Health literacy as a learning outcome in schools

Purpose: The aim of this paper is to define health literacy as a learning outcome in schools, and to describe the learning conditions that are relevant for targeting health literacy. Design/methodology/approach: The paper draws on theoretical and empirical educational literature, and also the experiences of the authors. Findings: Health literacy is defined as consisting of five core components: theoretical knowledge, practical knowledge, critical thinking, self-awareness, and citizenship. The first three components are rather similar to the commonly-accepted health literacy concept, but the definition given in this paper expands the concept via two additional – but essential – components. It is emphasized that when one is aiming to develop students' internal capacity to construct their own meanings regarding health topics, these two additional components are called for. The paper argues that one of the main aims of health teaching in schools should be to foster students' ability to define their own beliefs, identity and social relations. Moreover, if it is desired that students should become responsible citizens, acting in an ethically responsible way, competencies such as ethical reflection skills should be developed in schools. The paper also highlights the fact that the development of certain health literacy components calls for particular kinds of learning conditions. Originality/value: The paper identifies the core components of health literacy as a learning outcome and gives practical examples of means to achieve a particular target.peerReviewe

Health literacy and the school curriculum : The example of Finland

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Uusi työkalu kouluikäisten terveyden lukutaidon mittaamiseen

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Opetusta ja oppiainetta kehittämässä

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Developing an Instrument for Measuring Health Literacy among School-aged Children

Health literacy (HL) is an important determinant of health and health behaviours. The aim of this research was to develop a brief, comprehensive, and theory-based instrument for the measurement of subjective HL among school-aged children. A further aim was to examine the cross-national measurement invariance of this instrument in four European countries, i.e. Finland, Poland, Slovakia, and Belgium. The developmental process of the instrument was systematic, iterative, and validity- and reliability-driven. It involved 1) definition and elaboration of the construct, 2) choice of measurement method, 3) item generation, 4) a pilot study (N=401) including test-retest (N=117), and 5) field-testing, including construction of a brief instrument (N= 3853), and examination of the instrument’s international applicability (N=1468). All the samples were taken from pupils aged 13 and 15. Initially, 65 items were generated, of which 32 items were selected for the pilot study. After item reduction, the instrument contained 16 items. The test-retest showed high stability. For the field testing phase, a brief, 10-item instrument was constructed, referred to as Health Literacy for School-aged Children (HLSAC). The instrument, which exhibited a high Cronbach alpha (.93), and adequate fit with the data, included two items from each of five predetermined theoretical components (theoretical knowledge, practical knowledge, individual critical thinking, self-awareness, citizenship). In a cross-national measurement invariance examination, configural and metric invariance was established, but scalar invariance did not hold. Nevertheless, the HLSAC instrument’s internal consistency was high (α=.80–.90) and the fit with the data was adequate in each country. A comparison of health literacy mean values showed significant mean value differences between countries and age groups. Measurement of HL via reliable and valid instruments creates a basis for trustworthy assessment of HL levels and appropriate interventions. The HLSAC instrument is suitable for large-scale studies, and for use with children and adolescents. It constitutes a promising tool for subjective HL comparisons in the international context.Terveyden lukutaito on tärkeä determinantti terveydelle ja terveyskäyttäytymiselle. Tämän tutkimuksen tarkoituksena oli kehittää lyhyt, moniulotteinen ja teoriaan perustuva mittari kouluikäisten lasten terveyden lukutaidon mittaamiseen. Lisäksi tarkoituksena oli tutkia mittausinvarianssitestin avulla mittarin soveltuvuutta maiden väliseen vertailuun. Testi tehtiin neljässä Euroopan maassa (Suomi, Puola, Slovakia, Belgia). Mittarin kehittämisessä edettiin systemaattisesti ja huomioiden pätevyyteen ja luotettavuuteen liittyvät kysymykset. Kehitysprosessi sisälsi 1) terveyden lukutaidon käsitteellistämisen, 2) mittausmenetelmän valinnan, 3) väittämien luomisen, 4) pilottitutkimuksen (N=401) sisältäen toistomittauksen (N=117) sekä 5) mittarin viimeistelyn (N=3853) ja sen kansainvälisen toimivuuden tutkimisen (N=1468). Jokaisessa vaiheessa otos koostui 13- ja 15-vuotiaista oppilaista. Aluksi kehitettiin 65 väittämää, joista 32 valittiin pilottitutkimukseen. Analyysien perusteella väittämien määrä supistettiin 16:een. Pilottivaiheen toistomittaus osoitti korkeaa pysyvyyttä. Tämän jälkeen rakennettiin lyhyt 10 väittämää sisältävä mittari, jonka nimeksi tuli Health Literacy for School-aged Children (HLSAC). Mittarin sisäinen konsistenssi oli korkea (α=.93), malli sopi dataan asianmukaisesti ja se sisälsi kaksi väittämää seuraavista terveyden lukutaidon osa-alueista: teoreettiset tiedot, käytännön taidot, kriittinen ajattelu, itsetuntemus ja eettinen vastuullisuus. Neljän maan välisessä mittausinvarianssitestissä konfiguraalinen ja metrinen mittausinvarianssi todennettiin, mutta skalaarinen mittausinvarianssi ei toteutunut. Mittarin sisäinen konsistenssi oli korkea (α=.80–.90) ja malli sopi dataan asianmukaisesti jokaisessa maassa. Terveydenlukutaitoa osoittavien keskiarvojen vertailu maiden välillä osoitti merkittäviä keskiarvoeroja maiden ja ikäryhmien välillä. Pätevät ja luotettavat terveyden lukutaidon mittausmenetelmät luovat pohjan terveyden lukutaidon tasojen arvioinnille ja asianmukaisille interventioille. HLSAC mittari soveltuu laajamittaisiin tutkimuksiin lapsilla ja nuorilla, ja se on lupaava väline koetun terveydenlukutaidon vertailuun eri maiden välillä

