Addressing health literacy among long-term unemployed persons: the FORESIGHT intervention study.

BACKGROUND: Long-term unemployment is associated with various health risks and low health literacy. Occupational rehabilitation organizations that employ individuals with a history of long-term unemployment may be ideal settings for promoting health literacy. The purpose of this study was to develop and test an intervention to enhance health literacy in this setting. METHODS: The intervention was developed using the steps of the Intervention Mapping protocol. It focused on nutrition, physical activity, and mental health literacy, and included both problem-based learning and practical activities. The intervention was tested using a single-arm pre-post design. Health literacy was assessed at the individual level using the European Health Literacy Scale (HLS-EU-Q16) for general health literacy, the Newest Vital Sign test for functional health literacy, and domain-specific literacies for food, physical activity and mental health literacy. Additionally, structured interviews were conducted with social workers and management staff in the participating organizations to evaluate organizational readiness for change, covering domains such as knowledge of existing efforts, leadership support, implementation climate, health literacy of participants, and available resources. Changes in individual outcome parameters over time were analyzed using paired t-tests. Regression models were used to assess the association between participation in the intervention activities and changes in outcomes. RESULTS: A total of nine organizations participated in the study. The organizational readiness assessment revealed an increase in management support, though a slight decline in the implementation climate was noted. A total of 171 participants (65% men; mean age = 51.9 years, SD = 9.9) were included in the baseline assessment, and 110 were included in the six-month follow-up. Approximately 50% of participants took part in the intervention activities. Positive trends over time were observed for food literacy and mental health literacy, but not for other outcomes. No clear pattern emerged in the relationship between participation in the intervention activities and changes in the outcome variables. CONCLUSION: This study revealed small improvements in proximal outcome variables indicating feasibility and potential impact. However, more research is necessary to determine the effectiveness of this novel problem-based learning intervention.