Abstract

Background: Professional health literacy describes how health professionals engage with relevant knowledge to strengthen patients’ health literacy. Nurses are key multipliers in enhancing health literacy within the Austrian population and in advancing related public health goals. While the literature reveals deficits in professional health literacy among Austrian nurses, little is known about how health literacy-informed nursing practice (HLNP) is enacted. Therefore, we investigated which levels of knowledge are associated with HLNP. This knowledge is essential for developing practical educational interventions that foster genuine competence and contribute to improving nursing practice and public health outcomes.

Methods: A qualitative longitudinal study using reflexive grounded theory methodology included 31 semi-structured interviews with 13 registered nurses over a three-year period, reaching data saturation. The interviews were conducted in healthcare settings, transcribed verbatim, and analyzed through iterative coding and categorization to develop the theory.

Results: HLNP results from the integration of rule-based knowledge and case comprehension. Nurses adopt roles such as trust builders, information navigators, or motivators, tailoring their actions to patient needs and systemic conditions. HLNP is a dynamic, experience-based process that requires specialized knowledge, structural support, and continuous reflection. Challenges include addressing the complexity of health literacy, fostering genuine competence development, and navigating systemic barriers.

Conclusions: The developed reflexive grounded theory supports the design of educational interventions that promote HLNP by enhancing knowledge transfer, case understanding, supportive practice environments, and lifelong learning. Strengthening HLNP contributes to the achievement of public health goals by empowering nurses as health literacy multipliers and fostering innovation in nursing education.