Leena Paakkari

Measuring child and adolescent health literacy: a systematic review of literature

Purpose – A systematic review of literature was conducted to compile, analyse and describe the methodology and measurement of childhood/adolescent health literacy.Design/methodology/approach – Six online databases (ERIC, PubMed, CINAHL, Biomed Central, Web of Science and Sports Discuss) were systematically searched to identify English language, peer‐reviewed articles, published between 1980 and April 2011, which reported on the measurement of health literacy in a population under the age of 18. The search identified 16 articles to be included in the final review, from which, data were systematically extracted in order to answer four review questions concerning several aspects of the method and effectiveness of the completed studies.Findings – The majority (n=13) of the studies described the use of newly developed measurement tools and enquiry methods. The majority (n=14) assessed health literacy via task performance as opposed to examining self‐reported health literacy. Thirteen health topics and nine dis...

Student teachers’ ways of experiencing the teaching of health education

The aim of this phenomenographic study was to identify student teachers’ ways of experiencing the teaching of health education, and to determine the aspects that are educationally critical in gaining a deeper understanding of the teaching. Qualitative data (written essays, semi‐structured interviews) were gathered twice during health education teacher training. Teaching was seen as transferring knowledge and skills, supporting the active processing of knowledge, supporting transformation of conceptions, supporting holistic personal growth and building a learning community with the students. The teaching was reflected through five themes: the nature of the knowledge, the source of the knowledge, the teacher’s role, the pupil’s role and the direction of the interaction. The findings support earlier studies but also bring new perspectives to discussions of teaching conceptions. The study also confirms that, although some conceptions seem to be parallel across different educational settings, other conceptions appear to vary over different contexts.

Teacher Competencies in Health Education : Results of a Delphi Study

Objective The aim of this research study was to identify the core competencies for health education teachers in supporting the development of health literacy among their students. Method/Results A three round Delphi method was employed. Experts in health education were asked to identify core competencies for school health educators. Twenty six participants from the academic field were invited to participate in the study. Twenty participants completed the first round of the Delphi, while eighteen took part in round two and fifteen participated in the final round. Data were collected using an electronic questionnaire. The first round contained an open ended question in which participants were asked to name and define all the competencies they perceived were important. Thematic analysis was undertaken on these data. A list of 36 competencies was created from this round. This list was then returned to the same participants and they were asked to rate each competency on a 7 point semantic differential scale in terms of importance. The resulting data were then analysed. For the final round, participants were presented with a list of 33 competencies and were asked to rank them again, in order of importance. Conclusion Twelve core competencies emerged from the analysis and these competencies comprised of a mixture of knowledge, attitude and skills. The authors suggest that how these competencies are achieved and operationalised in the school context can be quite complex and multi-faceted. While the authors do not seek to generalise from the study they suggest that these competencies are an important input for all stakeholders, in order to question national and international teacher guidelines. In addition the competencies identified may provide a useful starting point for others to undertake deeper analysis of what it means to be an effective health educator in schools.

Subjective health literacy : Development of a brief instrument for school-aged children

Aims: The present paper focuses on the measurement of health literacy (HL), which is an important determinant of health and health behaviours. HL starts to develop in childhood and adolescence; hence, there is a need for instruments to monitor HL among younger age groups. These instruments are still rare. The aim of the project reported here was, therefore, to develop a brief, multidimensional, theory-based instrument to measure subjective HL among school-aged children. Methods: The development of the instrument covered four phases: item generation based on a conceptual framework; a pilot study (n = 405); test–retest (n = 117); and construction of the instrument (n = 3853). All the samples were taken from Finnish 7th and 9th graders. Results: Initially, 65 items were generated, of which 32 items were selected for the pilot study. After item reduction, the instrument contained 16 items. The test–retest phase produced estimates of stability. In the final phase a 10-item instrument was constructed, referred to as Health Literacy for School-Aged Children (HLSAC). The instrument exhibited a high Cronbach alpha (0.93), and included two items from each of the five predetermined theoretical components (theoretical knowledge, practical knowledge, critical thinking, self-awareness, citizenship). Conclusions: The iterative and validity-driven development process made it possible to construct a brief multidimensional HLSAC instrument. Such instruments are suitable for large-scale studies, and for use with children and adolescents. Validation will require further testing for use in other countries.

