faculty of educational science health literacy in childhood and … · 2015-12-10 · (i.e....

Health Promotion Conference Galway • 18/06/2015

Bielefeld University

Faculty of Educational Science

Centre for Prevention and Intervention in Childhood and Adolescence

Health Literacy in Childhood and Adolescence

Theories, Concepts and Models (TeCoMo)

JANINE BRÖDER

BIELEFELD UNIVERSITY, GERMANY

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Präsentationsnotizen

Hello, thank you. aim: to provide you with some preliminary thinking regarding the first sub-projects from the basic research track – TeCoMo. Need for TeCoMo: theoretical foundation for the target groups is lacking You will receive a short overview, some first entrypoints we have developed for addressing the project, and I will pose a couple challenges and open questions, were I hope to receive your valuable input on.





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Launched autumn 2013 Multidisciplinary approach with professionals from Public Health, Education, Psychology, Sociology, Social Work Leading partners located at University of Bielefeld and University of Education Freiburg Succesfully responded to call from the German Ministry of Education and Research (BMBF) Funds for 10 projects under the HLCA umbrella starting march 2015-2018





HLCA Subproject TeCoMo: Team

Janine Bröder [email protected]

Paulo Pinheiro [email protected]

Orkan Okan [email protected]





Overall objective To develop a comprehensive theoretical and conceptual framework on health literacy in childhood and adolescence

Issues to be addressed (1) Child development (2) Individual and contextual factors (3) HL of adults impacting on child health & wellbeing (4) Workable & applicable framework

Methods Mix of methods: Systematic reviews, deductive & inductive content analysis, expert validation using Delphi panel.

Duration March 2015-February 2018

HLCA-TeCoMo: Overview





HLCA-TeCoMo: Scope

Phase 1: Scoping available evidence • Systematic literature reviews

• on HL concepts and models in children and adolescents; and • exploring child development perspectives and developmental

factors with relevance for HL in children and adolescents • Exploring and discussing multiple entrypoints

Phase 2: Develop an definition and integrated conceptual framework of HL for the target group

Phase 3: Integrate children and adolescents’ perspectives into adult HL frameworks





Where to start from?





Build upon available concepts and models from HL research and adapt these to childhood and adolescence:

• e.g. Nutbeam’s Conceptual model and typology of HL [Nutbeam 2000]

• HL as (clinical) risk and HL as (personal) asset [Nutbeam 2008]

• e.g. HLS-EU model and matrix [Sørensen 2012]

• e.g. HL component model for children and adolescence from Finland [Paakkari & Paakkari 2012]

Body of HL Findings

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1st Entry point: when zooming in on the target group, we did step back and looked at present models regarding HL in general. How can we use them, integrate them and develop them further… Health literacy has gained increased attention for explaining discrepancies between health promoting and primary preventive activities, and health behaviours and health outcomes. We can make use of and build upon previous work of FOR EXAMPLE Nutbeam & Sorensen: Nutbeam’s famous conceptual model and Typology of HL: Functional Literacy: Basic skills in reading and writing, cpacity to apply these skills in everyday situations Communicative or interactive literacy: More advanced cognitive and literacy skills, greater ability obtain relevant information, derive meaning, and apply new information to changing circumstances Critical literacy: - More advanced cognitive and literacy skills, critical analysis of information, ability to use information to respond, adapt and control life events and situations. Does this work in children? How does it work and if not, how can we maybe modify it? The same is true for the more clinical vs. hl as personal asset view. Regarding the work of the HLS-EU: The model and the 3x4 matrix consider HL “over the lifecourse”. The challenge would be to apply and test it, continue to develop it and redefine it if needed. HLS-EU: 3x4matrix Definition: Health literacy is linked to literacy and entails people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course. And last but not least: leena Paakkari looking at hl in Adolescence from an educational perspective. Paakkeri: HL as consisting of five core components: �(1) theoretical knowledge: all-round education on health matters, including principles, theories, and conceptual models of various health phenomena. But its own rarely enough to enable health promoting habits. �(2) practical knowledge: or procedural knowledge or skills, including basic health- related skills that students should learn in order to behave in a health-promoting way. Contextual – thus only applicable in certain situation. (3) critical thinking: curious and investigative attitude towards the world, including a bent towards understanding health issues in a deeper way and perhaps, to create something new; ability to distinguish the conditions that promote health from those that do the opposite. (4) self-awareness: the ability to self-reflect; covers the capability to inquire and evaluate one’s thoughts, feelings and behaviour. General self-reflection vs. self-reflection as the self as a learner. being able to become conscious of one’s own feelings, needs, motives, values, attitudes, and experiences, plus their relation to one’s own ways of behaving in a health-enhancing way. (5) citizenship: the ability to act in an ethically-responsible way and take social responsibility, being able to understand their rights and responsibilities, and also to be aware of the effects of their thoughts and actions on other people and the world at large.





