A Health Equity Implementation Approach to Child Health Literacy Interventions

How researchers can translate health evidence into books for children

The health promotion literature that considers how scientific evidence can be effectively communicated tends to focus on evaluating the effectiveness of communication materials. This has resulted in a knowledge gap regarding effective knowledge translation processes. This study explores the process, reasoning and practices for developing books for children that incorporate evidence-based information to aid understanding of scientific evidence about health and environmental or natural disasters. This study is informed by a systematic review of the literature combined with responses to an email interview with authors of books for children. Nine published studies were included in the systematic review. Twenty-two authors responded to the email survey (25% response rate, following 86 invitations). We report seven key findings to guide the development of health-promoting books for children: (i) understand the needs and expectations of the audience, (ii) articulate the topic and research evidence, (iii) assemble a team with a mix of content knowledge and creative expertise, (iv) format should be chosen to suit the user group and guided by the creative team, (v) early testing with children and their support system is crucial, (vi) develop a dissemination strategy to reach the user group and (vii) engage in reflexivity through evaluation of effectiveness of messaging. The current investigation can guide the process, reasoning and practice of developing books for children that incorporate evidence about health and environmental disasters.

Organizational Health Literacy as a Tool for Health Equity: Application in a High-Risk Infant Follow-Up Program

BACKGROUND

Healthy People 2030 emphasizes personal health literacy (individual skills) and organizational health literacy-the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. However, research on the latter is in the early stages.

METHODS

This study describes an organizational health literacy assessment in a U.S. urban academic children's hospital. A variety of evidence-based health literacy assessments were used to assess patient information materials and the environment, including institutional practices, navigation, culture and language, and communication. Trained interviewers and analysts reached consensus for all assessments.

RESULTS

Information Items: SMOG scores (n = 9) ranged from 7th- to 14th-grade reading level (average = 11.3). PEMAT-P scores (n = 9) ranged from 43.8% to 93.8% understandability and 0% to 80% actionability. CDC CCI scores (literacy demand) (n = 6) ranged from 18.2% to 58.8% (≥90% = excellent). SAM scores (suitability) (n = 6) fell in the "adequate" range (43.2-58.3%). The PMOSE/IKIRSCH scores (complexity) (n = 3) noted low-moderate difficulty. Apter's Hierarchy (n = 4) revealed three numeracy domains (50% = descriptive purposes and decision-making, 100% = interpreting information). Organization-level: Walking interviews highlighted organizational facilitators and barriers related to the pre-visit and visit environments. HLE2 domain scores ranged from 52% to 68%.

CONCLUSIONS

Organizational health literacy demands far outweigh the average literacy skills of adults in the U.S. (patients and staff). Findings can be used to hone quality improvement and other processes to focus on structural solutions to increase health equity.

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.

Health equity: A concept analysis

BACKGROUND

Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions.

PURPOSE

Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy.

METHOD

Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity.

FINDINGS

Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology.

DISCUSSION

Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.

Promoting Child Health Equity through Health Literacy

Every child has the right to a fulfilling and thriving life [...].

Development of a Proposal for a Program to Promote Positive Mental Health Literacy among Adolescents: A Focus Group Study

Over the last years, there have been several studies that have shown insufficient levels of adolescents' mental health literacy (MHL). Knowledge about intervention programs that promote positive mental health literacy (PMeHL) among adolescents is still very scarce. In this sense, we defined as objectives to identify and describe the necessary components to design a program proposal that promotes adolescents' PMeHL. We conducted an exploratory, descriptive, qualitative study using two focus groups in July and September 2022 with an intentional non-probability sample of eleven participants (nine professional experts and two adolescents). Data were analyzed using content analysis, using NVivo^® 12 software (version 12, QRS International: Daresbury Cheshire, UK). We obtained a total of four categories and eighteen subcategories: structure (context; format; contents; length and frequency; pedagogical methods; pedagogical techniques; resources; denomination), participants (target group; program facilitators), assessment (timing; evaluation instruments), other components (planning, articulation and adaptation; involvement; training; special situations; partnerships; referral). The perspectives of the professional experts and of the adolescents that we obtained from this study contributed to the design of a proposal for a program to promote adolescents' PMeHL.

The greatest challenges and solutions to improve children's health and well-being worldwide in the next decade and beyond: Using complex systems and implementation science approaches

The health and well-being of children is paramount to health and well-being of society and is the foundation of health and well-being later in life. This paper presents the perspective that a complex systems approach that embeds implementation science is needed to address the rising challenges to child health and well-being in this decade (2020-2030) and beyond. Reflection on facilitators of the success of programs deemed promising to address child health and well-being in the past decade (2010-2020) is presented, to advance programs to address children's health and well-being. A priority that needs to be addressed is developing, testing and using theories of child and family health and well-being (and related initiatives) that can be used to build on existing successes to make progress. Understanding context including further elucidating the drivers of child health and well-being at multiple levels of relevant systems (e.g., health, education, community) across the life course, and considering implications for caregivers also require greater consideration. Methods to address future challenges to child health and well-being include co-designing initiatives that support child health and well-being with children and families themselves rather than using predesigned initiatives, thoughtful outcome selection, and reporting the challenges of implementing future programs to promote learning. The approaches, priorities and methods presented can be used to design or refine interventions, models or care or community-based initiatives and provide new direction to fields of child health enquiry.

Involving Children in Health Literacy Research

Despite the volume and breadth of health literacy research related to children, children's involvement in that research is rare. Research with children is challenging, but the principles of involvement and engagement underpin all health promotion work, including health literacy. This commentary reflects on the process of setting up a Children's Advisory Group to consult on an institutional ethnography study of health literacy work from children's standpoint. The Children's Advisory Group contributed feedback on the study ethics and design and piloted methods for rapport-building and data collection, including livestreamed draw-and-describe and modified Interview to the Double. Consulting with the Children's Advisory Group highlighted the importance of listening to children and recognizing and valuing children's imaginative contributions to methods for involving children in health literacy research. Insights from this commentary can be used to foreground equity-focused approaches to future research and practice with children in the field of health literacy.

Psychological Vulnerability Indices and the Adolescent's Good Mental Health Factors: A Correlational Study in a Sample of Portuguese Adolescents

Background: Psychological vulnerability (PV) indicates the individual’s inability to adapt to stressful situations. Adolescents experience negative impacts on their future mental health if they do not acquire the skills and knowledge necessary to have good mental health during their developmental stage. Aim: To compare the PV index among the three stages of adolescence and to explore the factors involved in good mental health, including the relationship between adolescents’ PV indices and sociodemographic variables, and the relationship between adolescents’ PV index and their knowledge of the factors that characterize good mental health. Method: An exploratory, cross-sectional, correlational study was carried out in three public schools in a region of Portugal, using online self-completed questionnaires: the Psychological Vulnerability Scale (PVS) and the Mental Health-Promoting Knowledge (MHPK-10). Results: Our convenience sample consisted of 260 adolescents, with a mean age of 14.07 years who were students between 5th and 12th grades, mostly female. Moderate PV indexes were obtained that were higher in late adolescence, i.e., in older adolescents, who were females in a more advanced school year, with worse self-perceptions of their physical and mental health and body image, and who frequently used a health service due to mental health problems. The association between the PV index and the level of knowledge about the factors involved in good mental health did not reach a statistical significance (p = 0.06). Conclusions: These results suggest a need for a design of personalized interventions that promote adolescents’ mental health literacy, that prevent PV, and that should be initiated in early adolescence.

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.