To measure General health literacy (HL) an adapted 47-item instrument, the HLS₁₉-Q47, and two adapted short forms, the HLS₁₉-Q12 and the HLS₁₉-Q16, were developed based on the HLS-EU instruments, to collect data. New instruments were developed to measure 

• Digital HL (instrument: HLS₁₉-DIGI), 
• Communicative HL with physicians in healthcare (instruments: HLS₁₉-COM-P-Q11 (long form) and HLS₁₉-COM-P-Q6 (short form), 
• Navigational HL (instrument: HLS₁₉-NAV), 
• Vaccination HL (instrument HLS₁₉-VAC)

Additionally, 31 core correlates, and 18 optional correlates were also included in the HLS₁₉ questionnaires. Participating countries had to implement at least the HLS₁₉-Q12 and the 31 core correlates; all other parts were optional.

The HLS₁₉ instruments were developed in English and translated into their national language(s) by 16 out of the 17 countries (Ireland used the original English version), thereby creating a rich spectrum of languages in which the instruments are now available:  Arabic, Bulgarian, Czech, Danish, Dutch, French, German, Hebrew, Hungarian, Italian, Norwegian, Portuguese, Russian, Slovenian, and Slovak. Additionally, some countries translated the instruments into migrant languages. As only the HLS₁₉-Q12 was mandatory to be implemented, not all instruments are available in all of these languages.

A detailed overview of available translations of the different HLS₁₉ instruments can be found HERE 

Interested in using the HLS₁₉ Instruments? 

Agreement for the use of the HLS₁₉ instruments will only be granted, if the following conditions are fulfilled:

1. The applicant is a non-profit academic and public research actor.
2. The planned study is carried out in public interest.
3. The HLS₁₉ Project must be acknowledged in any publication resulting from the use of the HLS₁₉ instrument as ‘The HLS₁₉ instrument used in this research was developed within “HLS₁₉ – the International Health Literacy Population Survey 2019-2021” of M-POHL’.
4. A PDF copy of publications resulting from the use of the HLS₁₉ instrument must be provided to the ICC after publication.
5. Any further translations of the instruments have to be provided to the ICC. The ICC and the HLS₁₉ Consortium can use these translated versions for its further research. For any use of these versions the same rights and rules apply as to the original HLS₁₉ instruments according to point 1 to 4. Furthermore, the new instruments can only be shared with others by a joint agreement with the ICC and the applicant. 

The HLS₁₉ instruments belong to the HLS₁₉ Consortium. Any use of the HLS₁₉ instruments needs contractual agreement between the applicant and the HLS₁₉ Consortium. For granting permission to the English version of the instruments the ICC will evaluate the application and decide on giving permission. For granting permission to translated versions the respective National Study Centre and the ICC both together will evaluate the application and decide on giving permission. The use of the instruments is free of charge.

An application including a contractual agreement with the conditions for using the HLS₁₉ instruments has to be provided. A template for the application and agreement can be found HERE
 

M-POHL Action Network and its projects

Christina Dietscher 
M-POHL policy co-chair
Austrian Federal Ministry of Labour, Social Affairs, Health, Care and Consumer Protection
christina.dietscher@gesundheitsministerium.gv.at

Diane Levin-Zamir 
M-POHL research co-chair
University of Haifa, School of Public Health and Clalit Health Services 
diamos@zahav.net.il 
www.haifa.ac.il and www.clalit.org.il 

Christa Straßmayr
International Coordination Center (ICC) of M-POHL and its projects
Austrian National Public Health Institute (Gesundheit Österreich GmbH)
christa.strassmayr@goeg.at

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Brach, C., Keller, D., Hernandez, L. M., Baur, C., Parker, R., Dreyer, B., Schyve, P., Lemerise, A.J. and Schillinger, D. (2012) 'Ten Attributes of Health Literate Health Care Organizations' Washington DC: Institute of Medicine of the National Académies.

Brach, C. (2017) 'The Journey to Become a Health Literate Organization: A Snapshot of Health System Improvement' Stud Health Technol Inform, 240, pp. 203–237.

DeGani, S., Nowak-Flück, D., Nicca, D. and Vogt D. (2020) 'Self-Assessment Tool to Promote Organizational Health Literacy in Primary Care Settings in Switzerland' International Journal of Environmental Research and Public Health. doi.org/10.3390/ijerph17249497.

