Field-Testing and Refinement of the Organisational Health Literacy Responsiveness Self-Assessment (Org-HLR) Tool and Process.

Health literacy refers to the skills and knowledge that influence a person's ability to access, understand and use information to make health-related decisions, which are influenced by the complexity of their health needs and the demands health services place on them. The aim of this study was to field-test the Organisational Health Literacy Responsiveness (Org-HLR) tool and process to determine their utility in assessing health literacy responsiveness and for supporting organisations to plan health literacy-related improvement activities. Four organisations in Victoria, Australia, field-tested the Org-HLR tool. Data were collected through direct observation, participant feedback, and focus groups. Forty-three individuals participated in field-testing activities, and 20 took part in focus group meetings. Themes relating to the applicability and utility of the Org-HLR self-assessment tool and process were identified. Field-testing resulted in a number of refinements to the tool and process. Twenty-eight indicators were removed, 29 were rephrased to improve their clarity, and four new indicators were added. The revised Org-HLR self-assessment tool contains six dimensions, 22 sub-dimensions and 110 performance indicators. The Org-HLR tool and process were perceived as useful for assessing health literacy responsiveness, prioritising improvement activities, and establishing a benchmark for monitoring and evaluation of improvements over time. Testing generated an improved Org-HLR tool and assessment process that are likely to have utility across a broad range of health and social service sector organisations.

Welche Erkenntnisse gibt es zu den Methoden, Rahmen und Indikatoren für die Evaluation von Handlungskonzepten, Programmen und Interventionen zur Gesundheitskompetenz auf Landes-, Regions- und Organisationsebene?

Auch wenn Gesundheitskompetenz in der Europäischen Region der WHO schon seit Langem Beachtung findet, so ergab doch eine Erhebung aus dem Jahr 2011, dass mehr als 47% der erwachsenen Bevölkerung in den acht teilnehmenden Mitgliedstaaten über eine suboptimale persönliche Gesundheitskompetenz verfügen. Zu den Initiativen zur Priorisierung der Gesundheitskompetenz im öffentlichen Gesundheitswesen zählen die Erklärung der WHO von Shanghai, das Aktionsnetzwerk der WHO zur Messung der Gesundheitskompetenz von Bevölkerung und Organisationen und der Bericht des Health Evidence Network zu Handlungskonzepten für Gesundheitskompetenz in der Europäischen Region der WHO. Der vorliegende Bericht enthält Evidenz über die Methoden, Rahmenkonzepte, Messinstrumente, Bereiche und Indikatoren, die auf allen Ebenen zur Evaluation von Handlungskonzepten, Programmen und Interventionen für Gesundheitskompetenz angewandt werden. Zwar gibt es nur begrenzte Erkenntnisse zur Evaluation nationaler Handlungskonzepte und Programme, jedoch wurden kommunale Programme und Interventionen unter Anwendung quantitativer, qualitativer und methodisch gemischter Ansätze analysiert. Grundsätzliche Überlegungen betreffen unter anderem die Entwicklung von Rahmenkonzepten und Indikatoren für eine Vielzahl von Bereichen, die eine in sich stimmige und vergleichbare Überwachung und Evaluation auf Ebene der Bevölkerung ermöglichen und so Rückschlüsse auf die Wirkung und Effektivität nationaler Handlungskonzepte und Programme zulassen.

Que sait-on des méthodes, des cadres et des indicateurs utilisés pour évaluer les politiques, les programmes et les interventions en matière de littératie en santé aux niveaux régional, national et organisationnel ?

