Climate-specific health literacy and medical advice : The potential for health co-benefits and climate change mitigation. An exploratory study

Background: Despite scientific consensus about the risks of climate change on human health, patients’ knowledge on climate change related health risks is largely unexplored. The current study aimed to investigate the current state of climate-specific healthy literacy in patients and the impact of climate-specific medical advice on patients’ behavior regarding health co-benefits. Methods: In December 2020 and January 2021, a total of 449 questionnaires comprising 23 items were completed by patients of general practitioners (GPs) and gynecologists. Results: The majority of general consultations by physicians (86.6% patients from GPs, 84.5% from gynecologists) did not contain any information about climate change or planetary health. Results indicated that climate change is regarded as a global health threat (84.3%) rather than a concern for patients’ own health (66.4%). Patients who received climate-specific medical advice by their physician showed higher knowledge about and awareness of climate change related health risks (p = 0.002) as well as emotional concern for their own health (p = 0.04) than patients who did not receive advice. Climate-friendly behavior was associated with greater concern about climate change related health-risks (p<0.0001). Conclusions: Climate-specific health literacy may play an important role for health co-benefits and climate change mitigation. In order to promote and protect both individual and planetary health, it is crucial to improve the status of climate-specific health literacy

Climate-specific health literacy in health professionals: an exploratory study

Background: Health professionals such as physicians and nurses may play an important role in the transformation process towards a healthy, sustainable and climate-sensitive society. However, little is known about their climate-specific health literacy. This study aimed to assess knowledge regarding climate change and its impacts on health and climate-specific health literacy in health professionals. Methods: In July/August 2022, a cross-sectional, questionnaire-based study was carried out at the University Hospital Regensburg, Germany, to assess climate-specific health literacy in nurses and physicians from various clinical specialties. Descriptive and exploratory statistical analyses were performed. Results: The study population consisted of 142 participants (57.7% women; response rate: 24,7%). Most participants (93%) considered climate change to be highly relevant. However, only 12% of respondents stated to be very well informed regarding the general consequences of climate change. Although 57% of all participants had never mentioned climate change in relation to health to their patients, participants with higher levels of knowledge regarding the effects of climate change were more likely to mention it compared to those with lower levels of knowledge. The most frequently stated obstacle to integrate the topic of climate change in clinical work was lack of time during work (79%), not enough information (42%) and lacking materials (39%). Differences between health professions were apparent. Conclusion: The results of our survey suggest that the current state of climate-specific health literacy differs between different groups of health professionals. There is a need to improve health professionals’ levels of climate-specific health literacy and to increase the potential in interprofessional cooperation regarding planetary health

Health-Promoting and Sustainable Behavior in University Students in Germany: A Cross-Sectional Study

Health-promoting and sustainable behaviors, such as active transportation and sustainable diets, are associated with positive effects on human health and the environment. In order to unlock the potential of university students as key actors and multipliers, it is of interest to investigate their level of knowledge about the health effects of climate change and their willingness toward and implementation of health-promoting and sustainable behaviors. In November 2021, an online survey was conducted among students at the University of Regensburg, Germany. A total of 3756 participants (response rate 18%; mean age 23 years; 69% women) provided valid data. A large proportion of medical students (48%) considered themselves well-informed about the health-related effects of climate change, while only a small proportion (22%) of students within economic/computer/data sciences and law felt informed. Most participants knew about the impact of climate change on malnutrition (78%), but considerably fewer were aware of its impact on cardiovascular diseases (52%). Participants who considered themselves informed were consistently more willing to engage in climate-friendly behavior, and this willingness was also reflected in their actions, as they simultaneously promoted a healthy lifestyle. Across all academic disciplines, there is a strong need for knowledge transfer regarding topics that combine health and sustainable development

Co-Creative Curriculum Development via Real-World Laboratory: A Mixed-Methods Assessment to Inform Planetary Health Education in Midwifery – A Study Protocol

The overarching aim of the research project is to integrate Planetary Health Education (PHE) and Planetary Health Literacy (PHL) into midwifery curricula following the co-creative real-world laboratory approach

Literacy concepts linking health and environmental aspects and their use in health professionals: A scoping review and conceptual framework

