[Professional health literacy among nurses in Germany: Results of a quantitative, cross-sectional survey]. / Professionelle Gesundheitskompetenz bei Pflegenden in Deutschland.

Professional health literacy among nurses in Germany: Results of a quantitative, cross-sectional survey Abstract. Background: Little is known about the professional health literacy (HL) of nurses, i.e., how well they are able to promote patients' HL. Existing studies have focused on personal HL, which does not entirely align with professional HL. Therefore, a new concept and questionnaire for professional HL have been developed and implemented for the first time. The results obtained for nurses in Germany are analysed with this article. Research question: It is asked how professional health literacy (HL) is distributed among nurses and which factors are associated with it. Methods: Data were collected through an online survey where nurses were asked about the difficulties they encounter in managing tasks in four dimensions: (1) information and knowledge management, (2) explaining and conveying information, (3) patient-centered communication, and (4) professional digital health literacy. Descriptive and multivariate, linear regression methods were used for analysis. Results: The 624 respondents rated the fourth dimension as the most difficult. The first and second dimensions were rated as similarly difficult, while the third dimension was considered least difficult. Higher professional HL is linked to better self-assessed training and framework conditions. Conclusion: Despite a relatively positive self-assessment, the results indicate areas that require improvement and should be addressed urgently.

[Citizen-centred health care in Germany: An analysis of expert interviews]. / Bürgerzentrierte Gesundheitsversorgung in Deutschland ­ eine Analyse von ExpertInneninterviews.

BACKGROUND: Citizens can represent a relevant key resource in health care, for example by actively practicing preventive health care and managing their own health care needs. In Germany, the role of citizens in the health care system has not yet been defined. Therefore, the aim of this study is, as a first step, to determine what is meant by "citizen-centred healthcare", since there is, as yet, no clear definition. METHODS: Between September and November 2022, semi-structured expert interviews were conducted with representatives from the fields of politics and self-administration and service providers and, with their consent, recorded and transcribed. A category system was developed inductively and deductively based on Mayring's content analysis. Using this, two members of the project team coded the interviews independently of each other using the QCAmap software. After a replication check of the deviations, the content could then be analyzed. RESULTS: A total of n = 10 interviews were conducted (n = 3 service providers, n = 2 self-administration, n = 5 politicians). The analysis revealed two different understandings of citizen-centred healthcare. Some of the experts understand citizen-centred healthcare as care that is provided close to home and easily accessible for citizens. The others interpret the term as care where citizens take on an active role. All interviewees saw the lack of health literacy among citizens as a key challenge. The social imbalance, which creates an inequality of opportunity in the involvement of citizens, was also mentioned several times. Opportunities were generally understood as the possibility of conserving resources and maintaining health. The analysis shows that there is still a lack of solutions that specifically address these challenges as well as the implementation of citizen-centred health care. DISCUSSION: The expert interviews demonstrate that there are two fundamentally different understandings of citizen-centred healthcare and how it should be established in Germany. Future research should therefore pursue the goal of developing a definition of "citizen-centred health care" by expert consensus. This can then form the basis for concrete, future goals for action. There was consensus among the experts regarding the problems that need to be considered in this context. Factors such as citizens' lack of health literacy and social imbalance should therefore be given more attention in the future.

Health information for hard-to-reach target groups: A qualitative needs assessment.

