Tools

• International Self-Assessment Tool for Organizational Health Literacy of Hospitals - short version (OHL-Hos-SF)
  
  The OHL-Hos-SF was developed by the M-POHL Working Group on Developing the OHL-Hos-SF, consisting of experts from 10 countries and involving hospital staff as “users of the tool”. The OHL-Hos-SF  has 8 standards (reflecting the OHL-Hos standards, but with revised wording, 19 sub-standards and 60 indicators (when including sub-indicators 72 items are used). The indicators for each sub-standard operationalize concrete observable or measurable elements.

  A factsheet on the OHL-Hos-SF can be found here. 
   

• International Self-Assessment Tool for Organizational Health Literacy in Primary Health Care Services (OHL-PHC) 
  
  The OHL-PHC was developed by the M-POHL Working Group on Organizational Health Literacy in Primary Health Care Service consisting of experts from 13 countries. The tool builds on the OHL-Hos and the OHL Self-AsseT (De Gani et al. 2020).  It has 7 standards, 19 sub-standards and 51 indicators (when including sub-indicators 70 items are used). The indicators for each sub-standard operationalize concrete observable or measurable elements. The tool is applicable at any type of organization that offers primary care, such as primary care centers, offices of generalist health professionals, ambulatory health care centers, family planning centers and pharmacies. 

  A factsheet on the OHL-PHC can be found here.
   

Both tools are available as word and excel documents. Word versions provide detailed introductions, excel versions enable the automatic creation of result overviews in percentage and as graphs. Supporting tools for summing up results from individual assessment and enable the visualization of results by creating automatic graphs were created.
 

Reporting

Participating countries are encouraged to publish their national results of the OHL project. In the final phase of the project, an International Report will be produced.

 Norway

The following activities are underway:

Assessment of organizational health literacy in hospitals

• The International Self-Assessment Tool for Organizational Health Literacy (Responsiveness) of Hospitals (OHL-Hos), which was developed by the International Working Group on Health Promoting Hospitals and Health Literate Healthcare Organizations (HPH & HLO) will be used in the M-POHL OHL project. In a first step the tool will be translated, cultural adapted, and piloted in the participating M-POHL countries. Building on the piloting results the tool might be slightly modified and is then ready for a larger roll out.
• In addition, a shortened assessment tool for hospitals will be developed based on the OHL-Hos tool as first piloting results showed that for some organizations a less extensive tool would be more acceptable and feasible.

Assessment of organizational health literacy in primary healthcare organizations and pharmacies

• A M-POHL OHL working group has developed the International Self-Assessment Tool for Organizational Health Literacy in Primary Health Care Services (OHL-PHC) from 2022-2023. The OHL-PHC builds on the OHL-Hos and the OHL Self-AsseT (De Gani et al. 2020). 
• Currently in 2024, first experiences on translating, cultural adapting and piloting of the tool are gained and shared with the OHL consortium.

Development, translation, cultural adaption, and piloting of the OHL assessment tools

A study design with five phases was developed by the International Coordination Center (ICC) of M-POHL: 

• Phase 1: Initiation of the international project 
• Phase 2: Development organizational health literacy assessment tools 
• Phase 3: Translation and cultural adaption of the organizational health literacy assessment tools
• Phase 4: Piloting of the organizational health literacy assessment tools in one or more healthcare organizations in each country
• Phase 5: International collecting and integrating of national experiences and results in an international report. 

In addition, several documents and supporting tools were provided to facilitate the process of translation, cultural adaption, and piloting of the tools and the documentation of experiences and results gained in this process.

International exchange on experiences with organizational health literacy assessments

Participating countries can attend M-POHL OHL project consortium meetings for an international exchange on their national experiences on their work on assessing organizational health literacy. Currently first experiences on translation, cultural adaption, and piloting are shared. In future, experiences on facilitating the uptake of organizational health literacy assessment tools and on implementing organizational health literacy by roll out procedures in the countries will be shared.
 

The M-POHL OHL Project 

One of the ways to improve the health literacy responsiveness of healthcare organizations is by integrating the organizational health literacy approach into organizational quality management. Therefore, already in 2022, M-POHL began a project with the aim of facilitating the assessment of organizational health literacy in healthcare organizations. These efforts were prolonged. The timeframe of this project is from 2023-2027. 

Why does M-POHL focus on organizational health literacy in healthcare organizations?

