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Open AccessArticle

Implementation and Long-Term Outcomes of Organisational Health Literacy Interventions in Ireland and The Netherlands: A Longitudinal Mixed-Methods Study

1
Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands
2
Health Promotion Research Centre, National University of Ireland Galway, University Road, H91 TK33 Galway, Ireland
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Population Research Center, Urban and Regional Studies Institute, University of Groningen, Landleven 1, P.O. Box 800, 9700 AV Groningen, The Netherlands
4
Health Impact Gezondheid & Zorg, Blinkertlaan 7, Dishoek, 4371 PV Veere, The Netherlands
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(23), 4812; https://doi.org/10.3390/ijerph16234812
Received: 12 September 2019 / Revised: 14 November 2019 / Accepted: 26 November 2019 / Published: 29 November 2019
Organisational Health Literacy (OHL)-interventions are needed to overcome health inequality. OHL-interventions have successfully identified communication barriers at the organisational level, but evidence is limited on the extent to which this leads to sustainable organisational change. This study aims to assess the implementation fidelity, moderators (barriers and facilitators), and long-term impact of OHL-interventions in hospitals in Ireland and The Netherlands. We used a longitudinal mixed-methods approach to assess two similar OHL-interventions in one Irish and three Dutch hospitals. The OHL-interventions concerned the improvement of navigation and implementation of health literacy-friendly communication throughout organisations. Participants were 24 hospital employees and 40 older adults who use hospital services. At six, eight, and eighteen months, we assessed the level of implementation, barriers and facilitators, and impact through questionnaires and in-depth semi-structured interviews. After older adults and professionals had identified a number of communication problems, we found that professionals had successfully implemented OHL-interventions to promote navigation and comprehensible communication. Limited resources and variation in organisational structures and procedures were perceived as barriers to implementation. The participation of service users, leadership support, and a stepwise implementation of interventions were perceived to facilitate implementation. In the long term, the OHL-interventions led to system-wide improvements, as shown by better embedding of health literacy policies, enhanced patient engagement, provision of plain language training and comprehensible information. Findings were similar for the two countries. Embedded OHL-interventions resulted in sustainable and system-wide health literacy changes in all four hospitals. Following implementation, OHL-interventions have the potential to promote health equity and empowerment among health service users. View Full-Text
Keywords: organisational health literacy; health care organisation; implementation; health equity; communication organisational health literacy; health care organisation; implementation; health equity; communication
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MDPI and ACS Style

Kaper, M.; Sixsmith, J.; Meijering, L.; Vervoordeldonk, J.; Doyle, P.; Barry, M.M.; de Winter, A.F.; Reijneveld, S.A. Implementation and Long-Term Outcomes of Organisational Health Literacy Interventions in Ireland and The Netherlands: A Longitudinal Mixed-Methods Study. Int. J. Environ. Res. Public Health 2019, 16, 4812.

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