The Influence of Dr. Rima Rudd's Organizational Health Literacy Scholarship in Maryland.

BACKGROUND: This article analyzes and reflects on Dr. Rima Rudd's organizational health literacy ideas and tools and their influence on the field generally and on four projects over 12 years in Maryland specifically. OBJECTIVE: We present four organizational health literacy projects - two from oral health and two from COVID-19 vaccination - that used or were influenced by Dr. Rudd's the Health Literacy Environment of Hospitals and Health Centers. METHODS: In the oral health projects, we describe the organizational assessments we conducted, the assessment results, and the actions organizations took in response. In a Frederick, Maryland, COVID-19 project, we worked with multiple organizations in a single city to train them in the organizational assessment process, and we report the activities and results of this training. In the Baltimore, Maryland COVID-19 project, we provided general information about organizational health literacy and trained key health professionals in local organizations. KEY RESULTS: Our results confirm that Dr. Rudd's tools work mainly as intended because they help organizations or third-party evaluators identify health literacy barriers and create health literacy insights. Also, we observed that organizational health literacy tools can support organizations' interest in equity goals and increase their willingness to spend time on health literacy projects. CONCLUSIONS: Translating knowledge and skills to actions can require more time than organizations can commit or be more difficult than they can handle. In our projects, the four most positive examples were driven by a collaboration between our team and a change champion who had the power to institute new ideas and actions. While it can take time and money to gain traction, our Maryland work shows that organizational assessments are accessible, practical and tangible. We conclude that Dr. Rudd's influence extends beyond specific tools and is reflected in the field's acceptance of organizational and professional responsibility for health literacy as an equity and justice issue. [HLRP: Health Literacy Research and Practice. 2024;8(3):e151-e158.].

PLAIN LANGUAGE SUMMARY: This article discusses Dr. Rudd's original and foundational contributions to organizational health literacy and the influence her tools and methods have had on 4 projects over 12 years in Maryland. We describe implementations and results for organizational health literacy assessments and training activities and conclude with lessons learned about organizational health literacy approaches and Dr. Rudd's impact on the field.

Using the Ecological Systems Theory to Understand Black/White Disparities in Maternal Morbidity and Mortality in the United States.

Maternal morbidity and mortality (MMM) is a significant problem in the USA, with about 700 maternal deaths every year and an estimated 50,000 "near misses." Disparities in MMM by race are marked; black women are disproportionately affected. We use Urie Bronfenbrenner's ecological systems theory to examine the root causes of racial disparities in MMM at the individual (microsystem), interpersonal (mesosystem), community (exosystem), and societal (macrosystem) levels of influence. This review discusses the interaction of these levels of influence on racial disparities related to MMM-covering preconception health, access to prenatal care, implicit bias among health care providers and its possible influence on obstetric care, "maternity care deserts," and the need for quality improvement among black-serving hospitals. Relevant policies-parental leave, Medicaid coverage during pregnancy, and Medicaid expansion-are considered. We also apply the ecological systems theory to identify interventions that would most likely reduce disparities in MMM by race, such as revising the educational curricula of health care professionals, enhancing utilization of alternate prenatal care providers, and reforming Medicaid policies.