Organizational health literacy of schools in Germany: results of a cross-sectional study.

A social gradient in health literacy is prevalent in children and adolescents, with those from lower socioeconomic backgrounds often having lower levels. Interventions aiming at an entire setting, such as the organizational health literacy approach, seem promising to tackle these inequities. Schools represent unique environments to implement such interventions. The HeLit-Schools project aimed at developing an organizational health literacy framework for schools. The framework contains eight quality standards, each underpinned by six indicators, and was translated into a self-assessment tool (OHLS-Q). In this cross-sectional study, the German version of the OHLS-Q was used to assess the implementation status of organizational health literacy in schools in Germany for the first time. School management members completed the questionnaire via an online survey, including sociodemographic, personal, and school information. Descriptive statistics were reported. The n = 598 participants from five federal states were Ø 52.3 years old and mainly female (73.6%). 49.1% worked in primary, 37% in secondary, and 13.9% in special education schools. Overall, respondents reported that 65.1% of the standards and indicators of the framework were (rather) highly implemented. A great variance can be found between the individual standards and indicators. Schools already participating in school health promotion programs or networks showed a higher percentage of implementation across all standards. A lack of resources (financial, time, and personnel) is reported. The results reveal important insights into barriers and facilitators for the implementation of organizational health literacy in schools. Future studies should focus on interventions that overcome identified barriers, targeting specific standards and indicators.