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communication, health literacy



  1. Howe, Carol J. PhD, RN, DCES, FAAN
  2. Adame, Tracine BSN, RN
  3. Lewis, Brennan DNP, RN
  4. Wagner, Teresa DrPH, CPH, RDN/LD, CHWI


Overview: In 2012, the Institute of Medicine Roundtable on Health Literacy established 10 attributes of a health literate health care organization that, if instated, would improve health information and empower patients to make more informed health decisions. Few studies have assessed how well organizations meet these attributes.


Purpose: This study sought to describe the extent to which health care systems in North Texas were adopting policies and practices that address the 10 attributes of a health literate health care organization. More specifically, we sought to describe key organizational leaders' and clinicians' perceptions in this regard.


Study design and methods: This was a mixed-methods study, conducted with a convenience sample of 74 key informants from 13 hospitals across five health care systems. Informants provided demographic data, and their perceptions of the extent to which their hospital met the 10 attributes were measured via the Health Literate Health Care Organization 10-item questionnaire (HLHO-10) and semistructured interviews.


Results: Mean scores for HLHO-10 items ranged from 3.74 to 5.39, with 7 as a maximum score. Qualitative data provided richer content, elaborating on the survey results. Workforce training in health literacy, patient inclusion in health information development and evaluation, and communication about health care costs were rated the lowest and were described as issues of concern.


Conclusion: Study findings indicated limited leadership and little systemic promotion of efforts to ensure health literate health care organizations, although individual health literacy champions sometimes stepped up with creative initiatives.