INTRODUCTION: Reaching socially disadvantaged families and older people with health information can be challenging. A needs assessment was conducted to learn more about their health-related needs and preferences and derive recommendations for health information. METHODS: Focus groups were conducted with socially disadvantaged families, older people and suitable disseminators, like counsellors from various types of counselling centres or welfare facilities (81 participants), and analysed using content analysis. RESULTS: Socially disadvantaged and hard-to-reach people want to understand health problems, become active in dealing with them themselves, and be involved in medical decision-making. Health information should consider the challenging everyday lives, the limited time available and the short attention span of socially disadvantaged families. There is a preference for short texts and videos. Older people may favour more comprehensive print products for complex topics. Matching photos and illustrations are vital to attract attention. Health information is preferably received via personal contact. Furthermore, online services and social media channels are popular. DISCUSSION: Some recommendations can be helpful for all target groups of health information, like more illustrations. Others are more specific to the groups investigated and require conceptual groundwork and greater resources, for example, a specific service for disseminators. CONCLUSION: Hard-to-reach target groups want to understand their health issues, and be proactive and involved in decision-making. Personal contact is of utmost importance. Disseminators play a crucial role and need information they can customize for their clients.

[Care counselling - Lessons learnt from an expert survey on the supply situation in the district of Lörrach]. / Pflegeberatung ­ Lessons learnt aus einer Expert*innenbefragung zur Versorgungssituation im Landkreis Lörrach.

BACKGROUND: There is a broad spectrum of care counselling offers. Various professional groups, each with different qualifications and objectives, carry out the counselling, and the accessibility and the service offers of the counselling centres vary greatly. The aim of this study was to develop recommendations for persons in need of care and their relatives in order to a) create more transparency and knowledge about the spectrum of care counselling for those in need of care and their relatives as well as the professionals in the field, and b) to optimize the structures of the heterogeneous spectrum of care counselling by means of a qualitative study with experts using the example of the district of Lörrach. METHODS: Based on a systematic literature research, 21 semi-structured expert interviews of five different stakeholder groups (representatives of persons in need of care and their relatives, service providers, suppliers, county and municipalities, politicians) were analyzed. All interviews were digitally recorded and transcribed verbatim. Data analysis was conducted based on the structuring content analysis according to Kuckartz. RESULTS: Nine main categories emerged from 21 experts' transcripts. The findings from four main categories relating to the criterion of transparency are shown below as examples. The experts report on numerous obstacles that they recognize for persons in need of care and their relatives in order to be able to take advantage of care counselling in a highly complex health care system. For people with no background knowledge of the health care system, the current care counselling structure is not transparent, and it is almost impossible to differentiate between the various care counselling services, some of which have different tasks to fulfil. The basic topic-specific advisory structure is characterized by multiple uncoordinated structures, also with regard to care, which makes it difficult even for professionals to gain an overview and orientation towards a targeted use of the counselling services for those seeking advice, such as persons in need of care and their relatives. The experts reaffirm the importance of creative ideas and different channels, taking into account generational differences and different information behaviour among those seeking advice, in order to increase the provision of information and the visibility of care counselling services. Low-threshold, citizen-oriented, regional and barrier-free access to information must be set up for persons in need of care and their relatives. At the district level, a central platform should be established primarily aimed at professional users which many want to be located at the care support center or, for example, at the district office where all threads come together and which includes all care counselling services and their areas of activity. DISCUSSION AND CONCLUSION: Overall, the study results reveal numerous systemic weaknesses in the spectrum of care counselling services and in the care system, which in this study were limited to the regional research field and considered from the perspective of care management. The analysis of the results highlights the importance of optimizing the structural quality of care counselling. A need to reform social legislation and, above all, long-term care insurance (Eleventh Book of the Social Code), can be derived from the interview analysis and should be further investigated in a nationwide survey.

[Tools to strengthen organizational health literacy in the health care sector]. / Tools zur Stärkung der organisationalen Gesundheitskompetenz in Einrichtungen der Gesundheitsversorgung.

