Systematic review of health literacy champions: Who, what and how?
Authors: Ayre Julie , Zhang Michael , Mouwad Dana , Zachariah Dipti , McCaffery Kirsten , Muscat Danielle 
Published: March 2023

AbstractBackgroundHealth literacy is an important aspect of equitable, safe, and high-quality care. For organisations implementing health literacy initiatives, using ‘change champions’ appears to be a promising strategy. This systematic review aimed to identify the empirical and conceptual research that exists about health literacy champions.MethodsWe conducted a systematic literature search using MEDLINE, Embase, CINAHL, Scopus, and PubMed, with additional studies identified by searching references and citations of included studies and reviews of organisational health literacy.ResultsSeventeen articles were included in the final review (case studies, n=9; qualitative research, n=4; quasi-experimental, n=2; opinion articles without case studies, n=2). Most articles had a high risk of bias. Often champions were not the focus of the article. Champions included staff across frontline, management and executive levels. Only five studies described training for champions. Key champion activities related to either 1) increasing organisational awareness and commitment to health literacy, or 2) influencing organisational strategic and operational planning. The most common output was ensuring that the organisation’s health information materials met health literacy guidelines.Articles recommended engaging multiple champions at varying levels within the organisation, including the executive level. Limited funding and resources were key barriers. Three of five articles reported positive impacts of champions on implementation of health literacy initiatives.DiscussionsFew articles described health literacy champions in adequate detail. More comprehensive reporting on this implementation strategy and further experimental and process evaluation research are needed to progress this area of research.RegistrationThis systematic review was registered with PROSPERO (CRD42022348816)Lay summaryWhy did we do this review?Health organisations may want to improve their health literacy practices. Studies suggest that ‘champions’ may help bring about change in an organisation.What did we do?We searched five research databases to find out what research exists about health literacy champions.What did we find?We found seventeen relevant articles. Most had a high risk of bias. Often champions were not the focus. Champions could be staff across all levels (frontline, management, executive). Only five studies described training. Champions had two main types of activities: 1) making staff more aware and committed to health literacy; 2) changing organisational strategies and processes. Often this meant making sure that health information met health literacy guidelines.The articles suggested it may be better to have more than one champion, at different levels within the organisation, including the executive level. Three of five articles reported that champions may have improved health literacy practices.What does this mean?Research does not tell us much about health literacy champions or their impact on health literacy practices. We need studies that describe champions and their training in detail, and test their impact on health literacy practices at different sites.