08 SES 03 A, Health Literacy
For the last few decades health literacy has been linked to the discussion of health disparities. Health literacy of the individuals is seen as critical in empowering people to “take control over the determinants of their own health” (WHO, 2013, p. 86), and is related to personal autonomy and agency. Forde and Raine (2008) argue that when discussing about health inequity there is a need to put attention to people’s autonomy and agency, and how they contribute to health through building capabilities and knowledge that foster good health. Because health literacy is a set of competencies to promote and sustain health that can be developed and learned, it becomes relevant in the discussions about health disparities that are avoidable and unfair (Whitehead, 1991). However, not much is known how health literacy is related to health disparities (Mantwill et al., 2015; Paasche-Orlow & Wolf, 2010; Sun et al., 2013), and if it is linked already among school aged children
Health disparities between and within countries are under constant discussion in the European region (Marmot et al., 2012), and they appear to exist throughout the lifespan. The disparities in adolescence track to adulthood (Inchley et al, 2016; Viner et al., 2012), which makes children and adolescents a particular group to be focused on, in addition to the fact that the disparities per se are a moral problem that should be addressed in every case. Health disparities are caused by many factors and some of them are the structural stratifiers such as income, access to education, social class, gender, ethnicity/race and employment opportunities (Viner et al., 2012). Many structural stratifiers that are often examined among the adults are also relevant in discussing health disparities among the young people, but they have not received that much attention so far (Inchley et al., 2016).
“Attempts to address health inequalities must include examination of differences in health status and their causes” (Inchley et al., 2016, p. 6). Here, the introduction of health literacy in disparities research may help to understand them better (Paasche-Orlow & Wolf, 2010), after all, it has been indicated as a determinant of health per se (e.g. Lee et al., 2015). Health literacy among young people has not been studied that much. One of the few is that Paakkari et al. (2018) study about school-aged children’s subjective health literacy. They found a statistically significant association between health literacy and age, gender, family affluence, school achievement, learning difficulties and educational aspiration.
Perhaps due to scarce amount of research linking health literacy to various background variables and health outcomes, not much is known about the actual pathways describing and explaining these links (Mantwill et al., 2015; Sun et al., 2013). This presentation will describe a study focusing on examining the association between health literacy and various health indicators (e.g. multiple health complaints, physical activity, sleep, perceived health, life satisfaction, self-esteem, smoking, BMI), and the mediating role of health literacy between various background variables (age, gender, family affluence, educational aspiration, school achievement) and health indicators.
The nationally representative sample consisted in total 3853 pupils (7th grader’s n=1918, 9th grader’s n=1935) from 359 schools, taking part into the Finnish national Health Behaviour in School-aged Children (HBSC), a WHO collaborative cross-national study in Spring 2014. Schools were chosen from the Finnish school register using a cluster sampling method that took into consideration provinces, the type of municipality (urban, semi-urban, rural) and the size of the schools. The participating class inside of each school was randomly selected. Thirteen- and fifteen year-old participants responded voluntarily and anonymously to a standardized questionnaire during one lesson. Pupils were informed about confidentiality of the study and that only group-level results would be reported. A health literacy instrument, Health Literacy for School-aged Children (HLSAC; Paakkari et al., 2016), was used to measure health literacy. Also, the HBSC- survey included questions about various health indicators. Data was analyzed with path modeling in Mplus 7.3. In the models we estimated a) the effects of gender, age, school achievement, FAS, and educational plans on health literacy and health indicators b) the effect of health literacy on health indicators, and c) the indirect effects of gender, age, school achievement, FAS, and educational plans on health indicators meadiated via health literacy.
The preliminary findings show that pupils’ health literacy has a statistically significant association with all health indicators that were measured. This argument was also valid after the inclusion of various background variables into the model, which confirms that poor health literacy is an independent risk factor for health disparities. The findings also show that health literacy is among the strongest measures that explain health indicators, and it mediates the effects of various background variables on the health indicators. Due to important role of health literacy explaining pupils’ health disparities, the role of schools in promoting learning of health literacy competencies cannot be underestimated. Acquiring health literacy skills at school could decrease health inequalities.
Forde, I., & Raine, R. (2008). Placing the individual within a social determinants approach to health inequity. The Lancet, 372(9650), 1694-1696. Inchley, J., & Currie, D. (2013). Growing up unequal: gender and socioeconomic differences in young people’s health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the, 2014. Lee, H. Y., Rhee, T. G., Kim, N. K., & Ahluwalia, J. S. (2015). Health Literacy as a Social Determinant of Health in Asian American Immigrants: Findings from a Population-Based Survey in California. Journal of General Internal Medicine, 30(8), 1118–1124. Mantwill, S., Monestel-Umaña, S., & Schulz, P. J. (2015). The relationship between health literacy and health disparities: a systematic review. PloS one, 10(12), e0145455. Marmot, M., Allen, J., Bell, R., Bloomer, E., & Goldblatt, P. (2012). WHO European review of social determinants of health and the health divide. The Lancet, 380(9846), 1011-1029. Paakkari, O., Torppa, M., Villberg, J., Kannas, L., & Paakkari, L. (2018). Subjective health literacy among school-aged children. Health Education, 118(2), 182-195. Paakkari, O., Torppa, M., Kannas, L., & Paakkari, L. (2016). Subjective health literacy: development of a brief instrument for school-aged children. Scandinavian journal of public health, 44(8), 751-757. Paasche-Orlow, M. K., & Wolf, M. S. (2010). Promoting health literacy research to reduce health disparities. Journal of health communication, 15(S2), 34-41. 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. Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., & Currie, C. (2012). Adolescence and the social determinants of health. The lancet, 379(9826), 1641-1652. Whitehead, M. (1991). The concepts and principles of equity and health. Health Promotion International, 6(3), 217-228.
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