08. Health and Wellbeing Education
Paper
Is Health Information Equally Available for Adolescents in Europe? A Cross-Country Analysis of Health Literacy in 11 Countries (HBSC)
Leena Paakkari, Markus Kulmala, Henri Lahti, Minna Torppa
University of Jyväskylä, Finland
Presenting Author: Paakkari, Leena
Access to information is a general human right. A set of capabilities to find, compare and assess the trustworthiness of information on health (referred here as HL-Info) is needed to secure equity in access to information, and to avoid being misinformed or uninformed. Recent PISA findings showed that only 7.2% of students can differentiate “between fact and opinion as applied to complex or abstract statements” (OECD, 2023). The proportion of adolescents who self-report finding it easy to differentiate whether online information is true or false is much bigger, 59 % in Europe (Smahel et al., 2020). Nevertheless, both figures show that there is a big proportion of those students who lack these central skills. Deprivations and disparities in capabilities to access health information present challenges on their own. However, they matter even more in terms of hampering opportunities to adopting health promoting behaviours (e.g. following physical activity (PA) recommendations) and pursuing good health (e.g. self-rated health, SRH). Co-occurrence of extensive amounts of misinformation, limited capabilities to access valid information, and disparities in health is a clear public health challenge, also among adolescents.
Health literacy (HL) has been recognized as an independent, important and modifiable determinant of health and health behaviour across the lifespan (e.g. Lim et al., 2021; Paakkari et al., 2019), and an important outcome of school health education (World Health Organization, 2021). Among adolescents, good general HL has been associated with various positive health indicators such as PA (Fleary et al., 2021) and good SRH (Paakkari et al., 2020). Also, HL has proven to act as a moderator between individual factors and health (incl., health behaviour), and in such a way that it promotes better health outcomes, especially among those in vulnerable situations (Lahti et al., 2024). Country differences in general HL have been noticed (Paakkari et al., 2020).
To assess if health information is equally available for adolescents in Europe (via HL-Info) and to inform education/public health police and practice, we need further research on low level of HL-Info in different European countries, and if different individual and familial factors place some adolescents in more vulnerable situations in terms of low HL-Info and thereby poorer health.
To address these gaps in understanding, we examined (i) if there are country differences in low HL-Info (in its distributions and correlators), and (ii) if low HL-Info serves as a correlator of SRH and PA across countries?
Methodology, Methods, Research Instruments or Sources UsedCross-sectional self-report 2021/22 Health Behaviour in School-aged Children study survey data were used. Data were collected through a stratified cluster sampling method using the school as the primary sampling unit. Ethical approvals and consent from the students and their guardians were collected. Participation was voluntary and anonymous. This paper reports findings from 11 countries (Belgium (fl.), Bulgaria, Czechia, Germany, Finland, France, Croatia, Kazakhstan, Malta, Poland and Slovakia) and 45,994 (N = 22939 girls, X = 22746 boys) 13- and 15-year-old adolescents in total.
Measures. (1) HL-Info: The Health Literacy for School-Aged Children (HLSAC; Paakkari O et al., 2019) instrument. To describe HL-Info, four out of ten items were used: having good knowledge on health, an ability to find information one understands, an ability to compare information from different sources and an ability to assess the trustworthiness of the information. In the analysis, HL-Info was used as a categorical (low-moderate-high; two lowest response options were combined to describe “low HL-Info”); (2) Individual factors: self-report (a) gender (girl, boy) and (b) age (13-years old, 15-years old); (3) Family affluence, measured with Family affluence scale (FAS; Torsheim et al., 2016); (4) Parental support (Zimet et al., 1988); (5) SRH (Kaplan & Camacho, 1983), used as a categorical variable; (6) PA (Persons meeting the PA guidelines; Moderate-to Vigorous-Physical-Activity (MVPA) Prochaska et al., 2001).
