Integrating Health Literacy Research Articles

The influence of health literacy competencies on patient-centered care among clinical nurses

Purpose: The aim of this study was to identify the relationships between health literacy competencies and patient-centered care among clinical nurses. Methods: The participants of this study were 254 nurses working in two hospitals in the D region. The data were collected from July to August 2020. The health literacy competencies for registered nurses scale and individualized care scale were utilized. Descriptive statistics, independent t-test, ANOVA, Pearson’s correlation coefficient and multiple regression analysis were used for data analysis. Results: The mean of health literacy competencies was 3.16±0.31 points on a four-point scale, and the average of patient-centered care was 3.69±0.50 points on a five-point scale. Regarding the nurses’ general characteristics, patient-centered care showed significant differences according to age (F=4.68, p=.010), marital status (t=-2.38, p=.018), religion (F=3.03, p=.030), total clinical experience (F=2.94, p=.021) and prior health literacy knowledge (t=3.20, p=.002). As a result of a hierarchical multiple regression analysis, health literacy competencies (β=.63) were found to significantly influence patient-centered care. The explanatory power of the model was 41.0% (F=25.58, p<.001). Conclusion: The study suggests that nurse’s health literacy competencies should be developed in order to improve patient-centered care. Nursing education should include an emphasis on integrating health literacy into the nursing school curriculum.

Integrating Health Literacy and Cultural Competency Concepts Across the Doctor of Pharmacy Curriculum

Objective. To determine the longitudinal impact of integrating health literacy and cultural competency content throughout the professional pharmacy curriculum and the impact of additional changes made to the curriculum based on the results of a longitudinal analysis. Methods. Health literacy and cultural competency concepts were integrated throughout a four-year professional pharmacy curriculum. A cohort of students were assessed using health literacy and cultural competency survey instruments at baseline, the end of the fall semester of the first professional (P1) year, and the end of each subsequent academic year. From the four-year assessment, a need for additional reinforcement in the spring P1 semester was identified, so a health literacy activity was incorporated into an introductory pharmacy practice experience (IPPE) for two cohorts of students. The outcomes were compared to those of a single cohort of students who had completed their P1 year prior to integration of the additional content. A health literacy survey instrument was given at the beginning and after completion of the semester to assess change. Preceptors also completed a brief survey. Results. Curricular integration improved health literacy and cultural competency attitudes and self-perceived ability in P1 students, as assessed by the instruments. However, declines in students' health literacy and cultural competency were identified when the students were retested in the spring semester. After implementing the health literacy IPPE activity, the health literacy scores of P1 students in the two subsequent years improved. Preceptors also gave positive feedback on the utility of this activity. Conclusion. Integrating health literacy and cultural competency content throughout the curriculum resulted in improvement in students' scores in these areas from the first to the fourth professional year, but when there were no integrated activities, scores dropped. Implementing additional activities improved student-perceived HL skills. Thus, it may be important to ensure there is inclusion of content in each semester of the curriculum to maximize effects.

Participation in microfinance based Self Help Groups in India: Who becomes a member and for how long?

Microfinance is a widely promoted developmental initiative to provide poor women with affordable financial services for poverty alleviation. One popular adaption in South Asia is the Self-Help Group (SHG) model that India adopted in 2011 as part of a federal poverty alleviation program and as a secondary approach of integrating health literacy services for rural women. However, the evidence is limited on who joins and continues in SHG programs. This paper examines the determinants of membership and staying members (outcomes) in an integrated microfinance and health literacy program from one of India's poorest and most populated states, Uttar Pradesh across a range of explanatory variables related to economic, socio-demographic and area-level characteristics. Using secondary survey data from the Uttar Pradesh Community Mobilization project comprising of 15,300 women from SHGs and Non-SHG households in rural India, we performed multivariate logistic and hurdle negative binomial regression analyses to model SHG membership and duration. While in general poor women are more likely to be SHG members based on an income threshold limit (government-sponsored BPL cards), women from poorest households are more likely to become members, but less likely to stay members, when further classified using asset-based wealth quintiles. Additionally, poorer households compared to the marginally poor are less likely to become SHG members when borrowing for any reason, including health reasons. Only women from moderately poor households are more likely to continue as members if borrowing for health and non-income-generating reasons. The study found that an increasing number of previous pregnancies is associated with a higher membership likelihood in contrast to another study from India reporting a negative association. The study supports the view that microfinance programs need to examine their inclusion and retention strategies in favour of poorest household using multidimensional indicators that can capture poverty in its myriad forms.

