Of road blocks and school health

India's school health program has suffered from lack of institutional commitment and compartmentalization at the school level. Health forms an important component of the Human Development Index, and some countries have successfully improved their own human development status through an integration of primary health care and primary education. In India, however, health services and health education have been seen as separate issues. In 1984, the Ministry of Health and Family Welfare adopted the National Programme for School Health (NPSH). The goal was to assist primary school teachers in implementing: regular medical check-ups for children, an immunization program, health and population education, safe and healthy school environments, and nutrition information. Unfortunately, NPSH's program suffered from conceptual and methodological limitations concerning the training of teachers for school health activities. The author recommends a conceptual model that emphasizes: 1) developmental and habit formation aspects; 2) small group and whole school activities involved in shared and cooperative learning; and 3) teaching and learning new knowledge and skills. This model views all teachers as involved the health education process, and it moves away from the current academic or service-oriented health program to a new participatory, problem solving, and life skills model. While the training of teachers would be necessary, it is also clear that the instructors would need increased support. The head school teacher would need to be committed to such a program, school performance evaluations would reflect an emphasis on health education, and teachers would have access to technical support.     

学校卫生保健教师专业能力标准的构建

目的构建适合学校卫生保健教师岗位任务需要的专业能力标准及其评价模型,为中小学校卫生保健教师队伍的专业化建设提供依据。方法采用岗位任务分析、质性访谈、专家咨询法筛选75项能力标准条目,对上海市16个行政区教育局卫生专干、教研员、中小学校校长、卫生保健教师及我国首届卫生教育专业本科毕业生共计282人进行问卷调研;采用项目分析确定各能力条目的适当性,探索性因子分析构建学校卫生保健教师专业能力标准的指标维度和结构特征。结果所构建的学校卫生保健教师能力标准体系由四大领域(基本素养、学校健康教育、学校基本卫生保健服务、学校卫生管理)、9个能力维度、70项具体的能力指标组成。9个维度包括"师德修养""专业通识素养""协助应对紧急/意外健康事件和管理常见病/慢性病""辅助预防接种和学生健康评估""监测/沟通学生健康状况""具备健康教育知识和教学技能""有效实施健康教育活动并持续改进效果""管理校园传染病和环境/饮水/食品安全""监测学校卫生状况并持续优化学校卫生管理策略"。能力标准总体系Cronbachα系数为0.98,各维度Cronbachα系数为0.86～0.96;总体系折半信度系数0.93,各维...     

Coordinated school health programs and academic achievement: a systematic review of the literature

BACKGROUND: Few evaluations of school health programs measure academic outcomes. K-12 education needs evidence for academic achievement to implement school programs. This article presents a systematic review of the literature to examine evidence that school health programs aligned with the Coordinated School Health Program (CSHP) model improve academic success. METHODS: A multidisciplinary panel of health researchers searched the literature related to academic achievement and elements of the CSHP model (health services, counseling/social services, nutrition services, health promotion for staff, parent/family/community involvement, healthy school environment, physical education, and health education) to identify scientifically rigorous studies of interventions. Study designs were classified according to the analytic framework provided in the Guide developed by the Community Preventive Services Task Force. RESULTS: The strongest evidence from scientifically rigorous evaluations exists for a positive effect on some academic outcomes from school health programs for asthmatic children that incorporate health education and parental involvement. Strong evidence also exists for a lack of negative effects of physical education programs on academic outcomes. Limited evidence from scientifically rigorous evaluations support the effect of nutrition services, health services, and mental health programs, but no such evidence is found in the literature to support the effect of staff health promotion programs or school environment interventions on academic outcomes. CONCLUSIONS: Scientifically rigorous evaluation of school health programs is challenging to conduct due to issues related to sample size, recruitment, random assignment to condition, implementation fidelity, costs, and adequate follow-up time. However, school health programs hold promise for improving academic outcomes for children.     