Data analysis involved cross-tabulation of 4 health literacy (HL) items for each country and age group, corrected for study design. Mean calculations for the HL scale, ANOVA testing, and Spearman correlations with mentioned variables were calculated. Linear mixed-effect models were used to predict HL with individual and familial factors.
Conclusions, Expected Outcomes or FindingsThe preliminary findings showed that, via HL-Info, health information is not equally available for adolescents in Europe. Disparities in access relate to both individual factors as well as familial and country environmental factors.
The proportions of those with 'low HL-Info' varied between countries: having information from 4.3% (Finland) to 27.1% (Kazakhstan), finding information one understands from to 7.9% (Finland) to 29.4% (Bulgaria), in comparing information from different sources from 10.5% (Finland) to 38.2% (Bulgaria), and in assessing the trustworthiness of information from 11.2% (Finland) to 36.1% (Bulgaria).
Across the countries, low HL-Info was associated with all measured background variables except gender. Low HL-Info was statistically significantly more prevalent among 13 year olds (than 15 year olds), lower affluent (compared to more affluent) families, and those with low support (compared to moderate or high support) from parents.
Country specific analysis revealed gender differences only in one country (Belgium), age differences in three countries (Belgium, Poland, Kazakhstan), and family affluence differences in seven countries (Belgium, Czechia, Germany, Finland, Poland, Slovakia, France). Low HL-Info was associated with parental support in all measured countries.
Low HL-Info was associated with SRH (poor/fair SRH more common) among all countries and following PA recommendations (not following more common) in seven countries.
To foster equity in access to valid health information and in health calls for educational and public health policies and practices targeted proportionally at population needs.
ReferencesHumprecht, E., et al.. (2020). Resilience to online disinformation: A framework for cross-national comparative research. The International Journal of Press/Politics, 25(3), 493-516.
Kaplan, G. A., & Camacho, T. (1983). Perceived health and mortality: a nine-year follow-up of the human population laboratory cohort. American Journal of Epidemiology, 117(3), 292-304.
Lahti, H., et al. (2024). What Counteracts Problematic Social Media Use in Adolescence? A Cross-National Observational Study. Journal of Adolescent Health, 74(1), 98-112.
Lim, M. L., et al. (2021). Association between health literacy and physical activity in older people: a systematic review and meta-analysis. Health Promotion International, 36(5), 1482-1497.
Paakkari, L., et al., (2019). Does health literacy explain the link between structural stratifiers and adolescent health?. European journal of public health, 29(5), 919-924.
Paakkari, L., et al. (2019). Does health literacy explain the link between structural stratifiers and adolescent health? European Journal of Public Health, 29(5), 919-924.
Paakkari, L., et al. (2020). A comparative study on adolescents’ health literacy in Europe: findings from the HBSC study. International Journal of Environmental Research and Public Health, 17(10), 3543.
Prochaska, J. J., et al. (2001). A physical activity screening measure for use with adolescents in primary care. Archives of pediatrics & adolescent medicine, 155(5), 554-559.
OECD (2023), PISA 2022 Results (Volume I): The State of Learning and Equity in Education, PISA. Paris: OECD Publishing.
Smahel, D., et al. (2020). EU Kids Online 2020: Survey results from 19 countries.
Torsheim, T., et al. (2016). Psychometric validation of the revised family affluence scale: a latent variable approach. Child Indicators Research, 9, 771-784.
World Health Organization (2021). Health literacy in the context of health, well-being and learning outcomes the case of children and adolescents in schools: the case of children and adolescents in schools. Copenhagen: Regional Office for Europe.
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of personality assessment, 52(1), 30-41.
08. Health and Wellbeing Education
Paper
How is the relation between Wellbeing and Sustainability Challenges addressed and linked to Education and Learning in Schools?
