School-Based Health Literacy Programs for Children (2-16 Years): An International Review

An Exploration of Satisfaction with Mental Health Counseling Services in Western Australia Among Sexuality and Gender Diverse Youth

Clinically significant psychological distress affects approximately 29.3% of Australian adolescents and 80.6% of sexuality and/or gender diverse youth (SGD-Y). Often, SGD-Y experience inadequate access and lower satisfaction with mental health services, stemming from age- and sexuality and/or gender diversity-status. Accordingly, exploration of factors affecting SGD-Y's access to, and satisfaction with, mental health services is critical. Using a social constructionist lens, we explored factors supporting SGD-Y's satisfaction with mental health services, and how these needs are or could be met. Seven LGBTQA+ youth aged 15 to 21 who received counseling in Western Australia in the last year, recruited via a university student participant pool and community organizations, participated in semi-structured interviews via video-conference, phone call, or SMS. Reflexive thematic analysis was inductively applied to participants' verbatim accounts. Satisfaction was tied to participants' sense of control over their healthcare-system experiences, shaped by four themes: person-centered support during the service-access process, resources to guide the search for services, confidence in therapists, and healthcare-system organization. Practices and policies supporting SGD-Y's self-determination during their service access may allow for empowering and personally meaningful therapeutic experiences. Developers of policies and initiatives may need to adopt a systems approach to foster SGD-Y's self-determination as they access services.

Health literacy profiles of final year pre-service teachers in two initial education programs compared with the general population: A cross-sectional study using the Health Literacy Questionnaire

ISSUE ADDRESSED

Health literacy (HL) can be developed throughout the lifespan starting from the early years highlighting that educational institutions, curriculum and teachers are powerful settings, places and people that can foster HL in youth. Current research shows that Australian teachers need more support to teach health education that promotes students' HL, with limited research focusing on pre-service teachers (PST). This study aims to identify the HL strengths and challenges of PST at one Australian university across two initial teacher education programs (HPE and primary) and compare their health literacy profiles with that of the Australian general population.

METHODS

The Health Literacy Questionnaire (HLQ) was administered in March and April, 2022 to measure HL in Australian PST. The research setting was a university in Sydney, Australia, with two of the University's undergraduate initial teacher education (ITE) programs (Health and Physical Education [HPE] and Primary). Of the 24 PST in the HPE cohort, 23 consented. Of the 70 PST in the Primary cohort, 34 consented. The results were compared with Australian Bureau of Statistics data.

RESULTS

The participants' median age was 22.3(4.3) years (SD), age ranged from 20 to 54 years, with 36% of participants under the age of 22 years. When comparing the PST data with the general population there were two significant differences: (1) PST scored significantly higher than the general population for Domain 4 (Social support for health, 3.41 vs. 3.19; p < 0.001; d = 0.57); and (2) the PST scored significantly lower for Domain 9 (Understand health information enough to know what to do, 4.02 vs. 4.27; p < 0.01; d = -0.43). In addition, we found that primary PST had significantly lower scores for domains 5-9 (demonstrative of interactive and critical HL), compared with the general Australian population.

CONCLUSIONS

Findings show that PST strengths are that they perceive that there they are able to access social support for health, however the PST find it more difficult to analyse and apply health information, compared with the general Australian population. SO WHAT?: Further understanding of health literacy profiles of Australian PST should influence the design of ITE programs and its health education curricular to ensure that PST are able to further develop their HL understandings and capabilities.

Predisposing factors of health promotion behaviors and health literacy in adolescents: A cross-sectional design

OBJECTIVE

This study was designed to measure health promotion behaviors, health literacy (HL) levels, and their predisposing factors among adolescents.

DESIGN

A cross-sectional design was used.

SAMPLE

The study was completed by 1046 students aged 11-14 years.

MEASUREMENTS

Data were collected via the HL for School-Aged Children Scale and the Adolescent Health Promotion Scale.

RESULTS

HL was significantly associated with gender, participation in sport activities, and health promotion behaviors. There was no confounding factor for HL. Adolescent health promotion behaviors were significantly associated with academic level, weight perception, participation in sport activities, and HL.

CONCLUSIONS

Nurses could improve communication and decision-making skills related to health behaviors and learn how to obtain health-related knowledge to promote the health of adolescents.

