Health literacy and health behavior among women in Ghazni, Afghanistan

Copyright © 2021 Harsch, Jawid, Jawid, Saboga-Nunes, Sørensen, Sahrai and Bittlingmayer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: Health literacy is a determinant of health and assessed globally to inform the development of health interventions. However, little is known about health literacy in countries with one of the poorest health indicators worldwide, such as Afghanistan. Studies worldwide demonstrate that women play a key role in developing health literacy. Hence, this study's purpose is to explore health literacy of women in Afghanistan and the associated factors. Methods: From May to June 2017, we randomly recruited 7-10 women per day at the hospital in Ghazni, a representative province of Afghanistan. Two trained female interviewers interviewed 322 women (15-61 years old) orally in Dari or Pashto on a voluntary basis and assessed their health literacy using the HLS-EU-Q16, associated socio-demographics, and health behavior. Results: Health literacy of women (among educated and illiterates) is low even compared to other Asian countries. Health literacy is linked to age and education. We found mixed evidence of the relationship between health literacy and contextual factors, help-seeking, and health-related behavior. Conclusion: This study provides novel data on health literacy and astonishing insights into its association with health behavior of women in Afghanistan, thus contributing to health status. The study calls for recognition of health literacy as a public health challenge be addressed in Afghanistan and other low-income countries affected by crises.info:eu-repo/semantics/publishedVersio

A comprehensive health effects assessment of the use of sanitizers and disinfectants during COVID-19 pandemic: a global survey

COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation (p-value \u3c0.001). Examination of risk factors based on multivariate logistic regression analysis showed that alcohols and alcohols-based materials were associated with skin effects (OR, 1.98; 95%CI, 1.87–2.09), per-chlorine was associated with eye effects (OR, 1.83; 95%CI, 1.74–1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90–2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92–2.44). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92–2.44). The use of sodium hypochlorite and per-chlorine also had a high chance of having respiratory effects. The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics especially when they are used or overused

Health Literacy as a Situational, Social Practice in Context - Insights from Three Research Projects among "Vulnerable Groups"