Bien que la Région européenne de l’OMS accorde de longue date son attention à la littératie en santé, une étude réalisée en 2011 dans huit États membres a montré que chez plus de 47 % de la population adulte, le niveau de littératie en santé n’était pas optimal. Les initiatives qui visent à accorder la priorité à la littératie en santé dans les politiques publiques comprennent la Déclaration de Shanghai de l’OMS, Santé 2020, le cadre politique européen qui soutient les interventions pangouvernementales et pansociétales pour la santé et le bien-être, et le rapport de synthèse du Réseau des bases factuelles en santé sur les politiques de littératie en santé dans la Région européenne de l’OMS. Le présent rapport répertorie les informations factuelles portant sur les méthodes, les cadres, les instruments de mesure, les domaines et les indicateurs utilisés pour évaluer les politiques, les programmes et les interventions en matière de littératie en santé à tous les niveaux. Les bases factuelles recueillies sur l’évaluation des politiques et des programmes nationaux ont été limitées, mais des programmes et des interventions locales ont été mesurés à l’aide de méthodes quantitatives, qualitatives et mixtes. Parmi les options politiques figurent la mise au point de cadres et d’indicateurs couvrant un ensemble de domaines susceptibles de permettre un suivi de la population et des évaluations cohérentes et comparables sur les effets et l’efficacité des politiques et des programmes nationaux.

Обзор имеющихся фактических данных о методах, механизмах и показателях, используемых для оценки стратегий, программ и мероприятий в сфере развития грамотности в вопросах здоровья на региональном, национальном и организационном уровнях

Хотя в Европейском регионе ВОЗ грамотности в вопросах здоровья давно уделяется большое внимание, данные проведенного в 2011 г. опросного исследования, в котором участвовали восемь государств-членов, показали, что более 47% взрослого населения этих стран обладают недостаточным уровнем личной грамотности в вопросах здоровья. К числу ключевых инициатив ВОЗ, призванных сделать развитие грамотности в вопросах здоровья приоритетным направлением государственной политики, относятся Шанхайская декларация ВОЗ, Сеть действий по оценке грамотности в вопросах здоровья среди населения и на уровне организаций, а также доклад Сети фактических данных по вопросам здоровья, посвященный мерам политики в области развития грамотности в вопросах здоровья в Европейском регионе ВОЗ. В настоящем обзоре приводятся данные о методах, рамочных механизмах, инструментах оценки, сферах и показателях, используемых для оценки эффективности стратегий, программ и мероприятий по развитию грамотности в вопросах здоровья на всех уровнях. Авторы доклада обнаружили, что объем данных об оценке национальных стратегий и программ весьма ограничен, однако при этом они установили, что в ходе оценки местных программ и мероприятий использовались количественные, качественные и смешанные методы. К числу предлагаемых к рассмотрению мер политики относится разработка рамочных механизмов и показателей, охватывающих целый ряд областей. Такие механизмы и показатели позволяют проводить последовательный мониторинг и оценку ситуации среди населения с использованием сопоставимых данных, чтобы определить уровень воздействия на ситуацию национальных стратегий и программ и оценить их эффективность.

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?

Although health literacy has long been a focus of attention in the WHO European Region, survey evidence in 2011 of eight Member States indicated that more than 47% of the adult population had suboptimal personal health literacy. Initiatives to prioritize health literacy in public policies include the WHO Shanghai Declaration, Health 2020, the European policy framework that supports action across government and society for health and well-being, and the Health Evidence Network report on health literacy policies in the WHO European Region. This review identifies evidence on the methods, frameworks, measurement instruments, domains and indicators used to evaluate health literacy policies, programmes and interventions at all levels. Limited evidence was found on evaluation of national policies and programmes, but local programmes and interventions have been measured using quantitative, qualitative and mixed-methods approaches. Policy considerations include the development of frameworks and indicators covering a range of domains to enable consistent and comparable population monitoring and evaluations to determine the impact and effectiveness of national policies and programmes.

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?

The Health Evidence Network (HEN) is an information service for public health decision-makers in the WHO European Region, in action since 2003 and initiated and coordinated by the WHO Regional Office for Europe under the umbrella of the European Health Information Initiative (a multipartner network coordinating all health information activities in the WHO European Region). HEN supports public health decision-makers to use the best available evidence in their own decision-making and aims to ensure links between evidence, health policies and improvements in public health. The HEN synthesis report series provides summaries of what is known about the policy issue, the gaps in the evidence and the areas of debate. Based on the synthesized evidence, HEN proposes policy options, not recommendations, for further consideration of policy-makers to formulate their own recommendations and policies within their national context.

Development of the Organisational Health Literacy Responsiveness (Org-HLR) self-assessment tool and process.