The relationship between gender, psychosocial factors, pain, health literacy and health-related quality of life in parents of Norwegian adolescents one year into the COVID-19 pandemic

BACKGROUND

Stress impacts healthy behaviours and may influence life and health-related quality of life (HRQOL). A stressful event occurred when the COVID-19 pandemic hit in March 2020. The present study aims to explore possible gender differences in stress, psychosocial factors (self-efficacy, self-esteem, loneliness), pain, HL, and HRQOL in parents of adolescents one year into the COVID-19 pandemic, and to explore possible associations between gender, demographic and psychosocial factors, pain, HL, and HRQOL.

METHODS

Parents of adolescents aged 16-17 took part in the study from January to February 2021, when the COVID-19 pandemic was ongoing. Data on socio-demographics, stress, self-efficacy, self-esteem, pain, HL, loneliness, and HRQOL were collected. HRQOL was assessed using RAND-36.

RESULTS

Among the 320 parents from the general population, the mean age was 47.6 (standard deviation (SD) = 4.6) years, 81% were mothers, 79% were married or cohabiting, 81% had a university degree, and the majority worked full time (78%) or part time (13%). The average pain score was low, 0.48 (95% CI [0.43-0.54]). However, 50% of the parents reported persistent pain and more mothers reported persistent pain compared to fathers (53% vs. 37%). The parents' mean (SD) score for RAND-36 was 52.1 (95% CI [51.2-53.0]) for the physical component summary (PCS) score and 51.0 (95% CI [50.0-52.1]) for the mental component summary (MCS) score. Mothers reported significantly lower scores for all the eight RAND-36 domains and the PCS and MCS scores. Adjusting for gender, age, living condition, education, pain, HL, self-efficacy and loneliness, we revealed no associations between stress and RAND-36-PCS. University education of four years or more was positively associated (B = 3.29, 95% CI: [0.78-5.80]) with RAND-36-PCS, while persistent pain was negatively associated (B = -7.13, CI: [-9.20- -5.06]). We identified a strong negative association between RAND-36-MCS and stress (B = -43.11, CI: [-48.83- -37.38]) and a positive association with older age (B = 0.21, CI: [ 0.04, 0.39)].

CONCLUSION

One year into the COVID-19 pandemic, we identified a strong negative association between stress and mental HRQOL, while pain was strongly negatively associated with physical HRQOL.

Anemia Awareness Program in a Suburban Middle School: A Pilot Study Promoting Students as Public Health Advocates in Their Community

INTRODUCTION

Almost a quarter of the people on earth are anemic, and most of them reside in regions of sub-Saharan Africa and South Asia. Anemia in children is linked with impaired cognitive and motor development and affects the future earning capacity. The most common cause of anemia is iron deficiency. The Indian Government has initiated multiple programs for the eradication of anemia. The prevalence of anemia has not decreased despite the improvements in the country's economy. It increased from 58.7% in 2015-16 to 67.1% in 2019-21 in children and from 50.4% in 2015-16 to 52.2% in 2019-21 in pregnant women. Maternal education, socioeconomic status, and number of children in the family are some factors that influence the prevalence of anemia. As these factors cannot be improved in a short time, we aimed to increase awareness about this issue by targeting school students from rural/semi-urban backgrounds.

METHODS

This pilot study aimed at promoting school students as public health advocates in their community. Anemia Awareness Program was conducted in a local middle school in the suburban area, which was attended by 153 class eight students (72 female). Pre- and post-test questionnaires comprising 20 multiple-choice/true-false type questions were used. Pre- and post-test scores were obtained. The second part of the study was the identification of students with anemia. Blood hemoglobin levels of 127 students (58 female) were measured from venous blood samples. The students were also asked to inform their friends/relatives about anemia and to send people with symptoms of anemia to the free two-day Anemia Awareness Camp organized by the Medical College Hospital for check-ups.

RESULTS

The mean post-test score (15.68/20) was much higher than the pretest score (2.99/20). Thirty-eight (25 female) out of 127 students had mild/moderate microcytic hypochromic anemia, suggesting iron deficiency. Thirty-two persons visited the free health camp to receive information from the students, of whom four had normal hemoglobin levels.

CONCLUSION

This pilot study showed that physician-conducted anemia awareness programs are relatively low-cost methods to spread information among the general population in India.

