Promoting Navigation Health Literacy at the Intersection of Schools and Communities. Development of the Game-Based Intervention Nebolus

Health literacy of students in Germany - Results of the HBSC study 2022

Background

Health literacy (HL) encompasses knowledge and skills for dealing critically and confidently with health information in individual and social contexts. Current studies show that a high proportion of children and adolescents have limited health literacy, depending on aspects of their social background. Health literacy is considered an important factor influencing health. Little is known about the development of health literacy over time and its connection with psychosomatic complaints in young people.

Methods

Based on the results of the Health Behaviour in School-aged Children (HBSC) study, this article focusses on the level of HL in 11-, 13-, and 15-year-old students (N = 6,475) over time and taking social differences into account. Finally, the relationship between HL and psychosomatic complaints is analysed. Univariate, bivariate, and multivariate analyses were carried out for this purpose.

Results

At 24.4 %, slightly more students have low HL in 2022 than in 2017/18 (21.4 %). There are differences in HL according to gender, age, type of school, and family affluence. Low HL is associated with a high psychosomatic burden.

Conclusions

The results highlight the need for target group-specific measures to promote young people's HL, which address individual and organisational aspects of HL.

[Navigational health literacy of the population in Germany]

AIM

Many health care systems are characterized by their high complexity and intransparency. Finding one's way through the multitude of services and finding the right place requires high navigational health literacy (NHL). NHL is defined as the ability to manoeuvre through the health care system and deal with the information required to do so. However, so far, there has been a lack of data on the population's NHL. The objective of this article is to analyse empirically the NHL in Germany and its association with socio-demographic and economic factors.

METHOD

NHL was surveyed with an instrument (HLS19-NAV) newly developed by an international working group, measuring the self-assessed difficulties in relation to 12 navigation-related information tasks. The HLS19-NAV has already been used in 8 countries, including Germany. In Germany, data on NHL was collected from 2,151 adult residents in a representative cross-sectional study. The relationship between socio-demographic and economic factors, and NHL was examined by using methods of analysis of variance and multivariate linear regression analysis.

RESULTS

Approximately 80% of the respondents showed low NHL with a mean score of 41.5 out of a possible 100 points. Those with low socio-economic resources, people of advanced age, people who had migrated to Germany or who were limited by health issues had a particularly low NHL. However, even people with good resources had a relatively low NHL. In contrast, the mean score was significantly higher among health professionals.

CONCLUSIONS

In recent years, numerous efforts have been made to reduce navigational difficulties and to better guide patients through the German health care system. However, according to the results of the study, there is still need for further action. Above all, structural measures are required: this includes the creation of sufficient, reliable information on the health care system and its organizations as well as the implementation of navigation aids, health care pathways and the creation of a health-literate health care system including organizations and health professionals that contribute to strengthening NHL in general.

Coronavirus-related health literacy levels among school administrators and influencing factors

Our study aimed to determine the level of coronavirus-related health literacy among school administrators and the factors that influence this. The sample of this cross-sectional study consisted of 402 school administrators serving in primary, secondary and high schools in Ankara. The data were collected between September 2021 and February 2022 using the descriptive characteristics questionnaire and the Coronavirus-Related Health Literacy Questionnaire (HLS-COVID-Q22). It was seen that 64.4% of the participants were male, 34.6% were 40 years old or younger and 35.6% were working in primary schools; 77.6% of the participants had a sufficient, 16.2% had a problematic and 6.2% had an inadequate level of coronavirus-related health literacy. Age, gender, chronic disease status, type of school they work in, level of knowledge about coronavirus, level of confusion due to knowledge about coronavirus, willingness to be vaccinated, believing that vaccines are safe/effective/compatible with their religious beliefs were found to affect coronavirus-related health literacy (p < 0.05). Gender, age, information satisfaction on coronavirus, confusion due to information on coronavirus and 'Overall, I believe that vaccinations are effective' explained 24.9% of HLS-COVID-Q22 variance (Adjusted R2 = 0.249, F = 13.080, p < 0.001). This study found the coronavirus-related health literacy level among school administrators to be sufficient. It found that their level of health literacy was affected by gender, age, chronic disease status, type of school they worked at, level of knowledge about coronavirus, level of confusion due to information about coronavirus, desire to be vaccinated and their thoughts about vaccines.

The untapped potential of Games for Health in times of crises. A critical reflection

Given its promising role in public health to address hard to reach population groups, game-based interventions (i.e., Games for Health, G4H) have experienced growing interest in recent years. Therefore, it is surprising that they have played only a minor role during the COVID-19 pandemic. Hence, the aim of this paper is to reflect the opportunities and challenges of G4H especially during the pandemic but also with regard to future health crises. As commercial video games (i.e., those that primarily aim to entertain its users) were often used to deal with the containment measures during the COVID-19 pandemic, we call for greater cooperation with commercial game makers to distribute health-related messages via entertainment games. With regard to G4H we see a need to (i) strengthen the intervention theory underlying game-based applications, (ii) to enhance the appeal of games in order to maintain the interest of users in the long term, and (iii) to improve the evidence base using appropriate study designs. Finally, we argue for (iv) greater user involvement, both in terms of developing game-based approaches and as co-researchers in solving complex health problems.

[School health promotion in pandemic times. Results of the COVID-HL school principal study]

Hintergrund

Die vorliegende Studie untersucht, in welchem Ausmaß Schulen Maßnahmen der Gesundheitsförderung und Prävention während der COVID-19-Pandemie umsetzen. Von besonderem Interesse sind hierbei Unterschiede nach demografischen Variablen, Schulform, Bundesland und die Beteiligung an Landesinitiativen der Gesundheitsförderung.

Methodik

Im Rahmen des COVID-Health-Literacy-Netzwerks wurde von März bis April 2021 eine Onlinestudie mit 2186 Schulleitungen in Baden-Württemberg, Hessen, Niedersachsen und Nordrhein-Westfalen durchgeführt. Der Umsetzungsstand der COVID-19-bezogenen schulischen Gesundheitsförderung und Prävention wurde mittels eines eigenentwickelten Instruments untersucht. Nach Analyse der faktoriellen Struktur des Instruments erfolgten uni- und bivariate Auswertungen.

Ergebnisse

Es lassen sich 3 Dimensionen des Umsetzungsstandes der schulischen Gesundheitsförderung identifizieren (1. COVID-19-bezogene Unterstützung der Schüler*innen, 2. Gesundheitsförderliche Gestaltung von Lehr‑, Lern- und Arbeitsbedingungen, 3. Prinzipien der Gesundheitsfördernden Schule). Eine geringe Umsetzung liegt für Aspekte der Lehr‑, Lern- und Arbeitsbedingungen sowie für Partizipation und die Kooperation mit schulexternen Akteuren vor. Signifikante Unterschiede des Umsetzungsstands ergeben sich zugunsten von weiblichen und älteren Schulleitungen sowie Grundschulen. Außerdem zeigen sich nicht homogene Unterschiede nach Bundesland. Differenziert nach Teilnahme an einem Landesprogramm findet sich lediglich für Schulen mit Zertifikat im Bereich Gesundheitsförderung ein höherer Umsetzungsstand.

Diskussion

Die Ergebnisse geben Hinweise darauf, dass die COVID-19-Pandemie für Schulen ein disruptives Ereignis darstellt, welches die Umsetzung schulischer Gesundheitsförderung erschwert. Vor allem gesundheitsförderliche Arbeitsbedingungen, Partizipation und Kooperation sollten in den Fokus genommen werden.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03535-w) enthalten