Health-Literate Preschools: an empirical study on preschool organizational health literacy

Abstract Background Organizational health literacy (OHL) extends beyond healthcare settings, aiming to embed health literacy into the policies and practices of diverse organizations. The Health-Literate Preschools project (HeLit-Preschools) applied OHL to the critical public health setting of early childhood education. Through eight standards, each specifying an area of action by six indicators to develop health literacy capacities in the setting, this study evaluates the current state of OHL implementation in preschools in Southern Germany. Methods Preschool directors participated in a cross-sectional online survey in two federal states during the winter of 2024/2025, providing sociodemographic data, institutional characteristics, and responses to the 48-item OHLP-Q self-assessment tool based on the HeLit-Preschools framework. Descriptive statistics were conducted using SPSS. Results The final sample comprised N = 446 participants (95% female, mean age 46.5 years), with an average of 22.1 years of work experience and 10.8 years in management roles. Nearly three-quarters (72%) reported high levels of OHL implementation in their preschools, although the degree varied by standard (49%-88%). The greatest challenges were linked to underlying conditions (e.g., funding, infrastructure, time, professional resources), networking and intersectoral cooperation, and addressing health needs and health literacy of the professional preschool team. Only 27% indicated that their preschool participated in a health promotion program or network; however, this subgroup reported higher levels of OHL implementation. Conclusions These findings provide the first comprehensive overview of OHL in German preschools, highlighting significant strengths but also clear needs for enhanced resources, professional staff health literacy, and inter-institutional cooperation. Further research should explore targeted interventions and strategies to support sustainable OHL integration in early education settings.