Development of the health literacy responsiveness (HLR) evaluation framework for HLR interventions

Abstract Background Health literacy responsiveness (HLR) interventions include actions at different levels of an organization to provoke change and improve environments ensuring equitable access to and use of information and services (1). However, generic instruments measuring the effect of HLR at intervention level are inconsistent, making evidence on HLR intervention effects difficult to compare (2). The objective of this study was to develop an evaluation framework based on core outcome domains of HLR to facilitate higher consistency in future evaluations of HLR interventions. Methods HLR outcomes were identified through a narrative literature review and categorized into domains through a content mapping process. Expert consensus on core outcome domains was reached through a Delphi process. Experts within the field of HLR were invited to participate and answer three questionnaires designed to rank and clarify potential core outcome domains. Quantitative and qualitative analysis was performed to select and complete the final core outcome domains in the HLR evaluation framework (HLR-EF). Results The literature search resulted in identification of nine reviews. A total of 383 outcomes were identified from these reviews and included in the content mapping process, which resulted in a total of 26 core outcome domains. Experts (n = 15) participated in the three-round Delphi process, which resulted in consensus on 15 core outcome domains in HLR-EF allocated under five headings. Conclusions The study has successfully managed to identify a set of core outcome domains applicable in future evaluations of HLR interventions based on systematic methodologies and expert consensus. Context-sensitive manuals for the use of the HLR-EF is under development and the instrument is ready to be applied in future evaluation of HLR interventions, potentially making future measuring, reporting and comparison of results significantly easier. Key messages • Instruments facilitating evaluation of HLR interventions are non-generic and inconsistent. • HLR-EF has been developed using a narrative literature review, content mapping, and a Delphi process, and defines 15 core outcome domains for evaluation of HLR interventions.