National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults

Health literacy is a multidimensional concept covering a range of cognitive and social skills necessary for participation in health care. Knowledge of health literacy levels in general populations and how health literacy levels impacts on social health inequity is lacking. The primary aim of this study was to perform a population-based assessment of dimensions of health literacy related to understanding health information and to engaging with healthcare providers. Secondly, the aim was to examine associations between socio-economic characteristics with these dimensions of health literacy.

Development and implementation of Taiwan's child health literacy test

Objectives: The aims of this study were to develop Taiwan's Child Health Literacy Test and to undertake a nation-wide survey in order to determine the current status of Taiwanese sixth graders' health literacy, and to understand the association between health literacy, healthy behavior, and health status. absp Methods: Taiwan's Child Health Literacy Test was developed through the process of concept clarification, a qualitative pilot, a development pilot, and a field test. In the field test, 162,609 sixth graders (56.9%) from 2,235 schools (83.3%) nationwide completed the questionnaire. We also collected the students' dates of birth, BMIs, self-reported health and healthy behaviors. absp Results: The final test consisted of 32 questions with item discrimination of 0.55-1.89 and item difficulty of-1.7-0.41 according to IRT; Cronbach's a was 0.87. Based on this information, the test was deemed appropriate for basic health literacy screening among children. Nation-wide, the average score for sixth graders' health literacy was 23.97 points (total score 32 points), with a correct rate of 74.9%. Those who were "good" in self-reported health scored highest in health literacy (M = 24.29). Health literacy was significantly positively related to healthy behavior (r = .25, p< .05), and negatively to risky behavior (r =-.28, p< .05). absp Conclusions: This study was the first curriculum-based child health literacy test developed from the viewpoints of both teachers and pupils in Taiwan through a rigorous procedure. The nationwide survey results may serve as a reference for decision-makers at the national health education level.

Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia

OBJECTIVES: The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia. DESIGN: An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation. SETTING: The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia. PARTICIPANTS: Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention. INTERVENTION: The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages. OUTCOME MEASURES: This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection. RESULTS: Significant differences in the Debris Index (OR=0.44 (0.22 to 0.88)) and the Modified Gingival Index (OR=0.34 (0.19 to 0.61)) indicated increased tooth brushing and/or improved toothbrushing technique in the intervention group. An increased proportion of intervention parents, compared to those in the comparison group reported that they had been shown how to brush their child's teeth (OR=2.65 (1.49 to 4.69)). Process evaluation results highlighted the problems with recruitment and retention of the study sample (275 complete case families). The child dental screening encouraged involvement in the study, as did linking attendance with other community/cultural activities. CONCLUSIONS: The Teeth Tales intervention was promising in terms of improving oral hygiene and parent knowledge of tooth brushing technique. Adaptations to delivery of the intervention are required to increase uptake and likely impact. A future cluster randomised controlled trial would provide strongest evidence of effectiveness if appropriate to the community, cultural and economic context. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Bisexuality in education: erasure, exclusion and the absence of intersectionality

Although many schools and educational systems, from elementary to tertiary level, state that they endorse anti-homophobic policies, pedagogies and programs, there appears to be an absence of education about, and affirmation of, bisexuality and minimal specific attention paid to bi-phobia. Bisexuality appears to be falling into the gap between the binary of heterosexuality and homosexuality that informs anti-homophobic policies, programs, and practices in schools initiatives such as health education, sexuality education, and student welfare. These erasures and exclusions leave bisexual students, family members and educators feeling silenced and invisibilized within school communities. Also absent is attention to intersectionality, or how indigeneity, gender, class, ethnicity, rurality and age interweave with bisexuality. Indeed, as much research has shown, erasure, exclusion, and the absence of intersectionality have been considered major factors in bisexual young people, family members and educators in school communities experiencing worse mental, emotional, sexual and social health than their homosexual or heterosexual counterparts.This book is the first of its kind, providing an international collection of empirical research, theory and critical analysis of existing educational resources relating to bisexuality in education. Each chapter addresses three significant issues in relation to bisexuality and schooling: erasure, exclusion, and the absence of intersectionality. From indigenous to rural schools, from tertiary campuses to elementary schools, from films to picture books as curriculum resources, from educational theory to the health and wellbeing of bisexual students, this book's contributors share their experiences, expertise and ongoing questions.