Work in Progress: A Report on Health Literacy in Denmark and the Netherlands.

This report focuses on the development of health literacy in two European countries, Denmark and the Netherlands. Denmark is part of the Nordic region, while the Netherlands is situated in the Western part of Europe. The report includes examples on Danish and Dutch health literacy research and lessons learned from practice. In Denmark, supported by health literacy research, health literacy developments have been advanced within some areas of practice. Health literacy advocacy initiatives promoted by the Danish Health Literacy Network and the Danish Society of Public Health provide promising perspectives for the future of health literacy in Denmark. In the Netherlands, the Dutch Health Literacy Alliance, researchers, and other relevant stakeholders are actively integrating health literacy in research and practice - both clinically and in communities. The vibrant Dutch health literacy community advocates for further national health literacy efforts to achieve governmental support.

Integrating Health Literacy Into Core Curriculum: A Teacher-Driven Pilot Initiative for Second Graders.

Limited research has addressed the effects of health literacy interventions in elementary schools. However, school-aged children's health literacy is critical because children make decisions about their health every day. The purpose of the pilot project was to explore the feasibility of integrated health literacy lesson plans for second graders. A pretest-posttest evaluation was conducted with second grade students following implementation of health literacy lessons that were integrated into core curriculum (language arts, science, and social studies). Health educators, a hospital/health care system, and a school district developed a partnership. A research team of teachers, administrators, health literacy experts and health care organizations designed and implemented health literacy lesson plans. A developmentally appropriate measure of health literacy was adapted from the Newest Vital Sign. Data showed that students' health literacy scores significantly increased after implementation of 4 lesson plans. This was an exploratory, pilot project that provided a useful starting point for discussing how to integrate health literacy into elementary school curriculum. An interdisciplinary team developed integrated health literacy materials that acknowledged the needs of teachers, the resources available, and the developmental stages of children. This intervention serves as a model for future health literacy initiatives in schools.

Abstract A009: Validation of an instrument to measure health professionals' health literacy competence

Abstract Introduction: Health literacy (HL) has been identified as a significant predictor of outcomes across the health continuum, including cancer care. As a result it is recommended that all health professionals receive health literacy training. Some institutions have begun integrating health literacy into training programs, but there is a dearth of reliable assessment tools to measure learners' knowledge. Only one validated instrument (Health Literacy Knowledge and Experience Scale (HL-KES)) exists that specifically assess health professionals' health literacy competence, but it was validated for use among nurses. The purpose of this study was to evaluate the reliability and validity of the HL-KES as a suitable measure for assessing the HL knowledge and experience of health promotion professionals. Methods: Advanced (junior and senior) students (n=250) enrolled in bachelor-level health promotion programs in three large public universities in Texas completed the 29-item HL-KES. Exploratory and confirmatory factor analyses were conducted to test the factor structure. Reliability estimates of the overall scale and subscales were assessed using the item covariance method with coefficient alpha (α). Results: The analyses identified three factors that accounted for 62% of the total variance. Twelve items loaded on factor 1 (Knowledge of HL challenges), four items loaded on factor 2 (knowledge of HL assessment strategies), and three items loaded on factor 3 (knowledge of HL principles for written healthcare materials). Results from the test of internal consistency indicated the HL-KES had acceptable reliability for the overall knowledge scale (Cronbach's alpha = 0.77). The sub-scales had Cronbach's alphas ranging from .31 to .52. Conclusion: The results suggest the HLKES is a reliable instrument for assessing health promotion professionals' health literacy knowledge. As a whole, the Cronbach's alpha for the instrument falls within the acceptable range (.65 - .90). The subscales, however, have low reliability coefficients. Cronbach's alpha is a function of test length and inter-item correlation and a couple of subscales had just a few items. Reduction in the number of items no doubt attenuated the internal consistency. Citation Format: Lenna Dawkins-Moultin, Lisako McKyer. Validation of an instrument to measure health professionals' health literacy competence [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A009.

Facilitators and Barriers to the Development of Health Literacy Capacities Over Time for Self-Management.