Globalization, digitalization, global pandemics, climate change, and infodemic pose increasing challenges to individuals, communities, and societies, which require good health literacy to maintain and promote health. Empirical evidence on HL (health literacy) has rapidly increased worldwide and exposed the inadequate levels of HL in most countries. Especially people with low socioeconomic background, low educational attainment, and migrants are considered vulnerable to low HL, based on quantitative studies and conclusions. A group that is multiply affected and variously described as vulnerable is people of Afghan descent. However, empirical evidence on their actual HL and their HL practices in everyday life is scarce. To empower people to respond adequately to current and future health-related changes, a good knowledge of HL in the relevant population group is indispensable. Since recent qualitative studies indicate that health literacy can only be adequately described as a real practice in its specific context and unique situation, I explore in this dissertation how HL can be captured and described as a contextual, situational social practice, using the example of people of Afghan descent with different research methods. This work incorporates three major research projects, each employing different methods to explore HL among Afghans and provide relevant insights into the concept of HL. Research on health and health literacy is diverse, so it is important to begin this work by outlining the different understandings of health and health literacy and common strategies for promoting them. Since health is understood from a health promotion perspective as a positive, comprehensive concept in a socio-ecological context, HL is consequently not understood as an individual autonomous skill but as a contextual, social practice. Accordingly, health and HL are also described in context by the groups under consideration, and their possible influence on HL is shown. The use of the term vulnerable is critically examined, and the focus is shifted away from the characteristics of the individual to the influencing circumstances. Based on raw determinants and health outcomes, HL in Afghanistan is rated as low. Given the diverse data on immigrant populations and the different theories explaining their health status, it is shown that immigrant populations face many pressures and need to acquire new HL. Third, building on the course offering: language course, it is argued that those participating in it (including Afghans) need to improve their HL. Building on account of the health literacy of so-called vulnerable groups, which traced the complexity and heterogeneity, it is concluded that HL needs to be understood and explored as a contextual, situational, social practice to adequately describe HL. Therefore, in the three research projects, special emphasis is placed on the respective overall social context, the situation's specifics, the use of language, the actual actions, and the meaning of social others. Furthermore, it is examined what can be learned from the respective methodological approach to HL with regard to HL as a contextual, situational social praxis, as well as how the vulnerability or resource wealth of the target group and the vulnerability- or capability-producing context are revealed. Last, important lessons for HL promotion were derived from all three projects. The first four contributions are from a quantitative, cross-sectional study in central Afghanistan that examines HL, determinants, outcomes, but also quality of life, and beliefs in two groups of people influential to health, heads of households (N= 524) and female patients and/or caretakers (N=322). Participants were in a two-stage randomization process identified and orally interviewed by trained interviewers of the same sex. The study provides empirical evidence of poor determinants of health and health outcomes, health behaviors that need improvement, and low health literacy. The analysis showed that HL is largely related to schooling opportunities (for women). Surprisingly, despite adverse circumstances, an astonishing number of Afghans exhibit positive health behaviors. A qualitative examination of the items of the HLS-EU-Q16 shows which activities are particularly difficult and, at the same time, particularly prerequisite-rich, which should also be better researched in the future for developing interventions. The second three contributions stem from the ELMi research project, which ethnographically researched the HL of immigrant youth (including three Afghan refugees) in everyday life and embedded the findings in a review and theoretical considerations. The limitations of reviews for describing HL in vulnerable groups became obvious in these three theoretical contributions. Furthermore, the frequent, mostly implicit theoretical orientation of HL as an individual rational-choice model and three alternative models for the description of HL were presented, a difference-deficit model was introduced, and a plea for applying sociological theories, especially the capability approach, was given. Overall, the ethnographic studies revealed the need for further studies of vulnerable groups from a salutogenic perspective, the conceptualization of HL as family HL, and the interwovenness of analog and digital worlds and respective HL. The third three contributions are from the SCURA research project, which ethnographically explored the role of health and health literacy in language and integration courses and developed appropriate methods for promoting HL in them. The contribution of integration courses to the promotion of HL was presented in detail, the corridor of possible interventions was explored and described, and concrete suggestions were made as to how the knowledge gained from language didactics can be transferred to health promotion and how language-sensitive health promotion can be used as an effective and sustainable method. Finally, the key strengths and limitations of the studies were highlighted, and the question of 'vulnerability' was revisited in light of the results found. Furthermore, the five aspects of HL as a contextual, situational, and social practice were re-examined with the help of the results obtained, and other studies, recommendations for the promotion of HL through context, acquisition, and targeted support were presented, and the capability approach was applied to the results. In many ways, this multi-project, multi-method, multi-perspective approach to HL of so-called vulnerable groups highlighted the need to describe HL as a contextual, situational social practice. Since many new, little-trodden paths were taken in this work, this work can serve as an impetus for many other researchers to critically examine the topic. The work unmistakably revealed how relevant a good understanding and targeted, context-sensitive promotion of HL is

Health and Health Promotion in Developing Countries: A Case study of Community-Based Health Promotion Approaches in Afghanistan