Adolescent health literacy: the importance of credible sources for online health information

BACKGROUND: Little research has examined adolescent health literacy and its relationship with online health information sources. The purpose of this study is to explore health literacy among a predominantly Hispanic adolescent population and to investigate whether exposure to a credible source of online health information, MedlinePlus^®, is associated with higher levels of health literacy. METHODS: An online survey was administered to a cross‐sectional random sample of high school students in South Texas. Self‐reported sociodemographic characteristics and data on health‐information‐seeking behavior and exposure to MedlinePlus^® were collected. Health literacy was assessed by eHEALS and the Newest Vital Sign (NVS). Linear and binary logistic regressions were completed. RESULTS: Of the 261 students who completed the survey, 56% had heard of MedlinePlus^®, 52% had adequate levels of health literacy as measured by NVS, and the mean eHEALS score was 30.6 (possible range 8‐40). Health literacy was positively associated with self‐efficacy and seeking health information online. Exposure to MedlinePlus^® was associated with higher eHealth literacy scores (p < .001) and increased the likelihood of having adequate health literacy (odds ratio: 2.1; 95% CI: 1.1, 4.1). CONCLUSION: Exposure to a credible source of online health information is associated with higher levels of health literacy. The incorporation of a credible online health information resource into school health education curricula is a promising approach for promoting health literacy.     

体育健康教育与初中生健康素养关系的交叉滞后分析

目的 了解体育健康教育与青少年健康素养的因果关系,为提升体育健康教育和青少年健康素养水平提供纵向实证研究依据。方法 采用整群抽样法选取湖北省襄阳市、辽宁省大连市和吉林省辽源市4所初中学校七年级的24个班学生为研究对象,采用间隔18周的纵向追踪设计对696名初中生进行2次问卷调查。测量工具采用修订后的学校体育健康教育量表以及初中生健康素养量表。结果 第1次测量(T1)运动督导可以正向预测第2次测量(T2)健康素养(β=0.18),T1健康素养也能够正向预测T2运动督导(β=0.18)(P值均<0.01);T1健康教育可以正向预测T2健康素养(β=0.57,P<0.01),T1健康素养不能正向预测T2健康教育(β=0.03,P>0.05);T1体育教学可以正向预测T2健康素养(β=0.39),T1健康素养也能够正向预测T2体育教学(β=0.10)(P值均<0.05)。体育健康教育的3个维度对健康素养的3个维度均具有正向预测作用(P值均<0.05)。结论 体育健康教育3个维度中,健康教育是影响初中生健康素养的主要因素,两变量之间存在纵向因果关系。运动督导、体育教...     

网格化健康教育模式提升大学生健康素养的实证研究

目的 探索高校网格化的健康教育模式在提升大学生健康素养中的应用效果,为促进学生健康生活方式与习惯养成提供参考.方法 采用分层随机整群抽样方法,抽取西安市西安交通大学2019级新生1 123名;干预组(578名)采用网格化健康教育模式,对照组(545名)保持常规健康教育模式.1个学期后,比较两组大学生健康素养情况.结果 ...     

School health education in California. The policies and contents of The Health Framework]

This paper introduces school health education activities in California. We focus on The Health Framework published by the California Department of Education. It describes the policies, objectives, and contents of health education for California public schools. This framework emphasizes health literacy for students and a comprehensive school health system that supports effective health education and make health an important priority at the school. The nine content areas presented by the framework describe health concepts, skills, and behaviors important for students. We analyzed this framework and its background including the trend of school health education in the United States and other health education related activities in California. Finally we compared the framework with school health education in Japan.     

Health Literacy of HIV-positive Individuals Enrolled in an Outreach Intervention: Results of a Cross-Site Analysis

This article examines health literacy among a group a HIV-positive persons at risk for receiving suboptimal health care due to histories of substance abuse, mental illness, incarceration, and unstable housing or homelessness. Participants receiving services from three outreach programs funded as part of a multisite demonstration project were screened for health literacy using the Test of Functional Health Literacy in Adults (TOFHLA) at program enrollment. The goal of this analysis was to identify demographics, risk factors, and health indicators associated with different levels of health literacy. Results indicated that although fewer than 30% of the sample scored in the marginal or inadequate range for health literacy, participants with these lower levels of health literacy were more likely to be African American or Latino/a, heterosexual, speak Spanish as their primary language, and have less than a high school education. The disparities in health literacy found in this study point to a need to assess level of health literacy and provide culturally sensitive health literacy interventions for persons with chronic diseases such as HIV. In addition to offering these services within HIV health care settings, health professionals can use other potential venues for health literacy assessment and intervention including substance abuse treatment and community-based social service, education, and training programs. Health care and support service providers also must become aware of the importance of health literacy when caring for all patients with HIV, particularly those most likely to have low health literacy.     