Background:Health literacy is a dynamic construct that is content and context specific. An understanding of the facilitators and barriers involved in the development of health literacy over time can provide important insights for the health care providers (HCP) in supporting patients with chronic illness.Objective:The study was conducted to expand an understanding of how health literacy development can be supported through exploration of the main facilitators and barriers in the process.Methods:This study used a longitudinal qualitative study design involving repeat interviews at three separate time points over a 12-month period. A purposive sample of 26 participants attending a structured cardiovascular disease risk-reduction program participated in the study, 17 of whom completed all three interviews. The European Health Literacy Survey measure was used to determine health literacy levels at the beginning and end of the 12-month period. Employing qualitative thematic analysis and a longitudinal-specific question framework, a trajectory approach was applied to explore individual cases longitudinally.Key Results:Facilitators and barriers to health literacy capacity development were identified. Participants demonstrated increased perceptions of having control and being empowered over time. However, this was also found to be affected by external life events. Study participants were also found to be embedding health knowledge, motivation, and behaviors over time within the everyday contexts of their lives. The relationship with the HCP permeated all aspects of health literacy capacity development, including aspects of treatment decision-making. Participants identified the need for psychological supports and the increased importance of looking after their mental health.Conclusions:Positive developments in health literacy capacities are important for the self-management of illness. Longitudinal findings underscore the importance of the HCP in supporting the development of health literacy capacities over time. These findings lend support to the need to integrate health literacy into medical and other HCP curricula to raise awareness of the concept of health literacy. [HLRP: Health Literacy Research and Practice. 2020;4(2):e104–e118.]Plain Language Summary:Using a longitudinal qualitative study design, this study proposes that health literacy capacities develop over time and that the health care provider (HCP) plays a central role in this process. Findings from this study support the need to embed health literacy training into medical and other applied HCP curricula to raise awareness of the concept of health literacy.

The Role of School Leaders' Health Literacy for the Implementation of Health Promoting Schools.

Background: The promotion of health literacy is seen as an urgent goal in public health and education and, hence, should be integrated in the school context as a component of the holistic health promoting school (HPS) approach. However, only limited empirical studies have addressed health literacy of school staff so far. Hence, this study aimed to examine the level of health literacy among school leaders and its association with the extent of HPS implementation. Methods: A cross-sectional study with n = 680 school principals and members of the school management board from Germany was carried out at the end of 2018. Individual health literacy, attitudes, and competencies towards HPS and occupational self-efficacy served as independent variables and the level of HPS implementation was the dependent variable. Data were analyzed using univariate and bivariate analysis as well as multiple binary logistic regression. Results: 29.3% of school leaders show a limited health literacy with significantly higher values found for male respondents. Regression analyses revealed that male gender (OR: 1.91, 95% CI: 1.22–2.99), HPS attitudes (OR: 3.17, 95% CI: 2.13–4.72), and HPS competencies (OR: 3.66, 95% CI: 2.43–5.50) were associated with a lower level of HPS implementation. Furthermore, regression analyses differentiated by gender showed that limited health literacy is associated with a low level of HPS implementation for male school leaders only (OR: 2.81, 95% CI: 1.22–6.45). Conclusions: The promotion of health literacy especially for male leaders would not only result in positive effects on an individual level but also could contribute to a stronger implementation of activities on school health promotion. We suggest integrating health literacy, HPS attitudes, and competencies more strongly into the qualification and in further training of school leaders.

International Perspective on Health Literacy and Health Equity: Factors That Influence the Former Soviet Union Immigrants.

Among the world’s 272 million international migrants, more than 25 million are from the former Soviet Union (FSU), yet there is a paucity of literature available about FSU immigrants’ health literacy. Besides linguistic and cultural differences, FSU immigrants often come from a distinct healthcare system affecting their ability to find, evaluate, process, and use health information in the host countries. In this scoping review and commentary, we describe the health literacy issues of FSU immigrants and provide an overview of FSU immigrants’ health literacy based on the integrated health literacy model. We purposefully consider the three most common locations where FSU immigrants have settled: the USA, Germany, and Israel. For context, we describe the healthcare systems of the three host countries and the two post-Soviet countries to illustrate the contribution of system-level factors on FSU immigrants’ health literacy. We identify research gaps and set a future research agenda to help understand FSU immigrants’ health literacy across countries. Amidst the ongoing global population changes related to international migration, this article contributes to a broad-scope understanding of health literacy among FSU immigrants related to the system-level factors that may also apply to other immigrants, migrants, and refugees.