Community-based health promotion approaches have proven to be very appealing and effective in rural and under-resourced countries such as Afghanistan. Surprisingly, however, empirical evidence and practical recommendations are lacking for Afghanistan, a country with some of the worst health indicators worldwide (e.g., maternal mortality rate). The purpose of this mixed-method exploratory case study was to identify community-based approaches to health promotion in Afghanistan and the factors that lead organizations and activities to succeed and sustain despite challenging circumstances. The author conducted extensive secondary research, a scoping review, 28 semi-structured oral qual- itative interviews with people working in health projects in Afghanistan, and obtained 22 written responses to a qualitative questionnaire sent to NGOs working in the health sector in Afghanistan as well. After transcribing and analyzing the content, she was able to exhaustively explore the topic by integrating and triangulating multiple perspectives. First, she presented the findings regarding the prerequisites for and determinants of health in Afghanistan by contrasting qualitative and quantitative data. This comprehensive overview illustrated not only the poor conditions and numerous challenges but also the diversity within the country. Second, she described the findings on the Afghan health system, structured along the components of the WHO Health System Framework. This allows for comprehending the well-planned strategies and comparing them to the actual situation. Third, she identified most (NGO-supported) healthcare providers and conducted a gap analysis of existing activities in 13 areas of health. Fourth, the qualitative findings provided insights into the concept of health, common health practices, community-based healthcare approaches, and success factors for working in Afghanistan. Overall, there are various health activities and approaches to health promotion in Afghanistan. The most successful approaches were those that work in the community, with trained female health workers who are trustworthy, committed, and paid, and who provide curative as well as preventive and promotive services. For working successfully in the Afghan setting, trust, collaboration with leaders, community participation, and training are highly recommended. Nonetheless, all activities took place in a context characterized by insecurity, corruption, poverty, low level of education, and cultural constraints. The author proposed the concept of “health care plus and beyond” as an approach applicable to all providers. This concept includes taking care of the immediate health need of the person and, at the same time, empowering them to improve their health. In conclusion, there is a great need for health promotion and health education in Afghanistan, which is worth exploring further. This study could not provide a complete picture, but it does pro- vide a very good first-hand understanding of the numerous influencing factors and facets of community-based health promotion, thus providing numerous starting points for further research and practice

State-organized Health Education in Germany – Health Literacy Promotion within Health Compromising Regulations

Background: Migrants and refugees often have low health literacy (HL), which negatively affects their health. Adult second language courses (SLC) (e.g. in Germany) are suggested as promising settings for improving HL, but empirical evidence is rare.Aim: To analyse the nature and process of promoting HL in German SLC and to derive implications.Methods: We systematically analysed the eight latest textbook series approved by the German Government and discussed it considering adult education and health promotion principles.Findings: The health topics discussed do not cover newcomers’ major health needs. Communicative situations on health are complex and require multiple linguistic skills, most activities do not support an in-depth, critical study of the health content and rarely use assets, e.g. plurilingual and pluricultural competence.Conclusion: Promoting HL in SLC is possible and recommendable for other countries. However to further unfold its potential, the limiting regulations and conditions must be improved.

Health Literacy as a Situational, Social Practice in Context - Insights from Three Research Projects among "Vulnerable Groups"