BACKGROUND: The National Action Plan to Improve Health Literacy calls for user-friendly and health-competent development of health care at all levels. After the first years of focusing on individual health literacy, the focus is increasingly on organizational health literacy. Organizational health literacy addresses different standards (e. g., management, communication, staff, users or patients) and levels in the organization (i.e., organizational, staff and user level). Numerous tools already exist to strengthen health literacy in hospitals. However, previous studies have rarely focused on a differentiated overview of tools to strengthen organizational health literacy by health literacy standards and differentiated by level of organization, staff and users. The article has two goals, one of which is to search for and review existing tools to strengthen organizational health literacy in health care institutions. In addition, selected tools for strengthening organizational health literacy for health care institutions, differentiated according to the eight fields of action and the three organizational levels (i.e., institution, staff, users), will be presented. METHOD: A search was carried out to identify tools on strengthening health literacy in facilities of health care. All the tools identified were reviewed, selected according to previously defined inclusion and exclusion criteria and assigned to the level (institution, employees or patients/clients and their relatives) as well as the eight fields of action of organizational health literacy. RESULTS: We found a total of N=191 tools for health care facilities. After taking into account the inclusion and exclusion criteria, a total of n=60 tools were selected and differentiated according to the level and standard of organizational health literacy. Some of these tools could be assigned to more than one field of action. Most tools (n=37) were found for Standard 5 "Health-competent communication users", while the lowest number of tools were identified for Standard 7 "Promoting the health literacy of employees" (n=4). Differentiation by level (i. e., organizational, staff, patients or clients) shows that there is a smaller number of tools for employees (n=43) compared to the level of the organization (n=76) or users (n=65). DISCUSSION: Overall, the study shows that numerous tools already exist to strengthen organizational health literacy for hospitals, in particular, and for health care settings, in general. In the future, however, it will be necessary to develop and test tools for individual standards of health literate organizations in health care facilities. Further, internationally provided and tested tools have to be adapted and piloted for the German-speaking countries and health care settings in order to address the health literacy of staff, users and their relatives in a sustainable manner. CONCLUSION: The development of health literate settings requires effort from health care organizations. Thus, tools for strengthening organizational health literacy should be provided and implemented by also focusing on the level of organization, staff and users so that the individual health literacy of users can be addressed and improved in the long-run.

[Health literacy and commitment to a general practitioner in low-acuity patients of emergency departments: results of the PiNo observational study in Northern Germany]. / Gesundheitskompetenz und Hausarztbindung nicht dringlicher Patientinnen und Patienten in Notaufnahmen: Ergebnisse der PiNo-Studie in Hamburg und Schleswig-Holstein.

INTRODUCTION: High utilization of emergency departments by low-acuity patients remains a major challenge for the health care system. Surveys of treatment urgency show that a considerable part of the emergency department population could also be cared for in the outpatient sector. Little is known about the contributing circumstances of non-utilization of outpatient care (despite indication). The expression of health literacy is often called to explain non-urgent use of emergency departments. The extent to which a distinguished commitment to primary care might have a moderating effect is currently not known. METHODS: The data for this secondary evaluation of a non-urgent emergency department population were taken from the cross-sectional observational study PiNo Nord ("Patients in the emergency departments of hospitals in Northern Germany") (Scherer et al. 2017). In five hospitals in Hamburg and the federal state of Schleswig-Holstein, health literacy and 'intensity of the commitment to a general practitioner' were measured by self-assessment questionnaires (HLS-EU-Q16, F-HaBi). In addition to descriptive data analysis, linear regression was used to estimate the 'intensity of the commitment to a general practitioner' and other somatic, psychological, and sociodemographic characteristics of the population on health literacy. RESULTS: 548 non-urgent adult patients (mean age 41.5 years, 54.4% men) were included in the evaluation: 55.5% had sufficient, 31.4% problematic and 13.1% inadequate health literacy. 88.3% of the population had a general practitioner. A higher 'intensity of the commitment to a general practitioner', female gender, a higher subjective urgency for treatment, better self-efficacy and better social support were associated with higher health literacy. No associations were found with regard to age, household income, education and migration background, current pain or the degree of physical complaints. DISCUSSION: The extent of health literacy of a non-urgent sample of the PiNo North study population, responding to the HLS-EU-Q16, was comparable to the health literacy of the general population. Health literacy and intensity of commitment to a general practitioner were positively associated. However, the intensity of GP commitment was rather low. The fact that younger respondents were more likely to provide information about their health literacy and the availability of specialists in urban areas could explain these findings. CONCLUSION: Improving commitment to primary care physicians could include providing individualized information on how to navigate the health care system. This could make it easier for patients to choose an adequate level of care - and thus have a steering effect on emergency department utilization.

