Organisational Health Literacy in Diabetes Healthcare: Protocol for a Multisite Implementation and Evaluation of OHL-Act

Health-literacy challenges are associated with greater risk and adverse outcomes of long-term conditions such as diabetes mellitus AND contribute to persistent health inequalities. In response, increasing attention has been given to Organisational Health Literacy (OHL), which addresses how healthcare organisations can make health information and services more accessible and easier to navigate for users (def: people receiving care, treatment, education or health-related support from the organisation) with diverse health-literacy needs. Despite the increased focus on the organisational perspective, most previous interventions have focused on individual health literacy. Thus, there is limited systematic evidence on organisational interventions designed to improve OHL and which mechanisms and contextual factors support and facilitate change. The aim of this paper is to describe the protocol for the implementation and evaluation of an OHL intervention (OHL-Act) across primary care and hospital settings caring for individuals with long-term conditions. The primary objective for the future project will be to evaluate whether the implementation of OHL-Act is associated with improvements in OHL across diverse healthcare organisations providing care and support for people living with long-term conditions. The OHL-Act comprises three workshops designed to strengthen OHL through facilitated reflections among staff and managers, a structured self-assessment of the organisation and identification and prioritisation of improvement ideas in a local action plan. The OHL-Act will be implemented in 8–10 Danish outpatient clinics and municipal units providing care and preventive services for people living with long-term conditions such as diabetes. A mixed-methods evaluation (2026–2029) will use the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework combined with the Practical, Robust Implementation and Sustainability Model (PRISM) to examine implementation processes, mechanisms of change and contextual factors. Data will be collected from surveys, organisational self-assessments, and implementation logs, as well as qualitative interview data. The study will generate insights into the implementation and effectiveness of the OHL-Act across healthcare settings and thereby give a deeper understanding of how OHL can be embedded in routine care and provide evidence of the development of more health-literacy-responsive and equitable healthcare systems.