Identifying Dimensions of Organizational Health Literacy in Hospitals: A Scoping Review
-
Meghdad Rahati
,
Zahra Sakeni
,
Abdolhosein Kalantari
,
Masoud Etedali
,
Alireza Ganjipour
,
Ali Valinejadi
Abstract
Background: Organizational health literacy (OHL) plays a crucial role in improving patients’ understanding and engagement in hospital care. Despite its importance, little is known about the comprehensive dimensions of OHL from a managerial perspective. This study aimed to identify key dimensions that can influence OHL in hospital settings to enhance patient care.
Methods: A scoping review was conducted to examine studies published from 2012-2024 regarding OHL in hospitals. Relevant studies were identified using a structured search strategy across multiple databases, including PubMed, Scopus, and Web of Science. Overall, 39 articles were selected after screening, and content analysis was performed using MAXQDA-10. The review adhered to the PRISMA guidelines for scoping reviews.
Results: The analysis identified six core dimensions of OHL: (i) leadership and management, (ii) policy and strategy formulation, (iii) human resources, (iv) organizational resources (including financial, physical, and informational), (v) processes, products, and services, and (vi) results. These dimensions were further categorized into 21 subcategories. Each dimension outlines essential components for improving hospital OHL, such as leadership support, staff training, communication strategies, and resource allocation. Additionally, the study highlights the role of technology, including electronic health literacy, in improving organizational performance.
Conclusion: By addressing the key dimensions that influence organizational health literacy in hospitals, hospital administrators can enhance patient understanding of healthcare services, improve safety and satisfaction levels, and foster a culture of health literacy. The provided framework offers a valuable management approach for integrating OHL into hospital operations, potentially leading to more informed and health-literate patient communities.
1. Wang M, Lo Y (2021). Improving Patient Health Literacy in Hospitals - A Challenge for Hospital Health Education Programs. Risk Manag Healthc Policy, 14:4415-4424.
2. Schillinger D, Keller D (2011). How Can Health Care Organizations Become More Health Literate. The other side of the coin: Attributes of a health literate health care organization. ed. Institute of Medicine, Washington, DC, USA.
3. Brach C (2017). The Journey to Become a Health Literate Organization: A Snapshot of Health System Improvement. Stud Health Technol Inform, 240:203-237.
4. Weaver N, Wray R, Zellin S, et al (2012). Advancing organizational health literacy in health care organizations serving high-needs populations: a case study. J Health Commun, 3:55-66.
5. Groene O, Rudd R (2011). Results of a feasibility study to assess the health literacy environment: Navigation, written and oral communication in ten hospitals in Catalonia, Spain. J Commun Health, 4:227-237.
6. Jukkala A, Deupree J, Graham S (2009). Knowledge of limited health literacy at an academic health center. J Cont Educ Nurs, 40(7):298-302.
7. Ahmed Alghawli AS, Nasser AA, Aljober MN (2021). A Fuzzy MCDM Approach for Structured Comparison of the Health Literacy Level of Hospitals. International Journal of Advanced Computer Science and Applications (IJACSA), 12 (7).
8. Weidmer BA, Brach C, Slaughter M, et al (2012). Development of Items to Assess Patients’ Health Literacy Experiences at Hospitals for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey. Medical Care, 50 (9):S12-21.
9. Kowalski C, Lee S, Schmidt A, et al (2015). The health literate health care organization 10 item questionnaire (HLHO-10): development and validation. BMC Health Serv Res, 1:15-47.
10. Hayran O, Özer O (2018). Organizational health literacy as a determinant of patient satisfaction. Public Health, 163:20-26.
11. Howe CJ, Adame T, Lewis B, et al (2020). Assessing Organizational Focus on Health Literacy in North Texas Hospitals. Am J Nurs, 120 (12):24-33.
12. Adsul P, Wray R, Gautam K, et al (2017). Becoming a health literate organization: Formative research results from healthcare organizations providing care for underserved communities. Health Serv Manage Res, 30 (4):188-196.
13. Farmanova E, Bonneville L, Bouchard L (2018). Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues. Inquiry, 55:46958018757848.
14. Zanobini P, Lorini C, Baldasseroni A, et al (2020). A Scoping Review on How to Make Hospitals Health Literate Healthcare Organizations. Int J Environ Res Public Health, 17 (3):1036.