Three Approaches to School Health Education as a Means to Higher Levels of Health Literacy

It is widely acknowledged that school health education is an important means for supporting the development of pupils’ health literacy. A growing number of papers have described or suggested a variety of classroom-based and whole-school practices for developing health literacy. However, few of these papers have systematically addressed the various ways of approaching health education in schools or sought to analyze how these approaches differ from each other. This paper aims to do this. It does so by representing three approaches to school health education: the facts and skills approach, the individual thinking approach, and the personal growth and citizenship approach. The approaches differ in complexity. They can be used in planning for learning experiences aimed at supporting the development of higher levels of health literacy. Furthermore, they can be used in teacher training when the aim is to help teacher trainees to become aware of their current ways of seeing school health education, and the differences that may exist between their understanding and more complex forms of understanding.

Finnish pupils’ perceptions of health education as a school subject

Only a few countries have introduced health education (HE) as a stand-alone school subject. In Finland every pupil in basic education grades 7–9 takes three obligatory courses in HE. This study investigated Finnish pupils’ perceptions of the teaching and learning of HE. It also explored how school- and family-related background variables are associated with these perceptions. Nationally representative data were obtained from a 2010 school-based study on Health Behaviour in School-aged Children (HBSC). A total of 4262 pupils from 7th and 9th grades (13 and 15 years old) responded anonymously to the questionnaire. Logistic regression analysis was performed to identify the associations between perceptions of HE and school- and family-related background variables. The majority of the pupils had positive perceptions of HE. In terms of their own learning, girls’ perceptions were more positive than boys’: 86% of 13- and 15-year-old girls agreed that HE classes had taught them to think about the advantages and disadvantages of various health behaviours, whereas only 79% of boys shared this opinion. School engagement had the strongest association with perceptions of HE: the more positive the attitudes towards school, the more positive were the perceptions of HE. Older girls perceived their learning and their participation in class discussions more positively than younger ones, and older boys were more critical of the teaching than younger ones. The pupils’ educational aspirations were not associated with their perceptions of HE, and perceived family affluence was associated only with girls’ perceptions of participation in HE classes. The pupils’ feedback on HE was positive and encouraging. There is a demand for the subject in society, and HE seems to have the potential to augment young people’s positive attitudes towards health issues, and to enhance their health literacy.

Health literacy and participation in sports club activities among adolescents

Aims: The aim of this research was to compare the levels of perceived health literacy among adolescents who do or do not participate in sports club activities. Organized sport club activities reach a high proportion of adolescents, and have the potential to contribute to the development of their health literacy. Methods: The cross-sectional data on health literacy among school children in Finland (aged 13 and 15, n=3852) were measured, as a part of the Health Behaviour in School-Aged Children (HBSC) study, using the Health Literacy for School-aged Children (HLSAC) instrument. Sports club participation and its association with health literacy were examined in relation to age, gender, family affluence, school achievement, and physical activity. The statistical analyses included cross-tabulation and the multilevel mixed-effects logistic regression analyses. Results: Perceived health literacy was higher among adolescents who participated in sports club activities. This conclusion was valid for boys and girls, for both age groups, among those who were physically active 6–7 days a week, had at least moderate school achievement, and those who belonged to the middle or high affluence families. From the health literacy perspective, participation in sports club activities was especially beneficial for those having low or moderate school achievement level. Conclusions: The sports club setting may work towards equalizing health literacy differences related to school achievement. However, the clubs should ensure that access is available to as many adolescents as possible; by this means they may spread beneficial influences, supporting the development of health literacy among broader population groups.

