This thesis questions the capacity of health care institutions to take into account the level
of health literacy of users, i.e. their ability to find, understand, appraise and use health
information. It is based on the fact that the level of health literacy of the population is
frequently insufficient to cope with the complex demands of our health systems. It is
motivated by the conviction that this imbalance is one of the aspects of social exclusion.
It takes the form of an article-based thesis. Four publications of which I am co-authors
form its core, while other parts introduce or complete them. It is composed of six chapters.
The first chapter, includes two articles. The first takes a critical look at the emergence of
the concept of health literacy: its history, its strengths, its limitations, and the risk of
contributing, through a focus on information alone and individual responsibility, to a
depoliticization of health promotion (Henrard et Prévost 2016). The second describes how
low health literacy levels can be considered a health and public health problem and
identifies a series of possible actions within health systems, including at the level of health
care institutions (Henrard et al. 2018). Both articles conclude by asserting that the concept
of health literacy represents a strategic opportunity to reinvest in the issue of social health
inequalities from within the health care system. I continue this introductory chapter by
developing a short argumentation regarding the choice to target our research on
organizational health literacy, i.e. at the level of health care institutions, more specifically
hospitals, and to intervene by means of a self-assessment tool, the V-HLO (for “Vienna
Health Literate Organization”) questionnaire. Finally, I explicitly state the objectives of this
thesis and our research questions.
The second and third chapters present the empirical part of the thesis, the “field research”.
I reproduce two published articles. Chapter two describes the translation and cultural
adaptation for French in Belgium of the V-HLO (Henrard et al. 2019). The interviews with
local experts carried out during the validation of the V-HLO-fr and the translated version
of the questionnaire, enabled us to improve the translation but also to identify obstacles
to the adoption of the tool: the difficulty in considering staff health literacy as a relevant
target for the tool, the fear of overloading staff, the feeling that certain elements of the
tool are outside the scope of health literacy or the lack of attention to the integration of services with primary care. These elements contributed to the future development of the tool. Chapter three describes the application of V-HLO-fr in exploratory case studies within the three main hospitals in the Liège region (Henrard et al. 2021). The V-HLO-fr application was fully tested in the three hospitals. The process appears to be acceptable, integrable and practicable. I identified points of attention to improve the mode of application of the questionnaire proposed. Strengths, for example the facilitation of patient navigation to the hospital, and weaknesses, for example the provision of information materials that are easy to read, understand and use, were highlighted.
In the fourth chapter, by inviting a few selected authors, I outline a critique of health
literacy at the historical and sociological level.
In the fifth chapter, I summarize the main results of our work, alongside the empirical
contributions from the research described in the second and third chapters, the beginning
of a critique of the concept of health literacy, I then highlight the limitations, in terms of
method, fields investigated and impact. I also raise a series of attention points in the
perspective of pragmatic use of the V-HLO-fr in the field. I position myself in favor of a
fundamentally critical health literacy.
In the sixth and final chapter, I discuss the projects that have resulted from this work and
the follow-up that it could take.