Organizational health literacy and health promotion in health care settings: Results from Germany

Abstract Introduction Health care organizations (HCO) are increasingly required to provide health literate structures and processes to strengthen organizational health literacy (OHL). So far, little is known about the extent of OHL in HCO in Germany. Aims are therefore 1) to examine the level of OHL in health care organizations, and 2) to investigate the impact of organizations level of health prevention and workplace health promotion on the level of OHL. Methods Analyses are based on a nationwide cross-sectional study (online survey) among management staff (N = 564) in HCO (hospitals, nursing homes, facilities for disabled people). OHL was measured by the German version of the ‘Health literate health care organization 10 item questionnaire’ (HLHO-10). Health prevention and workplace health promotion were operationalized by the “Worksite Health Promotion Capacity Instrument’ (WHPCI). Uni- and bivariate analyses were carried out, on an item-basis and as an index (median-split). Results Regarding OHL, 55.1 % of the health care organizations reported below-average levels of OHL. On an item-basis, the highest below-average levels were given for the standard ‘communication’ (59.1 %) and the ‘provision of information to patients/residents via various media’ (57.4 %). Regarding the level of health prevention (51.8 %) and the existence of workplace health promotion structures (55.7 %), more than half of HCO reported a below-average level. In addition, results showed that HCO that indicate a below-average level of prevention and few structures of workplace health promotion also revealed a below-average level of OHL. Conclusions There is need to strengthen OHL in German HCO. Key messages • HCO are required to strengthen HLO, particular in communication and participatory approaches. • A higher level of prevention and workplace health promotion on HCO can contribute to the implementation of OHL initiatives.


Background:
Health literacy (HL) -as a broad range of health-related competencies and skills-has been recognized as a determinant of health outcomes, and suggested to be a modifiable health resource and a factor contributing to empowerment and equity. Thus, there is a need to identify the state of HL in various population groups. The aim of this study was to investigate HL levels and associations between HL, physical activity and subjective health among students in general upper secondary and vocational Swedish-language schools in Finland.

Methods:
The study used cross-sectional data from the Finnish LIITUstudy among students in Swedish-speaking general upper secondary and vocational schools (N = 887; age 16-20 years) conducted in the spring and autumn 2020, during the covid-19-pandemic. Students answered a web-based questionnaire during school hours. HL was measured with the 10-item Health Literacy for School-Aged Children (HLSAC) instrument. Data was analyzed with descriptive statistics and logistic regression analyses.

Results:
According to preliminary findings, one third of students had high HL. HL was higher among female than male students, general upper secondary school students than vocational school students, and in spring than in autumn 2020. A higher proportion of students with high HL, as compared to students with low/medium HL, reached the national recommendations for physical activity, perceived their health to be excellent and, moreover, did not have recurrent psychological symptoms.

Conclusions:
The findings confirm previous research findings on the importance of HL in promoting health outcomes. The pandemic year 2020 provided a unique perspective to the subject. It would be important to survey and discuss the role of schools in providing equal opportunities for the promotion of HL as this may contribute to decreasing health disparities in the population. Key messages: One third of students in upper secondary education (age 16-20 years) had high HL; there were differences between genders, students on different educational paths, and in spring and autumn 2020.
High HL was associated with better self-rated health, less psychological symptoms and reaching national recommendations for physical activity among students in upper secondary education.

Background:
Recently, it was established that more religious people tend to have less favorable views of vaccination. The aim of this study was to assess the relationship between the religiousness and attitudes towards COVID-19 vaccination and disease, in five Western Balkans countries.

Methods:
Using online questionnaire and convenience sampling procedure, data were obtained from 1605 respondents aged 18-75 years. Perceived COVID-19 vaccine safety and efficacy, and observed danger and susceptibility to disease were assessed by short five-point Likert scales. Religiousness was estimated using single item scale. Multivariate regression analysis was employed.

Results:
In Serbia, respondents who assessed themselves as more religious considered vaccine against COVID-19 as less safe (b = -.10, p<.01) and effective (b = -.12, p<.01), were more prone to the attitude that dangers of COVID-19 are not that serious (b = -.09, p<.01), and believed to a greater extent that they are less susceptible to the virus (b = -.07, p<.01). Similarly, in Bosnia and Herzegovina more religious individuals were less convinced that vaccine is effective (b = -.07, p<.05), less inclined to believe that danger of the virus is serious (b = -.07, p<.05), and assessed their susceptibility as lower (b = -.06, p<.05). More religious people in Montenegro (b = -.06, p<.05) regarded the vaccine as less safe, while in North Macedonia (b = .06, p<.05) and Albania (b = .08, p<.01) stronger religiosity was associated with more favorable attitudes towards vaccine safety.

