Abstract
Background
Challenged health literacy is associated with poorer diabetes outcomes and contributes to persistent health inequalities. Organizational health literacy (OHL) focuses on how healthcare organizations can reduce complexity and support individuals with diverse health literacy needs. The OHL-Act is a participatory approach developed to strengthen OHL; however, there is limited evidence regarding its implementation across contexts, the mechanisms through which it drives change, and its effectiveness in achieving and sustaining improvements. This study aims to: 1) evaluate the reach, effectiveness, adoption, implementation, and maintenance of OHL-Act across diverse healthcare organisations, and 2) examine mechanisms of change as well as contextual facilitators and barriers influencing these implementation outcomes.
Methods
A multisite mixed-methods evaluation (2026–2028) will be conducted across hospital and municipal organizations implementing the OHL-Act in diabetes care. OHL-Act consist of three workshops engaging staff and managers in structured self-assessment and prioritization of improvement ideas. This evaluation is guided by the RE-AIM framework combined with PRISM to assess implementation processes, outcomes, and contextual influences. Data will be collected through surveys, organizational assessment, implementation logs, and qualitative interviews.
Results
The study is expected to generate evidence on the implementation of OHL-Act across healthcare settings, including insights into reach, adoption, and sustainability. It will identify key mechanisms driving organizational change and highlight facilitators and barriers influencing implementation across contexts.
Conclusions
This study is expected to contribute to the evidence on strengthening OHL in complex diabetes care. Findings may inform future strategies to support more equitable, accessible, and responsive healthcare systems.