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DOI: 10.1101/2023.03.15.23287331

Systematic review of health literacy champions: Who, what and how?

J.Ayre M. Zhang D. Muscat D. Zachariah D. Mouwad K. McCaffery
Background: Health literacy is an important aspect of equitable, safe, and high-quality care. For organisations implementing health literacy initiatives, using "change champions" appears to be a promising strategy. This systematic review aimed to identify the empirical and conceptual research that exists about health literacy champions. Methods: We conducted a systematic literature search using MEDLINE, Embase, CINAHL, Scopus, and PubMed, with additional studies identified by searching references and citations of included studies and reviews of organisational health literacy. Results: Seventeen articles were included in the final review (case studies, n=9; qualitative research, n=4; quasi-experimental, n=2; opinion articles without case studies, n=2). Most articles had a high risk of bias. Often champions were not the focus of the article. Champions included staff across frontline, management and executive levels. Only five studies described training for champions. Key champion activities related to either 1) increasing organisational awareness and commitment to health literacy, or 2) influencing organisational strategic and operational planning. The most common output was ensuring that the organisations health information materials met health literacy guidelines. Articles recommended engaging multiple champions at varying levels within the organisation, including the executive level. Limited funding and resources were key barriers. Three of five articles reported positive impacts of champions on implementation of health literacy initiatives. Discussions: Few articles described health literacy champions in adequate detail. More comprehensive reporting on this implementation strategy and further experimental and process evaluation research are needed to progress this area of research. Registration: This systematic review was registered with PROSPERO (CRD42022348816)