Development, pretesting and evaluation of self-assessment tools to assess the level of organizational health literacy in healthcare institutions Experiences from hospitals, facilities for longterm (elderly) care and people with disabilities from the EwiKo project in Germany

Background. In the project "Development of health literacy in healthcare institutions (EwiKo)", five self-assessment tools (self-checks) for recording organizational health literacy (OHL) in healthcare institutions (hospitals, facilities for long-term [elderly] care and people with disabilities, and in plain language) were developed, pretested and evaluated in pilot institutions. Aim. The aim of this study is to describe the multistage, participatory development process of the self-checks and to present the adaptations to the German-speaking context and to different types of (health) care institutions in the EwiKo project. Methods. Based on the International Self-Assessment Tool for Organizational Health Literacy of Hospitals (SAT-OHL-Hos-v1.0; n = 8 standards, n = 21 substandards, n = 155 items), five self-checks (for hospitals, facilities for long-term (elderly) care and for people with disabilities, and in plain language for people with cognitive impairments) were developed. The self-checks were pretested by N = 9 experts from N = 7 healthcare institutions. After the pretests, the instruments were revised and evaluated in the EwiKo project with N = 43 representatives in N = 6 pilot institutions. The pilot institutions' needs for change were recorded in focus group interviews and the self-checks were after the pilot phase (15-18 months) adapted. Results Before the pretests, the self-checks comprised n = 8 OHL standards, n = 21 substandards and n = 102 items. After the pretests, the self-checks were shortened and contained n = 8 OHL standards, n = 20 substandards and n = 77-89 items. After evaluating the instrument, the pilot institutions requested a more differentiated formulation of the items. The term "standard" was renamed to "fields of action of the OHL". After the revision, the self-checks comprised n = 8 fields of action of the OHL, n = 21 substandards and n = 81-93 items. The self-check in plain language was developed for the first time, has been translated into plain language, has undergone the pretest and contained 20 items in the piloted version. Conclusion. The assessment of OHL in health care facilities with validated instruments is indispensable in order to be able to plan and implement measures to strengthen OHL in a needs-specific manner. With the self-checks, it will be possible to assess the level of OHL by type of institution and to continuously review the success of the implemented measures to strengthen the OHL-in the sense of monitoring.