An exploratory mixed-methods study of organizational health literacy in a Neurosciences Intensive Care Unit

Organizational health literacy (OHL) is the degree to which organizations provide health information that is easy to access, understand, and use for healthcare decision-making. One such setting where OHL practices could be impactful is the Neurosciences Intensive Care Unit (NeuroICU), where brain injury often changes individual health literacy capability. We conducted a mixed-methods study using a validated OHL measure to assess current practices and identify priority areas for implementing initiatives to promote OHL in a Neurosciences Intensive Care Unit.

This exploratory mixed-methods study was conducted from August 2023 to April 2024 in an urban, tertiary-care NeuroICU. First, pre-seleced NeuroICU staff participated in 3 consecutive focus group sessions using the Organizational Health Literacy Responsiveness (Org-HLR) Assessment. Based on rapid qualitative analysis of focus groups transcripts, corresponding validated questions from the Org-HLR were selected for a NeuroICU-wide online survey. All NeuroICU staff were asked 26 questions addressing OHL concepts, including perceptions of leadership and culture, systems and processes, access to services, and communication practices and standards. Survey results are reported via descriptive statistics, and joint displays were created to integrate qualitative and quantitative results.

In this sequential, exploratory mixed-methods study, qualitative results identified three themes necessary for promoting OHL practices: a supportive leadership culture, a diverse workforce, and customized communication strategies. Quantitative findings demonstrated agreement with facilitators of OHL practices in which respondents endorsed having a supportive environment (82.4%), a commitment to equity and diversity (75%), and regular use of interpreter services (95.6%) promoted person-centered care. Qualitative and quantitative results also identified barriers to OHL practices such as having limited formats of health information for patients and families, and providing staff with resources to deliver person-centered care.

Our results demonstrate that a systematic OHL assessment of a criticalcare health system is feasible and identifies unmet needs that inform targeted interventions. The findings underscore the need for additional modalities of health information to support patients and families in the NeuroICU. Addressing these gaps in the NeruoICU setting may result in improved communication between clinicians, patients, and families.