• Improvements in health literacy are essential for successful healthcare, disease prevention, and health promotion.
• It is possible and meaningful to address low health literacy at the organizational level, where navigation support can be provided, communication can be improved through staff training, and people can be supported in making decisions and taking actions related to their health.
• The organizational approach allows for a systematic and sustainable implementation of health literacy measures in healthcare organizations as part of its quality management system.

Factsheet on OHL.

Aims

The main aim of the M-POHL OHL project is:

• to initiate and facilitate the assessment of organizational health literacy in healthcare organizations by developing, providing, and disseminating organizational health literacy assessment tools.

Thereby we aim to support healthcare organizations

• to engage with the issue of organizational health literacy,
• to obtain information about the strengths and weaknesses of organizational health literacy in their organization, and
• to improve their organizational health literacy.

Participants

Currently (in 2024) 17 M-POHL member countries have joined the OHL consortium: Austria, Belgium, Bulgaria, Czech Republic, Denmark, Germany, Israel, Ireland, Italy, Kazakhstan, Netherlands, Norway, Portugal, Serbia, Slovenia, Sweden and Ukraine. 

Coordination

The OHL project is coordinated by an International Coordination Centre (ICC) located at the Austrian National Public Health Institute (Gesundheit Österreich GmbH).

Core team of the International Coordination Centre (ICC) and their roles/responsibilities: 

• Robert Griebler - Scientific Coordinator
• Christa Straßmayr - Project Coordination and Research
• Thomas Link - Statistics and Research
• Denise Schütze - Statistics and Research

Further Information

• Factsheet on OHL

About the HLS₂₄

M-POHL aims to provide empirical data for monitoring health literacy in the WHO European Region, and this is best done by institutionalizing regular, high quality internationally comparative population health literacy surveys. Based on results from HLS₁₉, it was recommended that the health literacy of the adult resident population should be measured periodically in as many countries as possible. Therefore, a next health literacy population survey, the Health Literacy Survey 2024-2026 (HLS₂₄), was initiated with an overall project timeline from 2023 to 2027.

HLS₂₄ will allow countries that have already participated in HLS₁₉ to comparatively monitor their population health literacy, and new countries to initiate measuring adult population health literacy in their county. 

All participating countries will have the opportunity to contribute to the improvement of the HLS₁₉ measures on the specific health literacies - navigational, communicative, digital, and vaccination health literacy - and to the development of new specific instruments on mental and distributive health literacy and relevant covariates, i.e., determinants or consequences or mediators or moderators of health literacy, for the next round of international measurement. 
Participating countries will be support in translating instruments from generic English versions into their national languages, in pretesting these instruments and. in data cleaning. The ICC handles data processing for all countries and analyzes the country data to produce the HLS₂₄ International Report with co-authors from the participating countries. The ICC also supports follow-up articles in peer-reviewed journals. Based on HLS₂₄ data recommendations for policy, practice and research will be provided. 

Participants

Currently (in 2025) 21 M-POHL member countries plan to conduct the HLS₂₄: Austria, Belgium, Bulgaria, Czech Republic, Estonia, France, Germany, Hungary, Iceland, Ireland, Israel, Italy, 
Kazakhstan, Moldova, Netherlands, Norway, Portugal, Slovakia, Slovenia, Switzerland, and Ukraine. 

Coordination

The HLS₂₄ is coordinated by an International Coordination Centre (ICC) located at the Austrian National Public Health Institute (Gesundheit Österreich GmbH).

Core team of the International Coordination Centre (ICC) and their roles/responsibilities: 

• Robert Griebler - Scientific Coordinator
• Christa Straßmayr - Project Coordination and Research
• Thomas Link - Statistics and Research
• Denise Schütze - Statistics and Research

Design & methods

The HLS₂₄ will apply a multi-center cross-sectional study design. The study population is defined as all permanent residents aged 18 and above living in private households in the participating countries. National sample sizes are expected to be at least 1,000 respondents. The participating countries will use a multi-stage random sampling procedure or quota sampling. Data will be collected primarily in face-to-face or web-based interviews, or a combination of these. The timeframe for data collection will be between July 2024 and June 2026. 

The study design includes measuring general health literacy as well as specific types of health literacies should be measured. Besides the four specific health literacies measured in HLS₁₉ (navigational, communicative, digital, and vaccination health literacy), optional packages on mental health literacy and distributed health literacy will be provided. Data will be jointly analysed, and results will be published in national and international reports. 

