The Construction Level of Health Literate Health Organizations and Its Impact on Patients’ Health Literacy: Based on Self-Determination Theory and Structural Equation Modeling

This study aims to develop a scale for patient evaluation of health literate health care organizations (PEHLHO) tailored to the Chinese context, addressing deficiencies in existing tools. It also examines the relationships between PEHLHO, communicative health literacy (CHL), and enhancement of perceived health literacy (EPHL) in major Chinese cities. This includes their correlation with perceived service quality (PSQ) and perceived a community with shared future for doctor-patient (PCSF) to improve healthcare service quality and patient experiences in China. A PEHLHO Scale was developed using focus group discussions and the Delphi method, with other scales adapted from existing instruments. This cross-sectional study was conducted through an online survey administered in major cities from February 17, 2024, to March 4, 2024, which included Shanghai, Chengdu, Guangzhou, Beijing, Wuhan, Xuzhou, Nanjing, Suzhou across China. A total of 6411 questionnaires were collected. Following quality control standards, the remaining sample of 5206 valid responses met the minimum recommended size for structural equation modeling. Data analysis was performed using SPSS and AMOS software. Exploratory factor analysis of the PEHLHO Scale revealed 3 factors: health education, involvement in diagnosis and treatment, and convenient services. All scales showed good validity and reliability. Informing patients about service fees received the lowest score. A Structural-Process-Outcome model confirmed that PEHLHO positively influences PCSF and PSQ, with CHL and EPHL as mediators. This model was validated in additional cities, demonstrating good generalizability. Enhancing patient health literacy should focus on systemic changes. Establishing health literate health organizations (HLHOs) can improve CHL, doctor-patient communication, and patient health literacy, ultimately optimizing healthcare service quality and doctor-patient relationships. Promoting (HLHOs) in China has significant potential and importance.