextualizes hindering factors regarding the implementation of CIPE in the German health care system.ResultsOverall, 19 of the identified institutions agreed to participate with one director/manager per institution resulting in a response rate of almost 38.8%. The included institutions offer n = 85 CIPE trainings for health care professionals. Trainings offered mainly address the enhancement of domain, social and personal competencies of the participating health care professionals and follow three main objectives comprising better care of severely ill patients, improvement of patient safety by sustained risk management as well as a more patient centered care. Implementation of CIPE in Germany is influenced by various hindering factors mostly coming from systemic (missing incentives), behavioral (hierarchy problems) and methodological (limited quality assurance) factors.ConclusionCIPE is an evolving concept in the German health care system. There are various difficulties that impede a successful implementation of CIPE and might be mitigated by specific health policy interventions such as mandatory CIPE participation of health care professionals and comprehensive pre-license interprofessional education.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-227) contains supplementary material, which is available to authorized users.

Improving the quality of care for chronic diseases is an important issue for most health care systems in industrialized nations. One widely adopted approach is the Chronic Care Model (CCM), which was first developed in the late 1990s. In this article we present the results from two large surveys in the United States and Germany that report patients' experiences in different models of patient-centered diabetes care, compared to the experiences of patients who received routine diabetes care in the same systems. The study populations were enrolled in either Geisinger Health System in Pennsylvania or Barmer, a German sickness fund that provides medical insurance nationwide. Our findings suggest that patients with type 2 diabetes who were enrolled in the care models that exhibited key features of the CCM were more likely to receive care that was patient-centered, high quality, and collaborative, compared to patients who received routine care. This study demonstrates that quality improvement can be realized through the application of the Chronic Care Model, regardless of the setting or distinct characteristics of the program.

BackgroundAlthough health policy makers call for the transformation of health care organizations to health literacy responsive ones, there is limited evidence on the care experiences of patients with limited health literacy skills (HL) in respect to health care quality. We explored if HL and patient-reported experiences regarding access to care and support in care-coordination in primary care organizations (PCO) have an impact on patients satisfaction with the care received by their personal general practitioner (GP).MethodsA nationwide representative survey was administered in a random sample of 1125 German adults. Binary logistic regression analyses were performed to determine whether HL and perceived access to and coordination of care were associated with satisfaction with care received in primary care adjusting for demographics and health status.ResultsIn the unadjusted as well as adjusted model, better accessibility of the primary care practice (β= 1.858; 2.032 p < 0.001) frequent support in care coordination by the general practitioner (β = 2.680; 2.820 p < 0.001) as well as sufficient HL (β = 0.888; 1.228 p < 0.05) were independent predictors of a higher satisfaction with care received in the general practice.ConclusionGerman adults with sufficient HL and positive experiences regarding care coordination and access to care are more satisfied with care received by their personal general practitioner. This result is from major importance for primary care organizations intending to transform their processes and structures to respond to the health literacy needs of their patients more effectively.