Gaps in understanding health and engagement with healthcare providers across common long-term conditions: a population survey of health literacy in 29 473 Danish citizens

OBJECTIVES: To (1) quantify levels of subjective health literacy in people with long-term health conditions (diabetes, cardiovascular disease, chronic obstructive pulmonary disease, musculoskeletal disorders, cancer and mental disorders) and compare these to levels in the general population and (2) examine the association between health literacy, socioeconomic characteristics and comorbidity in each long-term condition group.

DESIGN: Population-based survey in the Central Denmark Region (n=29,473). MAIN

OUTCOME MEASURES: Health literacy was measured using two scales from the Health Literacy Questionnaire (HLQ): (1) Ability to understand health information and (2) Ability to actively engage with healthcare providers.

RESULTS: People with long-term conditions reported more difficulties than the general population in understanding health information and actively engaging with healthcare providers. Wide variation was found between disease groups, with people with cancer having fewer difficulties and people with mental health disorders having more difficulties in actively engaging with healthcare providers than other long-term condition groups. Having more than one long-term condition was associated with more difficulty in engaging with healthcare providers and understanding health information. People with low levels of education had lower health literacy than people with high levels of education.

CONCLUSIONS: Compared with the general population, people with long-term conditions report more difficulties in understanding health information and engaging with healthcare providers. These two dimensions are critical to the provision of patient-centred healthcare and for optimising health outcomes. More effort should be made to respond to the health literacy needs among individuals with long-term conditions, multiple comorbidities and low education levels, to improve health outcomes and to reduce social inequality in health.

Health literacy and the determinants of obesity: a population-based survey of sixth grade school children in Taiwan

BACKGROUND: Health literacy has become an important health policy and health promotion agenda item in recent years. It had been seen as a means to reduce health disparities and a critical empowerment strategy to increase people's control over their health. So far, most of health literacy studies mainly focus on adults with few studies investigating associations between child health literacy and health status. This study aimed to investigate the association between health literacy and body weight in Taiwan's sixth grade school children.

METHODS: Using a population-based survey, 162,209 sixth grade (11-12 years old) school children were assessed. The response rate at school level was 83%, with 70% of all students completing the survey. The Taiwan child health literacy assessment tool was applied and information on sex, ethnicity, self-reported health, and health behaviors were also collected. BMI was used to classify the children as underweight, normal, overweight, or obese. A multinomial logit model with robust estimation was used to explore associations between health literacy and the body weight with an adjustment for covariates.

RESULTS: The sample consisted of 48.9% girls, 3.8% were indigenous and the mean BMI was 19.55 (SD = 3.93). About 6% of children self-reported bad or very bad health. The mean child health literacy score was 24.03 (SD = 6.12, scale range from 0 to 32). The overall proportion of obese children was 15.2%. Children in the highest health literacy quartile were less likely to be obese (12.4%) compared with the lowest quartile (17.4%). After controlling for gender, ethnicity, self-rated health, and health behaviors, children with higher health literacy were less likely to be obese (Relative Risk Ratio (RRR) = 0.94, p < 0.001) and underweight (RRR = 0.83, p < 0.001). Those who did not have regular physical activity, or had sugar-sweetened beverage intake (RRR > 1.10, p < 0.0001) were more likely to report being overweight or obese.

CONCLUSIONS: This study demonstrates strong links between health literacy and obesity, even after adjusting for key potential confounders, and provides new insights into potential intervention points in school education for obesity prevention. Systematic approaches to integrating a health literacy curriculum into schools may mitigate the growing burden of disease due to obesity.

Understanding home literacy practices of young children in vulnerable communities: what we can learn from the research

Research indicates that children who arrive m school with limited experiences of literacy are frequently at a disadvantage with progress in school. Without the necessary literate cultural capital, they have difficulty learning to read and write, falling further behind their classmates throughout their schooling. It is important that we focus on what language and literacy experiences are occurring in the home and how these can be further supported.This chapter acknowledges the important role that families play in young children's language and literacy development, drawing attention to the importance of the home as a site for supporting the literacy growth of children. Data, to inform the chapter, are drawn from two sources. One source is a large-scale survey investigation that gained insight into the different home literacy practices of preschool children in some disadvantaged areas of Victoria. The data provide a snapshot into what literacy practices occur in these homes. The second source is a case study of a single family taken from a targeted literacy intervention program in the north-west of Victoria. This study highlights possibilities for supporting families in literacy interactions with their young children in the home. The findings from both studies point to practical approaches and strategies that promote and support home literacy practices. This chapter argues that supporting families in their role is just as important as these families supporting their children's language and literacy learning.