Understanding Critical Health Literacy Among Adolescents: Psychometric Properties of the CHLA Questionnaire in Lower Secondary Schools in Norway

BACKGROUND

Schools are important arenas for the promotion of critical health literacy (CHL) among adolescents. Key domains of CHL are information appraisal, understanding social determinants of health, and abilities to act on determinants of health. In this paper, we examine the psychometric properties of the Critical Health Literacy for Adolescents Questionnaire (CHLA-Q).

METHODS

A cross-sectional survey study was performed at 5 schools in Norway. Respondents included 522 pupils aged 13-15 years old. Confirmatory factor analysis (CFA) was conducted to examine the structural validity. Internal reliability was assessed using ordinal Cronbach's alpha.

RESULTS

The estimated model had acceptable closeness of fit. Five of 6 scales displayed adequate internal reliability.

CONCLUSION

The results indicate acceptable fit of the CHLA-Q framework and that 5 of the 6 scales are applicable to inform future research and interventions. More research is needed on measurement of the second domain of CHL.

The conceptualization and development of critical health literacy in children: a scoping review

The cognitive and social practices associated with critical health literacy, such as critical appraisal of health messages and participation in political processes to address wider determinants of health, are of lifelong benefit. Understanding how and where critical health literacy development can be supported early in the life course may improve health outcomes now and in the future. This scoping review focuses on how critical health literacy in children is conceptualized and the supportive environments available for its development. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines are used in reporting. Evidence retrieved was eligible for inclusion if it contained a substantive conceptual or empirical study of critical health literacy in populations aged 7-11 (middle childhood). From the included 18 peer-reviewed and grey literature sources, schools are identified as the setting most associated with the development of critical health literacy in the target age group. However, the action-oriented dimension of critical health literacy is rarely supported in the school setting. The review concludes that further research is needed to clarify how and where to support children to develop critical health literacy in and outside of school settings.

Fostering pupils' critical health literacy: examining the potential of physical education in lower secondary school

Background

In Norway, the introduction of an interdisciplinary subject named Public Health and Life skills has brought about renewed attention to how health is conceptualized and taught within and across school subjects. Physical education (PE) is one subject that has traditionally been linked to health outcomes. However, a narrow focus on increased physical activity as the main outcome of PE could be counterproductive in the pursuit of health. Critical health literacy (CHL) is put forward as a resource for health that can be nurtured in the PE context; this study hypothesizes that academic achievement in PE is positively associated with some aspects of CHL.

Methods

This cross-sectional study included 521 pupils aged 13-15 years old from five lower secondary schools in Norway. Structural equation models were used as the primary statistical analysis to test the hypothesis. The study controlled for parents' education, leisure physical activity, and participation in sports club activities.

Results

The results confirm the hypothesis, showing a positive and significant association between PE and CHL. The association remains when controlling for parents' education, leisure physical activity, and participation in sports club activities (β^_PE→_CHL-C1= 0.264, p = 0.001; β^_PE→_CHL-C2= 0.351, p < 0.000).

Conclusion

In our sample, academic achievement in PE was associated with higher levels of CHL. This study contributes to the ongoing discussion on the health benefits of PE. We argue that a resource-based health perspective can produce the appropriate aims for health in PE contexts and that the CHL concept contributes to illuminating key areas, promoting suitable teaching strategies, and bringing balance between an individual and collective focus for future health education, both within PE and across different subjects in school contexts.

Developing Healthy Lifestyle Behaviors in Early Age-An Intervention Study in Kindergartens

Childhood obesity prevention is a leading public health challenge requiring the adoption of healthy lifestyles at an early age. We examined how the kindergarten environment can promote eating sensibly, drinking water and becoming physically active. The effects of an intervention program among 42 Israeli kindergartens (1048 children, aged 4-6) whose teachers participated in a health education training program were compared to 32 kindergartens (842 children) whose teachers did not undergo this training program. An eight-month intervention program focused on knowledge/mathematical/logical/critical thinking, self-regulation/control acquisition, and sensible decision-making abilities. We hypothesized that nutrition and physical-exercise-oriented intervention programs, combining knowledge/mathematical logical thinking, would positively impact the quality of children's mid-morning snack and water consumption, their ability to express feelings following physical exercise, and the adoption of healthy lifestyles at home. The quality of mid-morning snacks and water consumption were observed in both groups pre- and post-intervention. Qualitative interviews documented children's subjective feelings following physical exercise. A significant improvement (p < 0.001) was observed in the mid-morning snacks composition and in water drinking habits in the intervention group; 80% of children offered a physiological explanation regarding energy expenditure processes following intense physical exercise. In conclusion, kindergarten interventions implemented by trained teachers can promote adoption of health behaviors necessary for obesity prevention.

