Integration of Health Literacy into Organizational Culture as a Prerequisite for Workplace Health Promotion

Introduction

Health literacy represents a significant prerequisite for the protection and promotion of health, disease prevention, and informed decision-making by individuals about their own health. In the work environment, it gains particular importance not only as an individual competence of employees but also as part of an organizational culture oriented towards health, safety, and quality of working life. Its systematic development requires creating conditions that support the accessibility and comprehensibility of health information, preventive behavior, and active employee participation. Integrating the principles of health literacy into strategic management and the daily processes of an organization can contribute to building a healthy work environment and the long-term preservation of work ability (Brach et al., 2012; Sørensen et al., 2012; WHO, 2010).

Health literacy is the ability to obtain, read, understand, and use health information so that a person can make correct decisions about their health (Akční plán rozvoje zdravotní gramotnosti, 2014). Health literacy is about how to clearly communicate health information and understand it correctly. Health literacy is important at all points within the continuum of health care – from well-being and health, through prevention and disease detection, to diagnosis and decision-making, as well as treatment and self-care (Osborne, 2018). In a narrower understanding of health literacy, emphasis is placed on healthcare information, understanding package inserts, abilities for personal participation in treatment, abilities to care for family members, and basic information about a healthy lifestyle. In a broader understanding, it involves the availability of all information related to health that can favorably influence health, strengthening people's ability to navigate life situations and make decisions that lead to the protection and enhancement of health (Holčík, 2010). A person with adequate health literacy can read informed consent forms, medical labels, prescriptions, and other medical information, understands written and spoken information received from healthcare professionals, and follows necessary procedures and regulations, such as medication and prescribed treatment regimens. It is about the connection between health and information. Health literacy is a key outcome of health education activities, which should be part of a broader concept of health promotion (DeYoung, 2009). The practical significance of health literacy refers to the degree of individuals' ability to obtain, process, and understand basic health information and services needed to make appropriate decisions regarding health care. Health literacy is based on the idea that both health and literacy are crucial resources for everyday life (WHO, 2009).

WHO (2013) defines health literacy as cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health, i.e., a person's ability to seek, understand, and use information about health and healthcare services in order to assess and make decisions about healthcare, disease prevention, and health promotion in everyday life, with the aim of maintaining or improving quality of life. Dimunová (2018) characterizes health literacy as an individual's ability to competently and appropriately apply knowledge and skills in specific health situations and the ability to implement effective preventive measures intervening in lifestyle towards health promotion. Definitions of health literacy include a public health perspective that can be easily adapted to an individual approach to three domains of health: healthcare, disease prevention, and health promotion. Discussions on the role of health literacy emphasize the importance of interaction between the demands of healthcare systems and the skills of individuals (Sørensen et al., 2012).

The participation of individuals in the labor market plays a central role in securing their livelihood and the basis for social insurance. Work is an influential factor throughout life and determines a person's health and well-being. At work, increasing complexity, rapid changes, and the altered work environment due to globalization and digitalization cause, among other things, an increase in the number of self-employed persons and the loss of boundaries between work and private life and other areas of life (Ehmann et al., 2021). The physical and mental health of an employee should also be at the center of the employer's interest, and health literacy should represent an integral part of corporate or organizational culture. Organizational culture represents a set of shared values, beliefs, basic assumptions, and behavioral norms that shape the functioning of an organization and influence the daily actions of its members. Every employee should adopt and identify with organizational culture as a value system (Robbins, Judge, 2019; Schein, 2010). It determines employee behavior in the organization and influences its functioning and performance. Creating organizational culture is a never-ending process influenced by top managers and leaders of the organization (Čmelíková, Čmelík, 2012). The type of organizational culture determines the decision-making processes of management and the work results that management expects from its employees (Kilíková, 2024). According to Warrick (2026), it can be defined as the prevailing beliefs, values, attitudes, behaviors, or practices that are typical for a certain group of people. From a group perspective, it refers to the entire organization according to its size or focus, country, or family. However, scientists refer to organizational culture as the culture of the entire organization or any unit where people work within the organization.

Health literacy in the work environment represents not only an individual competence of the employee but also a strategic development potential of the organization that needs to be systematically supported through educational, preventive, and organizational interventions. Health literacy as part of organizational culture means that the protection and promotion of health, understandable communication, and the creation of conditions for informed employee decision-making are a natural part of the values, management, and daily functioning of the organization (Brach et al., 2012; Schein, 2010; WHO, 2002; WHO, 2025).

A health-literate organization or a health-literate employer is one that actively creates an environment supporting the physical and mental health of its people, can effectively communicate health-related topics, and helps employees navigate the areas of prevention and company benefits. It is not just about formally fulfilling legal obligations but about a strategic approach to human resources, where a healthy employee means a prosperous company (Brach et al., 2012; Sørensen et al.; 2012; WHO, 2010).

Health literacy in the workplace includes the following components:

• Individual health literacy: The employee's ability to find, understand, evaluate, and apply information about safety, lifestyle, and medicine (including mental health and chronic disease prevention).

• Organizational health literacy: The extent to which a company creates rules, environments, and communication methods that make it easier for workers to navigate health resources and benefits.

