08 SES 04, Health literacy
In the past few years, the concept of health literacy gained continuously more awareness in Europe. In 2012, the results of a comparative international study on health literacy - The European Health Literacy Survey (HLS-EU Consortium, 2012) – were published. The results of the HLS-EU were eagerly discussed in the media and by politicians in several European countries. In particular in Germany and Austria various initiatives emerged that targeted the improvement of health literacy within the population. The reason for this reaction was that German and Austrian citizens had, according to the HLS-EU (HLS-EU Consortium, 2012), a comparably low health literacy. Although the methodology of this study has been criticized and considered as problematic, especially by researchers in the field of evidence-based medicine (Gigerenzer & Schäfer, 2018; Steckelberg, Meyer, & Mühlhauser, 2017), its publication had a positive effect: Health literacy and its improvement entered the political agenda and moved into the focus of research.
Following the definition of Sørensen et al. (2012), health literacy is ‘linked to general literacy and entails people’s knowledge, motivation and competences to access, understand, appraise, and apply health information […]’ (Sørensen et al., 2012, p. 3). Thus, health literacy is closely related to reading literacy and information literacy. In addition, because of the increasing relevance of the internet as a source of information regarding health related topics (Rossmann, Lampert, Stehr, & Grimm, 2018), digital literacy can also be seen as a part of health literacy. In the internet era, accessing information is usually not a difficult task, but when it comes to understanding or even critically appraising the information, the task gets more and more challenging (Zschorlich, Gechter, Janßen, Swinehart, Wiegard, & Koch, 2015).
Dealing with health related information in a competent way is a crucial basis for making informed choices for one’s health. Health issues concern everybody someday in his or her life, and even children are confronted with health related issues frequently.
Hence, fostering critical health literacy at a rather early point of the life course is crucial to increase equal opportunities regarding the individual’s health and the healthcare system (Bröder et al., 2017; Okan, Pinheiro, Zamora, & Bauer, 2015; Röthlin, Pelikan, & Ganahl, 2013). This is especially important for children with heterogeneous starting conditions, such as poor reading abilities, impairments and different socioeconomic backgrounds. Therefore, training programs aiming at the improvement of health literacy in children and adolescents are strongly needed. However, such training programs are rare – in particular in the German language area (Okan et al., 2015).
In order to respond to this gap, we developed an adaptive digital training program (ADT) for secondary students aged from 12 to 14 years, which addresses health literacy in a comprehensive way (including reading competences, digital literacy, the ability of evaluating online sources etc.). The ADT takes into account the diversity of students in Austrian mainstream classrooms by providing content in four linguistic difficulty levels. The difficulty level of the content is assigned to a particular student by the ADT according to the results of a reading assessment that is part of the program.
Our main research questions concern the evaluation of the ADT:
- Does implementing the ADT result in an improvement of secondary students’ health literacy?
- Does implementing the ADT result in an improvement of secondary students’ digital literacy?
- How do the students evaluate the ADT?
In spring 2018, we conducted participatory workshops with 38 students representing the target group. The aim of the workshops was to identify health related topics relevant for the target group. In addition, we wanted to know how a digital training program should be designed to meet the students’ needs. Based on the results of the workshops we created the content of the ADT. Between December 2018 and February 2019 the ADT is piloted in two Austrian secondary schools and the results of the pilot study will be reported. In spring/summer 2019, the ADT will be implemented and evaluated using a pretest-posttest design. About 800 students in the treatment group and 400 students in the control group will be involved. The pilot study is identical in design to the evaluation study. In total four 6th grade classes, three 7th grade classes and three 8th grade classes are part of the pilot. The sample consists of 186 students, 48.4% are female. The average age at the beginning of the pilot was 12.8 (SD=0.96). To assess the online health literacy of the students before and after the training we use the eHEALS (Norman & Skinner, 2006). In addition, we use an adapted short-version of the HLS-EU questionnaire to assess the general health literacy and a pilot version of the CLAIM instrument (Steckelberg, Hinneburg et al., in preparation) to assess the critical health literacy of the students. Before the training (pretest only) the reading competence of the students was assessed using the LGVT 5-12+ (Schneider, Schlagmüller, & Ennemoser, 2017) and as a control variable, we assessed the basic intelligence of the participants using the CFT 20-R (Weiß, 2006). After the training (during the posttest), the participants are asked to evaluate the ADT by answering a 7-item questionnaire (5-point-Likert scale) and three open questions. The questionnaire consists of questions regarding the training program as a whole (‘Did you enjoy working with the program?’ or ‘Did you learn anything new?’ – five response options ranging from ‘a lot’ to ‘very little’) and questions targeting a specific type of content of the training program (‘How interesting were the health topics for you?’).
