Implementation of an organisation-wide health literacy approach to improve the understandability and actionability of patient information and education materials: A pre-post effectiveness study

Mastroianni, Fiorina; Chen, Yen-Chia; Vellar, Lucia; Cvejic, Erin; Smith, Jessica; McCaffery, Kirsten; Muscat, Danielle M

doi:10.1016/j.pec.2019.03.022

Cited by 20 publications

(34 citation statements)

References 30 publications

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“…Our study showed that in various settings, system-wide improvements, such as health literacy policies, plain language training, and comprehensible written and digital information, were embedded at various organisational levels, which is in line with a few other recent studies using more systematic implementation approaches over longer periods [17,25,26]. Two studies carried out at the same site [25,26] reported successes, such as integrating health literacy into health systems and quality improvement processes, and creating a governance structure and a web-based platform for developing and testing plain health information [25]. This resulted in organisation-wide improvement of patient information materials related to their understanding and actionability [26].…”

Section: Discussionsupporting

confidence: 90%

“…Two studies carried out at the same site [25,26] reported successes, such as integrating health literacy into health systems and quality improvement processes, and creating a governance structure and a web-based platform for developing and testing plain health information [25]. This resulted in organisation-wide improvement of patient information materials related to their understanding and actionability [26]. Another study [17] reported embedding a variety of locally relevant health literacy interventions at nine sites, which resulted in process improvements at the organisational level, improved knowledge and skills among staff, community engagement, and some improvement in client outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Implementation barriers and the relative brief implementation period of up to six months could have influenced planning decisions and may have prevented observation of longer term effects [23,24]. Recently, a few studies reported positive outcomes in various settings when the implementation of OHL-interventions was guided by a systematic approach and longer implementation periods of up to three years [17,25,26]. These studies reported successes such as organisation-wide integration of health literacy into health systems and into processes for quality improvement, extensive application of health literacy interventions, increased competencies of staff, and improved understanding and actionability of patient-information materials [17,25,26].…”

Section: Introductionmentioning

confidence: 99%

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

Kaper

Sixsmith

Meijering

et al. 2019

IJERPH

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kaper

Sixsmith

Meijering

et al. 2019

IJERPH

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“…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].…”

Section: Description Of Studiesmentioning

confidence: 99%

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

Kaper

Sixsmith

Reijneveld

et al. 2021

IJERPH

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Organizational health literacy (OHL)-interventions can reduce inequality and demands in health care encountered by patients. However, an overview of their impact and critical factors for organization-wide implementation is lacking. The aim of this scoping review is to summarize the evidence on: (1) the outcomes of OHL-interventions at patient, professional and organizational levels; and (2) the factors and strategies that affect implementation and outcomes of OHL-interventions. We reviewed empirical studies following the five-stage framework of Arksey and O’Malley. The databases Scopus, PubMed, PsychInfo and CINAHL were searched from 1 January 2010 to 31 December 2019, focusing on OHL-interventions using terms related to “health literacy”, “health care organization” and “intervention characteristics”. After a full-text review, we selected 24 descriptive stu-dies. Of these, 23 studies reported health literacy problems in relation to OHL-assessment tools. Nine out of thirteen studies reported that the use of interventions resulted in positive changes on OHL-domains regarding comprehensible communication, professionals’ competencies and practices, and strategic organizational changes. Organization-wide OHL-interventions resulted in some improvement of patient outcomes but evidence was scarce. Critical factors for organization-wide implementation of OHL-interventions were leadership support, top-down and bottom-up approaches, a change champion, and staff commitment. Organization-wide interventions lead to more positive change on OHL-domains, but evidence regarding OHL-outcomes needs strengthening.

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“…9,10 There has also been growing movement toward, and an evidence base for, consumer involvement in the development and review of patient information materials. 11 However, it is unclear the extent to which new evidence and recommendations related to health literacy have been implemented in the development and evaluation of PtDAs since 2013.…”

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confidence: 99%

Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards

et al. 2021

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Background There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development. Purpose An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations. Data Sources Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions). Study Selection RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s). Data Extraction Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability. Data Synthesis Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ2 = 14.11, P = 0.0002, I2 = 92.9%). Limitations We were unable to access 13 of 24 PtDAs. Conclusions. Greater attention to health literacy and socially-disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support.

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Implementation of an organisation-wide health literacy approach to improve the understandability and actionability of patient information and education materials: A pre-post effectiveness study

Cited by 20 publications

References 30 publications

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

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

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

Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards

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