Table 1 The Ophelia (Optimising Health Literacy and Access) principles that guide the aims, development and implementation of structured interventions to improve health and equity outcomes in communities [15]

1. Outcomes focused

Improved health and reduced health inequalities

2. Equity driven

All activities at all stages prioritise disadvantaged groups and those experiencing inequity in access and outcome

3. Co-design approach

In all activities at all stages, relevant stakeholders engage collaboratively to design solutions

4. Needs- diagnostic approach

Participatory assessment of local needs using local data

5. Driven by local wisdom

Intervention development and implementation is grounded in local experience and expertise

6. Sustainable

Optimal health literacy practice becomes normal practice and policy

7. Responsiveness

Recognise that health literacy needs and the appropriate responses vary across individuals, contexts, countries, cultures and time

8. Systematically applied

A multilevel approach in which resources, interventions, research and policy are organised to optimise health literacy