Defining, assessing, and implementing organizational health literacy: barriers, facilitators, and tools – a systematic review

Background: Organizational health literacy (OHL) is increasingly recognized as a fundamental aspect of high-quality healthcare delivery, focusing on organizations' roles in enabling patients to access, understand, and use health information effectively. This systematic review synthesizes current research on OHL, focusing on its definitions, assessment tools, implemented practices, outcomes, and the factors influencing successful OHL integration within healthcare settings. Methods: Guided by PRISMA and following a predefined registered protocol (PROSPERO 2024:CRD42024537425), this systematic review analyzed studies from six key databases, using targeted keywords associated with OHL. Eligibility criteria isolated research on OHL tools, practices, and outcomes in healthcare settings. Independent reviewers conducted study selection, data extraction, and bias risk analysis. Systematic quality assessment and data extraction were performed to thoroughly evaluate OHL's impact on healthcare. Results: This systematic review identified 62 articles, published between 2010 and 2024, from 15 different countries. A notable share (30.6%) aimed to develop, validate, and pilot context-sensitive OHL assessment tools. Other studies included qualitative (24.1%), descriptive (14.6%), case studies (11.29%), cross-sectional (8.06%), mixed methods (8.06%), and quantitative (3.25%) approaches, investigating factors promoting and impeding OHL outcomes. The results highlight a 54.1% increase in studies during the COVID-19 pandemic compared to the pre-pandemic period. Conclusion: OHL is instrumental in advancing healthcare systems towards greater accessibility and patient-centeredness. Nevertheless, overcoming the identified implementation barriers is crucial for realizing OHL's full potential in enhancing healthcare equity and efficiency. Strategic efforts are needed to foster organizational support, adapt structural practices, and allocate necessary resources for OHL initiatives to enhance healthcare.