From a medical perspective, consider four Ds when outlining health care quality and HL

• Development Consider the developmental ability of the child

• Dependency Children depend on parents or other adults for health care

• Disease Epidemiology Children’s health, disease, and disability patterns differ from that of adults

• Demographics Consider the impact of poverty and single-parent families on children’s development and health care

First thoughts by Rothman et al. (2009)





Let’s widen the perspective and move towards health promotion …

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2nd EntryPoint: Rothman described when looking at HL of chronical disease patients. Good categorization of factors that we need to take into account/ are of relevance when elaborating HL in children and adolescence. Developmental change: Consider the developmental ability of the child, including his or her cognitive, emotional, and physical development. Dependency: Children depend on parents or other adults for accessing and receiving health care. i.e. health communication: is it directed towards the child, the caregiver, or both? recognize educational approaches! What is the impact of different literacy levels between parent and child? -> importance of health literacy in transitioning adolescents to adult care and functional independence. Differential epidemiology: Children experience a unique pattern of health, illness, and disability that is different from that of adults. How does the timing of disease occurrence may affect cognitive development and health literacy skills? Psychosocial impact of disease development in different age groups and how health communication may need to be different for different age groups and different diseases. Demographic patterns Many children are living in poverty and in single-parent families how does this affect their care, development and learning? Limited resources: how do socioeconomic disparities affect health literacy in children?





When do children start to acquire what kind of HL skills and knowledge?

• Children differ in their learning and developmental ability (i.e. cognitive, emotional, and physical development)

• Children understanding of health and illness develops as they move through linear learning stages [Borzekowski, 2009, applying Piaget’s concepts]

• Children as self-educated learners [George, 2013]

• Assistance or ‘scaffolding’ from adults or peers help children to master tasks or skills they otherwise could not [Borzekowski, 2009; Vygotsky, 1979]

1) Development

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Children as beings and not just becomings There is no typical child Different ages, gender, ethnicity, socioeconomic circumstances and capacity Different national and cultural contexts and educational institutions Subject to different structures and discourses on children and childhoods Conceptualisations of the child that homogenise and decontextualise children and their lives are being viewed as problematic [Brady et al., 2015] Children as social agents and co-constructors of their social worlds Understanding of child agency fundamental for understanding child’s dealing with health and wellbeing in everyday life Child agency not just a personal competence, but a multidimensional concept Bounded in intergenerational relations as well as in wider socioeconomic contexts and social and material resources Questioning whose actions should impact on whom Power and participation are situated and changeable, which calls for attention to how children’s agency is perceived, facilitated and restrained in specific settings [Brady et al., 2015] Children as a social (minority) group Understanding how children are placed and perceived in the structures of societies and in relation to other social groups Understanding of the dynamics in intergenerational relations between children, parents and adult society Understanding of power relations and the ways children are listened to and taken account of in different social settings, e.g. healthcare and school, Understanding of discourses and images of the child in social and health policy and health promotion interventions addressing children and young people [Brady et al., 2015]





2) Dependency

How and to what extend do children depend on their parents for (health) care and HL skills?