Monica Carlsson
Aarhus University, Denmark
Presenting Author: Carlsson, Monica
Global environmental changes in conjunction with substantial social justice issues are impacting the wellbeing of us all, raising significant concerns related to how education can address these challenges (Andreotti 2018). As pointed out in UNs 2022 sustainability development goals report, and research addressing health and sustainability challenges (Franzolin et al. 2022; Malqvist and Powell 2022), the COVID-19 pandemic and ongoing global environmental and climate change have deepened the global learning crisis, highlighting the interconnectedness of wellbeing challenges and broader sustainability challenges related to the degradation of nature, and environmental and/or climate change. This accentuates the need for creating a greater awareness of the potentials in linking wellbeing and sustainability in educational research and practice. Broad explorations of perspectives on how the relation between wellbeing and sustainability challenges is addressed and linked to education and learning in schools have been largely absent within research. The paper aims to address this gap, drawing on perspectives identified in a literature review within the research areas of wellbeing and sustainability education. Wellbeing and sustainability are often described as ‘wicked’ or complex problems and challenges, founded in issues of resource justice and inequalities in access to welfare resources, and research addressing these challenges points to the need for a shift towards focusing on the potential benefits of supporting relationality, social cohesion, solidarity, interdependence, and care in schools (Block et al. 2018; Spratt 2017). The conceptual framework that informs and inspires the analysis is drawing on notions of education as a common good and social sustainability, as well as perspectives on the relation between wellbeing, sustainability, and learning. Notions of education as a common good has gained momentum in policy in recent decades, connoting a form of shared wellbeing that is chosen and achieved together (see e.g. UNESCO 2015; 2021). In a discussion of these notions, the purpose of education in schools is described as “being and becoming in the world through engagement in individual and collective actions to take care of shared resources, ways of being, and systems in the interests of social justice and ecological care” (Lotz-Sisitka 2017, p. 65). This emphasizes that taking care of resources is at the core of social justice and that resources must be shared more equitably by all if we understand these resources as a common good. The sharing and (re)distribution of resources is central in notions of social sustainability, defined as a matter of resource distribution – hereunder of opportunities for education, health, wellbeing, and social care, and as distribution between people of opportunities to have, create and experience belonging in social relationships in everyday life (Duff and Hill 2021; Krøjer 2020; Vallance 2011). Spratt (2017) is in her analysis of discursive relationships between learning and wellbeing in wellbeing policy distinguishing between two discourses, wellbeing seen as for learning, and learning seen as for wellbeing. In the first discourse, wellbeing is seen as the servant of learning outcomes, which shows how it may be appropriated to develop a manipulative type of ‘care’ to foster the types of learning that focus solely on the characteristics of human capital favored in the job market. In the second discourse, learning is seen as the bedrock of human flourishing, and as valuable when individual personal development takes place in the context of a democratic learning community, which seeks to ensure all learning is personally fulfilling and meaningful. A similar understanding of the relationship between sustainability and learning is identified in analyses of sustainability policy, emphasizing a political interest in education continuing efforts aimed at economic growth at the expense of social and ecological considerations (see e.g. Jickling and Sterling 2017; McKenzie 2014).