15. Bremer D, Klockmann I, Jaß L, et al (2021). Which criteria characterize a health literate health care organization? a scoping review on organizational health literacy. BMC Health Serv Res, 21 (1):664.
16. Rathmann K, Salewski L, Vockert T, et al (2022). [Tools to strengthen organizational health literacy in the health care sector]. Z Evid Fortbild Qual Gesundhwes, 170:21-28.
17. McDonald C, Remedios L, Cameron K, et al (2022). Barriers, Enablers, and Consumer Design Ideas for Health Literacy Responsive Hospital Waiting Areas: A Framework Method Analysis. HERD, 15 (1):207-221.
18. Bahrambeygi F, Rakhshanderou S, Ramezankhani A, et al (2023). Hospital health literacy conceptual explanation: A qualitative content analysis based on experts and population perspectives. J Educ Health Promot, 12:31.
19. Palumbo R (2016). Designing health-literate health care organization: a literature review. Health Serv Manag Res, 29 (3):79-87.
20. Lloyd J, Song H, Dennis S, et al (2018). A paucity of strategies for developing health literate organisations: a systematic review. PLoS One, 13(4):e0195018.
21. Rowlands G, Trezona A, Russell S, et al (2019). What is the evidence on the methods, frameworks and indicators used to evaluate health literacy policies, programmes and interventions at the regional, national and organizational levels? , WHO Regional Office for Europe, Copenhagen.
22. Arksey H, O'Malley L (2005). Scoping studies: towards a methodological framework. Int J Soc Res Methodol, 8 (1):19-32.
23. Peters M, Godfrey C, Khalil H, et al (2015). Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc, 13 (3):141-6.
24. Tricco A, Lillie E, Zarin W, et al (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. The PRISMA-ScR statement. Ann Intern Med, 169 (7):467-473.
25. Sørensen K, Pelikan J, Röthlin F, et al (2021). Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU). Eur J Public Health, 25:1053-8.
26. Nour S, Kusrini SK, Suradi E (2021). Knowledge, attitude and barriers towards health literacy among health professionals working in hospital. Enfermería Clínica, 31:618-622.
27. Sentell T, Foss-Durant A, Patil U, et al (2021). Organizational Health Literacy: Opportunities for Patient-Centered Care in the Wake of COVID-19. Qual Manag Health Care, 30 (1):49-60.
28. Pelikan JM, Dietscher C (2015). Why should and how can hospitals improve their organizational health literacy? [Warum sollten und wie können Krankenhäuser ihre organisationale Gesundheitskompetenz verbessern?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 58 (9):989-95.
29. Walker J, Pepa C, Gerard P (2012). Assessing the health literacy levels of patients using selected hospital services. Clin Nurse Spec, 24 (1):31-7.
30. Woolsey AT, Driver S, Reynolds M (2015). Staff Assessment of a Rehabilitation Hospital’s Performance in Meeting the Health Literacy Needs of Inpatients. Archives of Physical Medicine and Rehabilitation, https://doi.org/10.1016/j.apmr.2015.08.313.
31. Kaphingst K, Weaver N, Wray R, et al (2014). Effects of patient health literacy, patient engagement and a system-level health literacy attribute on patient-reported outcomes: a representative statewide survey. BMC Health Serv Res, 14:475.
32. Roodbeen R, Vreke A, Boland G, et al (2020). Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers and suggestions for improvement reported by hospital based palliative care providers. PLOS ONE, 15 (6):e0234926.
33. Durmuş V (2021). Differences in health literacy level of patients from public and private hospitals: a cross-sectional study in Turkey. Public Health, 200:77-83.
34. Larrotta-Castillo D, Moreno-Chaparro J, Amaya-More A, et al (2023). Health literacy interventions in the hospital setting: an overview. Health Promot Int, 38(3):daac043.
35. Dahodwala M, Geransar R, Babion J, et al (2018). The impact of the use of video-based educational interventions on patient outcomes in hospital settings: A scoping review. Patient Educ Couns, 10 (12):2116-2124.
36. Malekzadeh S, Azami M, Mirzaei M, et al (2016). Comparative Investigation of Health Literacy Level of Cardiovascular Patients Hospitalized in Private and Educational Hospitals of Kerman City, Iran. Acta Inform Med, 24 (1):56-60.