The concepts of planetary, climate, and environment-related health literacy of health professionals may serve as predictors for the protection, promotion, and preservation of human and planetary health in the context of growing environmental health risks (Jochem et al. 2024). In this context, the health literacy of healthcare professionals is of particular importance, as they are experts in health issues and are tasked with promoting their patients' health literacy through their own health literacy (Schwendemann 2022). To evaluate and adapt existing models of health literacy in the context of climate change-related environmental changes, it is essential to record the entirety of the existing evidence base (Jochem et al. 2022; Wirtz &amp; Soellner 2022). So far, the existing literature on this topic has not yet been comprehensively and systematically evaluated. The objective of this scoping review is to synthesize research evidence on planetary, climate, and environmental health literacy concepts and models, and to identify research gaps to gain insight into the extent and nature of evidence relating to the coverage, manifestation, and applicability of these models as applied to health professionals. This study will thus subsume and categorize data on models of planetary, climate, and environmental health literacy and map key determinants among health professionals for the first time, with the aim of making recommendations for future research

Co-Creative Curriculum Development via Real-World Laboratory: A Mixed-Methods Assessment to Inform Planetary Health Education in Midwifery – A Study Protocol

The overarching aim of the research project is to integrate Planetary Health Education (PHE) and Planetary Health Literacy (PHL) into midwifery curricula following the co-creative real-world laboratory approach

The I-PHL-HP Modell: Planetary Health Literacy Domains, influential Factors and Determinants for Health Professionals—A modified Delphi Study

