Development of core outcome domains for the organizational health literacy responsiveness evaluation framework (OHLR-EF)

Abstract Background: Organizational health literacy responsiveness is the ability of health organizations and systems to recognize and respond to health literacy needs and improve health environments to ensure equitable access to and use of information and services. However, research concerning outcome measures of organizational health literacy responsiveness interventions is scarce, making it difficult to acquire aggregated knowledge on evaluations and compare effect. This study aims to develop an evaluation framework based on core outcome domains of organizational health literacy responsiveness. Methods: First, organizational health literacy responsiveness outcomes were identified through a narrative literature review, and secondly, categorized into domains through a content mapping process. Consensus was reached on core outcome domains through a three-round Delphi process. For this, experts within organizational health literacy research and practice were invited digitally to fill out questionnaires designed to rank and further define potential core outcome domains for the evaluation framework. Results: The literature search resulted in the identification of nine publications. A total of 383 outcomes were identified from these. The content mapping resulted in their categorization into 26 proposed outcome domains. 24 experts participated in the Delphi process, which resulted in consensus on 15 core outcome domains in the final evaluation framework. The core outcome domains were categorized under the five headings: 1) Organizational change, leadership, and management, 2) Workforce responsiveness, 3) Person-centered care and user involvement, 4) Access and navigation, and 5) Partnerships and transitions. Conclusions: The organizational health literacy responsiveness evaluation framework (OHLR-EF) enhances the stringency of future evaluations of organizational health literacy responsiveness interventions. The core outcome domains allow interventions of any scope to be easily assessed against the complete organizational health literacy responsiveness concept and the framework facilitates comparisons between methodologically or contextually related interventions.