Can Organizational Health Literacy Affect Patient Satisfaction?

Health institutions and hospitals have their own language and identity. Signs, symbols, directions, and written documents used in these institutions are usually prepared under the influence of medical language and may be difficult to understand for ordinary people. They must be user-friendly and easy to understand, but in some cases, they may be significant barriers to health services. It is important that organizations providing services should be designed according to the individuals’ needs and facilitate access as well as individuals knowing how to search for, find, and use which health service they need. Therefore, organizational health literacy has become an important issue in recent years due to its impact on the correct use of health services.

Organizational Health Literacy (OHL) is defined as “the ability of health organizations to provide services and information that are easy for patients to find, understand, and use, to help patients make decisions, and to remove existing barriers” during a roundtable of Institute of Medicine of the US National Academies in the year 2012. Ten attributes of Health Literate Health Care Organizations were defined in this study. OHL has become an important issue in the healthcare sector since that time and especially in today’s multicultural and multilingual societies. Additionally, studies indicate that improvements in OHL practices improve patient outcomes and also patient satisfaction.


In this cross-sectional study, we investigated the relationship between organizational health literacy, individual health literacy, and patient satisfaction. A study was conducted in three hospitals, one state hospital, one not-for-profit university hospital, and one for-profit private hospital in Istanbul, Turkey. The number of beds was more than 250 in each hospital. The university hospital and private hospital were engaged in medical tourism and accredited by the Joint Commission International, while the state hospital was accredited nationally. The state hospital was also open to medical tourism but did not have a specific organization for this purpose.

In the first stage of the study, we assessed the Organizational Health Literacy (OHL) of the hospitals by using the Turkish version of the HLHO-10 questionnaire during face-to-face interviews with six managers from each hospital. HLHO-10 is a questionnaire based on the “Ten Attributes of Health Literate Health Care Organizations,” as developed by Kowalski et al. The Turkish version of the HLHO-10 questionnaire had high reliability (Cronbach’s alpha=0.916) in our study group. We found a statistically significant difference between the mean scores of HLHO-10 of the hospitals (p=0.017). The mean HLHO-10 score was higher in the university hospital than the others and lowest in the state hospital. This finding indicated that the university hospital was the most health literate institution, according to the assessments of hospital managers in our study group.

In the second stage of the study, we collected data from inpatients of three hospitals (n=482 for the state hospital, n=491 for the not-for-profit university hospital, and n=486 for the for-profit private hospital) regarding patient satisfaction and individual health literacy during their discharge. Both the patient satisfaction and health literacy scores were significantly higher among the university hospital inpatients than the others. There was a positive, weak, and statistically significant correlation (r=0.074, p<0.05) between patient satisfaction and individual health literacy scores of the whole study group.

Some items in the patient satisfaction questionnaire were related to OHL. When mean scores of these items are analyzed separately and compared among the hospitals, we found that the inpatients of the university hospital have the highest scores. These findings together indicated that the level of OHL was highest in the university hospital, according to the perspectives of both the patients and hospital managers in our study groups.


We concluded that organizational health literacy might be a significant determinant of patient satisfaction since it was closely associated with patient satisfaction in our study group. However, it is difficult to interpret this finding as a cause-and-effect relationship due to the cross-sectional nature of the study, which is an important limitation of this study.

*The work was funded by TUBİTAK-Turkish Scientific and Technological Research Institution (3001-Baslangıcž AR-GE, No: 215S955).
**Detailed findings of the study are presented in the article published in the journal “Public Health”.

These findings are described in the article entitled Organizational health literacy as a determinant of patient satisfaction, recently published in the journal Public Health.



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