# Co-Creating Organisational Health Literacy: Formative Evaluation and Feasibility Testing of OHL-Act

## TL;DR

This study evaluates and refines a practical approach to improve organizational health literacy in healthcare settings to reduce health disparities.

## Contribution

The study introduces and tests a structured, co-creational workshop approach called OHL-Act to enhance organizational health literacy.

## Key findings

- OHL-Act was found to be feasible and acceptable for supporting organizational reflection on health literacy.
- Refinements included clearer language and structured facilitation guidance to address health literacy challenges.
- Leadership support and participant composition were identified as critical for successful implementation.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Organisational health literacy is critical for reducing health disparities formed and sustained in health systems.Although organisational health literacy is widely promoted as a public health strategy to address health literacy-related inequities, many existing tools lack evaluation; this study evaluates and refines a practical organisational health literacy approach through applications in practice.

Organisational health literacy is critical for reducing health disparities formed and sustained in health systems.

Although organisational health literacy is widely promoted as a public health strategy to address health literacy-related inequities, many existing tools lack evaluation; this study evaluates and refines a practical organisational health literacy approach through applications in practice.

Public health significance—Why is this work of significance to public health?
This study provides insights into how co-creational organisational health literacy approaches can be evaluated and refined in healthcare settings.The findings highlight the feasibility of a structured, bottom-up approach to support organisational reflection and prioritisation of organisational health literacy initiatives.

This study provides insights into how co-creational organisational health literacy approaches can be evaluated and refined in healthcare settings.

The findings highlight the feasibility of a structured, bottom-up approach to support organisational reflection and prioritisation of organisational health literacy initiatives.

Public health implications—What are the key implications or messages for practitioners, policymakers and/or researchers in public health?
This study demonstrates the feasibility of using a structured, co-creational workshop approach to support organisational reflection on health literacy in healthcare settings.The findings emphasise the importance of organisational context, including leadership support and participant composition, when implementing an organisational health literacy approach.

This study demonstrates the feasibility of using a structured, co-creational workshop approach to support organisational reflection on health literacy in healthcare settings.

The findings emphasise the importance of organisational context, including leadership support and participant composition, when implementing an organisational health literacy approach.

Background: Organisational health literacy (OHL) is increasingly recognised as a system-level strategy to address health literacy-related inequities in healthcare, yet evaluation of practical OHL tools and frameworks remain limited. This study aimed to examine the implementation experiences of the Danish OS! to inform refinements, and to examine the feasibility of the refined version, renamed OHL-Act, in practice. Methods: A two-phase study guided by the RE-AIM framework was conducted. Phase 1 comprised a formative evaluation of OS! based on interviews from previous applications, informing refinement. Phase 2 involved feasibility testing of OHL-Act in a specialised diabetes centre. Results: Across implementing organisations, OS! was experienced as a practical approach supporting reflection and the generation of OHL improvement ideas, while also revealing barriers. These insights informed refinements, including clearer language, more structured facilitation guidance, and explicit prompts addressing health literacy challenges and high-risk situations. Feasibility findings indicated that OHL-Act could be delivered as intended and was perceived as acceptable, relevant, and useful in supporting reflection and the generation of OHL improvement ideas. Conclusions: OHL-Act represents a structured, co-creational approach to support OHL work. Further research is needed to examine how generated improvement ideas translate into sustained action and their potential implications for equity.