Further Information 

• Factsheet HLS₂₄.

About the HLS₁₉

The Health Literacy Survey 2019-2021 (HLS₁₉) was M-POHL’s first project. Its aim was to measure population health literacy in as many member countries of the WHO European Region as possible. To plan and carry out this project, a consortium of participating countries was set up to make decisions, and working groups were formed to develop the study design as well as new survey instruments to measure navigational health literacy, communicative health literacy, digital health literacy, vaccination health literacy and the costs and economics of health literacy in addition to general health literacy.

Participants

Partners from M-POHL member countries were eligible to participate in HLS₁₉. They had to participate with a policy and a research representative so that both perspectives could work together in preparing and implementing the survey and using the results to improve population health literacy. To fulfill the research role, a National Study Center (NSC) was contracted to conduct the HLS₁₉ nationally, provide a national report the results, and represent the HLS₁₉ member country at the HLS₁₉ Research Assembly. For the policy role in the HLS₁₉, the national Ministry of Health usually sent a member of its own staff or nominated a representative from another suitable institution to the HLS₁₉ Policy Assembly. 

17 countries in the WHO European Region participated in the HLS₁₉ in the period 2019-2021: Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Ireland, Israel, Italy, Norway, Portugal, Russian Federation, Slovakia, Slovenia, and Switzerland. 

Coordination

The HLS₁₉ was coordinated by an International Coordination Centre (ICC) located at the Austrian National Public Health Institute (Gesundheit Österreich GmbH).

Core team of the International Coordination Centre (ICC) and their roles/responsibilities: 

• Jürgen M. Pelikan – Scientific Coordinator
• Christa Straßmayr - Project Coordination and Research
• Robert Griebler – Research
• Thomas Link – Statistics and Research
• Dominika Mikšová - Statistics and Research
• Peter Nowak – Finance and Contracting

M-POHL is open to all member states of WHO-Europe and enables associated membership for non-WHO European countries which are interested in joining at least one of the M-POHL projects. Observer status is also possible. In the Governance and Work Structure of M-POHL details on becoming a member, associated member and observer are outlined.

Why participate?

M-POHL contributes to the much-needed evidence on health literacy. M-POHL connects expertise from research and policy and fosters evidence-based policy and practice. It puts health literacy on the international and national agenda sustainably. Thus, participation in M-POHL provides a high-level international exchange on up-to-date health literacy developments, data, evidence, and lessons learned to improve research and national policies, as well as participating in framing the international health literacy agenda in close collaboration with WHO and other international bodies. Such agenda-setting for health literacy is needed more than ever since the orientation in the field of health is becoming increasingly challenging due to a number of dynamic trends, including health threats induced by the climate crisis, the chances and challenges of the digital transformation, pandemics like COVID-19, mental health challenges in the context of the current global multi-crisis, and the fast-growing medical and health knowledge and technologies.
Health literacy can help to mitigate the effects of these crises on health on different levels: health literacy guides and empowers individuals to increase their chances for health. Data on population health literacy and on health literate organizations, as well as evidence on effective interventions to improve health literacy, support decision makers in developing national policies on improving health literacy in populations and organizations, including healthcare systems. 
 

In 2023 the policy guide “Health literacy policies – how can they be developed and implemented?” was developed. It is a product of M-POHL, initiated and sponsored by the Swiss Federal Office of Public Health together with WHO/Europe and the Austrian National Public Health Institute.

The policy guide:

• shares insights from currently existing health literacy policies, strategies and action plans as well as expert experiences and opinions that aim to inspire the development of national health literacy policies and actions in Europe and beyond. 
• brings together insights from (1) existing literature on action plans and interventions, including an expert snowballing search within M-POHL and among other partners, (2) experience and good practices collected from the M-POHL members and other countries, and (3) feedback collected in webinars with policy- and decision-makers from M-POHL members and other countries;
• supports policy- and decision-makers as well as public administrators in reflecting, initiating, developing and implementing effective measures to improve health literacy of the population and health literacy friendliness of health organizations and interventions.

The recording of the webinar on Dec 6 with policy- and decision-makers can be found HERE.

The guide “Health literacy policies – how can they be developed and implemented?” can be downloaded HERE.