HealthLit4Kids: teacher experiences of health literacy professional development in an Australian primary school setting

Health literacy (HL) is a critical asset for 21st century learners to possess given its positive impact on health outcomes and educational attainment. Concerningly, HL is an area that primary school teachers report having a lack of understanding, confidence, and ability to teach. The HealthLit4Kids initiative aimed to address this issue through a series of teacher professional development (PD) workshops. To evaluate how teachers experienced the PD, teacher evaluations collected at the completion of each of the workshops were analysed using a mixed methods approach. According to the teachers, the PD had improved their understanding of HL, including how to implement it into their practice. The study also found that the teachers perceived that collaborative practice was a key strength of the programme, and that at the end of the PD, teachers described valuing HL more in their practice. Teachers reported time as a major barrier to them implementing the professional learning and suggested further resources could help to mitigate this barrier. Additional research is required to help substantiate the claims made in this research. This study also highlights the critical need for additional HL resources for primary school teachers.

Examining the relationship between health literacy and individual and sociodemographic factors in secondary school students

Aim

Health literacy (HL) is an important factor in health promotion, especially regarding children and adolescents. The present study aims to identify the individual and sociodemographic factors related to secondary school students' HL. This should make it possible to find specific strategies to improve HL.

Subject and methods

Data on the sociodemographic background (migrant background, number of books at home and spoken language at home), self-efficacy, online reading behaviour, subjective HL (adapted version of the European Health Literacy [HLS-EU] questionnaire) and the eHealth Literacy Scale (eHEALS) of 544 Austrian secondary school students (age 11-16, 46% girls) were collected. Regression analyses were conducted to test the hypotheses regarding those factors which influence students' subjective HL and eHL.

Results

Students subjective HL (M = 3.79, SD = .63) and eHL (M = 3.46, SD = .77) scores were rather high on average. Subjective HL was predicted by age, gender and online reading behaviour. However, only students' online reading behaviour was highly significant and was found to be the most influential predictor of subjective HL. Age and online reading behaviour were also found to be highly significant predictors regarding eHL.

Conclusion

Students' online reading behaviour and age are important factors linked to HL. Educational activities may serve to reduce health inequalities by fostering relevant internet skills, i.e. the skills needed to facilitate effective and critical use of internet information.

The imperative to develop health literacy: An ethical evaluation of HealthLit4Kids

An imperative exists to promote health literacy (HL) development in today's young people. Included in curricula worldwide, health literacy has been recognised as a social determinant in its own right, which has the potential to redress inequity and positively impact health and educational outcomes. While it has been shown that schools provide an ideal setting to support HL development, available evidence suggests that health may be undertaught in primary schools, and further resources are required to support educators' inclusion of HL in their lessons. The aims of this paper were to (1) highlight the ethical imperative to promote HL through schools and (2) provide an ethical evaluation of an existing HL intervention. Spike's (2018) four principles for public health ethics were employed as a framework for evaluating a program's ethical status and suitability in the school setting. In this paper, one program, HealthLit4Kids, is evaluated according to Spike's framework, and shown to be an ethically acceptable approach to foster HL in young people. These results model how other HL programs may be evaluated and offer critical insights concerning how HL could be promoted in an ethically acceptable manner in the classroom.