From nutrients to food literacy

This paper is based on a webinar broadcast by the Home Economics Institute of Australia in 2015. I should make clear at the outset that I will be discussing the academic literature, particularly that relating to nutrition education and foodliteracy that reports studies with measured outcomes. This may seem ‘last century’ to many Australian home economics teachers who long ago moved from teaching about nutrients to education about dietary practices. However, in nutrition science there has long been a fascination with the possible effects of education about nutrition on disease risks and outcomes. There has been an expectation among health researchers and governments that education should reduce disease risks and promote wellbeing among young people. I think this view is too narrow and unrealistic in contrast to more holistic approaches such as those of home economics and the emerging area of food literacy. In this brief overview I will discuss four areas to dowith the emerging area of food literacy education. First, I will discuss the emergence of a broader view of food and dietary patterns in the nutrition sciences and the reasons for this. Secondly, I will explore the competing assumptions behind ‘education’ versus those of ‘health promotion’ and public health, followed by different disciplinary views of the emerging area of food literacy with its emphasis on competencies. Finally, I will explore some interesting new developments in food literacy education.

Teacher research on literacy: turning around to students and technology

This chapter first reviews the evolution of teacher research that links inquiry to democracy, social justice, and educational change. It then examines key moves in teacher research in and on children's literacy education. The 'turn around' metaphor is utilized to emphasize our belief that teachers need to engage in research for their own well-being and that of their students and communities. Using the metaphor of teachers 'turning around' to students as researchers and to technology, the chapter explores productive directions for future teacher research, given the strengths of past research and opportunities of the present. The research in this chapter demonstrates that engaging in teacher research has the potential to change teachers' work and their subjectivities.

The e-health literacy framework: A conceptual framework for characterizing e-health users and their interaction with e-health systems

In current e-health research and development there is a need for a broader understanding of the capabilities and resources required for individuals to use and benefit from e-health services, i.e. their e-health literacy. The aim of
this study was to develop a new conceptualisation of e-health literacy with consideration of the experiences of a wide range of stakeholders and in alignment with current technologies. Concept mapping was used to generate a comprehensive and grounded model of e-health literacy. Concept mapping workshop participants included patients, health professionals and medical informatics experts. Eight workshops, carried out in Denmark and United Kingdom, generated 450 statements, separated into 128 clusters. Through an inductive structured analysis, seven domains were identified: 1. Ability to process information, 2. Engagement in own health, 3. Ability to engage actively with digital services, 4. Feeling safe and in control, 5. Motivation to engage with digital services, 6. Having access to systems that work, and 7. Digital services that suit individual needs. These empirically derived domains form an e-health literacy framework (eHLF) and provide new insights into the user’s ability to understand, access and use e-health technologies. The eHLF offers a framework for evaluating an individual’s or a population’s capacity to understand, use and benefit from technology to promote and maintain their health. Such a framework also provides a potential checklist for the development and improvement of e-health services.

Cultural adaptation and validation of the Health Literacy Questionnaire (HLQ): robust nine-dimension Danish language confirmatory factor model

Health literacy is an important construct in population health and healthcare requiring rigorous measurement. The Health Literacy Questionnaire (HLQ), with nine scales, measures a broad perception of health literacy. This study aimed to adapt the HLQ to the Danish setting, and to examine the factor structure, homogeneity, reliability and discriminant validity. The HLQ was adapted using forward-backward translation, consensus conference and cognitive interviews (n = 15). Psychometric properties were examined based on data collected by face-to-face interview (n = 481). Tests included difficulty level, composite scale reliability and confirmatory factor analysis (CFA). Cognitive testing revealed that only minor re-wording was required. The easiest scale to respond to positively was 'Social support for health', and the hardest were 'Navigating the healthcare system' and 'Appraisal of health information'. CFA of the individual scales showed acceptably high loadings (range 0.49-0.93). CFA fit statistics after including correlated residuals were good for seven scales, acceptable for one. Composite reliability and Cronbach's α were >0.8 for all but one scale. A nine-factor CFA model was fitted to items with no cross-loadings or correlated residuals allowed. Given this restricted model, the fit was satisfactory. The HLQ appears robust for its intended application of assessing health literacy in a range of settings. Further work is required to demonstrate sensitivity to measure changes.

Literacy into action: digital games as action and text in the English and literacy classroom

Using data gathered from a three-year research project exploring digital literacy and pedagogy with respect to video games, including classroom games-based pedagogy and curriculum and ethnographic research on students' digital game playing, this article locates and explores a key conceptual problem facing the incorporation of digital games into English and literacy classroom activities. This challenge is defined as "action" and refers to the non-visual and non-textual elements of gameplay. This challenge is explored both theoretically and through a practical discussion of various strategies developed by teachers in the project to approach this issue. The article draws on contemporary game studies in order to map out and highlight several key areas where action-based projects lead to critical reflection.