Health literacy in health systems: perspectives on patient self-management in Israel

Health systems will face new challenges in this millennium. Striking the balance between the best quality of care and optimal use of dwindling resources will challenge health policy makers, managers and practitioners. Increasingly, improvements in the outcomes of interventions for both acute and chronic patients will depend on partnerships between health service providers, the individual and their family. Patient education that incorporates self-management and empowerment has proven to be cost-effective. It is essential that health care providers promote informed decision making, and facilitate actions designed to improve personal capacity to exert control over factors that determine health and improve health outcomes. It is for these reasons that promoting health literacy is a central strategy for improving self-management in health. The different types of health literacy--functional, interactive and critical health literacy--are considered. The potential to improve health literacy at each of these levels has been demonstrated in practice among diabetics and other chronic disease patients in Clalit Health Services (CHS) in Israel is used as an example to demonstrate possibilities. The application of all three types of health literacy is expressed in: (i) developing appropriate health information tools for the public to be applied in primary, secondary and tertiary care settings, and in online and media information accessibility and appropriateness using culturally relevant participatory methods; (ii) training of health professionals at all levels, including undergraduate and in-service training; and (iii) developing and applying appropriate assessment and monitoring tools which include public/patient participatory methods. Health care providers need to consider where their patients are getting information on disease and self-management, whether or not that information is reliable, and inform their patients of the best sources of information and its use. The improved collaboration with patient and consumer groups, whose goals are to promote rights and self-management capabilities and advocate for improved health services, can be very beneficial.     

Schools, health literacy and public health: possibilities and challenges

Health literacy is a concept that can be widely embraced by schools. Schools throughout the world contribute to the achievement of public health goals in conjunction with their educational commitments. In this paper, the interface between a school's core business of education and public health goals is identified, and examples provided in the area of nutrition demonstrating how these links can operate at school level. The structure and function of the health promoting school is described and the author proposes that there is a very close connection between the health promoting school and the enabling factors necessary in achieving health literacy. Major findings in the literature that provide evidence of good practices in school health education and promotion initiatives are described. Also, those factors that make schools effective and which facilitate learning for students are identified. There is a substantial overlap between the successful components of a health promoting school and effective schools. This enables schools to potentially achieve all three levels of health literacy, including level 3-critical health literacy. However, there are three challenges that must be addressed to enable schools to achieve this level: the traditional structure and function of schools, teachers practices and skills, and time and resources. Strategies are proposed to address all three areas and to reduce the impediments to achieving the goals of health literacy and public health using the school as a setting.     

Health literacy of HIV-positive individuals enrolled in an outreach intervention: results of a cross-site analysis

This article examines health literacy among a group a HIV-positive persons at risk for receiving suboptimal health care due to histories of substance abuse, mental illness, incarceration, and unstable housing or homelessness. Participants receiving services from three outreach programs funded as part of a multisite demonstration project were screened for health literacy using the Test of Functional Health Literacy in Adults (TOFHLA) at program enrollment. The goal of this analysis was to identify demographics, risk factors, and health indicators associated with different levels of health literacy. Results indicated that although fewer than 30% of the sample scored in the marginal or inadequate range for health literacy, participants with these lower levels of health literacy were more likely to be African American or Latino/a, heterosexual, speak Spanish as their primary language, and have less than a high school education. The disparities in health literacy found in this study point to a need to assess level of health literacy and provide culturally sensitive health literacy interventions for persons with chronic diseases such as HIV. In addition to offering these services within HIV health care settings, health professionals can use other potential venues for health literacy assessment and intervention including substance abuse treatment and community-based social service, education, and training programs. Health care and support service providers also must become aware of the importance of health literacy when caring for all patients with HIV, particularly those most likely to have low health literacy.     

Associations between older adults' spoken interactive health literacy and selected health care and health communication outcomes

Recent trends in the conceptualization of health literacy lead toward expansive notions of health literacy as social practice, rather than as a narrower cognitive capacity to understand health-related texts and materials. These expansive and complex constructions of health literacy demand tools for assessing individuals' propensities to actively seek information in their interactions with health care professionals and other health information sources. This study proposes a measure of this information-exchange component of health literacy and examines its capacity to predict outcomes and processes such as satisfaction with health care and comprehension of spoken health messages. Results for this sample ( n = 334) of low socioeconomic status older adults (mean age = 74.70 years) reveal that indices derived from the Measure of Interactive Health Literacy (MIHL) do contribute unique variance-apart from document-based health-literacy--on several criterion measures such as satisfaction with health care services. Comprehension checking improved health message listening comprehension, but for White participants only. These findings invite further investigations of interactive health literacy involving different populations, message topics, and elicitation methods.     