Conclusions:
The relationship between religiosity and attitudes towards COVID-19 vaccination and disease is culturally conditioned. While in some Western Balkans societies religious beliefs render individual with a sense of lack of control triggering worry and anxiety, in some others they work as psychological shield against existential threats. Key messages: Religiosity should be considered as a relevant factor in vaccination campaigns implementation.
In the societies where negative attitudes towards vaccination prevail among the believers, religious leaders should be peculiarly educated and encouraged to participate in vaccination campaigns.

Introduction:
Health care organizations (HCO) are increasingly required to provide health literate structures and processes to strengthen organizational health literacy (OHL). So far, little is known about the extent of OHL in HCO in Germany. Aims are therefore 1) to examine the level of OHL in health care organizations, and 2) to investigate the impact of organizations level of health prevention and workplace health promotion on the level of OHL.

Methods:
Analyses are based on a nationwide cross-sectional study (online survey) among management staff (N = 564) in HCO (hospitals, nursing homes, facilities for disabled people). OHL was measured by the German version of the 'Health literate health care organization 10 item questionnaire' (HLHO-10). Health prevention and workplace health promotion were operationalized by the ''Worksite Health Promotion Capacity Instrument' (WHPCI). Uni-and bivariate analyses were carried out, on an item-basis and as an index (median-split).

Results:
Regarding OHL, 55.1 % of the health care organizations reported below-average levels of OHL. On an item-basis, the highest below-average levels were given for the standard 'communication' (59.1 %) and the 'provision of information to patients/residents via various media' (57.4 %). Regarding the level of health prevention (51.8 %) and the existence of workplace health promotion structures (55.7 %), more than half of HCO reported a below-average level. In addition, results showed that HCO that indicate a below-average level of prevention and few structures of workplace health promotion

Background:
The development of melanoma in adulthood is strongly associated with sunburns during childhood. Parental knowledge and behaviours play a key role in sun protection behaviour from which children can acquire general and integrated learning patterns. With this being known, numerous positive preventive health behaviours can be initially shaped in the family, with children having parents as a model.

Methods:
A cross-sectional approach (web-based questionnaire) was conducted to gather information regarding parents' knowledge and behaviours of children's sun protection, alongside the predictors that might influence the adoption of these behaviours, between April and May 2021. The survey was disseminated to 53 primary school teachers from 9 schools in Cluj-Napoca Romania, and the data set included 355 valid surveys (parents with at least one child aged between 0 to 12 years old) out of 476 total surveys. Descriptive statistics, Chi-square tests of association and logistic regressions were computed.

Results:
The study showed differences in children's sun exposure patterns, their sunburn and parental sun protection behaviour. Overall, parents reported fair sun protection behaviours and children's sunburn frequency was overall moderate among all children in the previous summer season. However, an increase in children's age generates an increase in parents' sunscreen application for their children in both planned and incidental situations. There were statistically significant associations between parents' sex and their knowledge about the fatal consequences of skin cancer or their level of education and the damage produced by tanning bed usage or sunscreen efficiency measures.

Conclusions:
These results are a starting point for various program interventions that can be done for parents in order to increase their knowledge on sun protection practices for their children. During the Covid-19 pandemic, individual and collective public health measures were undertaken to control the spread of the virus. Their effectiveness relies on people's abilities to understand and adopt the correct behaviors. This study aims to evaluate the role of Health Literacy (HL) in influencing the adherence to Covid-19 preventive measures and risk perception of a sample of workers employed in various activities involving close contact with the population in the province of Prato (Tuscany, Italy) in the second pandemic wave (November-December 2020). A cross-sectional survey was conducted on a sample of public workers (e.g., teachers, educators, assistants/aides, other health personnel). Data on knowledge, attitudes and practices towards (KAP) Covid-19 preventive measures and risk perception were collected. HL was measured with the HLS-EU-Q6 tool. Spearman correlation analysis was used to assess the correlation between HL and KAP and Covid-19 risk perception. Multivariate linear regression analyses were performed to evaluate the role of HL in predicting KAP and Covid-19 risk perception, adjusted for sex, age, comorbidity, educational level, country of birth. A total of 402 people participated in this study; 47.8% had a problematic HL level. The HL level was correlated with KAP and practices towards Covid-19 prevention measures; no significant associations were found with Covid-19 risk perception. In multivariate models, HL significantly and positively predicted a higher level of knowledge of Covid-19 preventive measures (B = 0.413 for problematic HL; B = 0.542 for sufficient HL). Confirming a previous study conducted in Prato in the first pandemic wave, HL did not predict adherence to Covid-19 infection control measures, probably due to fear of the disease and attention towards prevention behaviors being still higher in the second pandemic wave.