BACKGROUND: The World Health Organization describes health literacy as a critical determinant of health and driver of citizen empowerment and health equity. Several studies have shown that health literacy is associated with a range of socioeconomic factors including educational attainment, financial position and ethnicity. The complexity of the health system influences how well a person is able to engage with information and services. Health organisations can empower the populations they serve and address inequity by ensuring they are health literacy responsive. The aim of this study was to develop the Organisational Health Literacy Responsiveness self-assessment tool (Org-HLR Tool), and an assessment process to support organisations with application of the tool. METHODS: A co-design workshop with health and social service professionals was undertaken to inform the structure of the tool and assessment process. Participants critiqued existing self-assessment tools and discussed the likely utility of the data they generate. A review of widely used organisational performance assessment tools informed the structure and self-assessment process. The Organisational Health Literacy Responsiveness (Org-HLR) Framework (with seven domains/24 sub-domains) provided the structure for the assessment dimensions of the tool. The performance indicators were drawn from raw data collected during development of the Org-HLR Framework. RESULTS: Twenty-two professionals participated in the workshop. Based on the feedback provided and a review of existing tools, a multi-stage, group-based assessment process for implementing the Org-HLR Tool was developed. The assessment process was divided into three parts; i) reflection; ii) self-rating; and iii) priority setting, each supported by a corresponding tool. The self-rating tool, consistent with the Org-HLR Framework, was divided into: External policy and funding environment; Leadership and culture; Systems, processes and policies; Access to services and programs; Community engagement and partnerships; Communication practices and standards; Workforce. Each of these had 1 to 5 sub-dimensions (24 in total), and 135 performance indicators. CONCLUSIONS: The Org-HLR Tool and assessment process were developed to address a gap in available tools to support organisations to assess their health literacy responsiveness, and prioritise and plan their quality improvement activities. The tool is currently in the field for further utility and acceptability testing.

Progress in Implementing National Policies and Strategies for Health Literacy-What Have We Learned so Far?

Health literacy has been a prominent issue on the agenda of the World Health Organization (WHO) for almost two decades. WHO recently established a strong global mandate for public policy action on health literacy by positioning it as one of three key pillars for achieving sustainable development and health equity in the Shanghai Declaration on Health Promotion. Several countries have national health literacy policies, with many others expected to develop them in the immediate future. It is, therefore, timely to examine current policy approaches to health literacy. The purpose of this study was to analyze a selection of existing policy documents for their strengths, limitations and themes, and offer observations about their potential to improve health literacy and health outcomes. In doing so our intention is to offer lessons and advice from early adopters that will have usefulness for future policy development and implementation. We selected six policies for review; Australia, Austria, China, New Zealand, Scotland, and the United States. We used a set of criteria to guide a systematic analysis of policy documents for their context, intended target audiences, objectives, proposed actions and interventions, evidence of financial investment and intentions to monitor outcomes. We observed a number of common features that provide helpful signposting for future policy development in other countries. All represent a response to perceived deficiencies in the quality of patient communication and patient engagement. Most present health literacy as a universal challenge, with some also identifying groups who are of higher priority. They all recognize the importance of professional education in improving the quality of communication, and most recognize that the health literacy responsiveness of the health system needs to be improved. However, there was significant variability in linking resources to specific strategies and actions, as well as in the systems for monitoring progress and accountability for progress. This variability reflects important contextual differences between countries and health systems. However, this lack of specificity will likely have an impact on the priority given to improving health literacy and on the long-term sustainability of defined actions to improve health literacy in populations.

Development and testing of a framework for analysing health literacy in public policy documents.

Health literacy is a driver of community empowerment and a key determinant of health and equity. The World Health Organisation has established a strong global mandate for addressing health literacy through public policy action, by positioning it as one of three key pillars for achieving sustainable development and health equity in the Shanghai Declaration on Health Promotion. Policy document analysis is a useful way of determining the strengths and limitations of past and current policies, as well as the likely success of their implementation and impact on health outcomes. In this study, we developed a framework for analysing policy documents to assess the extent to which they prioritise and operationalise an emergent public health issue, in this case health literacy. Specifically, the framework enables a systematic exploration of (i) the stated policy goals and strategic objectives; (ii) the stated policy actions; and (iii) whether there is an intention to resource and monitor the stated policy activities. We tested the utility of the framework by applying it to a set of public policies in the Australian context. The framework presented in this study may be a useful tool for systematically analysing policy documents to reveal their strengths and limitations, and the extent to which they prioritise and operationalise health literacy.

