Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses

Objective
Health literacy refers to an individual's ability to seek, understand, and use health information. A range of indices exist that purport to measure health literacy across individuals and populations. This study aimed to review the development and content of existing indices and to critically appraise their properties.

Study Design and Setting
Using standardized search terms, published generic health literacy indices (1990–2008) were identified. Using a methodological framework, each was evaluated for purpose, validity (face, content, construct), reliability, responsiveness, feasibility, and generalizability.

Results
Nineteen instruments were evaluated. Three measurement approaches were identified: direct testing of individual abilities, self-report of abilities, and population-based proxy measures. Composition of underlying constructs and content varied widely across instruments, and none appeared to fully measure a person's ability to seek, understand, and use health information. The content was focused primarily on reading comprehension and numeracy; scoring categories were poorly defined and may not be mutually exclusive, and few indices had been assessed for reliability.

Conclusion
Health literacy is not consistently measured, making it difficult to interpret and compare health literacy at individual and population levels. Empirical evidence demonstrating validity and reliability of existing indices is required, and more comprehensive health literacy instruments need to be developed.

Schools, health literacy and public health: possibilities and challenges

Health literacy is a concept that can be widely embraced by schools. Schools throughout the world contribute to the achievement of public health goals in conjunction with their educational commitments. In this paper, the interface between a school's core business of education and public health goals is identified, and examples provided in the area of nutrition demonstrating how these links can operate at school level. The structure and function of the health promoting school is described and the author proposes that there is a very close connection between the health promoting school and the enabling factors necessary in achieving health literacy. Major findings in the literature that provide evidence of good practices in school health education and promotion initiatives are described. Also, those factors that make schools effective and which facilitate learning for students are identified. There is a substantial overlap between the successful components of a health promoting school and effective schools. This enables schools to potentially achieve all three levels of health literacy, including level 3—critical health literacy. However, there are three challenges that must be addressed to enable schools to achieve this level: the traditional structure and function of schools, teachers practices and skills, and time and resources. Strategies are proposed to address all three areas and to reduce the impediments to achieving the goals of health literacy and public health using the school as a setting.

Anaerobic degradation of organic materials - significance of the substrate surface area

In anaerobic degradation of substrates containing mainly particulate organic matter, solids hydrolysis is rate-limiting. In these investigations, the particle size of various substrates was reduced by comminution to support hydrolysis. Two positive effects of comminution were observed. For substrates with high fibre content, which are particularly resistant to biodegradation, a significant improvement of the degradation degree was observed as a result of comminution. Secondly, for all substrates tested, and particularly for those rich in fibres, the degradation rate of comminuted samples was significantly higher. The first reason for both effects is an increase of the sample surface area. Several methods for measuring the specific surface area of organic materials, including particle size analysis, Nitrogen-adsorption and enzyme adsorption, were used and compared for the purpose of this study, where the surface area accessible to microbial enzymes is critical. The significance of the surface area in anaerobic degradation of particulate substrates was investigated through a kinetic model where the hydrolysis rate was based on the sample surface area. Good agreements were obtained between model and experiments carried out with samples of various specific surface areas. These results reinforced the significance of the sample surface area in anaerobic degradation processes. However, other effects of comminution responsible for the increased degradation degree and degradation rate were identified and discussed. These include: the increase of dissolved compounds due to cell rupture, exposition of surface areas previously inaccessible for microbial degradation, and alteration of the sample structure such as the lignin-cellulose arrangements.

Specialisation within specialisation? Thoughts on the content of contemporary forensic psychology programs

This paper provides details of, and the rationale for, a Doctorate of Forensic Psychology recently developed at Deakin University, Melbourne, Australia. The course prioritises training in psycho-legal issues with children and young people. In discussing this program, the presenters identify two issue  that guided the development of the program. The first concerns the need to delineate forensic content from that in clinical programs, while still maintaining appropriate focus on the skills needed to work effectively in forensic settings. The second addresses the need for courses to acknowledge the marked diversity among forensic clientele and to develop competencies that lead to effective work practices with these sub-groups. In constructing the Deakin forensic program, it was noted that forensic psychologists required an increasing degree of expertise in the procedural and substantive aspects of the legal system. The authors propose that as forensic psychology gains momentum as a discrete area of expertise, there is an increasing need for practitioners to have a sound understanding of the legal institutions and practices they work under, as well as being able to apply specialist knowledge to particular sub-groups. This paper discusses these issues, and outlines how the authors sought to address them in their course curriculum.

Evaluating a measure of content quality for accounting narratives (with an empirical application to narratives from Australia, Hong Kong, and the United States)

This paper evaluates a texture-based approach developed by Sydserff and Weetman (1999), to examine corporate annual report narratives. This is achieved by using the texture index to evaluate information content (which includes readability) in accounting narratives. Specifically, we examine the letter to shareholders of reports from Australia, Hong Kong and the United States.

We suggest a texture-based evaluation provides a robust measure of narrative quality due to the incorporation of readability and content analysis. The ability to measure content quality assists in promoting accountability, with the aim of improving usefulness of corporate
information and disclosures, and greater investor confidence in capital markets.

