Abstract
Health literacy (HL) plays a key role in explaining health disparities. School nurses (SN) provide health related expertise within the school setting. A positive effect on the HL of children but also their teachers and parents has been suggested by some research, but gaps persist in the available information. As a pilot project, SN, which are not common in German schools, were placed in 28 public elementary and secondary schools in two German states. Children (11+ years, n = 2773), parents (n = 3978) and teachers (n = 420) participated in a 2017 baseline (T0) survey. Data collection was repeated in 2018 (T1). HL was measured using the Health Literacy for School-Aged Children scale (HLSAC) (children) and the European Health Literacy Short Scale (HLS-EU-Q16) (adults). Descriptive and multivariate data analyses were carried out. The HL of all groups increased between T0 and T1. Low child HL decreased from 17.9% to 14.9%. Problematic and inadequate HL dropped from 43.8% to 38.8% among parents and from 49.9% to 45.8% among teachers. Improvements were significant for children and parents but not for the teachers. Despite the relatively short intervention period and a relatively non-specific spectrum of interventions, there is some evidence that SN may contribute to strengthening HL within the school setting. The longer-term effects of SN on health literacy and child health should be further examined. For this, a clearer conceptualization of the scope of work of the SN in Germany including their educational interventions is imperative.
Highlights
Health literacy, understood as the “people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course” [1], plays a key role in explaining differences in health behaviors and outcomes across all population and age groups [2]
Three distinct target populations were invited to participate in the surveys: (a) All children 11 years and older enrolled at the selected schools, (b) the parents of all children attending the selected schools, including children under 11 years, and (c) all teachers working at the selected schools, resulting in two independent cross-sectional samples (T0 in 2017 and T1 in 2018)
Since the first school nurse projects have only recently been implemented in Germany, almost no data on possible outcomes for students, parents, and teachers were available at the start of the intervention [47]
Summary
Understood as the “people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course” [1], plays a key role in explaining differences in health behaviors and outcomes across all population and age groups [2]. Health literacy is closely linked to health-related behavior, for instance, nutrition habits or physical activities [3,4,5]. Poor health literacy is correlated with more smoking, drinking and binge drinking, less physical activity, unhealthy nutritional habits, and higher risks in terms of sexual and injury behavior [3,4,5]. On the other hand, is a major indicator of an individuals’ ability to make informed decisions about their lifestyle, diet, and health care and provides a good foundation for individual and population-related health promotion and disease prevention [6,7]. Public Health 2020, 17, 2577; doi:10.3390/ijerph17072577 www.mdpi.com/journal/ijerph
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