School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial

Objective To determine whether an education programme targeted at schoolchildren could lower salt intake in children and their families. Design Cluster randomised controlled trial, with schools randomly assigned to either the intervention or control group. Setting 28 primary schools in urban Changzhi, northern China. Participants 279 children in grade 5 of primary school, with mean age of 10.1; 553 adult family members (mean age 43.8). Intervention Children in the intervention group were educated on the harmful effects of salt and how to reduce salt intake within the schools' usual health education lessons. Children then delivered the salt reduction message to their families. The intervention lasted for one school term (about 3.5 months). Main outcome measures The primary outcome was the difference between the groups in the change in salt intake (as measured by 24 hour urinary sodium excretion) from baseline to the end of the trial. The secondary outcome was the difference between the two groups in the change in blood pressure. Results At baseline, the mean salt intake in children was 7.3 (SE 0.3) g/day in the intervention group and 6.8 (SE 0.3) g/day in the control group. In adult family members the salt intakes were 12.6 (SE 0.4) and 11.3 (SE 0.4) g/day, respectively. During the study there was a reduction in salt intake in the intervention group, whereas in the control group salt intake increased. The mean effect on salt intake for intervention versus control group was -1.9 g/day (95% confidence interval -2.6 to -1.3 g/day; P<0.001) in children and -2.9 g/day (-3.7 to -2.2 g/ day; P<0.001) in adults. The mean effect on systolic blood pressure was -0.8 mm Hg (-3.0 to 1.5 mm Hg; P=0.51) in children and -2.3 mm Hg (-4.5 to -0.04 mm Hg; P<0.05) in adults. Conclusions An education programme delivered to primary school children as part of the usual curriculum is effective in lowering salt intake in children and their families. This offers a novel and important approach to reducing salt intake in a population in which most of the salt in the diet is added by consumers.

E-learning opportunities and challenges for legal education in rural Victoria

Access to justice extends beyond consideration of the systems and institutions of justice; it includes infrastructure such as transport, health, education and communications. Rural, regional and remote (‘RRR’) communities are more likely to face difficulties in accessing advice and accurate information on laws and processes available for resolution of disputes. Perhaps more fundamentally, they rarely have a voice in effecting reforms in laws and related policies. For several decades, community legal centres, legal aid, courts, and a range of other institutions have used community legal education programs to improve knowledge and access to law and justice systems, services and organisations. The recent Productivity Commission Inquiry into Access to Justice Arrangements notes that, ‘Better coordination and greater quality control in the development and delivery of these [community legal education, legal information] services would improve their value and reach.’ At the same time, research into the professional needs of RRR legal practitioners has found that many of these practitioners face considerable difficulties accessing good quality continuing professional development (‘CPD’) and informal networking/support opportunities.6 Current and emerging internet-based technologies open up opportunities for legal organisations to better meet the educational needs of both rural communities and legal practitioners. Though limitations still exist at multiple levels, relatively low-cost, media-rich, synchronous and tailored education programs can now be delivered effectively in many rural and remote areas. However, complex layers of decisions are required to critically assess, harness and optimise technologies to best suit the needs of users, and to utilise teaching and learning techniques that best match the technologies and participant needs. Getting these elements — needs, technology and learning technique — right, nevertheless offers extraordinary opportunities. Sound decisions and good practices should enable state-wide and specialist law and justice-related services interested in improving their engagement with RRR communities to dramatically improve the reach and quality of outcomes, not only for distant participants but the spectrum of stakeholders.

Change in schools it’s more like sort of turning an oil tanker : creating readiness for health promoting schools

Purpose – The purpose of this paper is to add to the evidence of best practice in the implementation of the Health Promoting Schools (HPS) framework by examining the process of creating readiness for change in a large international school in South-East Asia. Using a settings-based approach and guided by readiness for change theory the data collected reflects which factors were most influential in the decision of the leadership team (LT) to adopt a comprehensive HPS model. It follows the process of creating readiness in the early stages of adopting a HPS approach and captures the critical factors effecting leader’s beliefs and support for the program. Design/methodology/approach – This research is a case study of a large pre-K-12 international school in South-East Asia with over 1,800 students. A mixed methods qualitative approach is used including semi-structured interviews and document analysis. The participants are the 12 members of the LT. Findings – Readiness for change was established in the LT who adopted a HPS approach. That is, they adopted a comprehensive model to address health-related priorities in the school and changed the school’s mission and accountability processes to specifically include health. Uncovering the reasons why the LT supported this change was the primary focus of this research. Building the motivation to change involved establishing a number of key beliefs three of which were influential in bringing about readiness for change in this case study. These included the belief that leadership support existed for the proposed change, a belief that there was a need for change with a clear discrepancy in the present and preferred operations in relation to addressing the health issues of the school and the belief that HPS was the appropriate solution to address this discrepancy. Research limitations/implications – Adopting a HPS approach is the first phase of implementation. Long-term research may show if the integrity of the chosen model is maintained as implementation continues. The belief construct of valence, that is, the belief that the change will benefit the change recipient, was not reliably assessed in this research. Further research needs to be conducted to understand how this construct is interpreted in the school setting. The belief construct of valence was not reliably assessed in this research. Further research needs to be done to understand how this construct fits in the school setting. Practical implications – This paper provides a promising example of how health can be integrated into the school’s Mission and Strategic Learning Plan. The example presented here may provide strategies for others working in the field of HPS. Originality/value – Creating readiness is an often over-looked stage of building sustainable change. International schools cater to more than three million students are a rarely researched in regards to health education. It is predicted that the numbers of students in international schools will grow to more than six million in the next ten years.