Introduction Planetary Health Literacy (PHL) enables individuals to understand and act upon the complex links between human health and global environmental change (Jochem et al., 2023). It empowers people to access, understand, appraise and apply information and services in ways that promote personal, community, and planetary health and well-being (Jochem et al., 2024). PHL also encourages participation in sustainability initiatives and fosters health co-benefits through structural and behavioral transformation (German Advisory Council on Global Change [WBGU], 2023). Following Schaeffer et al. (2023), professional health literacy (HL) in healthcare professions (HP) is understood as the motivation, knowledge and skills required to find, understand, evaluate and use knowledge and information that is relevant to one's professional role in various forms. This enables one to act professionally in accordance with the state of the art in everyday working life, as well as to prepare, convey and communicate health- and illness-related knowledge and information in such a way that it can be understood by patients, who can then critically assess it and use it to make decisions about health issues (Schaeffer et al., 2023). HP with high levels of professional PHL may play a crucial role as change agents. They can support systemic change within healthcare, prevention, and health promotion, i.e., promote healthy and sustainable lifestyles, empower people, and act as multipliers in their disciplines, institutions and communities (Albrecht et al., 2023). To fulfil this role, they require targeted training and education, interdisciplinary competencies, and institutional support (Brugger &amp; Horváth, 2024; Jochem et al., 2022). In addition to clinical and profession-specific knowledge, HP need insights into organizational processes and policy frameworks to drive cross-sectoral health promotion and prevention, and improve the ecological sustainability of their practice (Reismann et al., 2023). Responding to complex challenges or even crises at the intersection of natural systems, human, animal and plant health requires transformative education systems (Jacobsen et al., 2024). Therefore, identifying the corresponding key determinants is essential to inform curriculum development and competency-based training. So far, expert opinions have been the only source of evidence in this field. Building on a comprehensive scoping review (Kallenbach et al., 2025), we developed an integrative model – I-PHL-HP – that conceptualizes the core determinants and attributes of PHL for HP. While the model offers an initial framework, its components and structure require empirical validation. Further, the integration of stakeholder perspectives is needed to enhance its relevance and applicability (Kallenbach et al., 2025). This improves content validity, which is widely considered to be one of the most important characteristics of a measurement to assess needs and potential for improvement (Mokkink et al., 2024). Accordingly, this step will involve evaluating and validating the I-PHL-HP model, including its determinants and connections, based on a modified e-Delphi consensus process involving environment-related experts, health literacy experts, and different HP. The modified e-Delphi method is considered an appropriate way to reach a consensus among experts. This method enables input to be gathered from a broad range of stakeholders in order to examine areas of agreement and disagreement in more detail and improve the link between theory and practice, as well as scientific discourse (Niederberger et al., 2024). The diverse perspectives of key stakeholders in this field provide a comprehensive understanding of professional PHL, which is crucial for evaluating the importance of a PHL model for HP and achieving consensus on the key determinants in the development and promotion of professional PHL. The study aims to build a shared, integrative understanding of professional PHL for HP, its determinants, and to inform educational frameworks and institutional strategies accordingly. The specific objectives of this study are: I. To understand stakeholder perspectives about the proposed I-PHL-HP framework (Kallenbach et al., 2025). II. To collect expert suggestions for refinement of the I-PHL-HP model (Kallenbach et al., 2025). III. To achieve consensus on the key determinants, dimensions, and relationships within the I-PHL-HP model (Kallenbach et al., 2025). Method Expert selection Experts will be selected based on research, practice and teaching experience in the fields of environment-related and professional health literacy (Spranger et al., 2022). To ensure interdisciplinarity and a holistic understanding of PHL, the panel should be heterogeneous in terms of subject expertise and professional background. Following De Villiers et al. (2005), the panel should comprise at least 15–30 experts from various fields, in this case of environmental-related health literacy, including e.g. PHL, One Health literacy (OHL), climate-related health literacy (CRHL), ecological health literacy (EcoHL), environmental health literacy (EHL) and climate-change literacy (CCL) and experts of professional health literacy within HP. It would be desirable for all experts to have a professional background in a health profession with regard to practical expertise So the panel should also include different experts from the health sector, including curative care, rehabilitation, prevention, health promotion and public health, as well as vocational education and training of HP, including general practitioners and specialists from various fields such as doctors, assistants (surgical, anesthesia, medical and dental), psychologists, nursing professionals, midwives, emergency and paramedics, physiotherapists, occupational therapists, pharmacists and nutritionists. The following eligibility criteria will be applied when selecting Delphi experts: The expert must have professional experience in research and/or teaching and/or practice in environmental-related and/or professional health literacy of HP. These criteria are obtained through self-disclosure. Professional suitability will be assessed in discussion with all authors. The panel should be composed of experts from Germany and neighboring countries, as these countries have comparable contextual conditions for the education, training and continuing professional development of health professionals. This is important in order to test the conceptual I-PHL-HP model for practical application in an educational context. In order to take the holistic approach of planetary health