Implementing shared decision-making in Australia.

Person-centred care (PCC) and shared decision-making (SDM) are part of national clinical standards for an increasing number of areas of health care delivery. In addition to existing standards for accrediting hospitals, day surgery facilities, public dental services and medical education in Australia, new standards governing primary health care and digital mental health services have been added. Implementation and measurement of PCC and SDM to comply with standards, and training of health professionals, remain challenges for the Australian health sector. Consumer involvement in health research, policy and clinical service governance continues to increase and the National Health and Medical Research Council has begun to encourage consumer and community involvement in health and medical research. This increased consumer engagement and moves towards more PCC provision is reflected in a focus on encouraging patients to ask questions during their clinical care and supports improvements in consumer health literacy. SDM support tools are now being culturally adapted whilst a need for more systemic approaches to their development and implementation persists. With increasing resources and tools for all aspects of PCC and SDM challenges to find sustainable solutions to ensure tools are kept up to date with the best available evidence remain.

Evidence-based decision-making in nursing - development and piloting of a train-the-trainer concept for teachers at schools for health care professionals: A pilot study.

BACKGROUND: Train-the-trainer concepts (TTT concepts) to impart evidence-based practice competences aim at promoting the implementation of evidence-based practice. The aim of this study was to develop and pilot-test a TTT training program for teachers at schools for health care professionals. The program is based on the core curriculum "Evidence-based Decision-making" set up by the German Network for Evidence-based Medicine e.V. (DNEbM). METHOD: The study was conducted according to the UKMRC framework for complex interventions and consisted of Phase 1 (Development) and Phase 2 (Piloting). In Phase 1, the intervention was modelled on the basis of a systematic literature search. In Phase 2, the TTT concept was piloted with teachers at two schools for health care professionals. For the evaluation, short interviews with the participants were carried out after each module; classroom observations took place during the training and were followed by a focus group interview. In addition, baseline characteristics were collected prior to the training and descriptively evaluated. Critical health competence was surveyed using the Critical Health Competence Test (CHC test) before and after the course. The questionnaires, interviews and classroom observation protocols were processed according to Mayring's qualitative content analysis. Person parameters ±SD were calculated to determine the level of competence. RESULTS: Piloting took place in September 2018 and from September to November 2019. Eight teachers from two training institutions participated. The evaluation of the focus group interviews and the classroom observation protocols resulted in a category system comprising 6 main and 17 subcategories. The feasibility of the materials and methods could be demonstrated in both pilot tests. Reactivation and extension of prior knowledge were confirmed by the participants. The small group size was appreciated; the participants took an active part during the lessons and were stimulated to plan their own lessons. The evaluation of the CHC test revealed average person parameters of 432 ± 45 (pretest, n=8) and 512 ± 65 (posttest, n=8). DISCUSSION: Using mixed methods, the results show the feasibility of the curriculum. CONCLUSION: Further evaluation in a randomized controlled trial (RCT) is needed to prove the efficacy of the curriculum.

[Impact of an elective course in evidence-based clinical decision-making on competencies and attitudes of medical students: A pilot study]. / Auswirkungen eines Wahlfachs zur evidenzbasierten klinischen Entscheidungsfindung auf die Kompetenzen und Einstellungen von Medizinstudierenden: Eine Pilotstudie.