Subjective health literacy : Development of a brief instrument for school-aged children

Aims: The present paper focuses on the measurement of health literacy (HL), which is an important determinant of health and health behaviours. HL starts to develop in childhood and adolescence; hence, there is a need for instruments to monitor HL among younger age groups. These instruments are still rare. The aim of the project reported here was, therefore, to develop a brief, multidimensional, theory-based instrument to measure subjective HL among school-aged children. Methods: The development of the instrument covered four phases: item generation based on a conceptual framework; a pilot study (n = 405); test–retest (n = 117); and construction of the instrument (n = 3853). All the samples were taken from Finnish 7th and 9th graders. Results: Initially, 65 items were generated, of which 32 items were selected for the pilot study. After item reduction, the instrument contained 16 items. The test–retest phase produced estimates of stability. In the final phase a 10-item instrument was constructed, referred to as Health Literacy for School-Aged Children (HLSAC). The instrument exhibited a high Cronbach alpha (0.93), and included two items from each of the five predetermined theoretical components (theoretical knowledge, practical knowledge, critical thinking, self-awareness, citizenship). Conclusions: The iterative and validity-driven development process made it possible to construct a brief multidimensional HLSAC instrument. Such instruments are suitable for large-scale studies, and for use with children and adolescents. Validation will require further testing for use in other countries.peerReviewe

Health Education Teachers’ Assessment Conceptions and Practices : Identifying Assessment Profiles

The study explored the latent construct underlying the assessment conceptions and practices of Finnish Health Education teachers (n = 165) in the context of curricula, seeking thereby to identify the teachers’ assessment profiles. Six underlying factors were found to encompass their assessment conceptions and practices, namely Assessment supporting learning, Assessment of working, Self and peer assessment as part of grading, Common assessment criteria, Questionable assessment practices, and Norm-referenced assessment. Via cluster analysis, three distinct assessment profiles were identified, labeled as Problematic assessors, Learning supportive assessors, and Norm-based assessors. These findings can be used to develop Health Education teacher training and facilitate teachers’ assessment literacy.peerReviewe

Subjective health literacy among school-aged children

Purpose The aim of this study was to explore Finnish adolescents’ subjective health literacy (HL) in association to school achievement, learning difficulties, educational aspirations, and family affluence. Design/methodology/approach Nationally representative data were collected in Finland as part of the international Health Behaviour in School-aged Children (HBSC) study. The respondents consisted in total of 3,833 adolescents (7th and 9th graders) from 359 schools. The Health Literacy for School-aged Children (HLSAC) instrument was applied to measure adolescents’ subjective HL, while the Family Affluence Scale (FAS) was used to measure adolescents’ socioeconomic status. Information was gathered on school achievement, learning difficulties, and educational aspirations. Findings Approximately one third of the adolescents manifested a high level of HL, around 60% had a moderate level of HL, and about one tenth had low HL. The HL level was lower for boys than for girls, and lower for 7th graders than for 9th graders. In the total sample the strongest explanatory variables for HL were school achievement in the first language, and educational aspirations. Originality/value This study provides the first Finnish nationally representative examination of adolescents’ subjective HL levels, and how these vary across age and gender groups. In drawing conclusions and presenting suggestions for HL interventions, it is important to verify the nature of the HL examined in any given study, and how it was researched.peerReviewe