Health Literacy Among Bhutanese Adult Refugees in the United States: The Sociocultural Approach

Drawing on the accounts of literacy as socioculturally situated, this 2-year ethnography explores Bhutanese adult refugees’ health literacy at the intersection of their culture and experiences. This study illustrates the multifaceted relations between health literacy, culture, integration, and empowerment. This study indicates health literacy as sociocultural practice. Health literacy is mediated by Bhutanese adults’ oral tradition, language, education, and experiences over time. This study highlights health literacy as sociocultural participation—it resides in individuals’ community engagement. Rather than simply describing their limited functional health literacy as “a big problem,” this study recognizes Bhutanese adults’ ability to take action to improve personal and community health. This study challenges the deficit view rooted in adult literacy. It advocates integrating health literacy into adult literacy education to raise public awareness that health literacy promotes social justice, human rights, and world citizenship. Implications for a bottom-up approach to health literacy education are provided.

The Impact and Outcomes of Integrating Health Literacy Education Into Adult Basic Education Programs in Boston.

Background:Adult basic education (ABE) is the national system that offers educational services in English language development, reading, writing, math, technology, and communications to adults with low literacy, limited English, or both. These services range from basic levels to high school equivalency, with specialty programs in transition to community colleges and family literacy.Objective:This study sought to analyze the role of ABE in increasing health literacy among low literate and limited English populations and to identify effective models for teaching and learning about health in this setting.Methods:During a 2-year period, 90 students from three ABE programs in Boston participated in health literacy classes focused on healthy eating and received prevention screening services through local public health organizations. The majority of students classified themselves as Black, African American, or Latino. Participants ranged in age from 18 to 35 years; 64% of the participants were women. The three research sites were located in the Roxbury neighborhood of Boston, where health disparities and poverty rates are disproportionately high. During the study period, researchers conducted semi-structured interviews with teachers (N = 12) from each of the participating classrooms to gather information about the students in their health classes. Researchers also conducted semi-structured interviews and focus groups (N = 9) with students at each site during the study period to examine how they described changes in their knowledge, attitudes, and actions regarding health. Researchers also conducted ethnographic field research by observing health classes at each site, which was supplemented by collecting teachers' lesson plans as well as materials produced by learners.Key Results:ABE programs are a good setting for adults with limited literacy or limited English to increase their health literacy. The programs, which provide steady learning environments over time with staff skilled in adult learning, allow students to engage with health information in the context of their everyday lives, thereby increasing the likelihood of healthier practices.Conclusions:ABE programs play a vital role in developing health literacy among low literacy populations and are part of the solution for addressing health disparities. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S25–S32.]Plain Language Summary:This article describes the role that adult basic education plays in improving health literacy among low-literate and limited English populations. The impact and outcomes of learning about health were investigated for 90 adults in three programs in Boston where health disparity is high. The impact of different teaching/learning models also was compared.

Health literacy of undergraduate health profession students in Australia: A comparison of the island State of Tasmania and Other Australian universities

The aim was to explore the health literacy of undergraduate health profession students enrolled at the only university based on the Island of Tasmania and compared with students enrolled at other universities on the main island of Australia. The data was collected as a part of a larger international survey of tertiary health profession students. Capture of baseline evidence about levels of health literacy was to provide direction for how and when to incorporate core and specialised health literacy content into the health profession curriculum to promote work-readiness.This study was a cross-sectional descriptive online survey using a previously validated tool known as the Health Literacy Questionnaire. Variables influence health literacy status of students across Australia, including age, course enrolled in, and language spoken at home. In addition, health status, socio-economic status, and level of parental education influenced health literacy amongst students in Tasmania. These findings were relatively consistent with previous findings of other studies in Australia and other countries reporting health literacy status of health profession students.There is a need to integrate health literacy early in the curriculum of all health courses offered at the University of Tasmania. Medical students consistently demonstrated higher levels of health literacy compared with other health profession students, however, all health students reported health literacy deficiencies. Curriculum design needs to consider the nature of the student cohort with essential foundation modules embedded into the first year of health courses. Specialised modules addressing discipline-specific information also need to be integrated throughout each health profession curriculum.

Development of Saudi e-health literacy scale for chronic diseases in Saudi Arabia: using integrated health literacy dimensions.

ObjectiveHealth literacy has become a global issue, and it is important that patients and individuals are able to use information technology to access health information and educational services. The research objective is to develop a Saudi e-health literacy scale (SeHL) for measuring e-health literacy among Saudis suffering from non-communicable diseases (NCD).MethodsOverall, 14 relevant papers in related interdisciplinary fields were reviewed to select the most useful literacy dimensions. From these articles, we extracted the most common dimensions used to measure e-health literacy across the disciplines. Multiple workshops with multidisciplinary team members reviewed and evaluated items for SeHL.ResultsFour key aspects of e-health literacy—use of technology/media, information-seeking, usefulness and confidence—were identified and integrated as e-health literacy dimensions. These will be used to measure e-health literacy among Saudi patients with NCDs. A translation from Arabic to English was performed in order to ensure that translation process was accurate. A SeHL scale was developed to measure e-health literacy among Saudi patients. By understanding e-health literacy levels, we will be able to create a patient-education system to be used by patients in Saudi Arabia.ConclusionsAs information technology is increasingly used by people of all ages all over the world, e-health literacy has been identified as a key factor in determining health outcomes. To date, no comprehensive scale exists to assess e-health literacy levels among speakers of Arabic, particularly among people with NCD such as diabetes, cardiovascular diseases and hypertension.

