Sawyers, Luke
(2024)
The optimisation and evaluation of public health literacy.
PhD thesis, University of Nottingham.
Abstract
Introduction: Health Literacy (HL) is a key skill for the prevention of adverse health and the maintenance and promotion of good health outcomes, and is generally agreed to reflect a person’s ability to understand, access, appraise and apply health information. Due to HL reflecting a person’s skill to navigate health information, public HL has become a high priority in recent times. This growth has, however, expanded in parallel with disputes – and varied interpretations - regarding its conceptualisation. This heterogeneity may therefore lead to reliability, validity, and comparability issues. Moreover, many HL models are formed in reference to adults, and do not include differences in children compared with adults. Children actively engage in health decisions, and understanding potential HL differences is thus essential for supporting the transition towards health autonomy. Clarity on child and adult HL measurement appears unmet currently, and minimal child HL assessments have been conducted across England.
Aims: Two aims were outlined: to investigate the conceptual nature of HL in community adult and child populations; and to gather preliminary data on the state of child HL in England.
Methods: A scoping review of community HL intervention outcome practices was conducted (Sawyers et al., 2022). An international Delphi study followed this to achieve consensus on best practices for HL measurement in community adult and child populations, with the outcome being the development of a HL measurement framework. Lastly, a pilot study was implemented to assess the feasibility of measuring HL in 10-13 year old children as guided by the framework.
Results: Three series of results are presented. Firstly, the review identified a unidimensional profile for direct HL measurement, contrasting previous inferences of a convergence towards holistic practices. When proxy HL was analysed, substantial variation was reported, suggesting deviation in HL measurement beyond the direct domain. The Delphi study used four contexts as the base for the framework: adult direct (n = 12), adult proxy (n = 12), child direct (n = 15) and child proxy (n = 10). Within each context HL outcomes were identified, forming the final framework. The third study recruited a small pilot sample (n = 17), and provided an initial understanding of child HL measurement. Baseline figures for functional HL, communicative HL, critical HL, self-efficacy, health behaviours, and qualitative data for health learning were retrieved, and recruitment challenges through schools were identified as key barriers to a follow-up. Early, frequent communication, flexible research protocols, and school engagement at the project conceptualisation were highlighted as important for successful school recruitment.
Discussion: Current literature indications yield HL as multidimensional, but HL is frequently implemented in a unidimensional manner at the direct level and a variable way at the proxy level. Using expert consensus, a framework has been produced to clarify the HL outcomes important to consider in community adult and child populations. The framework aims to foster consistent, comparable, and valid community HL measurement practices, while encouraging researchers and policy stakeholders to consider child and adult HL research with a renewed focus. Though an initial pilot indicates feasibility of the framework, further follow-up is required to better understand child HL in England. Nevertheless, these findings support researchers in measuring adult and child HL more consistently, and provides suggestions when collaborating with primary and secondary schools in England on the basis of pilot study evidence.
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