Jürgen M. Pelikan

Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)

Background: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. Methods: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. Results: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29–62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. Discussion: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.

The Handbook of Salutogenesis

This in-depth survey of salutogenesis shows the breadth and strengths of this innovative perspective on health promotion, health care, and wellness. Background and historical chapters trace the development of the salutogenic model of health, and flesh out the central concepts, most notably generalized resistance resources and the sense of coherence, that differentiate it from pathogenesis. From there, experts describe a range of real-world applications within and outside health contexts, from positive psychology to geriatrics, from small towns to corrections facilities, and from school and workplace to professional training. Perspectives from scholars publishing in languages other than English show the global relevance of the field.Among the topics in the Handbook: Emerging ideas relevant to the salutogenic model of health Specific resistance resources in the salutogenic model of health The sense of coherence and its measurement The application of salutogenesis in communities and neighborhoods The application of salutogenesis to health development in youth with chronic conditions The application of salutogenesis in mental health care settings The Handbook of Salutogenesis summarizes an increasingly salient field for graduate and professional students of public health, nursing, psychology, and medicine, and for their instructors. It will also appeal to health-related academicians and professionals who wish to have a thorough grounding in the topic.

Health Promoting Hospitals – Assessing developments in the network

Hospitals are specific organizational settings for health promotion efforts. As health care institutions they are already oriented at health, or better at ill health, but with a rather limited focus on health outcomes for patients. Therefore, the Ottawa Charter explicitly asks for the reorientation of health services. And, hospitals also have considerable health effects for other stakeholder populations. This specific potential and challenge has been taken up by the WHO network of Health Promoting Hospitals (HPH), in the last two decades. Based on available literature the article relates the HPH concept to a more general paradigm of health promoting organizational settings; reconstructs the developmental phases of the international WHO HPH Network; elaborates on its concept development and implementation experiences, and discusses its rather limited investments in evaluation studies and the few assessments from outside. HPH has developed a convincing comprehensive concept by demonstration projects, using systematically action and evaluation research. To a lesser degree, the same holds true for its developments of health promotion policies for selected vulnerable groups and linking HPH to quality methodology. But there is no systematic evaluation of health promotion in and by hospitals, especially for the networks and member hospitals of HPH. Even if much of the relevant evidence for HPH comes and will have to come from more general clinical epidemiological, health promotion, quality, organizational and management research, there is need for specific HPH evaluation research, to better utilize, what can be learned from the social experiment of HPH.

Advancing a theoretical model for public health and health promotion indicator development

This paper discusses the work of the EUHPID Project to develop a European Health Promotion Monitoring System based on a common set of health promotion indicators. The Project has established three working groups to progress this task--health promotion policy and practice-driven, data-driven and theory-driven. The work of the latter group is reviewed in particular. EUHPID has taken a systems theory approach in order to develop a model as a common frame of reference and a rational basis for the selection, organization and interpretation of health promotion indicators. After reviewing the strengths and weaknesses of those health promotion models currently proposed for indicator development, the paper proposes a general systems model of health development, and specific analytical, socio-ecological models related to public health and health promotion. These are described and discussed in detail. Taking the Ottawa Charter as the preferred framework for health promotion, the socio-ecological model for health promotion adopts its five action areas to form five types of systems. The structure and processes for each of these five systems are proposed to form the basis of a classification system for health promotion indicators. The paper goes on to illustrate such a system with reference to indicators in the workplace setting. The EUHPID Consortium suggest that their socio-ecological model could become a common reference point for the public health field generally, and offer an invitation to interested readers to contribute to this development.

Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries

Background Health literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries. Methods A cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged ≥15 years were recruited during 2013–2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis. Results The questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbachs alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation ≥0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from <0.001 to 0.011) and perceived social status (P from <0.001 to 0.016), with evidence of known-group validity. Conclusions The HLS-EU-Q47 was a satisfactory and comprehensive health literacy survey tool for use in Asia.

Improving Organizational Health: The Case of Health Promoting Hospitals

This chapter presents the case of Health Promoting Hospitals (HPH) as one specific approach to dealing with health and organizations. The case will be presented by first clarifying the basic relationships between health, health promotion, and organizations, then by describing main characteristics of the development of the concept and network of HPH and health services, followed by sketching the problems and approaches of implementing health promotion in hospitals up to now. HPH implementation methodology will be summarized by the theoretical PRICES-HPH evaluation model, which has a strong focus on the role of capacity building in implementing health promotion interventions. This model guided the data collection and analysis in an international evaluation study on HPH networks and member hospitals (PRICES-HPH). Empirical results from the study will be presented to illustrate the relationship between capacity building and the implementation of workplace health promotion in HPH. The chapter will close with a short discussion comparing organizational health development and HPH.

