Health literacy, governance and systems leadership contribute to the implementation of the One Health approach: a virtuous circle.

One Health is an important approach to addressing health threats and promoting health through interdisciplinary health, policy, legislation and leadership research to achieve better human and animal health and better outcomes for the planet. The Covid-19 pandemic has triggered an urgent awareness of the need to develop innovative integrative solutions to address root causes of such threats to health, which requires collaboration across disciplines and amongst different sectors and communities. We explore how achieving the Quadripartite Organizations' One Health Joint Plan of Action can be supported by the concepts of 'One Health literacy' and 'One Health governance' and promote both academic and policy dialogue. We show how One Health literacy and One Health governance influence and reinforce each other, while an interdisciplinary systems leadership approach acts as a catalyst and mechanism for understanding and enacting change. Based on our understanding of how these elements influence the implementation of the One Health approach, we describe a model for considering how external triggering events such as the Covid-19 pandemic may prompt a virtuous circle whereby exposure to and exploration of One Health issues may lead to improved One Health literacy and to better governance. We close with recommendations to international organisations, national governments and to leaders in policy, research and practice to enhance their influence on society, the planetary environment, health and well-being.

Patients' Perspectives on the Use of a Newly Developed "Patients' Guide for Doctor's Visit": DocVISITguide.

During doctor's visits, fundamental decisions regarding a patient's diagnosis and therapy are taken. However, consultations often take place within a limited time frame and are characterized by an asymmetric interaction. Therefore, patients' questions can remain unanswered and concerns unspoken. A "Patients' Guide for Doctor's Visit" (DocVISITguide) was developed to prepare patients for their visits, supporting them to take an active role in the communication and leave the consultation well-informed. This paper describes the development of the DocVISITguide and its first small-scale evaluation based on a sequential explanatory mixed methods design from the patients' perspective. For this purpose, a small sample of patients completed a pre- and post-questionnaire, and two in-depth interviews were conducted. Most participants found the DocVISITguide easy to understand. The guide helped them to take a closer look at their own health situation and be better prepared for the visit. More than three-quarters (82%) of the participants would probably use the guide again, and all (100%) would recommend it to family and friends. However, some patients felt unsure about using the guide within the consultation and showing it to their physician. To counteract this uncertainty, physicians should be actively involved in the use of such guides in the future.

Adolescents' self-reported health status, behaviours and health issues addressed during routine school doctor consultations in Switzerland: an observational study.

BACKGROUND: We aimed to investigate the self-reported health status and behaviours of 7th-grade adolescents, associations with gender and educational track, as well as health issues addressed during routine school doctor consultations in Switzerland. METHODS: Data on health status and behaviours, specifically general well-being, stimulant and addictive substance use, bullying/violence, exercise, nutrition and health protection, and puberty/sexuality, were drawn from routinely collected self-assessment questionnaires from 1076 (of a total of 1126) students from 14 schools in the Swiss canton of Zug in 2020. Data on health issues addressed in school doctor consultations were collected by nine school doctors (for 595 individual consultations). Multilevel logistic regression analyses were used to investigate the association of gender and educational track with unfavourable health status or behaviours. RESULTS: Although 92% (n = 989) of the students reported being happy or satisfied overall, 21% (n = 215) often or almost always felt sad, and 5-10% had repeatedly been seriously physically hurt (n = 67), sexually harassed with words (n = 88) or experienced uncomfortable physical contact (n = 60). Female gender and a lower educational track were associated with unfavourable health status. In 90% (n = 533) of the school doctor consultations, at least one topic of disease prevention or health promotion was addressed, whereby the topics addressed depended strongly on the individual school doctors. CONCLUSIONS: Our findings revealed that unfavourable health status and behaviours were prevalent among adolescents but the health topics addressed in school doctor consultations were not tailored to students' self-reported health issues. A school-based approach that strengthens adolescents' health literacy and provides opportunities for patient-centred counselling has the potential to improve the current and future health of adolescents and, ultimately, adults. To realise this potential, it is essential for school doctors to be sensitised and trained to address students' health concerns. Emphasis should be placed on the importance of patient-centred counselling, the high prevalence of bullying, and gender and educational differences.