into account, experts from different perspectives of environmental literacy should be involved. If it is not possible to recruit experts from different health literacy fields and HP, this will be openly communicated to the other respondents and critically considered in the evaluation of the results. In addition to professional expertise, demographic and geographical characteristics (current job, affiliation, highest level of education, background in health profession, gender, country of residence, rural or urban residence, race and ethnicity) are requested, as are details of any potential conflicts of interest, in order to increase the informative value and objectivity of the study. Experience with a Delphi method is desirable, but not an exclusion criterion. Experts will be selected using a multi-stage process to assemble a diverse and objective panel. To this end, the authors' professional networks and recognized professional associations such as the German Network for Health Literacy (DNGK) and the International Health Literacy Association (IHLA) will be contacted, literature lists from the previous scoping review (Kallenbach et al., 2025) will be analyzed, and the process will continue using a snowball method. All experts will be invited to participate in the study via personalized emails and take part in the study on a voluntary basis and can withdraw at any time. It would be helpful for the evaluation of the study if they could state their reasons for doing so. Delphi design The study design comprises three rounds of surveys based on the modified e-Delphi method. These surveys are used to evaluate and obtain consent for the core determinants necessary for the emergence and development of professional PHL among HP, as set out in the I-PHL-HP model (Kallenbach et al., 2025). This method has already been shown to be effective in Delphi studies on professional health literacy of HP (Beese et al., 2025; Coleman et al., 2013; Karuranga et al., 2017). The methodological approach is based on the RAND methodological guidance for conducting and critically appraising Delphi panels, taking into account the Delphi critical appraisal tool (DCAT) checklist (Khodyakov et al., 2023) and recommendations for interdisciplinary standardized reporting in Delphi studies in social and health sciences (DELPHISTAR) (Niederberger et al., 2024), to ensure the highest possible quality throughout the research process. Using the e-Delphi method is intended to simplify and save time on the panel rounds to increase participation (Dalal et al., 2011). The e-Delphi panel will be conducted using the online survey platform Unipark®. According to the I-PHL-HP model (Kallenbach et al., 2025), all determinants will be assigned to the following categories: a) proximal and distal antecedents; b) competencies and attributes and c) consequences. The number of panel rounds is limited to three. The survey period for each panel round is two weeks. This avoids a too long time lag between rounds, which could cause participants to lose motivation and interest as the timeframe increases (Villiers et al., 2005). Participants who do not meet this timeframe despite receiving individual reminders will be excluded. Participants who miss a round cannot participate in another. The three panel rounds are scheduled to take place between the beginning of September and the end of November 2025. At the beginning of the survey, all participants will receive a letter with information about the objectives of this study, and a summary of the scoping review results according to Kallenbach et al. (2025). They will also be given access to the full study to help creating a shared knowledge base and boost participation rates. Participants' anonymity will be ensured by coding and guaranteed via a privacy policy. The survey instrument is a questionnaire based on the I-PHL-HP from Kallenbach et al. (2025) and according to Beese et al. (2025). Decision-making rules Round 1 The aim of the first round is to analyze the importance of a PHL model for HP, to optimize the proposed I-PHL-HP-framework model and its determinants (Kallenbach et al., 2025), and to reach an initial consensus. To this end, the questionnaire is divided into three sections: I. sociodemographic data; II. data on the structure and design of the model; and III. contents/determinates of the model. I. First, demographic, geographical and professional expertise data will be collected through self-reporting to ensure the desired interdisciplinarity and expertise. II. Then, the experts can provide feedback on the importance of a standardized PHL model for HP, on the overall structure of the I-PHL-HP model and how the dimensions are formulated, using the free text fields provided. They are also asked to provide feedback on the relationships between the model's dimensions, including any areas of overlap. The aim of this thematic analysis is to identify new dimensions and structures of the I-PHL-HP, which will then be refined based on expert opinions. III. The determinants of professional PHL of HP will be assessed using a four-point Likert scale according to their ‘importance’ for professional competence in dealing with complex planetary health challenges, with the overarching outcome being defined as follows: 'The ability to access, understand, appraise and apply complex planetary health challenges'. The scale ranges from 1 (‘strongly agree,’), 2 (‘agree’), 3 (‘disagree’) to 4 (‘strongly disagree’), for example: ‘Evaluate the positive and negative climate, environmental, and health effects of local, national, and international laws, regulations, and policies.’ Subsequently asking why the respective determinants are considered important or unimportant allows us to determine the goals that the experts are pursuing in the development of professional PHL among HP. This enables the consequences of the I-PHL-HP model to be evaluated and validated. The experts can suggest missing determinants or comment on existing ones. As in previous Delphi studies on health literacy in the USA and Europe, consensus is defined as agreement on the significance of a determinant by at least 70 % of the expert group (Beese et al., 2025; Coleman et al., 2013; Karuranga et al., 2017). This includes all determinants that receive strong agreement (‘strongly agree’) and agreement (‘agree’) from the experts. Determinants that are rated ‘strongly agree’ or ‘agree’ by 30–69 % of the experts are classified as ‘moderate’ and carried over to the next panel round. While there are no uniform consensus thresholds, ours are consistent with those used in other Delphi studies and published