Zur Rekonstruktion und Rehabilitation eines absonderlichen Funktionssystems – Medizin und Krankenbehandlung bei Niklas Luhmann und in der Folgerezeption

Zusammenfassung Niklas Luhmann hat seine Theorie der Funktionssysteme am Beispiel verschiedener konkreter Systeme entwickelt, bestimmte Aspekte auch in Die Gesellschaft der Gesellschaft systematisiert. Der Krankenbehandlung (Medizin) hat er zwar den Charakter eines großen Funktionssystems zuerkannt, diesem aber nur drei kleinere randständige Ausätze gewidmet und deren Ergebnisse auch nicht in Die Gesellschaft der Gesellschaft aufgenommen. Er bestimmt, vor allem gestützt auf semantische Kriterien, Krankenbehandlung (Medizin), als ein »absonderliches« System, mit einem »perversen« Code, und der Abwesenheit einer Reflexionstheorie, eines symbolisch generalisierten Kommunikationsmediums und eines symbiotischen Mechanismus. Für drei dieser Kriterien wird eine »Normalisierung« angeboten, um Krankenbehandlung (Medizin) soziologisch adäquater zu beschreiben und neue systemtheoretische Optionen für ein entstehendes »Gesundheitssystems« zu eröffnen. Mit »krank / nichtkrank « wird - in Abweichung von Luhmanns Vorschlag, aber konsistent mit seinen theoretischen Ansprüchen - ein eigener Codevorschlag gemacht und begründet. Für die angeblichen Defizite, Kommunikationsmedium und symbiotischer Mechanismus, werden ebenfalls konkrete Vorschläge entwickelt.

The Application of Salutogenesis in Hospitals

We relate Antonovsky’s concepts of salutogenesis (Antonovsky, 1979; 1993) to the hospital setting. We argue that salutogenesis is particularly challenging to this setting—and vice versa. However, we also demonstrate that salutogenesis, if understood as one dimension of hospital quality, could considerably contribute to the health gains of both patients and staff (and to a certain degree also to the health gains of people in a hospital’s neighborhood and catchment area). Drawing on a comprehensive literature search, we contrast our theoretical considerations with available research to assess which aspects of salutogenesis in relation to hospitals the scientific literature already covers. We also consider the application of salutogenesis in Health-Promoting Hospitals, one of the WHO-initiated setting-oriented health promotion networks. We conclude by outlining needs for further research.

Selbsthilfegruppen und Gesundheitsförderung im Krankenhaus – eine entwicklungsfähige Allianz für Gesundheit

ZusammenfassungHintergrundGesundheitsförderung und Selbsthilfegruppen weisen gemeinsame Wurzeln und Entwicklungen auf. Untersucht wird die Frage, wie sich dieses Verhältnis in der Programmatik und Praxis des internationalen Netzwerks „Gesundheitsfördernder Krankenhäuser und Gesundheitsseinrichtungen“ (HPH) darstellt.Materialen und MethodenHerangezogen werden Grundsatzdokumente des HPH-Netzwerks, Dokumentationen von HPH-Konferenzen, eine internationale Befragung von HPH-Mitgliederorganisationen und eine gesonderte Befragung von HPH-Netzwerkkoordinatoren.ErgebnisseIn den Strategiepapieren von HPH sowie in Konferenzthemen ist der Stellenwert von Selbsthilfegruppen zwar peripher, aber die Alltagspraxis der Kooperation ist teilweise gut entwickelt und zwar dort, wo sie auf das Sichtbarmachen und die Stärkung von Selbsthilfegruppen als zusätzliche Ressource für Patienten abzielt.SchlussfolgerungVorgeschlagen wird eine umfassende Kooperationsstrategie mit sechs aufeinander aufbauenden Stufen. Hinweise auf notwendige Strukturbildungen lassen sich aus den Erfahrungen der Initiative für „Selbsthilfefreundlichkeit im Gesundheitswesen“ in Deutschland und Österreich gewinnen.AbstractBackgroundHealth promotion and self help (patient) groups share many goals. The article investigates how their relationship has been developed in concepts and practice of the international network “Health Promoting Hospitals and Health Care Services” (HPH).MethodsAnalysis of basic documents of the HPH-movement and conference documentations was complemented by data from an international survey of HPH-member organizations as well as a special survey of network coordinators.ResultsIn strategic papers of HPH and in the international conference discourse a referral to self help (patient) groups is scarce, yet everyday HPH-practice in various degrees seems to promote cooperation with self help (patient) groups to strengthen them as a complementary resource for patients.ConclusionFor developing cooperation between HPH and self help (patient) groups a comprehensive strategy of cooperation including six progressive steps is recommended. For implementation the initiatives for “Self help friendly health care” in Germany and Austria provide valuable experiences.

Health Promotion for NCDs in and by Hospitals: A Health Promoting Hospital Perspective

This chapter focuses on health promotion strategies to tackle non-communicable diseases (NCDs) in and by hospitals. According to WHO data (Global status report on non-communicable diseases. Geneva. World Health Organization, 2010), the four leading NCDs—heart disease, diabetes, respiratory diseases, and cancers—account for 36 million deaths worldwide per annum. WHO argues that up to 80 % of heart disease, stroke, and type 2 diabetes and over a third of cancers could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diet, physical inactivity, and the harmful use of alcohol. While there is a broad and ongoing discussion on strengthening the role of primary healthcare in tackling NCDs, especially in low-income countries, we will, in line with our specific expertise, argue that, in upper-middle- and high-income countries, hospitals too can and have to contribute to the secondary as well as to the primary prevention of NCDs. We will outline how health promotion can be used by hospitals to expand common approaches towards prevention, treatment, and rehabilitation of NCDs, by focusing not only on risk factors but also on resources, and developing healthy settings and communities. Examples to illustrate our arguments will be provided.