37. Mathias EG, Dhyani VS, Krishnan JB, et al (2023). Community based health literacy interventions in India: A scoping review. Clinical Epidemiology and Global Health, 22.
38. Bonaccorsi G, Romiti A, Ierardi F, et al (2020). Health-Literate Healthcare Organizations and Quality of Care in Hospitals: A Cross-Sectional Study Conducted in Tuscany. Int J Environ Res Public Health, 17 (7):2508.
39. Noordman J, van Vliet L, Kaunang M, et al (2019). Towards appropriate information provision for and decision-making with patients with limited health literacy in hospital-based palliative care in Western countries: a scoping review into available communication strategies and tools for healthcare provider. BMC Palliat Care, 18 (1):37.
40. McKenna V, Sixsmith J, Byrne N (2023). Patient public involvement (PPI) in health literacy research: Engagement of adults with literacy needs in the co-creation of a hospital-based health literacy plan. Health Expect, 26 (3):1213-1220.
41. Lubasch J, Voigt-Barbarowicz M, Ernstmann N, et al (2021). Organizational Health Literacy in a Hospital-Insights on the Patients' Perspective. Int J Environ Res Public Health, 18 (23):12646.
42. Vollbrecht H, Arora V, Otero S, et al (2020). Evaluating the Need to Address Digital Literacy Among Hospitalized Patients: Cross-Sectional Observational Study. J Med Internet Res, 22 (6):e17519.
43. Lane S, Fitzsimmons E, Zelefksy A, et al (2023). Assessing Electronic Health Literacy at an Urban Academic Hospital. Appl Clin Inform, 14 (2):365-373.
44. Garcia-Marcinkiewicz A, Long T, Danielson D, et al (2014). Health literacy and anesthesia: patients' knowledge of anesthesiologist roles and information desired in the preoperative visit. J Clin Anesth, 26 (5):375-82.
45. Peiris R, Cornell S, Greaves K, et al (2022). Do hospital consent forms for cardiology procedures meet health literacy standards? Evaluation of understandability and readability. Patient Educ Couns, 105 (5):1254-1260.
46. Innis J, Barnsley J, Berta W, et al (2017). Measuring health literate discharge practices. Int J Health Care Qual Assur, 30 (1):67-78.
47. Cawthon C, Mion L, Willens D, et al (2014). Implementing routine health literacy assessment in hospital and primary care patients. Jt Comm J Qual Patient Saf, 40 (2):68-76.
48. Bertram M, Brandt U, Hansen R (2021). Does higher health literacy lead to higher trust in public hospitals? Int J Equity Health, 20 (1):209.
49. Brach C, Keller D, Hernandez L, et al (2012). Ten attributes of Health Literate Health Care Organizations. ed. Institute of Medicine of the National Academies, Washington, DC.
50. Suka M, Odajima T, Okamoto M, et al (2015). Relationship between health literacy, health information access, health behavior, and health status in Japanese people. Patient Educ Couns, 98 (5):660-8.
2. Schillinger D, Keller D (2011). How Can Health Care Organizations Become More Health Literate. The other side of the coin: Attributes of a health literate health care organization. ed. Institute of Medicine, Washington, DC, USA.
3. Brach C (2017). The Journey to Become a Health Literate Organization: A Snapshot of Health System Improvement. Stud Health Technol Inform, 240:203-237.
4. Weaver N, Wray R, Zellin S, et al (2012). Advancing organizational health literacy in health care organizations serving high-needs populations: a case study. J Health Commun, 3:55-66.
5. Groene O, Rudd R (2011). Results of a feasibility study to assess the health literacy environment: Navigation, written and oral communication in ten hospitals in Catalonia, Spain. J Commun Health, 4:227-237.
6. Jukkala A, Deupree J, Graham S (2009). Knowledge of limited health literacy at an academic health center. J Cont Educ Nurs, 40(7):298-302.
7. Ahmed Alghawli AS, Nasser AA, Aljober MN (2021). A Fuzzy MCDM Approach for Structured Comparison of the Health Literacy Level of Hospitals. International Journal of Advanced Computer Science and Applications (IJACSA), 12 (7).
8. Weidmer BA, Brach C, Slaughter M, et al (2012). Development of Items to Assess Patients’ Health Literacy Experiences at Hospitals for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey. Medical Care, 50 (9):S12-21.
