Measuring organizational health literacy in health care organizations serving high needs populations

Background: Low health literacy contributes to adverse health outcomes. Organizations, specifically health care systems, can measure health literacy with several instruments and tools. These instruments, however, are non-consultative, and fail to involve the organization in explaining the presence or absence of health literacy-related practices. Sustainability is limited because organizational barriers and facilitators for health literacy practices are not identified. The current project employs a consultative approach to health literacy assessments in rural Federally Qualified Health Center (FQHC) clinics, but can also be used in a variety of healthcare settings.

Methods: Based on the health literacy literature, six established domains of organizational health literacy were assessed: provider-patient interaction, patient education, print materials, technology, inter-staff interaction, and policy. With the instrument, observational environmental assessments and interviews with patients and organizational staff were conducted at the clinics.

Results: The consultative health literacy assessment revealed gaps in organizational health literacy practices, such as lack of awareness of health literacy within the organization and variation in perceived values of protocols, inter-staff communication and patient communication. Based on these findings, health literacy processes to be improved were identified, as well as barriers to their improvement perceived by organizational staff and providers. The collaborative process involving researchers and organizational staff may be better suited to improving health literacy practices than traditional approaches.

Conclusions: The instrument has been successful in identifying organizational health literacy gaps, and can inform an ongoing consultative process to implement organizational changes that aid in addressing health literacy gaps.