Development of an Evidence-Based Multidisciplinary Guideline for Policy and Practice to Increase Health Literacy among Older Adults in Europe: engaging stakeholders is crucial for optimal adoption and use of the guideline.

Introduction. Guidelines are often not fully implemented into practice or policy. It has been recommended to engage end-users in the development of guidelines to promote adoption and use of the guidelines. Therefore, the Intervention Research On Health Literacy (IROHLA) project aimed to produce a health literacy guideline for policy and practice, which meets the needs of the end-users in EU member states and will help them to effectively reduce health literacy problems.
Methods. We engaged stakeholders in all phases of the project: 1) We gathered evidence with a Delphi study, a survey with stakeholders and a literature review. 2) With the results of step 1 we designed key messages for the guideline for policy and practice that were pilot tested during face-to- face conferences and semi-structured telephone interviews. 3) In the development of a usable communication and dissemination strategy for the guideline, we used an online survey with stakeholders, face-to-face conferences and a web-based feedback round on the published draft guideline-portal.
Results. 1) 39 health literacy experts from various countries who had previously published about health literacy helped linking research evidence to practical advice for policy and practice. The IROHLA theoretical model and taxonomy were developed, facilitating the communication, development and assessment of health literacy interventions. Twenty promising interventions were selected. It became clear that many interventions have similar components and working mechanisms and that grouping them will provide a better overview of strategies to reduce health literacy problems.
2) Pilot testing key messages on jointly identified priority topics with the 20 partner organisations in the IROHLA project helped making messages more complete, clear and applicable by end-users. An important comment was that messages should contain a concrete action. The interviews are planned in September 2015.
3) The online survey about relevant questions and contributing factors to successful dissemination and adoption of the guideline, was distributed by umbrella organizations in the IROHLA project to their member organizations and completed by 28 end-users: persons involved in policy advice and from patient- and public organisations, professionals and researchers. They stated that health literacy is an issue in their countries, but policy makers and professionals are mostly unaware of the impact of health literacy on health. A European guideline for health literacy is seen as useful as inspiration, to start a programme and to learn from best practices but would always need local adaptation. The web-portal of the guideline developed in this project contains scientific and practical evidence with a focus on a broad range of health literacy interventions targeting the older adults, professionals and/or their context. Evaluation of the draft portal will be done in September 2015. Conclusions. Engaging stakeholders in the developmental process was crucial for identification of key issues to be addressed, for finding viable interventions in different cultural contexts and –hopefully- for presentation of the evidence in a user-friendly and sustainable web portal that meets the needs of end-users, will create awareness and support them in effective strategies reducing low health literacy. How the end-users will actually use our guideline will be measured in a follow-up study after launching the portal in November 2015.