Dietscher, C. and Pelikan, J.M. (2017) ‘Health-literate hospitals and healthcare organizations. Results from an Austrian feasibility study on the self-assessment of organizational health literacy in hospitals’ in Schaeffer, D. and Pelikan J.M. (eds.) Health Literacy, Forschungsstand und Perspektiven, Bern: Hogrefe, pp. 303-313.

Farmanova, E., Bonneville, L. and Bouchard, L. (2018) 'Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues' Inquiry, 55. doi:10.1177/0046958018757848.

Henrard, G., Vanmeerbeek, M., Buret, L. and Rademakers, J (2019): Dealing with health literacy at the organisational level, French translation and adaptation of the Vienna health literate organisation self-assessment tool. BMC Health Services Research, 19 (146). doi:10.1186/s12913-019-3955-y.

International Working Group Health Promoting Hospitals and Health Literate Healthcare Organizations (Working Group HPH & HLO) (2019) 'International Self-Assessment Tool Organizational Health Literacy (Responsiveness) for Hospitals - SAT-OHL-Hos-v1.3-EN-international (updated 2023). Vienna: WHO Collaborating Centre for Health Promotion in Hospitals and Healthcare (CC-HPH).

Kickbusch I., Pelikan, J. M., Apfel, F., and Tsouros, A. D. (2013) Health literacy. The solid facts. Copenhagen: WHO Regional Office for Europe.

Pelikan, J.M. (2019) ‘Health-literate healthcare organizations’ in Okan, O., Bauer, U., Levin-Zamir, D. and Sorensen, K. (eds.) International Handbook of Health Literacy – Research, Practice and Policy across the Life-Span. Policy Press, pp. 539-554.

Trezona, A., Dodson, S. and Osborne, R.H. (2017) 'Development of the organisational health literacy responsiveness (Org-HLR) framework in collaboration with health and social services professionals' BMC Health Services Research,18 (694).

Trezona, A., Dodson, S., Fitzsimon, E., LaMontagne, A. D. and Osborne R. H. (2020) 'Field-Testing and Refinement of the Organisational Health Literacy Responsiveness Self-Assessment (Org-HLR) Tool and Process. Int. J. Environ. Res. Public Health 2020, 17 (1000). doi:10.3390/ijerph17031000.

Toolkits, guides and useful information in English

Health Literacy Universal Precautions Toolkit

Implementing the AHRQ Health Literacy Universal Precautions Toolkit: Practical ideas for Primary Care Practices

Organizational Health Literacy Toolkit

HeLLO TAS! Toolkit - Toolkit for Health Literacy Learning Organizations

Patient and family engagement module of the CUSP Toolkit

Building Health Literate Organizations: A guidebook to achieving organizational change

The Gippsland Guide to becoming a Health Literate Organization

Make it easy: a handbook for becoming a Health Literate Organization

NALA Guide on becoming Literacy Friendly Organization

A Checklist for Health Literate Organizations

Health Literacy Online: A guide for simplifying the user experience

Health IT Literacy Guide

The health literacy environment of hospitals and health centers: Making your healthcare facility literacy‐friendly

Making Health Literacy real: The beginnings of my organization’s plan for action

Health Literacy Framework: A guide to action

Health Literacy Review: A guide

“What did the doctor say?:” Improving Health Literacy to protect patient safety

Always Use Teach-back! Toolkit

Toolkits, guides and useful information in German

Praxisleitfaden zur Entwicklung einer gesundheitskompetenten Organisation

Methodenbox: Die gesundheitsbezogene Sozialversicherung

Make it easy: a handbook for becoming a Health Literate Organization

Toolbox - Gesundheitskompetenz im eigenen Bereich umsetzen

Assessment of OHL 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 OHL in primary health care services and pharmacies

A M-POHL 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 2023, first experiences on translating, cultural adapting and piloting of the tool are gained and shared with the OHL consortium.
 

Common study design for the 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: Translation of the OHL assessment tools into national language(s), Phase 3: Cultural adaption of the OHL assessment tools, Phase 4: Piloting of the OHL assessment tools in one or more health care services in each country and Phase 5: International collecting and integrating of national experiences and results in an international report. In addition, a number of documents and supporting tools were developed 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 OHL assessments

Participating countries can participate at specific OHL Consortium meetings for an international exchange on their national experiences on their work on assessing OHL. Currently first experiences on translation, cultural adaption, and piloting are shared. In future, experiences on facilitating the uptake of OHL assessment tools and on implementing OHL by roll out procedures in the countries will be shared.

