How to improve patient-communication? Impact of organisational health literacy in Ireland and the Netherlands
How to improve patient-communication?
Impact of organisational health literacy interventions
in Ireland and the Netherlands
Marise Kaper, MSc
Jane Sixsmith, Louise Meijering, Janine Vervoordeldonk, Priscilla Doyle,
Margaret Barry, Andrea de Winter, Menno Reijneveld
Organisational health literacy interventions
• Organisational Health Literacy Interventions
(OHLIs) assess barriers and plan actions to
improve communication (Brach et al., 2012):
– navigation (complex signage)
– written (leaflets, forms, out patient letters)
– digital (web pages)
– oral (patient – provider interaction)
• Mixed findings on short term period (6 months):
– more awareness and reduction of barriers
– actions can be difficult to implement in
Study aim & framework
We aimed to evaluate the implementation, moderators and outcomes of
two OHLIs in Ireland and the Netherlands over 16 months;
using the framework of Carroll et al. (2007), modified by Hasson et al. (2010).
2. Intervention dose
2. Intervention complexity
3. Facilitation strategies
4. Participant responsiveness
5. Quality of delivery
Health care settings & Participants:
• One Irish hospital setting & three Dutch settings (hospital & rehabilitation)
• Staff (N=24): management, nurses, communications, IT.
• Health service users via adult literacy service
Implementation of two OHLIs:
• IRL: Literacy Audit for Health Care Settings Adult Literacy Toolkit (Lynch, 2009)
• NL: Quickscan Health Literacy Toolbox (Bax, 2014)
Evaluation of implementation by questionnaires and interviews:
1. Planning and assessment - 6 months
2. Action planning - 8 months
3. Long term outcomes - 16 months
Overview of results
• Fidelity to chosen
• Tailoring of OHLI
• Longer duration of
• + HSUs identified unique
• Contextual moderators:
• + Anticipation of staff
• + Commitment of
• - Lack of time/resources
• - Difference in
procedures & structures
Range of Outcomes
• +Awareness of health
literacy and barriers
• + Improved written and
• - Navigation and oral
Moderators enhanced or hindered OHLI implementation:
- Intervention complexity:
“My experience is, is that it is a lot. That it would be nicer if it [the OHLI tools]
were digitally better available". (NL participant 13, interview)
+ Context: anticipation of staff:
“See where you can reinforce each other. A stand-alone project has less chance
of success. It is nice that you link it to, self-management, patient-centeredness,
hospitality. It will give you more opportunities to implement”.
(NL participant 1, follow up)
+ Context: management commitment:
“It’s very good! The general manager, the director of nursing, they are very
committed to this. And like that it’s a patient experience initiative as well”.
(IRL, participant 23, follow up)
1. More awareness of health literacy communication barriers:
• “We said in advance, everyone scrolls, when you go to the website. I saw
this with those low-literate people, nobody scrolls. And then there is a lot
of information underneath”. (NL, participant 6, interview)
2. Structural improved quality of written and digital communication: health
literacy policies, plain language training, improved leaflets, letters and
• “The health literacy policy for the hospital? So that people have a process
to follow when they are developing information leaflets, (but also) any kind
of (patient) information”. (IRL, participant 21, follow up)
Conclusions & implications
• High implementation fidelity of OHLI
• OHLIs can contribute to improved
communication when (contextual) moderators
• Similar findings can promote transfer in EU.
• Choose OHLI components: impact on patients
and relevant for organisation.
• Format: concise, digital, user friendly.
• Implement OHLIs stepwise: enough time,
committee, involve health service users.
Bax, J. (2014). Quickscan Health Literacy Toolbox. Dutch Institute for Healthcare
Improvement (CBO), Utrecht, the Netherlands.
Brach, C., Keller, D., Hernandez, L. M., Baur, C., Parker, R., Schyve, P., Schillinger,
D. (2012). Ten Attributes of Health Literate Health Care Organizations.
Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A
conceptual framework for implementation fidelity. Implementation Science : IS, 2,
Hasson, H. (2010). Systematic evaluation of implementation fidelity of complex
interventions in health and social care. Implementation Science : IS, 5, 67.
Lynch, J. (2009). Literacy Audit for Health Care Settings. Retrieved from