Organizational Health Literacy as a Tool for Health Equity: Application in a High-Risk Infant Follow-Up Program

Abstract

Background: Healthy People 2030 emphasizes personal health literacy (individual skills) and organizational health literacy-the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. However, research on the latter is in the early stages.

Methods: This study describes an organizational health literacy assessment in a U.S. urban academic children's hospital. A variety of evidence-based health literacy assessments were used to assess patient information materials and the environment, including institutional practices, navigation, culture and language, and communication. Trained interviewers and analysts reached consensus for all assessments.

Results: Information Items: SMOG scores (n = 9) ranged from 7th- to 14th-grade reading level (average = 11.3). PEMAT-P scores (n = 9) ranged from 43.8% to 93.8% understandability and 0% to 80% actionability. CDC CCI scores (literacy demand) (n = 6) ranged from 18.2% to 58.8% (≥90% = excellent). SAM scores (suitability) (n = 6) fell in the "adequate" range (43.2-58.3%). The PMOSE/IKIRSCH scores (complexity) (n = 3) noted low-moderate difficulty. Apter's Hierarchy (n = 4) revealed three numeracy domains (50% = descriptive purposes and decision-making, 100% = interpreting information). Organization-level: Walking interviews highlighted organizational facilitators and barriers related to the pre-visit and visit environments. HLE2 domain scores ranged from 52% to 68%.

Conclusions: Organizational health literacy demands far outweigh the average literacy skills of adults in the U.S. (patients and staff). Findings can be used to hone quality improvement and other processes to focus on structural solutions to increase health equity.

Keywords: Healthy People 2030; NICU; assessment; early childhood development; follow-up care; follow-up clinic; health equity; health literacy; high-risk infants; organizational health literacy; prematurity.

Figure 2

Five steps for incorporating organizational health literacy practice into your work.

Figure 1

(A): Pre-Visit Environment. Major Themes: noted in ≥50% of assessments (≥2/4). Italicized text indicates specific examples addressed by 2 or more observers within a theme. (B) Visit Environment. Major Themes: noted in ≥50% of assessments (≥2/4). Italicized text indicates specific examples addressed by 2 or more observers within a theme. (old) = comment pertaining to prior clinic location. (new) = comment pertaining to new clinic location. (both) = comment pertaining to both clinic locations.

Figure 1

(A): Pre-Visit Environment. Major Themes: noted in ≥50% of assessments (≥2/4). Italicized text indicates specific examples addressed by 2 or more observers within a theme. (B) Visit Environment. Major Themes: noted in ≥50% of assessments (≥2/4). Italicized text indicates specific examples addressed by 2 or more observers within a theme. (old) = comment pertaining to prior clinic location. (new) = comment pertaining to new clinic location. (both) = comment pertaining to both clinic locations.