9. Kowalski C, Lee S, Schmidt A, et al (2015). The health literate health care organization 10 item questionnaire (HLHO-10): development and validation. BMC Health Serv Res, 1:15-47.
10. Hayran O, Özer O (2018). Organizational health literacy as a determinant of patient satisfaction. Public Health, 163:20-26.
11. Howe CJ, Adame T, Lewis B, et al (2020). Assessing Organizational Focus on Health Literacy in North Texas Hospitals. Am J Nurs, 120 (12):24-33.
12. Adsul P, Wray R, Gautam K, et al (2017). Becoming a health literate organization: Formative research results from healthcare organizations providing care for underserved communities. Health Serv Manage Res, 30 (4):188-196.
13. Farmanova E, Bonneville L, Bouchard L (2018). Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues. Inquiry, 55:46958018757848.
14. Zanobini P, Lorini C, Baldasseroni A, et al (2020). A Scoping Review on How to Make Hospitals Health Literate Healthcare Organizations. Int J Environ Res Public Health, 17 (3):1036.
15. Bremer D, Klockmann I, Jaß L, et al (2021). Which criteria characterize a health literate health care organization? a scoping review on organizational health literacy. BMC Health Serv Res, 21 (1):664.
16. Rathmann K, Salewski L, Vockert T, et al (2022). [Tools to strengthen organizational health literacy in the health care sector]. Z Evid Fortbild Qual Gesundhwes, 170:21-28.
17. McDonald C, Remedios L, Cameron K, et al (2022). Barriers, Enablers, and Consumer Design Ideas for Health Literacy Responsive Hospital Waiting Areas: A Framework Method Analysis. HERD, 15 (1):207-221.
18. Bahrambeygi F, Rakhshanderou S, Ramezankhani A, et al (2023). Hospital health literacy conceptual explanation: A qualitative content analysis based on experts and population perspectives. J Educ Health Promot, 12:31.
19. Palumbo R (2016). Designing health-literate health care organization: a literature review. Health Serv Manag Res, 29 (3):79-87.
20. Lloyd J, Song H, Dennis S, et al (2018). A paucity of strategies for developing health literate organisations: a systematic review. PLoS One, 13(4):e0195018.
21. Rowlands G, Trezona A, Russell S, et al (2019). What is the evidence on the methods, frameworks and indicators used to evaluate health literacy policies, programmes and interventions at the regional, national and organizational levels? , WHO Regional Office for Europe, Copenhagen.
22. Arksey H, O'Malley L (2005). Scoping studies: towards a methodological framework. Int J Soc Res Methodol, 8 (1):19-32.
23. Peters M, Godfrey C, Khalil H, et al (2015). Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc, 13 (3):141-6.
24. Tricco A, Lillie E, Zarin W, et al (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. The PRISMA-ScR statement. Ann Intern Med, 169 (7):467-473.
25. Sørensen K, Pelikan J, Röthlin F, et al (2021). Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU). Eur J Public Health, 25:1053-8.
26. Nour S, Kusrini SK, Suradi E (2021). Knowledge, attitude and barriers towards health literacy among health professionals working in hospital. Enfermería Clínica, 31:618-622.
27. Sentell T, Foss-Durant A, Patil U, et al (2021). Organizational Health Literacy: Opportunities for Patient-Centered Care in the Wake of COVID-19. Qual Manag Health Care, 30 (1):49-60.
28. Pelikan JM, Dietscher C (2015). Why should and how can hospitals improve their organizational health literacy? [Warum sollten und wie können Krankenhäuser ihre organisationale Gesundheitskompetenz verbessern?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 58 (9):989-95.
29. Walker J, Pepa C, Gerard P (2012). Assessing the health literacy levels of patients using selected hospital services. Clin Nurse Spec, 24 (1):31-7.
30. Woolsey AT, Driver S, Reynolds M (2015). Staff Assessment of a Rehabilitation Hospital’s Performance in Meeting the Health Literacy Needs of Inpatients. Archives of Physical Medicine and Rehabilitation, https://doi.org/10.1016/j.apmr.2015.08.313.
31. Kaphingst K, Weaver N, Wray R, et al (2014). Effects of patient health literacy, patient engagement and a system-level health literacy attribute on patient-reported outcomes: a representative statewide survey. BMC Health Serv Res, 14:475.
32. Roodbeen R, Vreke A, Boland G, et al (2020). Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers and suggestions for improvement reported by hospital based palliative care providers. PLOS ONE, 15 (6):e0234926.