A teacher professional development programme to enhance students’ critical health literacy through school-based health and physical education programmes

Health literacy is a critical asset for adolescents to develop given its positive impact on health outcomes. The few studies that have targeted teacher knowledge and attitudes show that teachers themselves find it difficult to: navigate the multi-modal nature of health information; critically evaluate the different modes and texts; and apply health-related information in a variety of contexts. This research study aimed to address this issue through developing and implementing a teacher professional development (PD) programme for three Australian secondary schools and nine Health and Physical Education (HPE) teachers to improve health literacy, particularly critical health literacy, content and pedagogies embedded in current HPE programmes. Fifteen HPE programmes were analysed using Nutbeam’s health literacy hierarchy and the Australian Curriculum: HPE outcomes and content, with this analysis informing a personalized PD programme. To evaluate how teachers experienced the personalized PD programme, interviews conducted at the completion of the PD programme were analysed using Braun and Clarke’s thematic approach. According to the teachers, the PD had improved their knowledge and understanding of the three levels of HL, including how to implement it into their practice. The personalized nature was a key strength of the PD programme as it allowed for changes to be made in a time-efficient manner, a known challenge for teachers. Teachers recommended the provision of additional resources that foster students’ critical health literacy levels and an additional session to ensure sustainable changes in planning and teaching practices.

Health Literacy and Health-Related Quality of Life in Beijing Adolescents: A Path Analysis

BACKGROUND

Health literacy is a critical driver of achieving an equitable world for every child and adolescent. Although the relationship between health literacy and health-related quality of life (HRQoL) has been documented, little is known among adolescents. In addition, due to lack of theory-driven empirical research, it remains unknown about the full relationship between health literacy, its antecedents, and HRQoL.

OBJECTIVE

This study aimed to apply Manganello's framework to investigate how health literacy was associated with its antecedents and HRQoL in Beijing secondary students.

METHODS

A cross-sectional study was conducted with 650 students in years 7 to 9 from four secondary schools in Beijing. Based on Manganello's health literacy framework, a self-administered questionnaire was used to collect information on health literacy, its antecedents (i.e., sociodemographics, self-efficacy, social support, school and community environment), and HRQoL. The 8-item Health Literacy Assessment Tool was used to measure health literacy (score range 0-37), and the KIDSCREEN-10 was used to measure HRQoL (score range 10-50). Path analysis was conducted to examine the mediating role of health literacy in the relationship between its antecedents and HRQoL.

KEY RESULTS

Overall, the average score of students' health literacy and HRQoL was 26.37 (±5.89) and 37.49 (±5.78), respectively. Health literacy was positively correlated with HRQoL (r = 0.36, p < .01). In the final path model, health literacy was not associated with HRQoL. However, students' social support, school environment, and community environment were associated with HRQoL. Health literacy was affected by self-efficacy, social support, and school environment (all p < .05).

CONCLUSIONS

A range of intrapersonal, interpersonal, and environmental factors were associated with health literacy and HRQoL. A holistic approach is needed to improve health literacy and HRQoL through multilevel intervention strategies such as increasing personal self-efficacy, promoting social support, and creating positive environments. [HLRP: Health Literacy Research and Practice. 2022;6(4):e300-e309.] Plain Language Summary: We investigated how health literacy was related to its influencing factors and HRQoL among Beijing secondary students in years 7 to 9. Health literacy and HRQoL were independent outcomes affected by a range of social-ecological factors including self-efficacy, social support, and perceptions of school and community environments.

Developing culturally appropriate food literacy resources for Aboriginal children with Foodbank WA's Superhero Foods®

ISSUE ADDRESSED

In Australia, food sovereignty of traditional landowners has been marginalised by the globalisation of food systems and resulted in limited opportunities for children to experience familiar bush tucker foods as healthy choices, particularly in a school environment. Superhero Foods^® themed teaching resources focus on the development of nutrition education materials that included traditional Aboriginal foods together with contemporary foods readily available in regional/remote communities.

METHODS

Consultation with an Aboriginal expert and Aboriginal artist; local, regional/remote teachers and stakeholders informed the development of tailored resources including food cartoon characters, school lesson plans and a storybook. The latter was guided by a resource development model. Users of the resources were surveyed to ascertain the useability, alignment with the Australian Dietary Guidelines, cross-curricular learnings and cultural relevance.

RESULTS

Respondents across regional/remote and urban locations completed a lesson plan and food character (clipart) survey (N = 51) and storybook survey (N = 14). Respondents advised the resources were relevant, enjoyable, engaging and culturally appropriate for all students regardless of Aboriginality. The resources provided learning opportunities for all children to enhance knowledge about Aboriginal culture and bush foods. Independent evaluation has further indicated the translation of messaging into student's knowledge and learning.

