A Scoping Review on How to Make Hospitals Health Literate Healthcare Organizations

The concept of health literacy is increasingly being recognised as not just an individual trait, but also as a characteristic related to families, communities, and organisations providing health and social services. The aim of this study is to identify and describe, through a scoping review approach, the characteristics and the interventions that make a hospital a health literate health care organisation (HLHO), in order to develop an integrated conceptual model. We followed Arksey and O’Malley’s five-stage scoping review framework, refined with the Joanna Briggs Institute methodology, to identify the research questions, identify relevant studies, select studies, chart the data, and collate and summarize the data. Of the 1532 titles and abstracts screened, 106 were included. Few studies have explored the effect of environmental support on health professionals, and few outcomes related to staff satisfaction/perception of helpfulness have been reported. The most common types of interventions and outcomes were related to the patients. The logical framework developed can be an effective tool to define and understand priorities and related consequences, thereby helping researchers and policymakers to have a wider vision and a more homogeneous approach to health literacy and its use and promotion in healthcare organizations.

Hospital patients with low health literacy found the system easy to use, reported high levels of satisfaction, and most said they preferred receiving the discharge information from the agent over their doctor or nurse. Patients also expressed appreciation for the time and attention provided by the virtual nurse, and felt that it provided an additional authoritative source for their medical information. The evaluation did not demonstrate the tool to have any effect on selfreported medication adherence, patients who received the schedule self-reported their medication adherence more accurately, perhaps indicating improved understanding of their medication regimen and awareness of non-adherence The revised teaching program (text and pictures) and use of a handheld mirror improved patient confidence in self-assessing an incision and increased ease in detecting an SSI. To examine an individual educational intervention on knowledge of heart attack warning signs and specific chest pain action plans for people with coronary heart disease.

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A brief education session using a single standardised tool and adapted to a patient assessment is effective in improving knowledge of potential AMI symptoms and appropriate responses in cardiac rehabilitation up to two months following. There was a significant improvement in follow-up adherence in the postintervention group compared to the preintervention group (P = .02).
Readmissions were similar in each group (P = .17). Treatment failure was the most common reason for readmission in both groups To examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge.

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The use of electronically available templated discharge instructions was associated with better readability than the use of cliniciangenerated discharge instructions. Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion The provision of an EMP improves information transfer and therefore increases the patients' knowledge of their individual drug treatment without prolonging the overall discharge process. There were no significant differences in medication selfefficacy or adherence between the intervention and control groups at three, six and 12 months postbaseline. This pilot project confirmed the benefit and cultural acceptability of this educational tool, and further refinement will explore how to better communicate the risks and benefits of non-standard donors. Through sequential interventions over 6 months, the percentage of discharge instructions written at 7th grade or lower readability level increased from 13% to 98% and has been sustained for 4 months. The reliable use of the EHR templates was associated with our largest improvements.
Improving the Readability of Pediatric Hospital Medicine Discharge Instructions . percentage of discharge instructions written at 7th grade or lower readability multifaceted:1) education and implementation of a general discharge instruction template in the electronic health record (EHR); 2) visible reminders and tips for writing readable discharge instructions; 3) implementation of disease-specific discharge instruction templates in the EHR; and 4) individualized feedback to staff on readability and content of their written discharge instructions. To determine whether parents who use a low literacy, pictogram-and photograph-based written asthma action plan have a better understanding of child asthma management compared to parents using a standard plan.

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Use of a low literacy written asthma action plan was associated with better parent understanding of asthma management The study protocol was abandoned prematurely due to clear lack of feasibility. Of 12 participants, 4 withdrew and none completed pulmonary rehabilitation (PR). The main reasons for non-participation or study withdrawal related to reluctance to attend PR (6 of 16) and the burden of increased appointments (4 of 16). Of the patients who initially declined the opportunity to complete an advance directive (n = 213), 33.8% (n = 72) said they did not understand the question when initially asked and therefore just said no. The HCAHPS scores improved during the trial period, which indicated that implementing this protocol had positive implications for patient satisfaction.
Engage (2) The purpose of this pilot study is to examine the usefulness and feasibility of providing focused antenatal care (FANC) in a group setting using a manualized intervention to improve patientprovider communication, patient engagement, and improve health literacy.

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Quantitative survey results indicate that midwives believe they are doing a good job communicating with and engaging antenatal patients regardless of whether care is provided individually or in a group format. However, focus group data provide a more comprehensive assessment of maternal health literacy and antenatal care. This study identified fifteen strategies to address health literacy needs of a hospital population. Implementation and evaluation will identify sets of strategies that have the maximum patient, clinician and organisational benefit.
Using co-design to develop interventions to address health literacy needs in a hospitalised population . key themes identified . interventions produced .
Step 1: hospitalised patients surveyed and data analysed using hierarchical cluster analysis to establish health literacy profiles .
Step 2  Multiple discrete design features that improved comprehension in one or a few studies (e.g., presenting essential information by itself or first, presenting information so that the higher number is better, adding icon arrays to numerical information, adding video to verbal narratives). In a few studies, we also found consistent, direct, fair or goodquality evidence that intensive selfmanagement interventions reduced emergency department visits and hospitalizations; and intensive self-and disease-management interventions reduced disease severity. Evidence for the effects of interventions on other outcomes was either limited or mixed. 30 8 Multimedia appears to be a promising medium for patient education; however, the majority of studies found that print and multimedia performed equally well in practice. Few studies involved patients in material development, and less than half assessed the readability of materials