Survey on national health literacy policies:

The EVPOP Policy Guide follows the logic of the well-known Public Health Action Cycle with five steps:  situation analysis, agenda setting, policy development, policy implementation, evaluation and monitoring. To facilitate countries using the EVPOP Policy Guide, it comes along with a checklist that supports the assessment of each step. To gain insights into where M-POHL member countries stand in relation to their HL policy journey, an exploratory survey was conducted using this checklist amongst M-POHL member countries. The results are summarized in a factsheet.

Videos on national experiences:

We would like to invite countries to contribute to the knowledge transfer by sending a video sharing their national experiences on health literacy policy work and in implementing health interventions.

If you would like to contribute, please follow these steps:

• Record your presentation, e.g. with zoom (max. 15 mins, please see an example from Austria above)
• Send the final video to Angelika Schlacher (angelika.schlacher@goeg.at)
• A title page to your video including the logo of M-POHL, EVPOP, the country’s flag along with the presenter’s name will be added to the video by the ICC.
• The video will be published on https://m-pohl.net/ 

Process of the EVPOP project

Health literacy has become a global priority for health promotion, disease prevention and for the quality and outcomes of healthcare. As health literacy is considered critical to achieving health and limited health literacy is still a widespread phenomenon, the topic is steadily gaining increasing interest among policy- and decision-maker.

To meet the growing demand of decision-makers, a policy guide was launched in 2023 to support policy- and decision-makers and administrators in implementing effective policies and actions to improve population health literacy on a national level. It is a product of M-POHL, initiated by the Swiss Federal Office of Public Health together with WHO/Europe and the Austrian National Public Health Institute (Gesundheit Österreich GmbH).

For the 2024-2027 period, M-POHL’s efforts on evidence-based policies and practices will continue. Countries participating in this project will have the opportunity to present their national experiences in implementing health literacy interventions, to influence priority setting concerning the focus of evidence collecting and mapping on policies and interventions, and to learn from the experiences of the other participating countries. 

Participants

• Currently (in 2024) the EVPOP consortium is established – information on participating countries will follow.  

Coordination

The EVPOP project is coordinated by an International Coordination Centre (ICC) located at the Austrian National Public Health Institute (Gesundheit Österreich GmbH).

Core team of the International Coordination Centre (ICC) and their roles/responsibilities: 

• Robert Griebler - Scientific Coordinator
• Christa Straßmayr - M-POHL Coordination and Research
• Angelika Schlacher - EVPOP Project Coordination and Research
• Thomas Link - Statistics and Research
• Denise Schütze - Statistics and Research
• Fabian Saxinger - Research

National HLS₁₉ reports​

• Health Literacy in Israel – National Report HLS₁₉

Journal publications

Baron-Epel, Orna; Link, Thomas; Griebler, Robert; Bøggild, Henrik; Berens, Eva-Maria; Bíró, Éva; Coy, Deirdre; De Gani, Saskia Maria; Schaeffer, Doris; Sørensen, Kristine; Le, Christopher; Lopatina, Maria; Rowlands, Gillian; Touzani, Rajae; Van den Broucke, Stephan; Vincze, Ferenc; Vrdelja, Mitja; Vrbovsek, Sanja; Levin-Zamir, Diane (2025): Pathways of how health literacy and social support are associated with health outcomes in 17 European countries: Results of mediation analyses. In: Public Health 241/:12-12-18. https://www.sciencedirect.com/science/article/abs/pii/S0033350625000538

Levin-Zamir, Diane; Van den Broucke, Stephan; Bíró, Éva; Bøggild, Henrik; Bruton, Lucy; De Gani, Saskia Maria; Søberg Finbråten, Hanne; Gibney, Sarah; Griebler, Robert; Griese, Lennert; Guttersrud, Øystein; Klocháňová, Zuzana; Kucera, Zdenek; Le, Christopher; Link, Thomas; Mancini, Julien; Miksova, Dominika; Schaeffer, Doris; Ribeiro da Silva, Carlota; Sørensen, Kristine; Straßmayr, Christa; Telo de Arriaga, Miguel; Vrdelja, Mitja; Pelikan, Jürgen (2025): HLS19-DIGI - a new instrument for measuring digital health literacy: development, validation and associations with determinants and health outcomes in 13 countries. In: Frontiers in public health 13.  https://doi.org/10.3389/fpubh.2025.1472706