Sleep education improves the sleep duration of adolescents: a randomized controlled pilot study

PURPOSE: To determine the feasibility and pilot a sleep education program in New Zealand high school students.

METHODS: A parallel, two-arm randomized controlled pilot trial was conducted. High school students (13 to 16 years) were randomly allocated to either a classroom-based sleep education program intervention (n = 15) or to a usual curriculum control group (n = 14). The sleep education program involved four 50-minute classroom-based education sessions with interactive groups. Students completed a 7-day sleep diary, a sleep questionnaire (including sleep hygiene, knowledge and problems) at baseline, post-intervention (4 weeks) and 10 weeks follow-up.

RESULTS: An overall treatment effect was observed for weekend sleep duration (F 1,24 = 5.21, p = 0.03). Participants in the intervention group slept longer during weekend nights at 5 weeks (1:37 h:min, p = 0.01) and 10 weeks: (1:32 h:min, p = 0.03) compared to those in the control group. No differences were found between groups for sleep duration on weekday nights. No significant differences were observed between groups for any of the secondary outcomes (sleep hygiene, sleep problems, or sleep knowledge).

CONCLUSIONS: A sleep education program appears to increase weekend sleep duration in the short term. Although this program was feasible, most schools are under time and resource pressure, thus alternative methods of delivery should be assessed for feasibility and efficacy. Larger trials of longer duration are needed to confirm these findings and determine the sustained effect of sleep education on sleep behavior and its impact on health and psychosocial outcomes.

HealthMap: a cluster randomised trial of interactive health plans and self-management support to prevent coronary heart disease in people with HIV

BACKGROUND: The leading causes of morbidity and mortality for people in high-income countries living with HIV are now non-AIDS malignancies, cardiovascular disease and other non-communicable diseases associated with ageing. This protocol describes the trial of HealthMap, a model of care for people with HIV (PWHIV) that includes use of an interactive shared health record and self-management support. The aims of the HealthMap trial are to evaluate engagement of PWHIV and healthcare providers with the model, and its effectiveness for reducing coronary heart disease risk, enhancing self-management, and improving mental health and quality of life of PWHIV.

METHODS/DESIGN: The study is a two-arm cluster randomised trial involving HIV clinical sites in several states in Australia. Doctors will be randomised to the HealthMap model (immediate arm) or to proceed with usual care (deferred arm). People with HIV whose doctors are randomised to the immediate arm receive 1) new opportunities to discuss their health status and goals with their HIV doctor using a HealthMap shared health record; 2) access to their own health record from home; 3) access to health coaching delivered by telephone and online; and 4) access to a peer moderated online group chat programme. Data will be collected from participating PWHIV (n = 710) at baseline, 6 months, and 12 months and from participating doctors (n = 60) at baseline and 12 months. The control arm will be offered the HealthMap intervention at the end of the trial. The primary study outcomes, measured at 12 months, are 1) 10-year risk of non-fatal acute myocardial infarction or coronary heart disease death as estimated by a Framingham Heart Study risk equation; and 2) Positive and Active Engagement in Life Scale from the Health Education Impact Questionnaire (heiQ).

DISCUSSION: The study will determine the viability and utility of a novel technology-supported model of care for maintaining the health and wellbeing of people with HIV. If shown to be effective, the HealthMap model may provide a generalisable, scalable and sustainable system for supporting the care needs of people with HIV, addressing issues of equity of access.

Mental health system development in Asia: does Australia have a role?