What is the evidence on existing policies and linked activities and their effectiveness for improving health literacy at national, regional and organizational levels in the WHO European Region?

Health literacy is gaining increasing attention as a means of promoting health. This evidence synthesis describes health literacy policies in the WHO European Region: their distribution, organizational levels, antecedents, actors, activities and outcomes, along with the factors influencing their effectiveness. Evidence was obtained by a scoping review of academic literature in English, Dutch and German and of grey literature in English, Dutch, German and Italian, supported by a Region-wide expert enquiry. Emerging findings were presented to representatives from 19 Member States of the Region to check for accuracy and omissions. The report highlights much good health literacy policy-related activity, mostly in the health and education sectors, and proposes areas for future development. Policy considerations to facilitate the sharing of good health literacy policy practice, the development of policy aims and activities across all societal areas, and the development of robust health literacy metrics to identify the need for and monitor effectiveness are presented.

Обзор имеющихся фактических данных о реализуемых мерах политики и связанных с ними мероприятиях, а также об их эффективности с точки зрения повышения грамотности в вопросах здоровья на национальном, региональном и организационном уровнях в Европейском регионе ВОЗ

Повышение грамотности в вопросах здоровья привлекает к себе все больше внимания в качестве одного из методов укрепления здоровья. В настоящем сводном докладе рассказывается о мерах политики в области повышения грамотности в вопросах здоровья в Европейском регионе ВОЗ: об их распределении, организационных уровнях, предпосылках, реализующих их субъектах, связанных с ними мероприятиях и итогах их реализации, а также о факторах, влияющих на их эффективность. Фактические данные были получены в ходе предварительного анализа научной литературы на английском, нидерландском и немецком языках и “серой” литературы на английском, нидерландском, немецком и итальянском языках с опорой на результаты общерегиональной экспертизы. Полученные данные были направлены представителям 19 государств-членов в Регионе с целью проверки их точности и наличия возможных упущений. Особое внимание в докладе уделяется масштабной и успешной деятельности в области выработки политики в отношении грамотности в вопросах здоровья, в основном в секторах здравоохранения и образования; в нем также предлагаются направления для дальнейшего развития. В докладе представлены стратегические выводы, призванные содействовать: распространению примеров успешной политики и практики в области повышения грамотности в вопросах здоровья; разработке стратегических целей и мероприятий во всех сферах жизни общества; разработке надежных показателей уровня грамотности в вопросах здоровья с целью определения потребности в реализации соответствующих мер и проведения мониторинга их эффективности.

Welche Erkenntnisse gibt es zu bestehenden Handlungskonzepten und verbundenen Maßnahmen sowie deren Wirksamkeit zur Verbesserung der Gesundheitskompetenz auf Landes-, Regions- und Organisationsebene in der Europäischen Region der WHO?

Gesundheitskompetenz findet als Mittel der Gesundheitsförderung zunehmend Beachtung. Die vorliegende Evidenzaufbereitung beschreibt Handlungskonzepte zur Verbesserung der Gesundheitskompetenz in der Europäischen Region der WHO: ihre Verteilung, Organisationsebenen, Bezugselemente, Akteure, Maßnahmen und Ergebnisse, sowie die Faktoren, die Einfluss auf ihre Wirksamkeit haben. Die Erkenntnisse wurden mittels einer Sondierung wissenschaftlicher Literatur auf Deutsch, Englisch und Niederländisch und grauer Literatur auf Deutsch, Englisch, Italienisch und Niederländisch und einer Expertenerhebung in der gesamten Europäischen Region gewonnen. Die Ergebnisse wurden Vertretern von 19 Mitgliedstaaten der Europäischen Region zur Prüfung auf Genauigkeit und Auslassungen vorgelegt. Der Bericht hebt viele gute Maßnahmen in Zusammenhang mit Gesundheitskompetenz hervor, größtenteils in der Gesundheits- und Bildungspolitik, und schlägt Bereiche für eine künftige Entwicklung vor. Es werden Grundsatzüberlegungen zur Förderung der gemeinsamen Nutzung guter konzeptioneller Praktiken im Bereich der Gesundheitskompetenz, der Entwicklung konzeptioneller Ziele und Maßnahmen über alle sozialen Bereiche hinweg sowie der Entwicklung belastbarer Kennwerte für Gesundheitskompetenz zur Identifizierung des Bedarfs und die Überwachung der Wirksamkeit vorgestellt.

