In the second stage, strategic thinking is translated into a plan of action, a sequence of steps the organization must take in order to implement its mission and vision and achieve its goals [19, 21]. This stage involves data collection and analysis, brainstorming, group thinking, establishment of emphases and organizational goals, organizational focus on decision-making processes, and construction and documentation of action plans, from the general to the particular, in various time frames. The product of this stage is an effective action plan consisting of goals and details of how each unit in the organization will contribute to the strategy, distribution of roles and tasks with a time table, and resources for carrying out the tasks [19]. It is essential that this stage be carried out by many staff members or a large number of key staffers with different perspectives to ensure creative and critical thinking regarding solutions [30].
While originating from the study of the reading and numerical skills that are necessary to function adequately in the healthcare environment, the concept of health literacy has expanded in meaning to include information-seeking, decision-making, problem-solving, critical thinking, and communication, along with a multitude of social, personal, and cognitive skills that are imperative to function in the health-system [49, 52, 59]. It has now diffused into the realm of culture, context, and language [49, 52, 59]. Although some authors have argued that health literacy is merely "new wine in old bottles", and is basically the repackaging of concepts central to the ideological theory and practice of health promotion [64], enhancing health literacy is increasingly recognized as a public health goal and a determinant of health. As new health literacy frameworks have emerged to clarify the deeper meaning of health literacy, its contribution to health, and the social, environmental, and cultural factors that influence health literacy skills in a variety of populations, there is a need for an integration of diverging definitions, conceptual frameworks and models of health literacy.
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