Globalization, digitalization, global pandemics, climate change, and infodemic pose increasing challenges to individuals, communities, and societies, which require good health literacy to maintain and promote health. Empirical evidence on HL (health literacy) has rapidly increased worldwide and exposed the inadequate levels of HL in most countries. Especially people with low socioeconomic background, low educational attainment, and migrants are considered vulnerable to low HL, based on quantitative studies and conclusions. A group that is multiply affected and variously described as vulnerable is people of Afghan descent. However, empirical evidence on their actual HL and their HL practices in everyday life is scarce. To empower people to respond adequately to current and future health-related changes, a good knowledge of HL in the relevant population group is indispensable. Since recent qualitative studies indicate that health literacy can only be adequately described as a real practice in its specific context and unique situation, I explore in this dissertation how HL can be captured and described as a contextual, situational social practice, using the example of people of Afghan descent with different research methods. This work incorporates three major research projects, each employing different methods to explore HL among Afghans and provide relevant insights into the concept of HL. Research on health and health literacy is diverse, so it is important to begin this work by outlining the different understandings of health and health literacy and common strategies for promoting them. Since health is understood from a health promotion perspective as a positive, comprehensive concept in a socio-ecological context, HL is consequently not understood as an individual autonomous skill but as a contextual, social practice. Accordingly, health and HL are also described in context by the groups under consideration, and their possible influence on HL is shown. The use of the term vulnerable is critically examined, and the focus is shifted away from the characteristics of the individual to the influencing circumstances. Based on raw determinants and health outcomes, HL in Afghanistan is rated as low. Given the diverse data on immigrant populations and the different theories explaining their health status, it is shown that immigrant populations face many pressures and need to acquire new HL. Third, building on the course offering: language course, it is argued that those participating in it (including Afghans) need to improve their HL. Building on account of the health literacy of so-called vulnerable groups, which traced the complexity and heterogeneity, it is concluded that HL needs to be understood and explored as a contextual, situational, social practice to adequately describe HL. Therefore, in the three research projects, special emphasis is placed on the respective overall social context, the situation's specifics, the use of language, the actual actions, and the meaning of social others. Furthermore, it is examined what can be learned from the respective methodological approach to HL with regard to HL as a contextual, situational social praxis, as well as how the vulnerability or resource wealth of the target group and the vulnerability- or capability-producing context are revealed. Last, important lessons for HL promotion were derived from all three projects. The first four contributions are from a quantitative, cross-sectional study in central Afghanistan that examines HL, determinants, outcomes, but also quality of life, and beliefs in two groups of people influential to health, heads of households (N= 524) and female patients and/or caretakers (N=322). Participants were in a two-stage randomization process identified and orally interviewed by trained interviewers of the same sex. The study provides empirical evidence of poor determinants of health and health outcomes, health behaviors that need improvement, and low health literacy. The analysis showed that HL is largely related to schooling opportunities (for women). Surprisingly, despite adverse circumstances, an astonishing number of Afghans exhibit positive health behaviors. A qualitative examination of the items of the HLS-EU-Q16 shows which activities are particularly difficult and, at the same time, particularly prerequisite-rich, which should also be better researched in the future for developing interventions. The second three contributions stem from the ELMi research project, which ethnographically researched the HL of immigrant youth (including three Afghan refugees) in everyday life and embedded the findings in a review and theoretical considerations. The limitations of reviews for describing HL in vulnerable groups became obvious in these three theoretical contributions. Furthermore, the frequent, mostly implicit theoretical orientation of HL as an individual rational-choice model and three alternative models for the description of HL were presented, a difference-deficit model was introduced, and a plea for applying sociological theories, especially the capability approach, was given. Overall, the ethnographic studies revealed the need for further studies of vulnerable groups from a salutogenic perspective, the conceptualization of HL as family HL, and the interwovenness of analog and digital worlds and respective HL. The third three contributions are from the SCURA research project, which ethnographically explored the role of health and health literacy in language and integration courses and developed appropriate methods for promoting HL in them. The contribution of integration courses to the promotion of HL was presented in detail, the corridor of possible interventions was explored and described, and concrete suggestions were made as to how the knowledge gained from language didactics can be transferred to health promotion and how language-sensitive health promotion can be used as an effective and sustainable method. Finally, the key strengths and limitations of the studies were highlighted, and the question of 'vulnerability' was revisited in light of the results found. Furthermore, the five aspects of HL as a contextual, situational, and social practice were re-examined with the help of the results obtained, and other studies, recommendations for the promotion of HL through context, acquisition, and targeted support were presented, and the capability approach was applied to the results. In many ways, this multi-project, multi-method, multi-perspective approach to HL of so-called vulnerable groups highlighted the need to describe HL as a contextual, situational social practice. Since many new, little-trodden paths were taken in this work, this work can serve as an impetus for many other researchers to critically examine the topic. The work unmistakably revealed how relevant a good understanding and targeted, context-sensitive promotion of HL is