Health Professionals' Experience with the First Implementation of the Organizational Health Literacy Self-Assessment Tool for Primary Care (OHL Self-AsseT)-A Qualitative Reflexive Thematic Analysis.

Organizational health literacy (OHL) is crucial for public health, in turn health care organizations play vital roles in improving populations' health literacy. Therefore, the aim of this qualitative study was to explore how the organizational health literacy self-assessment tool (OHL Self-AsseT) was implemented, used, and understood by primary care teams from a network of general practices and a Home Care Service Organization in Zurich, Switzerland. Reflexive thematic analysis with a constructivist orientation was used to analyze data from 19 interviews pre- and post-OHL Self-AsseT use. Normalization Process Theory supported structuring of inductively developed themes. Findings show that the participants experienced working with the OHL Self-AsseT meaningful, as it helped with "Addressing OHL construction sites" so that they could "build momentum for change". The experience of "Succeeding together in construction" led to a "feeling of team-efficacy during change". Practical use of the tool and/or discussions about OHL led to a growing conceptual understanding, which was described as "Using a construction plan-making sense of ongoing OHL activities". To conclude, the OHL Self-AsseT encouraged teams to initiate change, led to greater team-efficacy and supported the construction of OHL. Improved implementation strategies will support this intervention's scale-up as a base for effectiveness testing.

How Do Primary Care Organizations Rate Their Level of Organizational Health Literacy? Results of a Swiss Pilot-Study.

Primary care organizations offer a suitable setting to promote organizational health literacy (OHL) since they are a crucial interface for patients and clients. However, a clear picture on the OHL situation in primary care is lacking. The aim of this study was to assess OHL in Swiss primary care organizations by evaluating (i) how they rate their level of OHL and which improvement measures they accordingly plan (organizational level), (ii) what knowledge and attitudes among health professionals in primary care regarding OHL exist (individual level) and (iii) how teams working in general practitioners' practices and a home care service organization differ regarding OHL (organizational and individual level). The research design included an online survey (N = 74, health professionals) on the individual level and a checklist and intervention documentation (N = 10, primary care teams) on the organizational level. The study reveals a crucial demand regarding organizationally embedded OHL practices in the participating primary care teams, despite a rather comprehensive understanding of the concept. The greatest need for action was identified in strengthening health literacy of staff members, which underlines the necessity to develop interventions to systematically strengthen the health literacy of health professionals.

Relation of corona-specific health literacy to use of and trust in information sources during the COVID-19 pandemic.

BACKGROUND: COVID-19 has developed into a worldwide pandemic which was accompanied by an «infodemic¼ consisting of much false and misleading information. To cope with these new challenges, health literacy plays an essential role. The aim of this paper is to present the findings of a trend study in Switzerland on corona-specific health literacy, the use of and trust in information sources during the COVID-19 pandemic, and their relationships. METHODS: Three online surveys each with approximately 1'020 individuals living in the German-speaking part of Switzerland (age ≥ 18 years) were conducted at different timepoints during the COVID-19 pandemic, namely spring, fall and winter 2020. For the assessment of corona-specific health literacy, a specifically developed instrument (HLS-COVID-Q22) was used. Descriptive, bivariate, and multivariate data analyses have been conducted. RESULTS: In general, a majority of the Swiss-German population reported sufficient corona-specific health literacy levels which increased during the pandemic: 54.6% participants in spring, 62.4% in fall and 63.3% in winter 2020 had sufficient corona-specific health literacy. Greatest difficulties concerned the appraisal of health information on the coronavirus. The most used information sources were television (used by 73.3% in spring, 70% in fall and 72.3% in winter) and the internet (used by 64.1, 64.8 and 66.5%). Although health professionals, health authorities and the info-hotline were rarely mentioned as sources for information on the coronavirus, respondents had greatest trust in them. On the other hand, social media were considered as the least trustworthy information sources. Respondents generally reporting more trust in the various information sources, tended to have higher corona-specific health literacy levels. CONCLUSIONS: Sufficient health literacy is an essential prerequisite for finding, understanding, appraising, and applying health recommendations, particularly in a situation where there is a rapid spread of a huge amount of information. The population should be supported in their capability in appraising the received information and in assessing the trustworthiness of different information sources.

