This study initially assessed the capability of healthcare institutions to address the requirements of older patients through quantitative analysis. Subsequently, interviews were conducted with managers, clinical staff, and older patients to investigate the obstacles hindering the development of OHL within healthcare institutions. The study revealed a weak response from healthcare institutions to the needs of older patients, with influencing factors spanning patient-level, organization-level, and political-level domains.
Quantitative investigations have indicated the inadequate ability of healthcare institutions to meet the needs of older patients. On one hand, the generally low health literacy levels among the older in China hinder their access to and utilization of health information, negatively affecting their health outcomes (5, 29). Additionally, older individuals often experience multiple chronic conditions, increasing their reliance on healthcare institutions (30, 31). Qualitative inquiries have also identified physiological declines among older patients, such as vision or hearing loss, impairing their ability to access health information and effectively communicate with clinical staff, thereby complicating their access to healthcare resources. Furthermore, cognitive decline in older adults often necessitates repeated education by clinical staff and volunteers due to frequent forgetfulness. Low levels of education contribute significantly to the low health literacy rates among the older. Those with lower educational attainment tend to be slower in adopting new concepts, possess limited self-awareness, lack awareness of disease prevention strategies, and encounter challenges in acquiring scientific health knowledge and skills, resulting in diminished health literacy (30, 31). Overall, there is a considerable demand among the older for healthcare institutions.
On the other hand, the ability of healthcare institutions to address the needs of older patients remains inadequate. Qualitative research indicates that barriers to the establishment of OHL within healthcare institutions also involve organizational and policy-level factors.
From an organizational standpoint, healthcare facilities have not adequately addressed the digital disparity among older patients during the digitalization process. According to the statistical report on China’s internet development status released by the China Internet Information Center in (32), out of 253.88 million individuals aged 60 years and older in China, only 60.56 million people (23.85%) had internet access in 2019. Older individuals face challenges in effectively utilizing online health information platforms and telemedicine services, resulting in significant inconvenience in accessing daily health consultations and purchasing medications (33–35). Consequently, it is imperative for healthcare institutions to simplify electronic systems to facilitate older individuals’ access to health information. The shortage of medical personnel also significantly influences the development of OHL within healthcare institutions. During interviews, clinical staff expressed difficulties in dedicating time to communicate with older patients and provide health information resources due to the scarcity of medical staff. This finding aligns with previous research indicating that clinical staff often lack sufficient time for health literacy endeavors, especially in communication, owing to staffing shortages (36, 37); (38). Furthermore, the absence of health literacy training for medical personnel in healthcare institutions is recognized as an influencing factor. Several studies on health literacy consistently highlight that healthcare workers generally lack the necessary knowledge and skills to effectively communicate with patients with low health literacy (39). Hence, healthcare providers should offer training in health literacy, including navigation, health information, and communication, to cater to the needs of older patients.
At the policy level, the researchers examined interview transcripts with administrators and clinical staff in healthcare institutions and discovered a lack of regulations regarding the establishment of OHL within these institutions. This absence of regulation may stem from OHL being a relatively new concept in China, with Chinese scholars only beginning to explore it and not yet conducting empirical research. Consequently, healthcare institutions do not prioritize the development of OHL adequately. A study on barriers to establishing OHL in the German public health sector identified the absence of policy pressure as one of the impediments to OHL establishment in healthcare institutions (40). The absence of OHL policies and plans in healthcare institutions means that OHL is often excluded from the organization’s mission, vision, and strategic planning; thus, hindering its development. While some health literacy practices may be implemented by frontline staff, most are unfamiliar with the concept of health literacy (41–43). However, implementing specific regulations outlined in health literacy guides could enhance navigation and patients’ comprehension and utilization of health information in specific settings (44, 45). Therefore, it is crucial to formulate policies or regulations that integrate OHL into healthcare institution construction planning, enhance healthcare personnel’s awareness of OHL, and foster the establishment of OHL within healthcare institutions.
Limitations
Firstly, this study solely surveyed older patients in two tertiary health institutions in Yangzhou City, Jiangsu Province, China, potentially limiting the generalizability of the findings due to regional and cultural influences. Future research could broaden the scope by including health institutions from other regions in China to enhance sample representativeness. Secondly, the research team developed the instrument utilized for quantitative research in this study. However, the scale underwent two rounds of expert consultation, enhancing its credibility and reliability. Consequently, the scale can serve as a robust tool for older patients to assess the OHL of healthcare institutions.