title: Improving organizational capacity to address health literacy in public health: a rapid realist review.
abstract: OBJECTIVE
  Despite the growing significance of health literacy to public health, relatively little is known about how organizational capacity may be improved for planning, implementing and sustaining health literacy interventions. This study aimed to connect decision makers in a public health agency with evidence of how organizational capacity may be improved for delivering health literacy services.
  
  
  METHODS
  A rapid realist review of published and grey literature was conducted by a partnership between the Public Health Agency of Canada (PHAC) and the InSource Research Group.
  
  
  METHODS
  Realist review methodology attempts to understand what works for whom under what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms and their relationship to outcome. This review was completed in collaboration with a reference panel (comprised of a broad range of PHAC representatives) and an expert panel. Literature searching was conducted using three databases supplemented with bibliographic hand searches and articles recommended by panels. Data were extracted on key variables related to definitions, strategies/interventions associated with increased organizational capacity, contextual factors associated with success (and failure), mechanisms activated as a result of different strategies and contexts, key outcomes, and evidence cited.
  
  
  RESULTS
  Strategies found to be associated with improved organizational capacity for delivering health literacy services may be classified into three domains: (1) government action; (2) organizational/practitioner action; and (3) partnership action. Government action includes developing policies to reinforce social norms; setting standards for education; conducting research; and measuring health literacy levels. Organizational/practitioner action relates to appropriate models of leadership (both high-level government engagement and distributed leadership). Innovative partnership action includes collaborations with media outlets, those producing electronic materials, community organizations and school-based programs. Contextual factors for success include positive leadership models, interorganizational relationships, and a culture committed to experimentation and learning. Potential mechanisms activated by strategies and contextual factors include increased visibility and recognition of health literacy efforts, enthusiasm and momentum for health literacy activities, reduced cognitive dissonance between vision and action, a sense of ownership for health literacy data, and creation of a common language and understanding.
  
  
  CONCLUSIONS
  Government initiated interventions and policies are powerful strategies by which organizational capacity to improve health literacy may be affected. Using the foundations created by the government policy environment, organizations may improve the impact of health literacy interventions through supported distributed leadership.
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; School of Population Health, The University of Adelaide, Australia; InSource Research Group, Vancouver, Canada. Electronic address: cdwillis@uwaterloo.ca.
authors.forename: C D
authors.initials: CD
authors.lastname: Willis
authors.affiliation: InSource Research Group, Vancouver, Canada; North American Research & Analysis, Inc., USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Saul
authors.affiliation: InSource Research Group, Vancouver, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Bitz
authors.affiliation: InSource Research Group, Vancouver, Canada; Health Actions, First Nations Health Authority, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Pompu
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; InSource Research Group, Vancouver, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Best
authors.affiliation: Research and Knowledge Development, Strategic Initiatives and Innovations Directorate, Public Health Agency of Canada, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Jackson
mesh_terms: D002170:Canada; D057191:Capacity Building / Q000458:organization & administration*; D057220:Health Literacy; D006801:Humans; D011635:Public Health Administration
keywords: Evidence synthesis; Health literacy; Health policy; Realist review