08 SES 10, Conceptualizing Health Literacy and Action Competence as Outcomes of Health Education
The roundtable is based on results from a collaborative research project with the purpose to contribute to the debate on the outcomes of health education in schools, and especially to the discussion on action competence and health literacy as outcomes of health education. Action competence and health literacy are often mentioned as desired outcomes of health education and health promotion in schools - outcomes which are consistent with the theory and principles of health promotion, hereunder empowerment, participation and democracy. In general, in depth discussion of educational (rather than solely health) outcomes is rare, and research is needed if this is to be ameliorated.
Action competence has been defined as “the ability to act, initiate and bring about positive changes with regard to health”, and four main components of action competence described: knowledge, commitment, visions and action experiences (Jensen 1997). The concept of action competence is embedded in critical education philosophy, and a clear distinction is made between action competence and behavior change, in order to demarcate action competence from the utilitarian philosophy underpinnings and notions embedded in behavior change theories (Saugsted 1993).
Health literacy “represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health” (Nutbeam 1998). One way of operationalizing it is through a distinction between three different literacy domains (Nutbeam 2000): critical health literacy, interactive health literacy, and basic health literacy. The first domain emphasises the importance of individual and community action, “to be active participants in shaping those policies and practices that impact on their own health, and that of their community and country” (St Leger 2001).
The objective of the study is to gain insight into the different ways the two concepts have been developed, and the different conceptualizations and operationalizations, hereunder the different philosophical underpinnings and epistemological and methodological differences in studies where the concepts play a major role. Furthermore the objective is to explore the pedagogical approaches the two concepts are related to, and the strengths and weaknesses of using the two concepts as outcomes of health education.
As in the case of the concepts that action competence and health literacy are closely related to, hereunder empowerment, participation and democracy, it would be surprising if these concepts have one single and agreed meaning in and between the different disciplinary fields and contexts they have been used in. They are, what Green and Tones (2010) refers to as, ‘contested concepts’, which take on different meanings within different political ideologies and programmes, underpinned by different kinds of knowledge, values and philosophy. By contrasting the two concepts and related pedagogical approaches we hope both to bring out and clarify these meanings, and hereby contribute to the discussion of educational outcomes in health education.
The research project will engage with the following research questions:
- What are the origins of the two concepts? Why were they developed and introduced? Which challenges where they supposed to meet? How do they respond to the global social challenges people are facing today in terms of taking care of their and others' health?
- Which various disciplinary fields and which contexts have the concepts been applied in?
- How are the concepts defined? What are their constituting parts? What is left out and why?
- How are the concepts associated to other outcomes in school health education (e.g. healthy behaviour and healthy lifestyles), and to the overall aims of schools (democracy and participation)?
- What are the strengths and weaknesses of using the two concepts as outcomes of health education?
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