Literacy education in the age of new media

This chapter focus on the question of literacy education itself-on how this is to be understood in the current and emerging age, how it is changing, and what it is for. It also engages the other key question here, that of what constitutes 'new media,' or rather, as Levinson puts it, 'new new media'-media forms emerging on the scene more or less constantly, and each time ever newer. Increasingly, literacy guidelines in many parts of the world call on teachers to incorporate attention to multimodal and electronic texts into their classrooms and curriculum. Curriculum guidelines addressing the 'new literacies' are structured around an expanded view of literacy that recognizes the changing and dynamic nature of text and textual forms, and call on research into the textual, communicative and cultural practices of young people as they engage with online popular culture and the digital world.

A model for critical games literacy

This article outlines a model for teaching both computer games and videogames in the classroom for teachers. The model illustrates the connections between in-game actions and youth gaming culture. The article explains how the out-of-school knowledge building, creation and collaboration that occurs in gaming and gaming culture has an impact on students' understanding of their own lifeworlds. The authors demonstrate how the development of curricula around and with games and gaming cultures can incorporate and capitalise on approaches to learning and collaboration, design and identity that students have developed in their own gaming practices.

Renewing assessment practices: literacy teaching and learning in digital environments

Interpretations of “literacy” and approaches to literacy pedagogy and assessment are under renewal as meaning-making and learning are increasingly situated in digitized environments. While the implications of these shifts are in part technological, they are also relational, as students are increasingly positioned as interactive with participatory roles in self-knowledge and increased responsibility for their learning. However, while shifts are occurring in understandings of literacy and approaches to literacy pedagogy, the same cannot be said for the way in which assessments of digital literacies are undertaken. There is a lack of valid, reliable, and practical assessments of new literacies to inform and help students to become better prepared for study, work, and citizenship in digital environments. This article maps five characteristics of effective formative assessment in print-based classrooms with seven affordancesin digital learning and assessment to suggest an analytical framework for examining teacher and student assessment in digital environments. Drawing on data from a research project in which a team of teachers introduced a one-to-one computing program and worked to renew their literacy assessment practices, this article discusses how each of the seven affordances are enacted in the assessment practices in a years five and six primary school classroom. The findings from this research project show that educational technologies have the potential to enable new approaches to teaching, learning, and assessment that better align with the needs of twenty-first century literacy learners. The findings alsosupport approaches to formative assessment that value print and multimodality and engage students in more flexible and differentiated ways. They can enable teachers and students to be re-positioned as designers, knowledge producers, and collaborative learners. The seven affordances provide a framework that holds rich possibilities for teacher learning and planning as prompts to support reflection on formative assessment practices, critique habitual practices, and considernew opportunities.

Transition: improved literacy outcomes research study

This paper reports on the Transition: Improved Literacy Outcomes Research Study established by the Department of Education and Training (DET). The purpose of the study was to identify the most useful and usable data for educators to access in order to ensure that student literacy learning is maximised during the transition from Primary to Secondary school.1. The research followed a mixed-methods approach, combining a statistically defensible sample of schools selected to represent school types (primary, secondary, combined), locations (rural, regional, urban) and all regions with a survey and follow- up interviews.2. The results are presented as a mixture of statistics, case studies and discussion. The case studies were developed from both survey data and interview data.3. Leaders and teachers overwhelmingly valued teacher judgement (through AusVELS) as the most useful data in understanding students’ strengths and weaknesses, followed by On-Demand testing.4. NAPLAN results were frequently transferred between schools, but were found to be less useful than other data by teachers.5. School leaders and teachers are currently using data for ability streaming, or for tailoring curriculum for individual student needs. A number of schools use the Literacy data for achieving a balance of student abilities within classes.6. Support for access to, and use of, data is mainly manual, with some use of spreadsheets.7. As the number of feeder Primary schools to a single Secondary school increases, data management becomes a much larger burden on the Secondary staff concerned.8. In Secondary schools, there was a clear demand for Literacy data, but these data were not always those that were being provided by their feeder Priamary schools. This mis-match appears to lead to some frustration among Literacy transition staff at both levels of schooling.9. A gap that needs filling is around the nature of the pedagogies at the two school levels. Not knowing, or misunderstanding, the approaches and needs of each level of schooling leads to the passing on of irrelevant Literacy data in some instances.10. The need for a common template for transition data was expressed by many Transition staff, both Primary and Secondary. In some instances the secondary school had set up a local template for this11. It would be advantageous for data to be directly up-loaded or transferred into a system via electronic tools already in use, such as an Excel spreadsheet.12. We would recommend that the capacity to provide some visualisation of data, and the compilation of internal Literacy data such as teacher judgements and AusVELS levels, or additional testing carried out by the school.13. Student background data was seen by many Secondary transition staff as being equally as valuable as more formal Literacy data for determining student needs.