• Intergenerational and power relations • Children as

• beings and not just becomings • embodied social agents and co-constructors of their social

worlds • a social (minority) group

• Capabilities

[Bühler-Niederberger et.al, 2015; Alanen et.al., 2015]

Dependent Autonomous

[Nussbaum, 2011,2003; Sen, 2001]

[Mayall, 2015]

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Children as beings and not just becomings There is no typical child Different ages, gender, ethnicity, socioeconomic circumstances and capacity Different national and cultural contexts and educational institutions Subject to different structures and discourses on children and childhoods Conceptualisations of the child that homogenise and decontextualise children and their lives are being viewed as problematic [Brady et al., 2015] Children as social agents and co-constructors of their social worlds Understanding of child agency fundamental for understanding child’s dealing with health and wellbeing in everyday life Child agency not just a personal competence, but a multidimensional concept Bounded in intergenerational relations as well as in wider socioeconomic contexts and social and material resources Questioning whose actions should impact on whom Power and participation are situated and changeable, which calls for attention to how children’s agency is perceived, facilitated and restrained in specific settings [Brady et al., 2015] Children as a social (minority) group Understanding how children are placed and perceived in the structures of societies and in relation to other social groups Understanding of the dynamics in intergenerational relations between children, parents and adult society Understanding of power relations and the ways children are listened to and taken account of in different social settings, e.g. healthcare and school, Understanding of discourses and images of the child in social and health policy and health promotion interventions addressing children and young people [Brady et al., 2015]





3) Disease Epidemiology

What is the relation between children’s health, disease, and disability patterns and HL?

• A higher vulnerability of children to risk factors for psychological, emotional, or learning disorders

• Age-specific risk patterns and disease burden • Highest DALY’s for 10-14 year’s old:

Unipolar depressive disorders, Lower respiratory infections, Road traffic accidents • Acute vs. chronic diseases • NCD’s vs. communicable diseases

[Gore et al. 2011; Glaeske, 2008; Bergmann et al. 2008]





4) Demographics

What is the impact of poverty and other socio-economic issues on children’s development of HL? • Disproportional affect of health inequalities and socio-

economical dispositions on children

• Highly divers and heterogenic milieu compositions

• Relevance of social and physical environment on the child’s capacity to develop in a healthy way





5) Democratic Citizenship

How to develop HL and take on an active citizenship, acting in an ethical- and social-responsible way?

• HL empowerment as a participatory, self-learning process • Moving beyond one’s own perspective

• HL as a social, democratic practice instead of a hierarchical, authoritarian way of education

• Acknowledging the pluralistic, subjective dimensions of Health and HL • There is no one (healthy) way • Respect for children’s autonomy?

[George, 2013; Paakkari & Paakkari, 2012]

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Citizenship: ability to act in an ethically-responsible way and take social responsibility





• HL as a multiple literacy is not limited to theoretical & practical knowledge, but includes • critical thinking • self-awareness • citizenship

5) Democratic Citizenship

[Paakkari & Paakkari, 2012]





… Let’s think in an even wider HLCA paradigm!





(Re)Thinking Health

(Re)Thinking Child Development

Biomedical Models

Social Models

Social-ecological Models

Salutogenic Models

(Re)Thinking Literacy

Cognitive Perspectives

Psycholinguistic Perspectives

Sociocultural Perspectives

New Literacy studies

Multiliteracies

Critical Literacy

(Re)Thinking the Basic Concepts

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Innovative approach: Take a step back and rethink the two concepts of HL as ONE what are their implications for each other? How too learn from previous approaches? What‘s their relation? How do they correlate with each other? What are the implications for the when including child development? Mention that the top two are rather traditional perspectives, while the social-ecological and salutogenic models and the „new“ approaches to literacy are rather holistic Refer to key note speakers‘ presentation. Brain Street new literacy studies; Luis Saboga Nunes salutogenic paradigm Social Models: Social Determinants of Health





TeCoMo’s expected innovation

• Adding to the knowledge base of HLCA: bridging the multidisciplinary gap

• HLCA is of cross-disciplinary nature and relevance • Integrating different disciplines and their health and literacy

perspectives

• Moving towards a holistic perspective • Zooming out from an individual-level perspective by integrating

an ecological and structural perspectives

• Improved understanding of the interaction between child development, social environments and health outcomes

• Recognizing the target group • Apply health literacy to different life phases

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Consitution of power relations towards adults, transgenerational relations.





TeCoMo Project: Theories, Concepts, and Models on Health Literacy in

Childhood and Adolescence

Health

Literacy

Challenge: Synthesizing Perspectives

?

?

?

?

Child development Citizenship

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Challenge Nr.1: Synthesising information and valuing the exisiting paradigmas and approaches





Thank you for your attention!

Contact [email protected] [email protected] [email protected]

faculty of educational science health literacy in childhood and … · 2015-12-10 · (i.e....

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