33. Durmuş V (2021). Differences in health literacy level of patients from public and private hospitals: a cross-sectional study in Turkey. Public Health, 200:77-83.
34. Larrotta-Castillo D, Moreno-Chaparro J, Amaya-More A, et al (2023). Health literacy interventions in the hospital setting: an overview. Health Promot Int, 38(3):daac043.
35. Dahodwala M, Geransar R, Babion J, et al (2018). The impact of the use of video-based educational interventions on patient outcomes in hospital settings: A scoping review. Patient Educ Couns, 10 (12):2116-2124.
36. Malekzadeh S, Azami M, Mirzaei M, et al (2016). Comparative Investigation of Health Literacy Level of Cardiovascular Patients Hospitalized in Private and Educational Hospitals of Kerman City, Iran. Acta Inform Med, 24 (1):56-60.
37. Mathias EG, Dhyani VS, Krishnan JB, et al (2023). Community based health literacy interventions in India: A scoping review. Clinical Epidemiology and Global Health, 22.
38. Bonaccorsi G, Romiti A, Ierardi F, et al (2020). Health-Literate Healthcare Organizations and Quality of Care in Hospitals: A Cross-Sectional Study Conducted in Tuscany. Int J Environ Res Public Health, 17 (7):2508.
39. Noordman J, van Vliet L, Kaunang M, et al (2019). Towards appropriate information provision for and decision-making with patients with limited health literacy in hospital-based palliative care in Western countries: a scoping review into available communication strategies and tools for healthcare provider. BMC Palliat Care, 18 (1):37.
40. McKenna V, Sixsmith J, Byrne N (2023). Patient public involvement (PPI) in health literacy research: Engagement of adults with literacy needs in the co-creation of a hospital-based health literacy plan. Health Expect, 26 (3):1213-1220.
41. Lubasch J, Voigt-Barbarowicz M, Ernstmann N, et al (2021). Organizational Health Literacy in a Hospital-Insights on the Patients' Perspective. Int J Environ Res Public Health, 18 (23):12646.
42. Vollbrecht H, Arora V, Otero S, et al (2020). Evaluating the Need to Address Digital Literacy Among Hospitalized Patients: Cross-Sectional Observational Study. J Med Internet Res, 22 (6):e17519.
43. Lane S, Fitzsimmons E, Zelefksy A, et al (2023). Assessing Electronic Health Literacy at an Urban Academic Hospital. Appl Clin Inform, 14 (2):365-373.
44. Garcia-Marcinkiewicz A, Long T, Danielson D, et al (2014). Health literacy and anesthesia: patients' knowledge of anesthesiologist roles and information desired in the preoperative visit. J Clin Anesth, 26 (5):375-82.
45. Peiris R, Cornell S, Greaves K, et al (2022). Do hospital consent forms for cardiology procedures meet health literacy standards? Evaluation of understandability and readability. Patient Educ Couns, 105 (5):1254-1260.
46. Innis J, Barnsley J, Berta W, et al (2017). Measuring health literate discharge practices. Int J Health Care Qual Assur, 30 (1):67-78.
47. Cawthon C, Mion L, Willens D, et al (2014). Implementing routine health literacy assessment in hospital and primary care patients. Jt Comm J Qual Patient Saf, 40 (2):68-76.
48. Bertram M, Brandt U, Hansen R (2021). Does higher health literacy lead to higher trust in public hospitals? Int J Equity Health, 20 (1):209.
49. Brach C, Keller D, Hernandez L, et al (2012). Ten attributes of Health Literate Health Care Organizations. ed. Institute of Medicine of the National Academies, Washington, DC.
50. Suka M, Odajima T, Okamoto M, et al (2015). Relationship between health literacy, health information access, health behavior, and health status in Japanese people. Patient Educ Couns, 98 (5):660-8.
| Files | ||
| Issue | Vol 54 No 9 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i9.19855 | |
| Keywords | ||
| Organizational health literacy Hospitals Health literacy management Scoping review Patient safety Electronic health literacy | ||
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How to Cite
1.
Rahati M, Sakeni Z, Kalantari A, Etedali M, Ganjipour A, Valinejadi A. Identifying Dimensions of Organizational Health Literacy in Hospitals: A Scoping Review. Iran J Public Health. 2025;54(9):1870-1882.
