Mapping the Ophelia process for health literacy and equity: a scoping review

Background

Health literacy is a determinant of health. The Ophelia process is a co-design framework for developing locally tailored health literacy actions, but evidence on its application and outcomes remains fragmented. This review was conducted within JACARDI, Joint Action on Cardiovascular Diseases and Diabetes.

Methods

A scoping review following PRISMA-ScR was conducted by searching PubMed, Embase, Cochrane Library, Scopus, CINAHL, Web of Science and PsycINFO up to December 2025. Peer-reviewed studies applying at least one Ophelia phase in health or community settings were included. Data were extracted on study characteristics, populations, phases, co-design activities, interventions and outcomes.

Results

Twenty-five articles were included: 18 primary studies and 7 protocols published between 2014 and 2025. Studies were mainly conducted in Australia, Europe and Canada, across community care, rehabilitation, diabetes care, COPD, dermatology, mental health, prison health. All primary studies implemented Phase 1, combining the Health Literacy Questionnaire with qualitative methods to identify local needs. Phase 2 co-design was reported in 8 studies, while only 6 completed Phase 3 implementation and evaluation. Implemented actions included organisational improvements, professional training, diabetes self-management education, community programmes, tailored follow-up and adapted screening reminders. Outcomes included improved organisational responsiveness, increased professional skills, greater patient confidence and engagement, better service navigation and higher mammography booking rates after language-concordant telephone reminders.

Conclusions

The Ophelia process is a flexible, equity-oriented approach for translating health literacy needs assessments into locally relevant interventions. Limited progression from needs assessment to implementation and evaluation highlights the need for stronger evidence on effectiveness, sustainability and long-term impact.

Key messages

• Ophelia helps turn health literacy data into equity-driven, locally tailored action.

• Its policy value lies in turning community insight into equitable, locally actionable health solutions.