Assessing health numeracy among community-dwelling older adults

Quantitative information occupies a central role within health care decision making. Despite this, numeracy has attracted little research attention. Therefore, the purpose of this study was to (1) describe the health numeracy skill of a nonclinical, Canadian community-based senior population and (2) determine the relationship between health numeracy skill and prose health literacy, education, and math anxiety in this population. A convenience sample of 140 men and women, 50 + years, completed a questionnaire assessing demographic details, math anxiety, functional health literacy (Shortened Test of Functional Health Literacy for Adults STOFHLA), general context numeracy, and health context numeracy skills. Most participants had adequate functional health literacy (prose and numeracy) as measured by the STOFHLA, poorer general context numeracy skill, higher health context numeracy skill, and moderate math anxiety. Approximately 36% of the variation in general context numeracy scores and 26% of the variation in health context numeracy scores were explained by prose health literacy skill (STOFHLA), math anxiety, and attained education. This research offers an initial assessment of health numeracy skills as measured by three existing numeracy scales among a group of independently functioning older Canadian adults. This work highlights the need for clarification of the numeracy concept and refinement of health numeracy assessment instruments. Moreover, identifying patients' numeracy strengths and weaknesses will enable the development of focused numeracy interventions and may contribute to moving individuals further along the continuum of health literacy proficiency.     

参与式健康教育模式对中职护生健康素养提升效果评估

评价参与式健康教育和传统发放宣传材料2种不同方法对中职护生健康素养干预效果,为制定更有效的健康素养提升措施提供依据.方法 于2017年10月9日-12月10日采用分层多阶段随机抽样法在大同市某中职卫校选择护理专业二年级学生173名进行随机对照试验,实验组(92名)采用参与式健康教育,对照组(81名)采用传统的健康教育,分别干预2个月.采用"2016年全国居民健康素养监测调查问卷",分别在干预前、后对实验组和对照组进行问卷调查.结果 护生总健康素养平均得分对照组干预前、后分别为(36.04±9.43)(36.01±10.17)分,实验组干预前、后分别为(35.78±8.91)(49.53±13.53)分,两组干预前差异无统计学意义(t=0.18,P=0.86),干预后差异有统计学意义(t=-6.93,P=0.00);对照组干预前、后差异无统计学意义(t=0.03,P=0.98);实验组干预前、后差异有统计学意义(t=-11.36,P=0.00).总健康素养水平对照组干预前后分别为3.70%,4.94%,实验组干预前后分别为4.35%,45.65%,两组干预前差异无统计学意义(χ2=0.00,P=1.00),干预后差异有统计学意义(χ2=36.58,P=0.00).干预后总健康素养增量对照组和实验组分别为(-0.02±7.52)(12.75±10.77)分,差异有统计学意义(t=-8.93,P=0.00);对照组和实验组健康素养水平增量分别为1.24%,41.30%.结论 参与式健康教育模式比传统健康教育方法对提高健康素养的效果更显著,可对其他专业的学生进行干预实验,验证该健康教育模式的效果.     

Building healthy public policy

Policies in literacy and health need to address two perspectives: how basic literacy skills influence the health of populations and individuals; and health literacy--the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. There are three potential areas for action to improve literacy and health literacy: the health system, the education system, and within the broader sphere of culture and society. Despite some increasing attention in the last 20 years, low literacy levels remain a major problem in Canada. Policies need to be sensitive to culture, especially among Aboriginal peoples, Francophones and new Canadians. Public policies are needed to: Improve literacy outcomes (for example, support for a pan-Canadian literacy strategy, early childhood education and family literacy programs, and efforts to reduce high school drop out). Improve health literacy (for example, support integrated policy and program development across sectors, integrated research and knowledge translation initiatives, and efforts to build links between literacy and health networks). Reduce disparities by strengthening levels of literacy and health literacy among vulnerable groups.     

