Development of this portal with stakeholders

Development of this portal with stakeholders

Our aim is to cover all important and relevant aspects to improve health literacy

The Health Literacy Centre Europe portal has been developed within the project “Intervention Research On Health Literacy among the Ageing population” (IROHLA). Our goal is to present a guideline for policy and practice at national, regional and local level. The guideline shows policymakers the specific and important measures they can take and shows implementers of those policies practical interventions to improve health literacy for older people in EU countries (See figure  below).

Figure: Levels of the IROHLA guideline


The guideline provides recommendations on the appropriate prevention, treatment and care of people with specific risk factors, diseases and conditions. It is based on the best available evidence. In addition, the guideline can play an important role in health policy development and implementation in healthcare and social services.

Mixed-method approach

In order to develop the health literacy guideline for the ageing population we used a mixed-method approach of linking research evidence from the IROHLA project to practical advice for policy and practice. All results of the IROHLA activities and existing evidence contributed to the development of the guideline. The steps taken in the final stage of the project were as follows:

A) Explorative studies were conducted to strengthen evidence on the following topics:

  1. Development and evaluation of photonovels to support doctor-patient communication.
  2. The contribution of a community-based participatory action approach to improve critical health literacy.
  3. Criteria for successful e-health interventions: mapping the needs and experiences of older adults with low health literacy.
  4. Development and pilot testing of for health literacy focused communication training for professionals.
  5. Implementation of environmental health literacy interventions in healthcare settings.

B) Development of guideline

Steps taken to develop the guideline on the portal were as follows:

Policy level

  1. appraisal of health literacy policy documents;
  2. development and testing of Policy Brief;
  3. consulting policy makers and other stakeholders to assess their needs
  4. consulting stakeholders on success factors of Policy Brief;

Guidance level

  1. finding preconditions for successful implementation (literature review);
  2. strengthening the evidence based approach (IROHLA conducted a series of systematic reviews to evaluate available evidence);
  3. understanding the role of context (literature review) including a stakeholder analyses;
  4. understanding the essential characteristics of a a user-friendly portal.

Practice level

  1. appraisal of healthcare practice guidelines to determine how ‘health literacy proof’ they are;
  2. integration of IROHLA findings in comprehensive approach (including 20 selected interventions);
  3. development of checklist of barriers and facilitators for implementation of practice guidelines (literature review and appraisal by experts in the project);
  4. pre-testing of guidelines under development.

Engaging stakeholders is crucial in development of guidelines

A person involved in policy advice: “Health literacy is an issue in most countries, but largely unknown among policy makers and national organisations. Health literacy may be implicitly addressed as part of other programmes, e.g. health promotion or information campaigns on accessing healthcare services”. When asking stakeholders, we specifically realised that a lot of our target groups are unaware of the influence of health literacy on health.

Therefore, we engaged stakeholders in all phases of the development of the IROHLA health literacy guideline on the HLCE-portal. We use different wording for nearly the same issues in order to reach our target groups with our knowledge on health literacy. And we developed concrete tools to incorporate this knowledge into daily practice.

Engaging stakeholders in the developmental process was crucial for identification of key issues to be addressed, for finding viable interventions in different cultural contexts and for presentation of the evidence in a user-friendly and sustainable web portal that meets the needs of end-users creating awareness and supporting them in developing effective strategies to reduce low health literacy.

Comprehensive approach and 20 selected interventions

Comprehensive approaches in prevention and healthcare have been shown to be more effective compared to single interventions. Comprehensive interventions are those that include several components (More information you will find here.). The selection of intervention components can be based on theories and evidence about the underlying mechanisms or pathways. Different pathways or mechanisms may explain the relationship between health literacy interventions and outcomes.

In the IROHLA project best practices and evidence-based approaches are identified in the health, social and private sector. A combination of these practices and approaches, presented in the guideline, when joined in a comprehensive intervention, may reduce health literacy problems. You will find them here.

Realising optimal quality and usability of the guideline 

A high quality health literacy guideline describing a comprehensive approach can improve the quality of prevention and healthcare by helping policymakers, professionals, educators and other experts to make informed decisions regarding interventions and implementing these interventions successfully. The quality of guidelines for public health and clinical practice varies (Burda 2014, refs) and it was concluded that the guideline developmental process needs improvement. Areas for improvement include increased stakeholder engagement, formulation of recommendations and discussion of the barriers and facilitators

Engaging stakeholders is crucial for optimal adoption and use of the guideline

We engaged stakeholders in all phases of the project in order to optimise the quality:

  • We gathered evidence with a Delphi study, a survey with stakeholders and a literature review. Thirty-nine health literacy experts from various countries, who had previously published on the topic of health literacy, helped to link research evidence and practical advice for policy and practice. The IROHLA theoretical model and taxonomy were developed, facilitating the communication, development and assessment of health literacy interventions. Twenty promising interventions were selected. It became clear that many interventions had similar components and working mechanisms and that grouping them would provide a better overview of strategies to reduce health literacy problems.
  • With the results of step 1 we designed key messages for the guideline for policy and practice that were pilot tested during face-to-face conferences and semi-structured telephone interviews. Pilot testing key messages on jointly identified priority topics with the 20 partner organisations in the IROHLA project helped to make the messages more complete, clear and applicable to end-users. An important comment was that messages should contain a concrete action.
  • In the development of a usable communication and dissemination strategy for the guideline, we used an online survey with stakeholders, face-to-face conferences and a web-based feedback round on the published draft guideline. The online survey about relevant questions and contributing factors to successful dissemination and adoption of the guideline, was distributed by umbrella organisations in the IROHLA project to their member organisations and completed by 28 end-users: persons involved in policy advice, patient- and public organisations, professionals and researchers. They stated that health literacy is an issue in their countries, but that policy makers and professionals are mostly unaware of the impact of health literacy on health. A European guideline for health literacy is seen as useful to start a programme and to learn from best practices but it would always need local adaptation. Testing the draft guideline with the AGREE-tool led to some adjustments, for instance in providing more references on the messages.

Engaging stakeholders in the developmental process was crucial for identification of key issues to be addressed, for finding viable interventions in different cultural contexts and  for presentation of the evidence in a user-friendly and sustainable web portal that meets the needs of end-users creating awareness and supporting them in developing effective strategies to reduce low health literacy. How the end-users will actually use our guideline will be measured in a follow-up study after launching the portal in November 2015.


  • AGREE tool users manual. Download PDF here
  • Carrol C, Patterson M, Wood S, Booth A, Rick J, Balain S (2007). A conceptual framework for implementation fidelity. Implementation Science 2007, 2:40. This article is available here.
  • NICE pathways: link here
  • Fleuren M, Wiefferink K, Paulussen T (2004). Determinants of innovation within healthcare organisations; Literature review and Delphi study. International Journal for Quality in Health Care 2004; Volume 16, Number 2: pp. 107–123.
  • Communicating research for evidence-based policy making, EC DG Research 2010,
  • Lavis JA et all (2009) SUPPORT tools for evidence-informed health policy making 13: preparing and using policy briefs to support evidence-informed policy making, Health research Policy and Systems, 2009 (Supp 1): S13
  • Caplan N. The two communities theory and knowledge utilizaion. American Behavioral Scientist. 1979;22(3): 459-70
  • Freeman R Strategicmanagement: a steakholder approach. Bosting: Ptiman; 1984.
  • Stakeholder mapping. BSR’s Five-Step Approach to Stakeholder Engagement. BSR; November 2011. Download PDF here