Co-Creating Organisational Health Literacy: Formative Evaluation and Feasibility Testing of OHL-Act

Organisational health literacy (OHL) is increasingly recognised as a system-level strategy to address health literacy-related inequities in healthcare, yet evaluation of practical OHL tools and frameworks remain limited. This study aimed to examine the implementation experiences of the Danish OS! to inform refinements, and to examine the feasibility of the refined version, renamed OHL-Act, in practice.

A two-phase study guided by the RE-AIM framework was conducted. Phase 1 comprised a formative evaluation of OS! based on interviews from previous applications, informing refinement. Phase 2 involved feasibility testing of OHL-Act in a specialised diabetes centre.

Across implementing organisations, OS! was experienced as a practical approach supporting reflection and the generation of OHL improvement ideas, while also revealing barriers. These insights informed refinements, including clearer language, more structured facilitation guidance, and explicit prompts addressing health literacy challenges and high-risk situations. Feasibility findings indicated that OHL-Act could be delivered as intended and was perceived as acceptable, relevant, and useful in supporting reflection and the generation of OHL improvement ideas.

OHL-Act represents a structured, co-creational approach to support OHL work. Further research is needed to examine how generated improvement ideas translate into sustained action and their potential implications for equity.