Health literacy: a policy challenge for advancing high-quality health care

Health literacy, at the intersection of health and education, involves more than reading ability. Studies of health literacy abilities show that many Americans with the greatest health care needs have the least ability to comprehend information required to navigate and function in the U.S. health care system. This paper defines health literacy as an important policy issue and offers strategies for creating a health-literate America.     

某战区部队官兵健康素养现状调查分析

目的了解某战区部队官兵健康素养现状,为制定适宜战区官兵的健康传播策略提供依据。方法采用分层整群随机抽样的方法,对某战区部分官兵1865人进行健康素养调查,用χ2检验进行分析。结果调查对象具备健康素养比例为14.30%,其中具备基本知识和理念、健康生活方式与行为和基本技能素养的比例分别为13.87%、30.23%和50.92%。不同特征中老兵总体健康素养（17.84%）和知识与理念（17.93%）、生活方式与行为（39.27%）具备比例高于新兵;中专及以上文化程度官兵总体健康素养（18.05%）和知识与理念方面（17.21%）高于高中及以下官兵;由城镇入伍的官兵在总体健康素养（17.54%）和知识与理念（17.35%）、健康技能方面（53.41%）高于由农村入伍官兵。结论某战区部队官兵具备健康素养的总体水平不高,部队开展的健康教育活动起到了一定的作用。今后要定期开展健康素养调查分析,及时掌握健康素养水平,评估健康教育效果,制定适宜战区官兵的健康传播策略。     

初中生健康素养量表的编制与信效度分析

目的 编制初中生健康素养量表,为更好地评估初中生健康素养水平和开展学校健康教育提供参考。方法 根据世界卫生组织提出的健康素养定义,参照《中小学生健康教育指导纲要》 和 《中国公民健康素养——基本知识与技能(试行)》有关中学生健康教育的内容,构建初中生健康素养初始量表,对476名重庆市初中生进行调查,并分析量表信效度。结果 经6种方法筛选后保留50个条目,通过探索性因子分析和验证性因子分析,形成功能性、互动性、评判性健康素养3维度9因子的初中生健康素养量表。量表内部一致性Cronbach′s系数为0.948,重测信度为0.840,各维度得分间的相关系数为0.409-0.605,各维度与总得分之间的相关系数为0.614-0.941。结论 编制的初中生健康素养量表总体信效度较好,可为同类研究提供参考。     

健康素养研究领域的演进路径与热点预测

目的探讨与揭示国际健康素养领域发展脉络、研究热点,把握正确研究方向。方法以Web of Science引文数据库中健康素养领域研究文献为数据源,并采用引文编年图和主路径相结合的方法以及共词分析法。结果英美等发达国家较早关注健康素养领域,其研究数量与质量排在世界前列,健康素养研究主题经历了从健康素养测评工具的研制,到健康素养对卫生保健和卫生产出影响的研究,再到健康素养干预措施和效果评价研究,最后,健康素养的研究对象不断细化这样一条主要发展脉络。健康信息素养、健康促进与健康教育、慢性病患者的健康素养、精神健康素养和HIV患者健康素养是该领域的研究热点。结论健康素养领域的研究呈现多元化趋势,无论是理论研究还是实践方面,都朝着更为深入和具体的方向推进。     

Food pyramids, keeping clean and sex talks: pre-service teachers' experiences and perceptions of school health education

This paper reports findings from the first stage of an anticipated four-stage research project investigating the effectiveness of teacher education in health education. Prior to receiving any teacher education in health education, pre-service teachers (student teachers) were surveyed for their experiences of secondary school health education, and their beliefs about and attitudes towards the subject. Data were collected from questionnaire surveys (n = 295) and focus group interviews (n = 61). Results showed that student teachers had more exposure to school health education than had been assumed and had more positive attitudes towards the subject area than indicated by other studies into school health education. Many reported having had sexuality education and drug and alcohol programmes, but these were commonly described in contexts of safety rules and risk avoidance behaviours. Participants had greater understanding of and more exposure to mental health education than had been predicted. Those aged 20 years and younger reported significantly greater exposure to a range of school health education topics than did those aged 21-30 years or 30+ years. This difference is attributed to the younger participants receiving health education based on the Health and Physical Education in the New Zealand Curriculum, introduced into schools in 1999.