In alignment with the Healthy People 2030 framework which promotes health literacy, an assessment of perceptions towards leadership and culture around OHL in a quaternary level Neuro ICU was performed. Identification of perceptions around priorities toward OHL is a crucial first step for designing interventions to promote health equity and OHL.

Stakeholders representing nursing administration, bedside nurses, advance practice providers, and attending physicians from the Neuro ICU convened to participate in a recorded, one-hour long session. The following domains of dimension one in the previously validated Org-HLR tool were discussed: demonstration of leadership and commitment to OHL, the organizational priority of health literacy, promotion of equity and diversity, and promotion of patient-centered philosophies. The session was facilitated by a research team comprising a health literacy expert, research fellows and coordinators. A Likert Scale rating was used to score domains, and a grounded theory approach was used for thematic analysis. Nvivo 14 was used for transcription and data analysis.

Over the course of one hour, six participants representing a multidisciplinary team shared perceptions on the leadership and culture of the Neuro ICU. Three major themes emerged: 1) ICU staff have a clear understanding of the connection between health equity and OHL; 2) a consensus that leadership and culture strive for patient-centered care and advocacy but often cannot provide accessible, understandable, and actionable information to patients; 3) individual values around diversity, equity, and inclusion were not always reflected by institutional values.

This study represents the first OHL assessment of a Neuro ICU and demonstrates interest in promoting OHL and health equity for critically ill patients. Future studies include prioritization and implementation of interventions to promote OHL in ICU settings.