• Health-supportive leadership: Managers and supervisors who actively support wellbeing, respect employee needs, and reduce the stigma associated with seeking help (Brach et al., 2012; Franke et al., 2014; Sørensen et al.; 2012).

The importance of digital health literacy in the workplace:

• Psychological wellbeing: Studies show that individual health literacy directly improves employees' mental health. This effect is even stronger when supported by the organization itself and understanding management.

• Work ability and safety: Knowledge in occupational health protection reduces the risk of burnout, prolongs the ability to work, and ensures safer management of workplace risks.

• Lifestyle and prevention: Educational programs (e.g., preventive check-ups or on-site counseling) help workers detect risk factors early, such as prediabetes or high blood pressure (Brach et al., 2012; Franke et al., 2014; Sørensen et al.; 2012).

Key employer strategies for supporting employee health literacy:

• Use understandable language: replace complex medical jargon in manuals, insurance contracts, and safety instructions with simple and clear language.

• Educate managers: provide team leaders with training in mental health first aid so they know how to properly support their subordinates.

• Use alternatives to brochures: offer interactive workshops, peer support groups, and practical tools instead of passively distributing leaflets.

• Adapt the approach to employees: take into account that needs differ by age, education, job position (e.g., administration vs. production), or language (Brach et al., 2012; WHO, 2010; WHO, 2022).

Figure 1 Workplace Health Model (source: CDC, 2024)

Expected benefits of developing health literacy in the organizational environment

The systematic development of employee health literacy represents a significant part of workplace health promotion and the creation of an organizational culture oriented towards health, safety, and quality of working life. Health literacy influences employees' ability to understand health information, critically evaluate it, and use it in decisions about their own health. Its support can bring positive effects at the individual, collective, and organizational levels (Brach et al., 2012; Sørensen et al., 2012; WHO, 2010). The benefits of developing employee health literacy can be perceived in six areas:

1. Strengthening individual responsibility for health

A higher level of health literacy creates the prerequisites for a more active and conscious approach by employees to protecting and promoting their own health. Employees with developed health competencies are better able to identify factors affecting their health status, recognize potential health risks, and make informed decisions regarding lifestyle, prevention, and the use of healthcare. However, strengthening individual responsibility must be accompanied by creating appropriate organizational conditions. Responsibility for health cannot, therefore, be transferred solely to the individual but must be understood as a shared responsibility of employees and the employer (Sørensen et al., 2012; WHO, 2010).

2. Improving employee orientation in health information

Developing health literacy supports employees' ability to effectively find, understand, critically evaluate, and practically use health-related information. It takes on particular importance in the context of the growing amount of digital health information, whose professional accuracy, credibility, and comprehensibility may vary. Employees with a higher level of health literacy can better distinguish between scientifically based recommendations and unverified claims, navigate preventive programs, and communicate more effectively with healthcare professionals. In the organizational environment, it is therefore important to ensure the availability of current, understandable, and trustworthy health information (Brach et al., 2012; Norman, Skinner, 2006; Sørensen et al., 2012).

3. Supporting preventive and health-promoting behavior

Health literacy represents one of the prerequisites for developing preventive behavior and adopting health-promoting habits. Its systematic strengthening can motivate employees to regularly undergo preventive check-ups, engage in adequate physical activity, maintain a balanced diet, ensure sufficient recovery, and manage stress effectively. An important area is also the recognition of early signs of health problems and the appropriate use of healthcare services. The effectiveness of preventive interventions can be increased by linking them to specific working conditions, the availability of preventive activities, and support from the organization's leadership (Nutbeam, 2008; Sørensen et al., 2012; WHO, 2010).

4. Reducing preventable health risks

Increasing health literacy can contribute to better recognition and management of modifiable health risks related to the work environment, work habits, and employee lifestyle. Particular attention should be paid to risks associated with prolonged sedentary work, insufficient physical activity, poor ergonomic conditions, chronic stress, excessive workload, and inadequate recovery. Health-literate employees can more actively use available preventive measures and identify situations threatening their health in a timely manner. However, education alone does not replace the employer's obligation to ensure safe and healthy working conditions. Reducing health risks therefore requires a combination of individual competencies and systemic organizational measures (Sørensen et al., 2012; WHO, 2010; WHO, 2022).

5. Improving employee wellbeing and satisfaction

Supporting health literacy can positively influence subjective health perception, psychological well-being, and employees' ability to cope with daily work demands. The development of mental health literacy is of particular importance, encompassing the ability to recognize signs of psychological strain, use appropriate stress management strategies, and seek professional help. Organizations that promote open communication about health, psychological safety, respect for individual needs, and work-life balance create favorable conditions for enhancing job satisfaction. Health literacy can thus form part of a broader strategy to support workplace well-being and prevent psychosocial risks (WHO, 2022).