Becoming a health literate organization: Formative research results from healthcare organizations providing care for undeserved communities.

Background Integrating health literacy into primary care institutional policy and practice is critical to effective, patient centered health care. While attributes of health literate organizations have been proposed, approaches for strengthening them in healthcare systems with limited resources have not been fully detailed. Methods We conducted key informant interviews with individuals from 11 low resourced health care organizations serving uninsured, underinsured, and government-insured patients across Missouri. The qualitative inquiry explored concepts of impetus to transform, leadership commitment, engaging staff, alignment to organization wide goals, and integration of health literacy with current practices. Findings Several health care organizations reported carrying out health literacy related activities including implementing patient portals, selecting easy to read patient materials, offering community education and outreach programs, and improving discharge and medication distribution processes. The need for change presented itself through data or anecdotal staff experience. For any change to be undertaken, administrators and medical directors had to be supportive; most often a champion facilitated these changes in the organization. Staff and providers were often resistant to change and worried they would be saddled with additional work. Lack of time and funding were the most common barriers reported for integration and sustainability. To overcome these barriers, managers supported changes by working one on one with staff, seeking external funding, utilizing existing resources, planning for stepwise implementation, including members from all staff levels and clear communication. Conclusion Even though barriers exist, resource scarce clinical settings can successfully plan, implement, and sustain organizational changes to support health literacy.

Adult Education and the Health Literacy of Hispanic Immigrants in the United States

ABSTRACTDiscussion on the advantages of integrating health literacy into adult education has primarily been theoretical and conceptual. There is a need for studies that assess the impact of adult education on health literacy. This study implemented a quasi-experimental design to explore whether basic adult instruction may constitute a venue for improving health literacy among Spanish-speaking immigrants. Participants included adults in a High School Equivalency program in a US-Mexico border community who received either a standard GED curriculum or a GED curriculum enhanced with health literacy content. The Short Spanish TOFHLA was used to measure health literacy. While S-TOFHLA scores and health literacy levels improved in all participants, no statistically significant differences were observed across groups. Results are consistent with recommendations supporting adult education as a strategy for improving health literacy.

Health Literacy and Atrial Fibrillation: Relevance and Future Directions for Patient-centred Care.

Atrial fibrillation (AF) is a common cardiac arrhythmia with significant clinical outcomes, and is associated with high medical and social costs. AF is complicated for patients because of its specialised terminology, long-term adherence, symptom monitoring, referral to specialty care, array of potential interventions and potential for adversity. Health literacy is a frequently under-recognised, yet fundamental, component towards successful care in AF. Health literacy is defined as the capacity to obtain, process and understand health information, and has had markedly limited study in AF. However, health literacy could contribute to how patients interpret symptoms, navigate care, and participate in treatment evaluation and decision-making. This review aims to summarise the clinical importance and essential relevance of health literacy in AF. We focus here on central aspects of AF care that are most related to self-care, including understanding the symptoms of AF, shared decision-making, adherence and anticoagulation for stroke prevention. We discuss opportunities to enhance AF care based on findings from the literature on health literacy, and identify important gaps. Our overall objective is to articulate the importance and relevance of integrating health literacy in the care of individuals with AF.

Embedding health literacy into health systems: a case study of a regional health service.