This paper also investigates these exploratory results to consider variations in quality between different countries. Considerable differences were found between the countries with Hong Kong reports generally superior. These tentative findings provide a small contribution to the comparative annual report literature and the emerging area of narrative evaluation.

Novel data management algorithms in peer-to-peer content distribution networks

The peer-to-peer content distribution network (PCDN) is a hot topic recently, and it has a huge potential for massive data intensive applications on the Internet. One of the challenges in PCDN is routing for data sources and data deliveries. In this paper, we studied a type of network model which is formed by dynamic autonomy area, structured source servers and proxy servers. Based on this network model, we proposed a number of algorithms to address the routing and data delivery issues. According to the highly dynamics of the autonomy area, we established dynamic tree structure proliferation system routing, proxy routing and resource searching algorithms. The simulations results showed that the performance of the proposed network model and the algorithms are stable.

Applying social critical literacy theory to deaf education

This article explores social critical literacy theory and its application to deaf education. It argues that critical literacy offers an approach that can lead to engagement with and empowerment over written text, repositioning students as researchers of language. Texts that represent deaf people - if only through their absence - offer an opportunity for deaf students to engage in literate practices in meaningful contexts. An example of critical text analysis is provided using articles on a contested issue: cochlear implantation.

Shifting to more authentic language and literacy activity in the middle years

This paper reports on the shifts in literacy teaching and learning that occurred at a Melbourne primary school, one of twelve schools that took part in a large research project undertaken by staff at Deakin University funded by the Victorian Department of Education, Training and Youth Affairs: Middle Years Literacy Research Project. The project focused on literacy teaching, learning, and assessment of students in the middle years of schooling. Through close collaboration between the researcher and teachers at the school, significant changes were made to the language and literacy program. These changes reflected current language theory and extended the school's focus on independent learning to the area of literacy. The development of more authentic ways of assessing student learning grew out of the work in the project as teachers sought assessment practices that were consistent with their philosophy of teaching and learning. With a focus on developing authentic literacy practices, teachers developed new ways of tracking and reporting student achievement.

What's the difference and where is the evidence? Investigating student teachers learning about literacy in a school based vs university based experience

This paper is in response to increasing national and international interest in the role of university teacher education programs in preparing pre-service  teachers in the area of early years literacy. The most effective manner to  facilitate this learning in teacher education is however not known and much debate exists about the merits of university-based versus school-based  approaches. It is within this context that the authors of this paper conducted a study that investigated student teachers learning about literacy through two different approaches both with distinctive design features. The first approach offered student teachers a school based experience, adopting a two hour micro-teaching model in a preparatory classroom; the other, a mainstream university based approach where students attended a tutorial for two hours. These two approaches were then compared for factors that student teachers articulated through a written survey. In analysing the data, two main findings emerged; firstly from the student teachers’ perspective, choice of approach resulted in improved learning and secondly, from the researchers’ perspective that student teachers placed in the school based approach emerged with a deeper understanding of the complexity of literacy teaching in general.

Towards cultural competence : Australian Indigenous content in undergraduate psychology

This paper discusses the development and preliminary analysis of psychology undergraduate courses on cultural competence in relation to Indigenous Australians. The paper summarises the process that led to the formation of draft curriculum guidelines for psychology academics, including the need to critically examine the assumptions and history of Western psychology in relation to Indigenous peoples, the inclusion of non-conventional teaching and learning methods, staff and institutional support, and appropriate staff development. The paper then discusses the responses of students to one of the courses developed from these guidelines. The courses were well received by students and although they do not in themselves teach professional psychological skills in working effectively with Indigenous people, they provide a solid basis for the development of such skills. Because this is a relatively new area, it is likely that there will be much refinement of these courses in coming years.

It takes more than breadcrumbs to learn generic skills : collaborating to improve information literacy

The effective teaching and learning of generic skills is becoming an important component of undergraduate education with the introduction of graduate attribute programmes in some Australian universities. Research shows that contextualised learning of these skills is important, but is a discipline-specific context sufficient to ensure student success in acquiring these skills? This paper studies the effectiveness of information skills
learning by a group of undergraduates using Brookfield’s concept of critical reflection and Critical Incident Questionnaire (CIQ). Most students reported positive experiences where the learning environment encouraged a deep approach to learning and negative experiences where that environment encouraged a surface approach. To ensure that students’ approach to
learning is appropriate for achieving the level of information literacy required of graduates, the study recommends the integration of information skills learning into course curricula through the close collaboration of academic and library staff.

The transformative potential of adult literacy learning

This paper explores the potential of literacy education to promote transformative learning in adults. Transformative learning theory is a flourishing area of research in adult education, and is concerned with describing and analysing fundamental changes in how adults view themselves and their world. According to the leading theorist of transformative learning, Jack Mezirow, literacy education has unique transformative potential. Although there is little research on this question, the available studies suggest that there is enormous potential for literacy education to act as a catalyst for transformative learning in adults.