6. Supporting Work Ability and Long-Term Employment Sustainability

The development of health literacy can contribute to maintaining work ability by promoting a healthy lifestyle, early recognition of health problems, and more effective use of preventive healthcare. In the context of an aging workforce and increasing demands on employees' physical and mental performance, supporting individuals' ability to actively participate in maintaining their health throughout their working lives is of particular importance. Long-term integration of health literacy into organizational culture can create conditions for sustaining work performance, reducing health-related work strain, and supporting active and healthy aging in employment. However, these benefits also depend on working conditions, the nature of work, and the availability of appropriate organizational measures (Ilmarinen, 2009; Sørensen et al., 2012; WHO, 2010).

Overall Benefit for the Organization

Systematic support of employee health literacy can create a synergistic effect, where the development of individual health competencies is linked to strengthening an organizational culture oriented towards health. In the long term, this approach can contribute to creating a safer work environment, supporting workplace well-being, strengthening employee participation, and sustaining work ability (Brach et al., 2012; Ilmarinen, 2009; Sørensen et al., 2012; WHO, 2010).

Figure 2 Schematic representation of a health-literate organization (Image generated using artificial intelligence (OpenAI, ChatGPT, 2026) based on the author's assignment)

Implementing elements of health literacy support into the environment of an organization or company and creating a so-called health-literate organization can be achieved through the development of an action plan.

DRAFT ACTION PLAN FOR IMPLEMENTING INTERVENTIONS TO SUPPORT EMPLOYEE HEALTH LITERACY (12-month implementation cycle)

Objective of the Action Plan: Systematically develop employee health literacy through targeted educational, preventive, and organizational interventions and integrate health support into the organizational culture of the workplace.

Table 1 Specification of Implementation Phases of the Action Plan to Support Health Literacy

(source: own processing based on WHO, 2010; CDC, 2024 methodological frameworks and principles of organizational health literacy according to Brach et al., 2012)

Key Areas of Interventions Supporting Employee Health Literacy

• Health Education: developing employees' ability to obtain, understand, critically evaluate, and use health information when making decisions about their own health.

• Prevention and Healthy Lifestyle: promoting physical activity, healthy nutrition, stress management, and the use of preventive healthcare services through accessible and individually tailored workplace health promotion programs.

• Health-Literate Organization: creating organizational conditions that support the accessibility and comprehensibility of health information, employee participation, and the active involvement of organizational management and individual organizational units in health promotion.

• Digital Health Literacy: strengthening employees' ability to search for, critically evaluate, and use electronic health information and develop competencies needed for the safe use of digital healthcare services (Brach et al., 2012; Norman, Skinner, 2006; Sørensen et al., 2012; WHO, 2010).

Proposed Indicators for Evaluating the Effectiveness of Health Literacy Support Interventions

• Health Literacy Level: change in the score of a validated assessment tool before and after the intervention (e.g., HLQ – Health Literacy Questionnaire; HLS19-Q12 – Health Literacy Survey Questionnaire; eHEALS – eHealth Literacy Scale).

• Employee Participation: percentage of employees involved in activities.

• Health Competencies: change in the ability to navigate health information and make informed health decisions.

• Organizational Environment: number and scope of implemented health-promoting measures.

• Sustainability: integration of interventions into internal policies and regular organizational activities (Brach et al., 2012; Norman, Skinner, 2006; Osborne et al., 2013; Pelikan et al., 2022; Sørensen et al., 2012; WHO, 2010).

Implementation of the action plan creates conditions for developing employee health competencies, strengthening preventive behavior, and building an organizational culture oriented towards health. The long-term aim is to transform the workplace into a health-literate organization, where health support is part of strategic management and daily practice (Brach et al., 2012; Sørensen et al., 2012; WHO, 2010).

Opportunities for Nurses' Participation in Supporting Employee Health Literacy

Nurses represent significant actors in supporting employee health literacy. Their role lies particularly in:

• assessing the level of health literacy and identifying educational needs,

• education in the field of disease prevention, healthy lifestyle, and mental health,

• support of digital health literacy and critical evaluation of health information,

• implementation of preventive interventions and support of informed decision-making about health,

• interdisciplinary collaboration in the creation and implementation of health promotion programs,

• evaluation of intervention outcomes and continuous improvement of educational practices.

Nurses can thus contribute to transforming the workplace into an environment where health literacy is part of the organizational culture and systematic health support (Brach et al., 2012; Sørensen et al., 2012; WHO, 2010).

Table 2 Specification of nurses' roles in promoting health literacy

(processed according to: Brach et al., 2012; Sørensen et al., 2012; WHO, 2010)

Conclusion

Health literacy represents a significant prerequisite for the protection and promotion of health, disease prevention, and informed decision-making of individuals about their own health. In the work environment, it acquires special importance not only as an individual competence of employees, but also as part of an organizational culture oriented towards health, safety, and quality of working life. Its systematic development requires creating conditions that support the availability and comprehensibility of health information, preventive behavior, and active participation of employees. The integration of health literacy principles into strategic management and daily processes of the organization can contribute to building a healthy work environment and long-term preservation of work ability (Sørensen et al., 2012; WHO, 2010; Brach et al., 2012).

Author: PhDr. Mgr. Mariana Magerčiaková, PhD., MPH, MBA, univ. doc. KU
Catholic University in Ružomberok, Faculty of Health

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