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.

National reporting

Norway

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Overall aims of M-POHL regarding organizational health literacy

Organizational health literacy (OHL) has different objectives. These are:

• To further develop instruments on measuring OHL and start an international comparative project on measuring OHL in as many as possible member countries of WHO-Europe.
• To contribute to the development of a multi-level, international database on OHL.
• To support and advise WHO-Europe and its member countries on interventions to improve OHL. 

Objectives of the M-POHL OHL project 2023 - 2027

The main aim of the OHL project is:

• to initiate and facilitate the assessment of OHL in health care services by developing, providing, and disseminating OHL assessment tools.

Thereby we aim to support health care organizations

• to engage with the issue of OHL,
• to obtain information about the strengths and weaknesses of OHL in their organization, and
• based on the above, to improve their OHL.

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Jürgen Pelikan

M-POHL co-chair & Principal Investigator of the International Coordination Center (ICC) of HLS₁₉
Austrian Public Health Institute (Gesundheit Österreich GmbH)
juergen.pelikan@goeg.at

Christa Straßmayr

Project Coordination of the International Coordination Center (ICC) of HLS₁₉
Austrian Public Health Institute (Gesundheit Österreich GmbH)
christa.strassmayr@goeg.at

Publications on international HLS₁₉ results 

• Short Summary of the HLS₁₉ International Report 
• Executive Summary of the HLS₁₉ International Report 
• HLS₁₉ International Report on the methodology, results and recommendations
• Factsheets on HLS₁₉ instruments
• Articles on HLS₁₉

Publications on national HLS₁₉ results 

• Austria
• Bulgaria
• Czech Republic
• France
• Germany
• Hungary
• Israel
• Italy
• Norway
• Portugal
• Russian Federation
• Switzerland

Publications on HLS-EU (using international data) 

Pelikan, J. M., Straßmayr, C., & Ganahl, K. (2020). Health Literacy Measurement in General and Other Populations: Further Initiatives and Lessons Learned in Europe (and Beyond). In G. D. Logan & E. R. Siegel (Eds.), Health Literacy in Clinical Practice and Public Health. New Initiatives and Lessons Learned at the Intersection with other Disciplines (pp. 170-191): IOS Press.

Pelikan, J.M., Ganahl, K, Van den Broucke, S. and Sørensen, K (2019). Measuring health literacy in Europe: Introducing the European Health Literacy Survey Questionnaire (HLS-EU-Q), in Okan, O, Bauer, U, Pinheiro, P, Levin-Zamir, D. and Sørensen, K (eds.) International Handbook of Health Literacy, Research, practice and policy across the life-span, Policy Press, pp. 115-138.

Pelikan, J. M.; Ganahl, K.; Roethlin, F. (2018): Health literacy as a determinant, mediator and/or moderator of health: empirical models using the European Health Literacy Survey dataset. In: Global Health Promotion 1757-9759; Vol 0(0): 1–10, DOI: 10.1177/1757975918788300 

Pelikan, J. M.; Ganahl, Kristin (2017): Die europäische Gesundheitskompetenz-Studie: Konzept, Instrument und ausgewählte Ergebnisse. In Doris Schaeffer, Jürgen M. Pelikan (Eds.), Health Literacy Forschungsstand und Perspektiven, pp. 93-126

Pelikan, J. M. and Ganahl, K. (2017). Measuring Health Literacy in General Populations: Primary Findings from the HLS-EU Consortium's Health Literacy Assessment Effort. Studies Health Technology Information, 240, pp. 34-59.

Sørensen K., et al. (2015). Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). The European Journal of Public Health, 25 (6), pp.1053-1058. 

Sørensen, K., et al. (2013). Measuring Health Literacy in Populations: Illuminating the Design and Development Process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health,13 (1), p. 948.

Sørensen, K., et al. (2012). Health Literacy and Public Health: A Systematic Review and Integration of Definitions and Models. BMC Public Health, 12 (1), p. 80.

HLS-EU Consortium (2012). Comparative report of health literacy in eight EU Member States. The European Health Literacy Survey HLS-EU.
    

Video and Infographics on HLS-EU

HLS-EU - Health Literacy – Motiongraphic

HLS-EU - Gesundheitskompetenz (German version)