An integrative review on the development of health literate organizations

To analyze and synthesize scientific evidence on structured actions and institutional practices aimed at promoting organizational health literacy within healthcare organizations. This is an integrative literature review conducted across eight international and regional databases. Studies describing planned or implemented actions to promote organizational health literacy were included. The selection process followed predefined eligibility criteria, with screening by title, abstract, and full-text review. Data analysis focused on identifying implemented strategies, attributes of health literate organizations, and barriers and facilitators to implementation, based on established theoretical frameworks. Twenty-two studies published between 2014 and 2022 were included, predominantly conducted in Europe and the United States. Identified actions were grouped into four main thematic axes: institutional diagnostic assessment; adaptation and simplification of communication materials and processes; workforce training and capacity building; and user and community involvement, often through co-design approaches. The studies addressed the ten attributes of health-literate organizations to varying degrees, with greater emphasis on clear communication, facilitated access to services, and leadership engagement. The most frequently reported barriers were limited leadership buy-in and insufficient resources, each identified in 11 studies (50%), followed by time constraints, reported in 9 studies (40.9%). The findings indicate that organizational health literacy should be understood as a systemic and integrated approach rather than isolated interventions. The identified actions show potential to foster health literate organizations, provided they are supported by committed leadership, internal policies, and continuous evaluation and training processes.