Conceptualizations of Health literacy and Action competence as outcomes of health education

Author(s):

Leena Paakkari(presenting / submitting)Venka Simovska(presenting)Monica Carlsson(presenting)

Conference:

ECER 2014

Network:

08. Research on Health Education

Format:

Round Table

Session Information

08 SES 10, Conceptualizing Health Literacy and Action Competence as Outcomes of Health Education

Round Table

Time:

2014-09-04

15:30-17:00

Room:

B101 Sala de Aulas

Chair:

Raili Välimaa

Contribution

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?

Method

The research is based on a review of key literature on the two key concepts and on the pedagogical approaches the two concepts are related to, and include both theoretical and empirical studies. The analysis is structured by the research questions above, with supplementary questions in the analysis of the pedagogical approaches the two concepts are related to. These will be developed on the basis of the results from the first conceptual analysis. The research is carried out in a group of researchers that has either mainly worked with action competence or mainly with health literacy, based in respectively a Finnish health promotion department and a Danish department of education. We will read and discuss all texts that have been identified as key literature, and our different theoretical perspectives and disciplinary backgrounds will help us to continuously question the assumptions regarding the concept that we are bringing into the research. The analysis is inspired by a critical discourse analysis approach to qualitative inquiry. Critical discourse analysis does not pretend to be objective or neutral: instead it is upfront in both providing a positioned perspective, and revealing positions (Porter 2007). It offers the possibility of heightened reflexivity enabling us to use or resist the positions that have been revealed in the analysis (Cheek 2004: 1149). The aim of the roundtable is to present work in progress results from the first part of the research. On the basis of three contributions focusing on results on the different ways the two concepts have been developed, and the different conceptualizations and operationalizations, we invite the participants to a discussion of the differences between the two concepts, and of the potential strengths and weaknesses of using the concepts as outcomes of health education. The three contributions in the roundtable are outlined below.

Expected Outcomes

The concept of action competence is in its origin construed as an education ideal meeting societal challenges related to health, environment, sustainability, peace, democracy and inequality (Schnack 2000). The presentation will focus on the conceptual development of action competence (Jensen and Schnack 1994; Saugsted 1993), give examples of different operationalizations (Jensen 1997; Mogensen and Schnack 2010; Carlsson and Simovska 2012), and outline the fields and contexts in which the concept has played a major role for curriculum and pedagogical development (Jensen and Simovska 2005; Breiting et al. 2009). The concept of health literacy could be seen to be developed within two main streams: one that focuses on patients’ abilities in health care settings (e.g. AMA 1999), and one that highlights broader abilities to promote one’s own health and that of the others in varying settings (e.g. Nutbeam 1998, Nutbeam 2000). The presentation outlines (i) how defining and measuring of health literacy has moved from the emphasis on pure functional literacy skills towards emphasizing broader citizenship skills including future survival skills of the citizens, and (ii) what kinds of pedagogical decisions this shift in emphasis area calls for. While there has been distinctly different conceptualizations and operationalizations of health literacy over the years, the changes in conceptualizations and operationalizations of action competence has been surprisingly small over time. In their operationalized forms both concepts make themself available for measurements. The question is if we are able to retain the political ideals and values that are underpinning the concepts in these measurements: Will what we can operationalize and measure be included in future curriculum and pedagogical development - and the rest left out?

References

American Medical Association (AMA). (1999). Health literacy: Report of the Council of Scientific Affairs. Journal of the American Health Association, 281(6), 552-557. Breiting, S., Hedegaard, K., Mogensen, F., Nielsen, K., & Schnack, K. (2009). Action competence, conflicting interests and environmental education: The MUVIN Programme. The Danish School of Education, Aarhus Universitet. Carlsson, M., & Simovska, V. (2012). Exploring learning outcomes of school-based health promotion – a multiple case study. Health Education Research, 27(3), 437-447. Cheek, J. (2004). At the Margins? Discourse Analysis and Qualitative Research. Qualitative Health Research, 14(8), 1140-1150. Green, J., & Tones, K. (2010). Health Promotion: Planning and Strategies. London: Sage publications. Jensen, B.B. (1997). A case of two paradigms within health education. Health Education Research, 12(4), 419-428. Jensen, B.B., & Schnack, K. (1994.) Action competence as an educational challenge. In: B.B. Jensen, & K. Schnack (Eds.), Action and action competence as key concepts in critical pedagogy (pp. 5-18). Studies in educational theory and curriculum, 12, 518, Royal Danish School of Educational Studies. Jensen, B.B., & Simovska, V. (2005). Action-oriented knowledge, information and communication technology and action competence. In: S. Clift, & Jensen, B. (eds). The Health Promoting School: International advances in Theory, Evaluation and Practice. Copenhagen: Danish University of Education Press & WHO. Leger, S.L. (2001). Schools, health literacy and public health: Possibilities and challenges. Health Promotion International, 16(2), 197-205. Mogensen, F., & Schnack, K. (2010). The action competence approach and the 'new' discourses of education for sustainable development, competence and quality criteria. I: Environmental Education Research, 16(1), 59–74. Nutbeam, D. (1998). Health promotion glossary1. Health Promotion International, 13(4), 349-364. Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Education, 15(3), 259-267. Porter, C. (2006). Ottawa to Bangkok: changing health promotion discourse. Health Promotion International, 22 (1), 72-79. Saugsted T. (1993). Action oriented health education: a critical review of health campaigns in Denmark. Health Promotion International; 8(1), 13-19. Schnack, K. (2000). Action competence as a curriculum perspective. In: B.B Jensen, K. Schnack, & V. Simovska (Eds.), Critical environmental and health education – research issues and challenges, (pp. 107–27). Copenhagen: Research Centre for Environmental and Health Education, Danish University of Education.

Author Information

Leena Paakkari (presenting / submitting)

University of Jyväskylä

Jyväskylä

Venka Simovska (presenting)

Department of Education, Aarhus University, Denmark

Monica Carlsson (presenting)

Aarhus University

Danish School of Education

Copenhagen

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