CONCLUSIONS

Key enablers to the success of the resource included; free online access, the highly engaging nature of the resources and adaptability to be implemented across a number of Aboriginal language groups in WA. Ensuring visual representation of healthy choices was fundamental to reinforcing nutrition messaging. Superhero Foods resources are a positive and important inclusion in the health promotion toolbox for Aboriginal children. SO WHAT?: Superhero Foods are novel nutrition education resources depicting Aboriginal foods and Aboriginal children. These food literacy resources will engage children's understanding of Aboriginal culture, improve food literacy and strengthen equitable access for regional and remote communities.

Public Libraries as Supportive Environments for Children's Development of Critical Health Literacy

Critical health literacy enables individuals to use cognitive and social resources for informed action on the wider determinants of health. Promoting critical health literacy early in the life-course may contribute to improved health outcomes in the long term, but children's opportunities to develop critical health literacy are limited and tend to be school-based. This study applies a settings-based approach to analyse the potential of public libraries in England to be supportive environments for children's development of critical health literacy. The study adopted institutional ethnography as a framework to explore the public library as an everyday setting for children. A children's advisory group informed the study design. Thirteen children and 19 public library staff and community stakeholders were interviewed. The study results indicated that the public library was not seen by children, staff, or community stakeholders as a setting for health. Its policies and structure purport to develop health literacy, but the political nature of critical health literacy was seen as outside its remit. A supersetting approach in which children's everyday settings work together is proposed and a conceptual model of the public library role is presented.

Preliminary Effectiveness of a Strategy to Promote Healthy Lifestyle Habits in Schoolchildren

Purpose: To measure the preliminary effectiveness of a strategy to promote healthy lifestyle habits in schoolchildren, aged 6 to 12 years, living in the Andean region of Colombia, 2018–2021. Design and Methods: This is a Nursing Methodological Research, developed in phases: (1) Context and schoolchildren characterization; (2) Strategy design guided by the Whittemore and Grey criteria and the Bronfenbrenner ecological conceptual model; (3) Strategy validation with 11 experts; (4) Trial to evaluate preliminary effectiveness. We applied the strategy in seven different schools with the educational community including 955 schoolchildren between 6 and 12 years of age, 551 parents, 130 teachers and 7 members of the food staff. Results: Our health promotion strategy “Prosalud” has five components: citizenship feeding and nutrition, physical activity, and rest; environment protection, and directing one’s own life. It includes all the participants of the educational community. Conclusions: According to experts, the health promotion strategy “Prosalud” is valid to help promoting healthy lifestyle habits among schoolchildren. This strategy demonstrates its preliminary effectiveness in a group of school children from 6 to 12 years of age, their parents, teachers, and school food staff, in the Andean region of Colombia.

Comparison of Health Literacy Assessment Tools among Beijing School-Aged Children

Health literacy is a broad and multidimensional construct, making its measurement and conclusions inconsistent. This study aims to compare the patterning of health literacy using different assessment tools and examine their impact on children’s developmental outcomes. A cross-sectional study was conducted with 650 students in Years 7–9 from four secondary schools in Beijing. Health literacy was measured by the eight-item health literacy assessment tool (HLAT, score range 0–37), the six-item Newest Vital Sign (NVS, score range 0–6), and the 16-item Health Literacy Survey (HLS, score range 0–16). Based on Manganello’s health literacy framework, information on upstream factors (e.g., gender, ethnicity, socioeconomic status) and developmental outcomes (e.g., health-promoting behaviours, health service use, global health status) was collected. Overall, the average scores for health literacy were 26.34 ± 5.89, 3.64 ± 1.64, and 13.72 ± 2.94, respectively, for HLAT, NVS, and HLS. The distribution of health literacy varied by socio-demographics and individual characteristics except for gender, no matter which health literacy assessment tool was used. The magnitude of associations between health literacy, its upstream factors and developmental outcomes was greater when using three-domain instruments (HLAT and HLS) than using single-domain instruments (NVS). The approach to health literacy measurement will influence the conclusion. Using multidimensional assessment tools may better capture a child’s health literacy and contribute to the maximum efficiency and effectiveness of school-based health literacy interventions.