Our first preliminary findings show that the children enjoyed working with the program. Most of them found the topics really interesting and they reported having learned a lot of different things. Also the teachers were convinced that the children benefitted from the program and they appreciated the different topics. Regarding the pre-post comparison of the different competences at this point, we can only report very preliminary results. At the moment we can rely only on the data of ca. 100 children since the data of 80 children are not yet analyzed. For those children we could analyze the data some positive results can be reported. The pre-post-comparison of eHEALS-instrument shows that the online health literacy slightly improved during the training. Furthermore some aspects of digital competence were improving, but the other instruments did not show significant differences between the two measures.
Bröder, J. et al. (2017). Health literacy in childhood and youth: a systematic review of definitions and models. BMC Public Health, 17:361. Gigerenzer, G. & Schäfer, J. (2018). Unstatistik des Monats: 54 Prozent der Deutschen haben eingeschränkte Gesundheitskompetenz. Retrieved from http://www.rwi-essen.de/unstatistik/76/ HLS-EU Consortium (2012). Comparative Report of Health Literacy in eight EU Member States: The European Health Literacy Survey HLS-EU. Retrieved from https://www.healthliteracyeurope.net/hls-eu Norman, C. D., & Skinner, H. A. (2006). eHEALS: The eHealth literacy scale. Journal of Medical Internet Research, 8(4), 1–7. Okan, O., Pinheiro, P., Zamora, P., & Bauer, U. (2015). Health Literacy bei Kindern und Jugendlichen: Ein Überblick über den aktuellen Forschungsstand. Bundesgesundheitsblatt, 58, 930-941. Rossmann, C., Lampert, C., Stehr, P., & Grimm, M. (2018). Nutzung und Verbreitung von Gesundheitsinformationen: Ein Literaturüberblick zu theoretischen Ansätzen und empirischen Befunden. Gütersloh: Bertelsmann Stiftung. Röthlin, F., Pelikan, J., & Ganahl, K. (2013). Die Gesundheitskompetenz der 15-jährigen Jugendlichen in Österreich. Abschlussbericht der österreichischen Gesundheitskompetenz Jugendstudie im Auftrag des Hauptverbands der österreichischen Sozialversicherungsträger (HVSV). Wien: LBIHPR. Schneider, W., Schlagmüller, M., & Ennemoser, M. (2017). LGVT 5-12+. Lesegeschwindigkeits- und –verständnistest für die Klassen 5-12. 2., überarbeitete und neu normierte Auflage. Göttingen: Hogrefe. Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: Asystematic review and integration of definitions and models. BMC Public Health, 12:80. Steckelberg, A., Meyer, G., & Mühlhauser, I. (2017). Fragebogen nicht weiter einsetzen. Diskussion zu dem Beitrag Gesundheitskompetenz der Bevölkerung in Deutschland. Deutsches Ärzteblatt, 114(18), 330. Weiß, R. H. (2006). Grundintelligenztest Skala 2 – Revision (CFT 20-R). Göttingen: Hogrefe. Zschorlich, B., Gechter, D., Janßen, I. M., Swinehart, T., Wiegard, B., & Koch, K. (2015). Gesundheitsinformationen im Internet: Wer sucht was, wann und wie? Zeitschrift für Evidenz, Fortbildung und Qualität Im Gesundheitswesen, 109(2), 144–152.
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