Que sait-on de l’efficacité des politiques existantes et des activités en rapport avec celles-ci, s’agissant d’améliorer l’éducation sanitaire aux niveaux national, régional et organisationnel dans la Région européenne de l’OMS ?

L’instruction en matière de santé suscite une attention croissante comme moyen de promouvoir la santé. Cette synthèse des données probantes décrit les politiques en faveur de l’éducation à la santé dans la Région européenne de l’OMS : répartition, niveaux organisationnels, antécédents, acteurs, activités et résultats, ainsi que les facteurs influençant leur efficacité. Les données probantes ont été obtenues grâce à l’examen de publications du monde universitaire en allemand, anglais et néerlandais, ainsi que de la littérature grise en allemand, anglais, italien et néerlandais, avec l’appui d’une mission d’expertise à l’échelle régionale. Les conclusions qui en ont été tirées ont été présentées aux représentants de 19 États membres de la Région afin d’en vérifier l’exactitude et de déceler les omissions. Ce rapport met en exergue une multitude d’activités en rapport avec les politiques visant une bonne instruction en matière de santé, surtout dans les secteurs de la santé et de l’éducation, et propose des axes de développement futur. On y présente des considérations sur les stratégies à appliquer afin de faciliter la diffusion des bonnes pratiques pour les politiques d’éducation sanitaire, la formulation d’objectifs stratégiques et l’organisation d’activités dans tous les secteurs de la société, ainsi que la mise au point de bons outils de mesure afin de déterminer les besoins sur le plan de l’éducation sanitaire et d’observer le degré d’efficacité en la matière.

Development of the organisational health literacy responsiveness (Org-HLR) framework in collaboration with health and social services professionals.

BACKGROUND: The health literacy skills required by individuals to interact effectively with health services depends on the complexity of those services, and the demands they place on people. Public health and social service organisations have a responsibility to provide services and information in ways that promote equitable access and engagement, that are responsive to diverse needs and preferences, and support people to participate in decisions regarding their health and wellbeing. The aim of this study was to develop a conceptual framework describing the characteristics of health literacy responsive organisations. METHODS: Concept mapping (CM) workshops with six groups of professionals (total N = 42) from across health and social services sectors were undertaken. An online concept mapping consultation with 153 professionals was also conducted. In these CM activities, participants responded to the seeding statement "Thinking broadly from your experiences of working in the health system, what does an organisation need to have or do in order to enable communities and community members to fully engage with information and services to promote and maintain health and wellbeing". The CM data were analysed using multidimensional scaling and hierarchical cluster analyses to derive concept maps and cluster tree diagrams. Clusters from the CM processes were then integrated by identifying themes and subthemes across tree diagrams. RESULTS: Across the workshops, 373 statements were generated in response to the seeding statement. An additional 1206 statements were generated in the online consultation. 84 clusters were derived within the workshops and 20 from the online consultation. Seven domains of health literacy responsiveness were identified; i) External policy and funding environment; ii) Leadership and culture; iii) Systems, processes and policies; iv) Access to services and programs; v) Community engagement and partnerships; vi) Communication practices and standards; and vii) Workforce. Each domain included 1 to 5 sub-domains (24 sub-domains in total). CONCLUSIONS: Using participatory research processes, a conceptual framework describing the characteristics, values, practices and capabilities of organisational health literacy responsiveness was derived. The framework may guide the planning and monitoring of health service and health system improvements, and has the potential to guide effective public health policy and health system reforms.