Research and Implementation of Distributed Computing Management System for College Students' Sports Health Based on Integrated Regional Collaborative Medical Care

This paper constructs and applies a university student sports health management system through the theory of integrated regional collaborative medical care and distributed computing technology. Firstly, it analyzes the current situation and problems of cross-regional medical care, the root causes, and the corresponding business scenarios, reflecting the development trend of cross-regional medical care, in the light of the current practical needs of cross-regional medical care. In response to the strong demand for cross-regional medical care, this paper gives the overall design of the distributed computing system, for the deployment and architecture of the cross-regional platform; the registration of cross-regional patients, regional platforms, and health events and documents; and data exchange, service integration, and process integration, etc. The corresponding design is given. The research was conducted on several medical institutions to refine the functional requirements for the construction of the regional collaborative medical platform, and the requirements were analyzed to present the research results of the collaborative medical project. Based on this, requirements were made for the preparation of the project construction data center and medical institutions, and the remote consultation and two-way referral modules of the distributed collaborative medical platform were designed, which are processed and analyzed through a system composed of multiple servers. The results are returned to the user, and the design results were tested for functionality, compatibility, security, and other usability tests. The necessity and feasibility of the college physical health test data platform were analyzed. Students have various needs for physical test data management, the necessity of designing the college physical health test data platform, and the feasibility of the college physical health test data platform in terms of technical means, theoretical basis, and social environment.

Developing Indicators to Measure Critical Health Literacy in the Context of Norwegian Lower Secondary Schools

A critical health literacy (CHL) approach is recommended for promoting health in the school context. This construct is complex and includes three interconnected domains: (A) appraisal of critical information, (B) awareness of the social determinants of health (SDH), and (C) collective action to promote health and well-being. In recent literature reviews, no measurement instrument that covers all three domains of CHL in the school-context was found. Our aim was to develop self-reported measurement scales for each domain of CHL. The development process reported in this study was conducted in two stages. In the first stage, an initial item pool was generated based on literature reviews and focus group interviews (N = 15) with adolescents (steps 1–2). In the next steps, items were adjusted and removed based on the feedback from an expert panel and from representatives from the target group (steps 3–5). In stage two, we aimed to reduce the number of items and develop scales for each domain. We then piloted the current draft, which consists of 28 items (N = 114). A sub-sample (N = 10) of the participants were interviewed after they completed the survey to examine the instrument’s face validity. Cronbach’s α was used to assess the internal reliability of the scales; the reliability was promising for scales A (α = 0.83) and C (α = 0.85) but was below the recommended value for scale B (α = 0.61). The model fit indices were promising (TLI_scaleA = 0.97, RSMEA_scaleA = 0.055, TLI_scaleB = 1.05, RMSEA_scaleB = 0.00, TLI_scaleC = 0.95, RMSEA_scaleC = 0.074). The piloted version of scales A and C were positively correlated with subjective health literacy, health-related quality of life, and subjective health; however, we found no such correlations for scale B. The post-survey group interviews led to some adjustments in scales A and B. The revised version of CHLA-Q must be tested using a larger sample; this will enable more robust statistical testing of the properties of the items and the scale.

School-based interventions to improve health literacy of senior high school students: a scoping review protocol

OBJECTIVE

The objective of this review is to map the details of school-based interventions used to improve health literacy of senior high school students.

INTRODUCTION

The global prevalence of poor adult health literacy is caused, in part, by limited health education in secondary schools. Enhancing adolescent health literacy could potentially improve adult health literacy, health behavior, and health outcomes.

INCLUSION CRITERIA

Studies investigating school-based interventions to improve health literacy of senior high school students, regardless of design, characteristics, and assessment tools, will be eligible for inclusion. Studies that provide combined data (senior high school students mixed with other students) or have a compulsory component outside of school will be excluded.

METHODS

MEDLINE (Ovid), Embase (Ovid), ProQuest Education Journals, Education Research Complete, SAGE Journals, and Index New Zealand will be searched for journal articles published in English since 1998. Two independent reviewers will screen titles and abstracts for eligibility, retrieve potentially relevant papers in full, and extract data from included studies. A third reviewer will resolve any disagreements. Quantitative analysis (eg, frequency analysis) will indicate: geographic region of studies, design and targeted population (school grade of study participants); the mode of delivery (extracurricular or during school hours, implemented by teachers or other professionals), duration, and health literacy model and domain of the interventions. Descriptive qualitative content analysis will be used to summarize, code and classify key characteristics of the interventions (eg, teaching models and strategies, content, and related skills) and main outcomes related to health literacy into meaningful categories.