Ethical underpinnings for the development of health literacy in schools: ethical premises (‘why’), orientations (‘what’) and tone (‘how’)

BackgroundSchools are seen as crucial environments to influence and develop the health literacy of new generations, but without sufficient reflection on the ethical underpinnings of intentions and interventions around health literacy. In contrast, we argue here that ethics are fundamental to all education. The article adopts a ‘One world’ approach that generalizes broadly across the so-called Global North and Global South. It also generalizes across various age groups among school pupils, advocating age appropriate application of the arguments advanced.Main textOur analysis examines why health literacy should be promoted in schools and argues that the purpose should embrace the values of social justice and should not stop at individual and national cost benefit analysis. Discussion about the orientation of health literacy highlights meta-cognitive skills around critical thinking, self-awareness and citizenship rather than lists of practical skills. Finally, approaches to health literacy in classrooms are presented with an ethical tone that draws attention to the power relations responsible for health inequities and that does not assume that such power relations are the given framework for health literacy interventions and activities. These arguments are reinforced by urging that related debates address dynamic social realities such as international migration.ConclusionsWe reiterate the need for ethical questions to be consciously and systematically addressed from early on, beginning with intentions to promote health literacy even before these intentions are translated into action, within the political space where education meets public health and health promotion. We underline again the context of fluidity and dynamism, as new challenges emerge within pedagogies and curricula, especially in response to changing populations in the society around.

Subjective Health Literacy among School-Aged Children.

Purpose The purpose of this paper is to explore Finnish adolescents’ subjective health literacy (HL) in association to school achievement, learning difficulties, educational aspirations, and family affluence. Design/methodology/approach Nationally representative data were collected in Finland as a part of the international Health Behaviour in School-aged Children study. The respondents consisted in total of 3,833 adolescents (7th and 9th graders) from 359 schools. The Health Literacy for School-aged Children instrument was applied to measure adolescents’ subjective HL, while the Family Affluence Scale was used to measure adolescents’ socioeconomic status. Information was gathered on school achievement, learning difficulties, and educational aspirations. Findings Approximately one-third of the adolescents manifested a high level of HL, around 60 per cent had a moderate level of HL, and about one-tenth had low HL. The HL level was lower for boys than for girls, and lower for 7th graders than for 9th graders. In the total sample, the strongest explanatory variables for HL were school achievement in the first language, and educational aspirations. Originality/value This study provides the first nationally representative examination of adolescents’ subjective HL levels, and how these vary across age and gender groups. In drawing conclusions and presenting suggestions for HL interventions, it is important to verify the nature of the HL examined in any given study, and how it was researched.

Democratic school health education in a post-communist country

Purpose The purpose of this paper is to discuss the findings of an intervention program built on the concept of children’s health literacy, particularly on its citizenship component. This intervention program employed the Investigation-Vision-Action-Change model for action-oriented teaching, where children were supported to investigate different health issues that affect them, create visions about desirable changes, and act toward desirable change. The intervention was implemented in the conditions of a post-communist country (Slovakia) where the majority of health education programs are behaviorally oriented, without giving space to children’s own perceptions and decisions. The study seeks to explore whether fostering children’s participation in forming the school environment improves the three selected factors of school well-being, namely, children’s perception of school, their subjective well-being, and violent behavior in school. Design/methodology/approach A cluster-randomized controlled trial design was used where ten classes of children aged nine to ten years were randomly assigned to either experimental (n=89) or control group (n=96). The dependent variables were pre- and post-tested using measures drawn from the Health Behavior in School-aged Children study for Slovakia. Findings The intervention program was shown to yield empirically robust effects, given the significant improvement in children’s perceptions about school, violent behavior, and their well-being, with medium-to-large effect sizes (Hedges’s g ranging from 0.74 to 0.96). Originality/value The present study offers an effective approach to enhance the respect for the children’s views on issues that affect them, particularly within post-communist conditions.