Exploring the attributes of organizational health literacy in Chinese healthcare institutions from the perspective of the social-ecological theoretical model: a grounded theory study

Abstract

Organizational health literacy (OHL) is essential for reducing adverse outcomes associated with limited health literacy, including medication errors, increased hospitalization, and widening health disparities. Although the complexity of the healthcare system represents a major barrier for people with insufficient health literacy, the organizational attributes within this system that may help address these barriers remain insufficiently examined in China. This lack of research restricts the development of effective system-level interventions for creating a more accessible and equitable healthcare environment. This study aimed to address this gap by examining OHL attributes within China’s healthcare system. Participants who met the inclusion criteria were recruited from six healthcare institutions for semi-structured interviews using purposive and theoretical sampling. The participants represented a diverse group of stakeholders, including managers, administrators, healthcare workers, and patients. Interview data were analyzed by integrating grounded theory with the social-ecological theoretical model, and three levels of coding were applied to the textual data: open coding, axial coding, and selective coding. This process led to the identification of the attributes of OHL in healthcare institutions. Analysis of data from 35 participants showed that the constitutive characteristics of OHL in healthcare institutions included three main dimensions: (1) patient-related factors (e.g., health information-seeking abilities); (2) healthcare provider-related factors (e.g., patient-centered communication approaches); and (3) healthcare institution environment-related factors (e.g., organizational strategies for streamlining care processes). Based on the socio-ecological model, this theoretical framework clarifies the multi-level interactive dynamics that influence OHL. This study identifies key and previously underexplored OHL attributes in China, providing an evidence-based blueprint for system-level improvement. The consistency of these attributes with the socio-ecological model highlights the need for multi-faceted interventions that simultaneously target patients, healthcare workers, and institutions. Therefore, this study provides a basis for future research and policy development aimed at building health-literate healthcare organizations in China.