Dissertation - Doctoral Health Literate Discharge Practices in Ontario Hospital


Jennifer Innis


Health literate discharge practices meet the health literacy needs of patients and families at the time of hospital discharge. This dissertation used a mixed methods, sequential design to gain insight into the use of these practices in Ontario hospitals.

The Health Literate Care Model was used to guide the first two studies. The first study used a Delphi panel to find the best indicators of health literate discharge practices, based on the indicators of Project RED (Re-Engineered Discharge). This led to the development of 36 indicators, which were contextualized to Ontario, and were used to create an organizational survey tool. This survey was administered to 143 hospitals in Ontario. There were 99 participants from 79 hospitals (participation rate 55%). Exploratory factor analysis was done and reliability of the survey was established.

The third study used organizational learning theory to examine how acute care hospitals take on health literate discharge practices by interviewing managers, educators and front-line staff in 10 hospitals that participated in the survey.

In the fourth study, multiple regression analysis was used to examine the relationship between organizational characteristics and use of health literate discharge practices, as determined by the survey results. Smaller hospital size was associated with greater use, and survey scores were found to be highest in the North region. A significant interaction was found between size and location.

The development of the organizational survey tool could be used by researchers, hospitals and policy makers to measure and monitor the use of health literate discharge practices in Ontario hospitals. The results of the qualitative study offer insights into how organizational learning is used by hospital managers and leaders to adopt health literate discharge practices.


Jan Barnsley


Whitney Berta


Imtiaz Daniel