[Organizational Health Literacy of German Public Health Departments (OHL-PH): Development of a Conceptual Model Employing Expert Interviews]. / Organisationale Gesundheitskompetenz deutscher Gesundheitsämter (OGK-GA): Entwicklung eines theoretischen Modells mit Hilfe von ExpertInneninterviews.

OBJECTIVE: In addition to the users' individual health literacy (HL), the organizational health literacy (OHL) of health care organizations plays an important role as well in assuring the health of the poipulation. In Germany, public health departments are responsible for public health at population level. They should help their users to access, understand and navigate and use information and services in their health-related decisions. This study addresses the question of the best conceptual model of OHL of the German public health departments for the first time. METHODS: In this explorative study, eleven guideline-oriented interviews with experts from public health departments were conducted in three German federal states. Subsequently, the transcripts underwent qualitative content analysis. RESULTS: A new conceptual model consisting of twelve attributes was identified for OHL of public health departments in Germany. These twelve characteristics can be assigned to the aspects "leadership and organizational culture", "employees" and "development and implementation of information and services". CONCLUSIONS: This model for the OHL-PH lays the foundation for future research in this area. It enables the development of a self-assessment tool and therefore the measurement of the level of OHL as well as the identification of barriers. Increasing the OHL of German public health departments by overcoming these obstacles can make a significant contribution to improving public health.

Barriers to Organizational Health Literacy at Public Health Departments in Germany.

BACKGROUND: Strengthening individual health literacy and knowledge about health challenges are important preventive approaches in public health to improve health equality. Health care organizations have come into focus in this regard. They need to raise their organizational health literacy (OHL) to help users to access and navigate information and services. OBJECTIVE: In Germany, public health departments (PHDs) are responsible for public and environmental health at the population level. This study breaks new ground as it is the first to investigate the OHL of these health care organizations. The study attempts to answer what barriers keep them from raising their OHL and how can these be overcome? METHODS: In this explorative study, 10 guideline-oriented interviews with experts from PHDs were conducted in two states in Germany. Qualitative content analysis was used to extract the results from the experts´ statements. KEY RESULTS: Eleven barriers to raising OHL were identified. Obstacles were found in leadership and organizational culture, design and implementation of information, and in human resources. False expectations due to negative preconceptions about public service were identified as a new barrier that had not been elucidated in prior literature. The same applies to lack of cooperation on cross-sectoral topics as well as lack of accessibility. Clear communication of tasks and clear jurisdictional authority are some of the recommendations for lowering these barriers. Other examples include identifying and using synergies and involvement of target groups. CONCLUSIONS: Overcoming these obstacles could improve the OHL of German PHDs. This, in turn, could improve the health of the general population and thus contribute significantly to overall public health. Extrapolating to the whole of Germany and other countries could further strengthen research on OHL. [HLRP: Health Literacy Research and Practice. 2021;5(3):e264-e271.] Plain Language Summary: Public health departments (PHDs) must be able to help their users access, understand, and use health information and services. This competence is called organizational health literacy (OHL). Ten experts from German PHDs were interviewed about barriers to raising OHL. This article reports the barriers identified and recommendations for lowering them, as well as three previously unknown obstacles.

Inverse regulatory coordination of motility and curli-mediated adhesion in Escherichia coli.

During the transition from post-exponential to stationary phase, Escherichia coli changes from the motile-planktonic to the adhesive-sedentary "lifestyle." We demonstrate this transition to be controlled by mutual inhibition of the FlhDC/motility and sigma(S)/adhesion control cascades at two distinct hierarchical levels. At the top level, motility gene expression and the general stress response are inversely coordinated by sigma(70)/sigma(FliA)/sigma(S) competition for core RNA polymerase and the FlhDC-controlled FliZ protein acting as a sigma(S) inhibitor. At a lower level, the signaling molecule bis-(3'-5')-cyclic-diguanosine monophosphate (c-di-GMP) reduces flagellar activity and stimulates transcription of csgD, which encodes an essential activator of adhesive curli fimbriae expression. This c-di-GMP is antagonistically controlled by sigma(S)-regulated GGDEF proteins (mainly YegE) and YhjH, an EAL protein and c-di-GMP phosphodiesterase under FlhDC/FliA control. The switch from motility-based foraging to the general stress response and curli expression requires sigma(S)-modulated down-regulation of expression of the flagellar regulatory cascade as well as proteolysis of the flagellar master regulator FlhDC. Control of YhjH by FlhDC and of YegE by sigma(S) produces a fine-tuned checkpoint system that "unlocks" curli expression only after down-regulation of flagellar gene expression. In summary, these data reveal the logic and sequence of molecular events underlying the motile-to-adhesive "lifestyle" switch in E. coli.