Objective The aim of the present study was to describe how one regional health service the Illawarra Shoalhaven Local Health District embedded health literacy principles into health systems over a 3-year period. Methods Using a case study approach, this article describes the development of key programs and the manner in which clinical incidents were used to create a health environment that allows consumers the right to equitably access quality health services and to participate in their own health care. Results The key outcomes demonstrating successful embedding of health literacy into health systems in this regional health service include the creation of a governance structure and web-based platform for developing and testing plain English consumer health information, a clearly defined process to engage with consumers, development of the health literacy ambassador training program and integrating health literacy into clinical quality improvement processes via a formal program with consumers to guide processes such as improvements to access and navigation around hospital sites. Conclusions The Illawarra Shoalhaven Local Health District has developed an evidence-based health literacy framework, guided by the core principles of universal precaution and organisational responsibility. Health literacy was also viewed as both an outcome and a process. The approach taken by the Illawarra Shoalhaven Local Health District to address poor health literacy in a coordinated way has been recognised by the Australian Commission on Safety and Quality in Health Care as an exemplar of a coordinated approach to embed health literacy into health systems. What is known about the topic? Poor health literacy is a significant national concern in Australia. The leadership, governance and consumer partnership culture of a health organisation can have considerable effects on an individual's ability to access, understand and apply the health-related information and services available to them. Currently, only 40% of consumers in Australia have the health literacy skills needed to understand everyday health information to effectively access and use health services. What does this paper add? Addressing health literacy in a coordinated way has the potential to increase safety and quality of care. This paper outlines the practical and sustainable actions the Illawarra Shoalhaven Local Health District took to partner with consumers to address health literacy and to improve the health experience and health outcomes of consumers. Embedding health literacy into public health services requires a coordinated whole-of-organisation approach; it requires the integration of leadership and governance, revision of consumer health information and revision of consumer and staff processes to effect change and support the delivery of health-literate healthcare services. What are the implications for practitioners? Embedding health literacy into health systems promotes equitable, safe and quality healthcare. Practitioners in a health-literate environment adopt consumer-centred communication and care strategies, provide information in a way that is easy to understand and follow and involve consumers and their families in decisions regarding and management of the consumer's care.

Healthy Reading: Teaching Strategies for Integrating Health and Literacy Education

Across the world, development of health literacy skills with elementary school students improves health outcomes, reduces health risks, and increases academic success. As elementary school classroom teachers are often responsible for delivering the health curriculum to their students, this article examines ways to integrate health literacy with reading instruction. The authors describe learning experiences designed to develop knowledge and skills about nutrition and healthy eating choices in different cultural contexts. Mutual development of reading and health literacy skills leads to development of skills essential for supporting health and academic success. While the innovative strategies described here are designed in the context of U.S. classrooms, teaching health literacy in conjunction with critical literacy skills has global relevance.

Development of a Core Online Health Literacy Course in Canada

Health literacy has implications for people’s ability to make healthy decisions and manage their own health. To improve health literacy, we need to improve the knowledge and skills of those who receive and those who provide health information and services, while paying attention to demands of the environment that shape people’s skills and abilities. Higher education can play a critical role in nurturing a health literate population. This article articulates the need to integrate health literacy courses into health-related degree programs through the integration of Bandura’s work and Core Competencies for Public Health put forward by Canada. Offering such courses in varying formats will help prepare learners to better understand the growing demand for a health literate workforce and will contribute to the ongoing public health initiatives in improving health-related settings by removing health-related barriers. This article outlines the need for a systematic development of health literacy courses based on the integration of instructional and health literacy principles. An example of a core online undergraduate health literacy course in Canada is presented. Insights are offered into how educators can develop and modify their own health literacy courses, which aim to help learners explore ideologies, practices, tools, and policies guiding health literacy efforts for diverse people across settings.

Promoting health literacy in the classroom

Objective: Research has shown that developing health literacy in early life is critical to reducing lifestyle-related diseases, with schools being identified as central settings for this purpose. This paper examines how one classroom-based health educational programme, IMOVE, helped Danish primary school pupils develop health literacy related to physical activity. It discusses curriculum-integrated health education’s contribution to promoting health literacy. Design: Qualitative classroom observation. Setting: IMOVE was implemented in 12 school classes (grades 5–7) in four public schools in Copenhagen, Denmark, during the autumn and winter of 2013–2014. Participants numbered 281 pupils and nine teachers. Method: We used Nutbeam’s conceptualisation of health literacy as a theoretical framework to assess which levels of health literacy the programme would promote; we assessed these using data derived from 59 IMOVE lesson transcripts. Results: IMOVE primarily contributed to the development of functional health literacy by building a relational understanding between everyday practice and step numbers. We observed the presence of interactive health literacy in discussions about how pupils and teachers could change their daily practices. Only a limited number of discussions supported the development of critical health literacy. Conclusion: Our findings suggest that educators can successfully integrate health literacy development into classroom-based curriculum teaching, with pupils’ own step counts and associated reflections positively influencing learning. However, in this study, classroom teaching was limited to a focus on cognitive skills and only partially supported the development of more critical health literacy skills. Our findings call for further research into approaches to support classroom-based critical health literacy development.