recommendations (Beese et al., 2025; Coleman et al., 2013; Karuranga et al., 2017). Any determinants that receive less than 30 % agreement are removed from the questionnaire ahead of the second panel round. Any determinants rated as 'disagree' or 'strongly disagree' by more than 30 % of the experts in the first round will not be included in the subsequent questionnaire. The quantitative data will be subjected to descriptive statistical analyses (e.g., using mean values, standard deviations). Round 2 The aim of the second round is to achieve a growing consensus by taking into account new aspects from the first round. To this end, the experts are given the overall results of the panel and their own results from the previous round. This means they can see the modified I-PHL-HP model and what percentage of panel experts assigned a certain degree of importance to each determinant. They will also receive all suggestions for further determinants. The experts are then asked to rate the modified determinants according to their importance using the familiar Likert scale. Descriptive statistics are used to evaluate and analyze the results. Those determinants that are rated 'strongly agree' by at least 70% of panel participants are retained for the third round. All other determinants are discarded. They also have the option of commenting on the I-PHL-HP and determinants in free text fields. Thematic analysis is used to process these comments. Round 3 In the final round, the experts evaluate the importance of the remaining determinants that achieved a consensus of over 70 % ‘strongly agree’ after the second panel round. The aim is to reach a final consensus on the most important PHL determinants and to achieve knowledge integration. A final proposal for the revised I-PHL-HP model, based on the results of the first and second panel rounds, serves as the basis for this. The results achieved in round 3 are also evaluated quantitatively using descriptive statistics. All determinants that achieve a consensus of over 70 % ‘strongly agree’ in this round are then integrated into the final I-PHL-HP model. Qualitative and quantitative analysis After each panel round, the experts receive a feedback report containing summaries of responses and listing their own. The intention is for the experts to use this information to reflect on their own perspectives, enabling them to make more informed decisions in the subsequent survey (Khodyakov et al., 2023). All results from the panel list are weighed equally, as each expert is assumed to have the same level of expertise. Quantitative data from the e-Delphi rounds are analyzed using the statistical software Statistical Package for the Social Sciences (SPSS)®. First, a descriptive analysis of the socio-demographic variables and I-PHL-HP determinants is carried out using percentages. To analyze and classify the data, measures of central tendency and dispersion are provided, as well as a frequency distribution for each item in each round (Tsai et al., 2024). The qualitative data from the comment fields will be evaluated via MAXQDA® using thematic analysis to summarize additional, potentially significant determinants of professional PHL among HP and thus supplement the quantitative results (Forbes, 2022). Discussion The results obtained will be used to evaluate the content validity of the I-PHL-HP through multi-perspective analysis by various experts. This will enhance the quality of PHL research into the emergence, development and promotion of professional PHL among HPs (Beese et al., 2025). Understanding of resource-oriented and sustainable healthcare, prevention and health promotion will improve efforts to achieve more equitable health outcomes, particularly for marginalized groups (Jochem et al., 2022). Additionally, the validated I-PHL-HP model will provide HP in practice and education with a framework for identifying competency gaps and implementing targeted training and continuing education measures. Integrating expert advice into future planetary health educational frameworks can enable a high level of competence among health professionals in this area. (Asaduzzaman et al., 2022; Guzmán et al., 2021). It can also facilitate interdisciplinary health professionals’ collaboration in addressing global challenges (WHO, 2023). The core determinants of professional PHL and the corresponding model can be used by decision-makers to create standardized practices that ensure consistent and effective communication between health sectors (Jacobsen et al., 2024; Jochem et al., 2024). The strength of the Delphi approach to identifying an integrative model with PHL core competencies for HPs lies in discussing core competencies with a diverse, interdisciplinary panel of experts (Beese et al., 2025). Based on these findings, robust measurement tools will be developed to operationalize, measure and implement professional PHL in education and in HP's daily practice. The main challenges of this Delphi study are recruiting experts and maintaining their motivation throughout the three rounds, and developing a robust, evidence-based questionnaire (Niederberger &amp; Deckert, 2022). Therefore, the approach will be highly transparent, in compliance with the RAND guidelines and taking into account the checklists, both during the planning phase and in the final report (Khodyakov et al., 2023; Niederberger et al., 2024)

Quality of instruments assessing Planetary and One Health Literacy related constructs: Protocol for a systematic review

Planetary Health Literacy (PHL) adapts the traditional concept of health literacy to include the ecological determinants of health, systemic thinking, and future-oriented responsibility (Jochem et al. 2022). PHL encompasses the knowledge, competencies, values, and motivation that individuals and communities need to understand and respond to the complex links between planetary systems and human health. It provides a comprehensive and holistic approach similarly to One Health Literacy which can be defined as “the knowledge, motivation and competencies to access, understand, appraise and apply all relevant information that are related to One Health […] to sustainably balance the health and quality of life of us humans, the animals and the environment” (Blankart et al. 2024) To assess the advancement of Planetary Health Literacy or One Health Literacy, it is crucial to employ high-quality instruments. These tools are essential for facilitating monitoring, tracking, and evaluation of educational progress, interventions, and projects, as well as supporting evidence-based curriculum development in Planetary and One Health