BACKGROUND: Evidence-based medicine (EbM) as a teaching subject is increasingly taken into account in the Master Plan 2020. To date, neither theoretical requirements nor practical applications of EbM have been consistently implemented in the clinical curriculum. To fill this gap, a digital and tutor-based EbM course has been developed. The aim is to identify the student characteristics (statistical competence, Need for Cognition (NFC), work and experience patterns (AVEM), diagnostic uncertainty) of the first cohort in order to ensure successful course implementation and to prepare future doctors for their role as mediators of health literacy using EbM methods. METHODS: The long-term study started in the summer term 2019 with 10 medical students during their clinical training. The measurements were conducted before (t0) and after course attendance (t1). Socio-demographic variables were taken at t0, the Quick Risk Test, PRU questionnaire, the NFC scale and the AVEM were collected at t0 and t1. RESULTS: Half of the students started their doctoral thesis before attending the course. The first test results of the Quick Risk Test (t0) were between 50 % and 90 % and at t1 between 60 % and 100 %. The students showed high scores on the NFC scale (X¯=4.6, SD=0.52, Δ X¯ t0 - t1=0.1) and medium scores on the Perfectionism scale (X¯=3.8, SD=0.51, Δ X¯ t0 - t1=0.1), Resignation Tendency (X¯=3.8, SD=1.17, Δ X¯ t0 - t1=0.1) and on the scale Aggressive Problem Solving (X¯=3.9, SD=1.06, Δ X¯ t0 - t1=0.2). They achieved high levels of Anxiety Due to Diagnostic Uncertainty (X¯=4.8, SD=0.69, Δ X¯ t0 - t1=0.4) and on the scale Concern about Poor Outcomes (X¯=3.9, SD=1.54, Δ X¯ t0 - t1=0.6). The scale Restraint in Disclosing Uncertainty to Patients was more pronounced than the scale Restraint in Disclosing Errors to Physicians (X¯=3.5, SD=0.93, Δ X¯ t0 - t1=-0.3 compared to X¯=2.3, SD=1.20, Δ X¯ t0 - t1=0.1). DISCUSSION: Statistical competence improved with course attendance, with only one student being able to correctly answer all items at t1. NFC and AVEM were strongly expressed and were not very sensitive to change in the sample. The greatest changes were observed on the scales of concern about poor results and fear of diagnostic uncertainty, both of which decreased with course participation. CONCLUSION: In the long term, the development of a new measuring instrument to assess EbM competencies instead of the Quick Risk Test is conceivable. The longitudinal design will also enable us to make causal interpretations and to track changes in students' competence feelings, behaviour and attitudes.

Development and piloting of a blended learning training programme for physicians and medical students to enhance their competences in evidence-based decision-making.

INTRODUCTION: In 2016, the German Network for Evidence-based Medicine revised its basic curriculum for competences in evidence-based medicine. A curriculum-based training programme for physicians and medical students to enhance their competences in evidence-based decision-making was developed. The training programme was planned on the basis of problem-based learning. The aim of this qualitative pilot study was to explore the feasibility and acceptability of the training programme. Hypotheses concerning its influence on critical health literacy and the attitude toward evidence-based decision-making were to be generated. METHODS: Participating healthcare professionals received a structured training in a blended learning format. Data collection was conducted during the training sessions. The lessons were observed and protocolled and the working results were documented. Two focus group interviews were conducted after the training blocks with focus on acceptability and feasibility of the training programme. Interview transcripts and protocols were analysed using qualitative content analysis according to Mayring. Data saturation was intended by an iterative process of testing, analysing and revising the training programme. In addition, critical health literacy was assessed using the validated Critical Health Competence test. Levels of competence were calculated to measure the effect of the training on critical health competences. RESULTS: Two pilot courses with 29 physicians and other healthcare professionals were conducted between January and March 2019. Overall, the training programme proved to be feasible. The participants rated the comprehensibility of the learning modules as high. However, the practical exercises (e.g. role plays in shared decision-making) revealed that relevant subjects were insufficiently understood (e.g. the difference between the benefits and harms of a diagnostic test and its test accuracy). The interactive instructional design was appreciated. The participants appraised the work tasks as comprehensible but also challenging and requested a theoretical introduction to statistical terms in preparation for work tasks. The programme was revised iteratively according to the results. Critical health competences increased significantly after the training. Mean values (±SD) of levels of competence were 571.21 (±82.87) before training and 671.90 (±51.38) after training (p<0.0001) (levels of competence with a range from 0 to 1,000). CONCLUSION: The training programme is feasible and was well accepted by the participants. It should be established as a continuing medical education opportunity for practitioners. Evaluation in a randomised controlled trial is recommended. Furthermore, the training can easily be adapted for interprofessional training. A concept for long-term implementation is needed.