BACKGROUND: Socioeconomic trends herald what many describe as the Asian Century, whereby Asian economic, political and cultural influence is in global ascendency. Broadening relevant ties between Australia and Asia is evident and logical and may include strengthening alliances in mental health systems. AIM: We argue the importance of strengthening Asian mental health systems and some of the roles Australian mental health workers could have in promoting strengthening the Asian mental health system. METHODS: This paper is a narrative review which sources data from reputable search databases. RESULTS: A well-articulated Australian strategy to support strengthening the mental health system in Asia is lacking. While there are active initiatives operating in this space, these remain fragmented and underdeveloped. Coordinated, collaborative and culturally respectful efforts to enhance health education, research, policy, leadership and development assistance are key opportunities. CONCLUSION: Psychiatrists and other mental health professionals have a unique opportunity to contribute to improved mental health outcomes in Asia.

Critical psychologies for critical health literacies

Health education is largely informed by psychological theories and practices that pursue reductionist views of people learning. However, critical attention is moving to understand health in ways that reconsider relationships to context and the forms of life within which everyday living takes place. This shift is apparent in theoretical developments from health literacy to critical health literacies. The discussion herein presents an introduction to critical health literacies focusing on potential contributions critically oriented psychologies offer this work. Research is introduced from critical health psychology, critical educational psychology and critical community psychology to engage psychological phenomena as jointly constituted via embodied, discursive and relational means. Subsequently, it is argued, by re-evaluating understanding in this way, a prospective kind of psychosocial theory is elucidated capable of promoting and sustaining health inclusive education.

Towards a Vietnamese university public health nutrition framework: Needs assessment.

There is a significant need for the improvement of nutrition education in Vietnamese universities in order to better prepare health and education professionals to respond to contemporary nutrition transition problems. Strong leadership at national and ministerial levels will be required to set a clear agenda for changes in this area.

ED-HOME: improving educator confidence and patient education in the emergency department

BACKGROUND: Barriers to effective patient communication in the emergency department (ED) are well recognised; time, resources and staff and consumer expectations. This project aimed to improve the quality of health education provided in the ED by increasing nurses' confidence as educators.

METHOD: By providing a staff information package including the introduction of a new structured education tool; ED-HOME, and by assessing the confidence and self-efficacy of the nurses in the process, we hoped to determine if an improvement in practice and confidence was achieved. A quantitative, pre and post-test questionnaire comparison study was undertaken before and after a four week implementation period. The project examined the attitudes and practices of registered emergency nurses and was conducted in one metropolitan emergency department.

RESULTS: Results indicated that nurse confidence and self-efficacy improved by using the new structured ED-HOME format and both staff satisfaction and education competence increased. Participants positively responded to the new tool and recommended future use in the ED.

CONCLUSION: This project demonstrates that if emergency nurses feel more confident with their educating practices and by using a structured format, patients will benefit from better quality patient education provided in the ED.

What do we know about preventing drug-related harm through social developmental intervention with children and young people

This chapter examines the evidence for the effectiveness of interventions aiming to reduce drug-related harm by improving conditions for healthy develeopment in the earliest years through adolescence. Of the interventions beginning prior to birth, there is efficacy evidence that family home visitation is a feasible strategy for implementation with disadvataged families and can reduce risk factors for early developmental deficits and thereby improve childhood development outcomes. There is efficacy evidence for strategies such as parent education and school preparation through the pre-school age period. Some of the strongest evidence for efficacy in reducing developmental pathways to drug-related harm comes from interventions delivered through the early school years to improve educational environments. Of the interventions targeting the high school age period, school drug education has been the most commonly evaluated. The evidence suggests that short term reduction in both drug use and progression to frequent drug use may be achievable through this strategy, but the prospects for longer-term and population-level behaviour change is still unclear. In overview, a range of prevention strategies have been developed and evaluated. Most of the exisiting evidence is restricted to efficacy studies and there are future challenges to progress evaluation through to studies of effectiveness. In general, prevention programmes appear more successful where they maintain intervention activities over a number of years and incorporate more than one strategy. Much of the existing research has been based in North America and evaluates discrete programmes. Future research should test effects in other countries, in different social contexts and seek to better understand the interrelated effects of combining interventions within the community. Developmental prevention programmes target different age periods and social settings, hence communities have the challenge of coordinating a mixture of programmes that address the local conditions that adversely influence child and youth development. There are opportunities in this work to coordinate prevention activities using funding from different jurisdictions (e.g., crime prevention, health promotion, mental health, education, substance abuse prevention).