Measuring subjective health literacy of Finnish school-aged children

Author(s):

Leena Paakkari(presenting / submitting)Olli Paakkari(presenting)Minna Torppa Jorma Tynjala Kristiina Ojala Lasse Kannas

Conference:

ECER 2014

Network:

08. Research on Health Education

Format:

Paper

Session Information

08 SES 09, Perspectives on Health Literacy

Paper Session

Time:

2014-09-04

11:00-12:30

Room:

B101 Sala de Aulas

Chair:

Maria Teresa Machado Vilaça

Contribution

According to World Health Organization (2013) we live in a health literacy crisis. The crisis is caused by the mismatch between the claims that the societies have imposed to people for taking care of their health and that of the others, and the skills that people possess. These days the management of health information and provided health care systems are more challenging, and the same time people are faced with even greater challenges for the maintenance of health. Similarly, societies have not been able to provide the kind of instruction and guidance that support the development of sufficient competence (World Health Organization, 2013). Thus, it is not surprising that health literacy of the population has been named as one of the key global health promotion goals and objectives (Wharf Higgins, 2012; see also Nutbeam, 2000; Tassi, 2004). Concurrently, it is not surprising that the development of children’s health literacy has been emphasized; in childhood the foundations for health and wellbeing throughout the lifespan are built (cf. World Health Organization, 1997).

Recent research shows that the level of health literacy in Europe is worryingly low. "The European health literacy Project" (HSL-EU Consortium, 2012) measured health literacy in eight European countries, and revealed that the participants showed limited health literacy. This situation is alarming due to number of negative consequences that inadequate health literacy has on both individual and societal level. Inadequate health literacy has been found to be a clear and independent risk factor for poor health (Volandes & Paashe-Orlow, 2007). Health literacy is also known to explain people's health habits, quality of life and health inequalities (Berkman et al., 2011, Brown et al, 2007, Sharif & Blank, 2010, Sun et al., 2013). Berkman et al. (2011) showed in their systematic review that there is a clear link between low health literacy and the ability to interpret health-related information and the incorrect use of medicines, to mention some. Poor health literacy at population level increases health care costs of the society (Howard et al, 2005; Kickbusch, 2008).

Interest in the development and the measuring of health literacy has increased in recent years. At the moment broad population-level health literacy measurements are mainly directed at adults (e.g. the European Health literacy survey), whereas tools for examining children’s health literacy are rare (Ormshaw et al, 2013). However, the development of health literacy across lifespan requires its measuring and monitoring in all age groups (World Health Organization, 2013). Similarly, it is important to identify and to increase an understanding of what factors explain children’s health literacy, and how health literacy is related to children’s’ perceived health and health behaviour.

The aim of this research is

to develop a tool to measure school-aged children’s self-reported (i.e. subjective, perceived) health literacy
to examine children’s self-reported health literacy
to study the association between self-reported health literacy, and perceived health and self-reported health behaviour

The presentation will focus on describing (i) the development of the health literacy instrument and (ii) research design to examine the association between the health literacy, and perceived health and health behaviour.

Method

The empirical data will be obtained from the Health Behaviour in School-aged Children (HBSC) study 2014 in Finland. The data will provide information on demographic factors, learning difficulties, health behaviour, and wellbeing indicators. The data will be cross-sectional, and collected through structured questionnaires anonymously. The nationally representative sample consists of 13- and 15-old Finnish pupils (n=3 300). The primary sampling unit will be the school, and the participating class/group from the school will be randomly selected. The health literacy tool will be developed using the conceptualization of Paakkari and Paakkari (2012) as a theoretical framework. The intent is to measure children’s perceived competence (i) to make sound health decisions that benefit their own health and that of the others, and (ii) to identify and work on the factors that constitute health chances. Health literacy will be measured through five core components: (1) theoretical knowledge (factual knowledge on health issues), (2) practical knowledge (e.g. ability to seek health-related information, ability to seek appropriate medical care), (3) critical thinking (e.g. ability to evaluate the validity of health-related information, ability to critically evaluate the possible consequences of various health choices), (4) self-awareness (e.g. ability to consider the applicability of health-related information to one’s own life), and (5) citizenship (e.g. ability to ethically consider the consequences of various health choices, ability to participate in the activities that promote collective wellbeing). The formulation of the items and the response scale will be based on the guidelines for measuring general self-efficacy (see Schwarzer & Fuchs, 1995).

Expected Outcomes

It is expected that the research will increase understanding of (i) the level of adolescents' health literacy and of the factors it is associated with, and (ii) the link between health literacy and health behaviour of children. The research provides information on and understanding of what kind of knowledge and skills should be promoted among young people, so that they could understand themselves, others and the world, and make decisions that promote health and wellbeing in their surroundings.

References

Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine, 155(2), 97-107. Brown, S. L., Teufel J. A, & Birch, D. A. (2007). Early adolescents perceptions of health and health literacy. Journal of School Health, 77(1), 7-15. HLS-EU consortium (2012). Comparative report of health literacy in eight EU member states: The European health literacy survey HLS-EU , online publication, HTTP://WWW.HEALTH-LITERACY.EU Howard, D. H., Gazmararian, J., & Parker, R. M. (2005). The impact of low health literacy on the medical costs of Medicare managed care enrollees. The American journal of medicine, 118(4), 371-377. Kickbusch, I. (2008). Health literacy: an essential skill for the twenty-first century. Health Education, 108(2), 101-104. Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health promotion international, 15(3), 259-267. Ormshaw, M., Paakkari, L., & Kannas L. (2013). Measuring child and adolescent health literacy: a systematic review. Health Education, 113(5), 433-455. Paakkari, L. & Paakkari, O. (2012). Health literacy as a learning outcome in schools. Health Education, 112(2), 133-152. Sharif, I. & Blank, A. E. (2010). Relationship between child health literacy and body mass index in overweight children. Patient education and counseling, 79(1), 43-48. Schwarzer, R. & Fuchs, R. (1995). Self-efficacy and health behaviour. Teoksessa M. Conner & P. Norman (toim.) Predicting health behavior. Buckingham: Open University Press, 163-196. Sun, X., Shi, Y., Zeng, Q., Wang, Y., Du, W., Wei, N., & Chang, C. (2013). Determinants of health literacy and health behavior regarding infectious respiratory diseases: a pathway model. BMC public health, 13(1), 261 (online) Retrieved from: http://www.biomedcentral.com/1471-2458/13/261 Tassi, A. (2004). The emergence of health literacy as a public policy priority: from research to consensus to action. Literacy Harvest, 11(1), 5-10. Volandes, A. E. & Paasche-Orlow, M. K. (2007). Health literacy, health inequality and a just healthcare system. The American Journal of Bioethics, 7(11), 5-10. Wharf-Higgins, J. (2012). Preface: A health literacy syllabus. Teoksessa R. Marks (toim.) Health literacy and school-based health education. Bingley: Emerald Group Publishing Limited, xi-xvi. World Health Organization (1997). Promoting health through schools: A Report of a WHO expert committee on comprehensive school health education and promotion- WHO Technical Report Series 870. Geneva. World Health Organization (2013). Health literacy: Solid facts. Copenhagen.