Promoting Cancer Literacy using Online Storytelling in Kenya

The aim of the CaLioS research project is to understand the cancer-related health literacy of cancer patients in sub-Saharan Africa and to improve it through a co-developed website that displays shared patient experiences in order to improve quality of life and treatment outcomes in the long term. For example, cancer literacy in Kenya and the most common cancers there (breast and prostate) will be studied, and an intervention will be developed and evaluated. This will provide initial empirical data and experience for the development of the intervention, which will be extended to other diseases and countries in sub-Saharan Africa in a subsequent research project. Despite the increasing number of new cancer cases in sub-Saharan Africa, empirical evidence on living with cancer, everyday challenges, cancer literacy and interventions to improve it is scarce. And although storytelling is important in sub-Saharan Africa, and studies from the Global North show that shared patient stories can successfully improve knowledge and coping skills, there is a lack of scientific evidence on the use of stories to promote cancer literacy. The project will first conduct a situational analysis of cancer literacy in Kenya (systematic review and thematic analysis using the precede-proceed model) and explore cancer-related educational opportunities. It will also explore the role of cancer patients' lived experiences in promoting cancer literacy and recommendations for an online cancer literacy intervention (qualitative interviews with multiple key informants). Second, narrative interviews with breast and prostate cancer patients about their lived experiences will be conducted, videotaped, pedagogically edited and made available on a co-designed website and social media. Third, the lived experiences of cancer patients will be analysed in detail to gain an in-depth understanding of cancer patients' lives, challenges and strategies for coping and living. Fourthly, it will be investigated whether the use of this online service improves the cancer literacy of cancer patients more than standard services. Finally, a proposal for a larger research project to extend this intervention to other diseases and countries and to scientifically evaluate its implementation and success will be developed in collaboration with partners from sub-Saharan Africa

Students Having Parents with Mental Health Issues and Teachers' Mental Health Literacy

Bruland D, Kornblum K, Harsch S, Bröder J, Okan O, Bauer U. Schüler mit einem psychisch erkrankten Elternteil und die Mental Health Literacy von Lehrkräften. Praxis der Kinderpsychologie und Kinderpsychiatrie. 2017;66(10):774-790.Mental health issues of parents of school children often negatively affects the children as well, including their school performance and social behavior in the school setting. Teachers are then required to take actions with regards to supporting children in their coping with and mastering of their home situation and their responds to educational demands. As such, schools' and teachers' actions can either support affected children and fulfill a protective function or respond inappropriately, with negative impact on the affected children. Although the societal discussion about and acceptance of mental illnesses have increased in recent years, scientific knowledge on how well teachers are prepared for meeting the needs of affected students remains insufficient. Therefore, this research study examines teachers' attitudes towards, knowledge about, and competencies regarding children affected by a mentally ill parent. 15 in-depth interviews and 3 focus groups (n = 11) with teachers from primary and secondary schools were conducted and systematically analyzed. Although burdens in the family are perceived as major influences on children's school day and performance, teachers report to not feel sufficiently prepared for and uncertain about supporting and coping with the special needs of affected students. Instead they report to "learn from a case to case" basis. Recognizing the family situation of children with mentally ill parents is reported to be especially difficult for teachers. Responding inadequately and insensitive to the needs of affected children was perceived as a serious burden for teachers themselves. While schools can function as entry points to professional social help systems, teachers frequently reported barriers and challenges in accessing, communicating, and collaborating with these systems. The practical implications of these results regarding the "Mental Health Literacy" of teachers are being discussed

The impact of child maltreatment on non-suicidal self-injury: data from a representative sample of the general population

Abstract Background Child maltreatment is an identified risk factor for Non-Suicidal Self-Injury (NSSI). The aim of the current study was to investigate effects of different types of maltreatment, and mediating effects of depression and anxiety on NSSI in the general population. Methods A representative sample of the German population, comprising N = 2498 participants (mean age = 48.4 years (SD = 18.2), 53.3% female) participated in this study. Child maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ),NSSI was assessed with a question on lifetime engagement in NSSI, depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-2) and anxiety symptoms by the General Anxiety Disorder questionnaire (GAD-2). Results Lifetime prevalence of NSSI in this sample was 3.3, and 30.8% reported at least one type of child maltreatment. Participants in the NSSI group reported significantly more experiences of child maltreatment. Emotional abuse was endorsed by 72% of all participants with NSSI. A path analytic model demonstrated an unmediated direct effect of emotional neglect, a partially mediated effect of emotional abuse, and a fully mediated effect of sexual abuse and physical neglect by depression and anxiety on NSSI. Conclusions Especially emotional neglect and abuse seem to play a role in the etiology of NSSI above and beyond depression and anxiety, while sexual and physical abuse seem to have a rather indirect effect