Health Literacy in the Canton of Zurich: First Results of a Representative Study.

Managing health information and services is difficult for nearly half of the population in Switzerland. Low health literacy has been shown to result in poorer health and health outcomes as well as a higher utilization of health services. To date, studies on health literacy in Switzerland have focused on a national level. However, Switzerland is a federal state with 26 cantons and a strongly decentralized health system. Therefore, the aim of this study is to understand how health literacy is distributed within the population of the canton of Zurich specifically, and to develop methods to determine whether an individual has a higher or lower level of health literacy. There were a total of 1000 participants in this representative study. Data was collected by an adapted version of the HLS-EU-Q47 and additional sociodemographic questions. The majority (56%) of the reported difficulties concerned accessing, understanding, appraising, and applying health information. The findings confirm that health literacy follows a social gradient, whereby financially deprived individuals and those with a low educational level report lower health literacy. The need for action to strengthen the health literacy of these population groups is therefore urgent. Interventions should pay particular attention to these vulnerable groups and tailor resolutions to their needs and preferences.

Mental Health Literacy in Zurich: A First Measurement Attempt Using the General HLS-EU-Q47.

Background: Mental health literacy (MHL) promises to be an important factor for public health by enabling people to take responsibility for their own mental health. To date, there is no measurement tool that allows the assessment of a comprehensive understanding of MHL as part of health literacy (HL). Nonetheless, the widely used Health Literacy Survey European Questionnaire 47 (HLS-EU-Q47) includes items assessing at least some MHL-aspects in the context of HL. The present study aimed at investigating how these MHL-aspects are related to HL, health behavior and health outcome and how they differ between sociodemographic groups. Methods: Data from the Health Literacy Survey Zurich 2018, collected by an adapted version of the HLS-EU-Q47, served to investigate these relationships. Results: MHL-aspects were related to HL, health behavior and health outcome. Nearly half of all respondents (45%; N = 904) showed low MHL levels, particularly those with higher age and higher financial deprivation. Conclusions: Relations of MHL-aspects with HL, health behavior, and health outcome indicate their potential importance for future interventions in public health, addressing mental health and MHL. A specific MHL tool is needed to comprehensively investigate these relations, which could be developed by extending the present measurement approach.

Self-Assessment Tool to Promote Organizational Health Literacy in Primary Care Settings in Switzerland.

Dealing with health information and taking care of one's own health are key aspects of health literacy and a difficulty for nearly half of the population in Europe. Limited health literacy often results in poorer health outcomes. Health literacy is a fundamental health determinant, and its improvement provides great potential for addressing public health challenges. Health care organizations play an important role in improving population's health literacy. Health literate health care organizations facilitate access, understanding and use of health information and decrease the demands and complexities of the health care system. Few efforts have been taken so far to promote organizational health literacy, especially in German-speaking countries. This project aimed at developing a self-assessment tool, which enables primary care organizations to assess and improve their level of health literacy. The self-assessment tool was developed and evaluated with general practitioners and community care organizations in Switzerland. Here the participative development process, outcomes and the three modules of the self-assessment tool are presented: (1) manual with detailed introduction and instruction, (2) checklist for self-assessment of organizational health literacy and (3) handbook with measures for improvement. The aim of this tool is that organizations are able to identify the need for action, plan and implement improvement measures.