[Digital health literacy in Germany - requested, but not supported? Results of the empirical study TK-DiSK]. / Digitale Gesundheitskompetenz in Deutschland - gefordert, aber nicht gefördert? Ergebnisse der empirischen Studie TK-DiSK.

In Germany, the digital transformation is considered the key to "growth and prosperity". Beyond the debate on the required technical conditions, digital health literacy is seen as a prerequisite for a democratic and patient oriented digitization of the health system. The study "TK-DiSK: digital - self-determined - competent" aimed at examining the perspectives and status of stakeholders in the German health system and of further developing the concept of digital health literacy. Document analysis, surveys and interviews revealed a paradox about digital health literacy: though it is generally seen as a "highly relevant' issue, there is hardly any substantial discussion of it. Interviewed experts did not share a common understanding of its content, disagreed on ways of promoting it, and disputed the agencies to be held responsible for ensuring digital health literacy. Focus groups with patients clearly showed that the facilitation of patient autonomy is a central aspect for their assessment of digital health technologies. This article develops a timely definition of digital health literacy and argues for a comprehensive and targeted promotion addressing individuals as well as organizations.

[For discussion: What potential does digitization hold for patient safety?] / Zur Diskussion: Welches Potential hat Digitalisierung für die Patientensicherheit?

Digitization is comparatively underdeveloped in the German healthcare system. Many digital applications are potentially capable of improving patient safety. This potential cannot be exploited in the long term with regional and time-limited projects. The present article identifies care areas where digital solutions are possible and necessary for safe patient care. In order for digital solutions and applications to be available to policyholders in the first healthcare market, producer of eHealth solutions will have to consider the goals of patient safety from the very beginning. In addition, processes and structures for proof of benefit must be implemented. (As supplied by publisher).

[Patient involvement in clinical practice guidelines is poor after 12 years of German guideline standards: A review of guideline methodologies]. / Unzureichende Patientenbeteiligung an der Leitlinienentwicklung in Deutschland ­ eine Analyse der von der AWMF verbreiteten ärztlichen Empfehlungen.

BACKGROUND: As early as 1997, the German Guideline for Guidelines laid down patient participation in guideline development as the cornerstone of good, trustworthy medical guidelines. The German Guideline Assessment Tool (DELBI) published in 2005 requires patients or relatives to be involved in the development of medical guidelines. Ideally, this should be effected through membership in the author group. The Association of the Scientific Medical Societies in Germany (AWMF) recommends this approach for the so-called S3 guidelines (systematically developed guidelines) and S2k guidelines (consensus-based guidelines). The present study addresses the question of whether and to what extent German guideline publishers adhere to these principles of patient orientation. METHODS: For this purpose, a descriptive analysis of the guidelines valid at the beginning of November 2017 was carried out. All guidelines (n=520) of the AWMF member societies were assessed. We evaluated S3- and S2k guidelines only, as these are of particular importance for patient involvement due to the requirement of an interdisciplinary guideline group. Data were reported on the involvement of patients (as co-authors of medical guidelines) and on the existence of guidance documents addressing patients and the public (so-called patient information and patient guidelines). RESULTS: Regarding the 105 (165) S3 (S2k) guidelines, we found evidence on patient involvement in guideline development in 99 (134) cases (94 % of S3 / 81 % of S2k guidelines). In 61 (87) guidelines, authors had contributed to the authors group (58 % / 53 %) and 59 (80) guidelines with voting rights (56 % / 48 %). For 50 (15) S3 (S2k) guidelines (48 % / 9 %), the guideline report provided information on the existence or planned development of guidance documents for patients and the public (patient guidelines or patient information). Guidance-related patient information was available on the internet for only 37 (2) S3 (S2k) guidelines (35 % / 2 %). CONCLUSION: A substantial gap remains between patient / public involvement standards for guideline development and practice in Germany, even 12 years after the publication of national guideline standards. This is a missed opportunity since guidelines without adequate participation of those affected by the recommendations have a problem of legitimacy and transparency. Only guidelines where patients were involved in all voting processes during development build and strengthen trust between patients and the medical profession. And only those who present the rationale for medical recommendations in a generally understandable and comprehensible manner let affected individuals make individual decisions.

