Dealing with health literacy at the organisational level, French translation and adaptation of the Vienna health literate organisation self-assessment tool

Background
Efforts to address health literacy should favour a system-based approach with the dual aim both of fostering the material conditions and creating a work culture inside health care organisations that makes it easier for people to use information. The Vienna Health Literate Organisation (V-HLO) self-assessment tool is a German-speaking questionnaire for quality managers of health care organisations. Its objective is to provide a diagnostic of the strengths and weaknesses of the organisation in terms of health literacy. Our goal was to translate and culturally adapt this questionnaire for the French-speaking part of Belgium.
Methods
We followed the Translation, Review, Adjudication, Pretesting, and Documentation (TRAPD) team model for cross-cultural translation of questionnaires. We used cognitive interviews with quality experts to pre-test the translation.
Results
Cognitive interviews allowed us to improve the translation by removing certain ambiguities, providing contextual clarifications or rephrasing some items in such a way as to render them more culturally appropriate. Local experts generally judged the tool to be relevant and applicable to their context. The insight gained with regard to their cognitive process when completing the V-HLO allowed us to identify possible barriers to the adoption of the tool (such as difficulties in considering staff literacy as a relevant target for the tool, fear of overwhelming staff, a feeling that some items fell outside the scope of health literacy and lack of attention for integration of services with primary care) and could contribute to the future development of the tool.
Conclusion
We translated and adapted the V-HLO self-assessment tool for French. The French version of the V-HLO will now be implemented in our local context to assess whether it can make it easier for people to deal with the complexities of health care organisations.