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A health literacy intervention for registered nurses: Development and feasibility testing
Malene Nerbøvik Stavdal1,2, Marie Hamilton Larsen3, Ingeborg Strømseng Sjetne4
1Department of Public Health and Interdisciplinary Health Sciences, University of Oslo, Norway.
Background:
Health literacy is essential for improving long-term health outcomes, enhancing quality of care, and ensuring patient safety in healthcare systems. Thus, supporting registered nurses in applying health literacy in practice is essential. While health literacy research is expanding, limited attention has been paid to how healthcare personnel develop health literacy sensitivity (i.e., knowledge, skills, and attitudes healthcare personnel require to effectively meet patients' health literacy needs).
Objective:
(1) Develop and assess the feasibility of a health literacy intervention for registered nurses working in a general hospital setting. (2) Explore potential changes in health literacy sensitivity, work-related factors, and mental well-being for registered nurses, following the intervention. (3) Evaluate registered nurses' experiences with implementing the intervention.
Design:
Pre-post feasibility study employing qualitative and quantitative approaches.
Setting:
Medical ward, general hospital.
Participants:
N=32 registered nurses.
Methods:
An advisory panel, Magnet4Europe's gap-analysis tool, and prior research were used to design the intervention. Health literacy sensitivity was measured using the Instrument of Health Literacy Competencies. Work-related factors and mental well-being were measured using four validated surveys. Quantitative data were analyzed using descriptive, non-parametric statistics. Registered nurses' experiences with implementing the intervention were assessed through individual and group interviews and analyzed using thematic analysis.
Results:
The final intervention included a dedicated health literacy nurse trained to motivate and guide colleagues in improving patients' health literacy. During a 6-month intervention period, registered nurses participated in internal health literacy education, project groups, morning briefings, and reflection groups. The intervention targeted all registered nurses (N = 32) working on a medical ward (i.e., cardiovascular, stroke, and geriatric conditions). The pre-post study showed statistically-significant improvements in 7 of the 9 domains measuring registered nurses' health literacy sensitivity (pre n = 29, post n = 20). Additionally, teamwork scores between registered nurses and physicians showed a statistically-significant improvement. Qualitative (n = 9) analyses of registered nurses' experiences of the intervention revealed three main themes: (1) "Strengthening health literacy through increased resources, embedded routines, and interdisciplinary collaboration," (2) "Between support and strain: health literacy sensitivity as a professional challenge," and (3) "Registered nurses' increased awareness and understanding of health literacy sensitivity".
Conclusion:
Post-intervention measures demonstrated a significant increase in registered nurses' health literacy sensitivity through structured routines, interdisciplinary collaboration, access to resources, and support from a designated health literacy nurse. However, health literacy sensitivity remained a balance between rewarding engagement and burdensome responsibility.
Trial Registration:
Open Science Framework: https://osf.io/935vj/.
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