Measuring attributes of health literate health care organizations from the patients' perspective: Development and validation of a questionnaire to assess health literacy-sensitive communication (HL-COM).

BACKGROUND: Studies addressing the organizational contexts of care that may help increase the patients' ability to cope with a disease and to navigate through the health care system are still rare. Especially instruments allowing the assessment of such organizational efforts from the patients' perspective are missing. The aim of our study was to develop a survey instrument assessing organizational health literacy (HL) from the patients' perspective, i. e., health care organizations' responsiveness to patients' individual needs. METHODS: A pool of 30 items was developed by a group of experts based on a literature review. The items were developed, tested and prioritized according to their importance in 11 semi-structured interviews and cognitive think-aloud interviews with cancer patients. The resulting 16 items were rated in a standardized postal survey involving a total of N=453 colon and breast cancer patients treated in cancer centers in Germany. An exploratory factor analysis, a confirmatory factor analysis and structural equation modelling were conducted. Item properties were analyzed. RESULTS: 83.2 % of the patients were diagnosed with breast cancer, 16.8 % had a diagnosis of colon cancer. The patients' mean age was 61 (26-88), 89.4 % were female. The most common comorbidities were hypertension (34.0 %) and cardiovascular disease (11.0 %). The final prediction model included nine items measuring the degree of health literacy-sensitivity of communication. The model showed an acceptable model fit. The nine items showed corrected item-total correlations between .622 and .762 and item difficulties between 0.77 and 0.87. Cronbach's α was .912. DISCUSSION: In a comprehensive development process, the original item pool comprising several aspects of organizational HL was reduced to a one-dimensional scale. The instrument measures an important aspect of organizational HL; i.e., the degree of health literacy-sensitivity of communication (HL-COM). HL-COM was found to impact patient enablement, mediated through the support by physicians. Future research will have to test these associations in the context of other diseases or institutions.

Information overload in healthcare: too much of a good thing?

The rapidly growing production of healthcare information - both scientific and popular - increasingly leads to a situation of information overload affecting all actors of the healthcare system and threatening to impede the adoption of evidence-based practice. In preparation for the 2015 Cochrane Colloquium in Vienna, we discuss the issues faced by three major actors of this system: patients, healthcare practitioners, and systematic reviewers. We analyze their situation through the concept of "filter failure", positing that the main problem is not that there is "too much information", but that the traditional means of managing and evaluating information are ill-suited to the realities of the digital age. Some of the major instances of filter failure are inadequate information retrieval systems for point-of-care settings, the problem of identifying all relevant evidence in an exceedingly diverse landscape of information resources, and the very basic lack of health information literacy, concerning not only the general public. Finally, we give an overview of proposed solutions to the problem of information overload. These new or adapted filtering systems include adapting review literature to the specific needs of practitioners or patients, technological improvements to information systems, strengthening the roles of intermediaries, as well as improving health literacy.