Methodology, Methods, Research Instruments or Sources UsedThe paper is drawing on research within the areas of wellbeing and sustainability education identified in a literature review on perspectives on social justice, equity, and agency when schools address health, wellbeing, and sustainability challenges (Carlsson, in review). First understandings of wellbeing and sustainability challenges within the research area of wellbeing and sustainability education are discussed. Thereafter the analysis of perspectives on how the relation between wellbeing and sustainability challenges is addressed in schools is presented, drawing on perspectives identified in the literature review. The literature review is based on systematic search of research articles published in journals conducted in the PsycInfo and ERIC databases, including journal articles published in English between January 2013 and December 2022, peer reviewed, target population aged 7–15 (primary, middle and lower secondary school). Search terms were: (Health* OR Wellbeing*) AND (Children* OR "young people*" OR youth*) AND School AND Education AND ("social justice*" OR Equity) AND sustainability. Using a search string combining all search terms identified 2423 records in the two databases. Citations from the search were imported to the Covidence systematic review system, where a screening and selection process took place in two steps: first title and abstract, then full texts were screened to select articles for inclusion in the analysis. Removing duplicates left 1917 records whose title and abstract were screened in the Covidence systematic review program. Following this screening process, 52 articles were retrieved and assessed for eligibility. An additional 12 articles were identified as potentially relevant by searching reference lists, of which 8 were retrieved. A total of 60 articles were thoroughly assessed. After excluding articles that did not meet the inclusion criteria described above, 23 articles were eventually included in the analysis processes. In this paper I have returned to these articles, identifying, categorizing, and discussing examples of perspectives on how the relation between wellbeing and sustainability challenges is addressed and linked to education and learning in schools. The analytical approach is narrative (interpretative), based on descriptive qualitative content analysis, and informed and inspired by the conceptual framework presented above. The paper concludes with a discussion of potentials and challenges in linking wellbeing and sustainability in educational research and practice.
Conclusions, Expected Outcomes or FindingsIn the presentation I will share results from the analysis, focusing on examples of perspectives underpinned by conceptions of 1) resource justice and equal sharing of resources, 2) the natural environment as a common good, 3) relations between people and the more-than-human.
1) This perspective highlights cultural and structural barriers in relation to a more equal sharing of resources, pointing out that socioeconomically deprived areas have significantly less high quality public green spaces and children living in these areas are thus less likely to have access to green spaces. This unequal access means that children who are already at risk of poor health have the least opportunity to reap the health benefits of green spaces and face educational inequalities.
2) Drawing on notions of the natural environment as a common good, framing environmental issues as social justice issues, this perspective is emphasizing the intimate links between health, wellbeing, and the stewardship of the commons - the natural environment - shared by people in a local community. Potentials in students developing a sense of connection to and an awareness of their interdependence with other living things and their responsibilities in relation to the larger whole of the environmental commons are underlined.
3) Within the perspective focusing on relations between people and the more-than-human it is argued that human–nature connectedness has a restorative effect on children’s wellbeing and that giving them a sense of being able to make a difference and care for nature, can lead to children developing an awareness of interconnections between environmental and human health.
ReferencesAndreotti, V. et al. (2018). Mobilising Different Conversations about Global Justice in Education: Toward Alternative Futures in Uncertain Times, Policy and Practice: A Development Education Review, Vol. 26, 9-41.
Block, T., Goeminne, G., & Van Poeck, K. (2018). Balancing the urgency and wickedness of sustainability challenges: three maxims for post-normal education. Environmental Education Research, 24(9), 1424–1439. Routledge.
Carlsson, M. (in review). Schools addressing health, wellbeing, and sustainability challenges: a literature review of perspectives on social justice, equity, and agency. (Paper submitted to Health Education January 2024).
Duff, C. & Hill, N. (2022). Wellbeing as social care: On assemblages and the ‘commons’. Wellbeing, Space and Society 3.
Franzolin, F., Carvalho, G.S., Santana, C.M.B., Calegari, A.d.S., Almeida, E.A.E., Soares, J.P.R., Jorge, J., Neves, F.D. and Lemos, E.R.S. (2022), Students’ Interests in Biodiversity: Links with Health and Sustainability, Sustainability, 13, 13767.
Jickling, B., & Sterling, S. (2017). Post-Sustainability and Environmental Education. In B. J. S. Sterling (Ed.), Post-Sustainability and Environmental Education, 1-11. Palgrave.
Krøjer, J. (2020). Social sustainability in the welfare state and welfare institutional care. Langegaard, L.L. and Dupret, K. (eds.) Social sustainability – concept, field and critique, 81-102, Frydenlund Academic.
Lotz-Sisitka, H. (2017). Education and the common good, in B. Jickling & S. Sterling (Eds.) Post-sustainability and environmental education, 63–78. Palgrave Mc Millan.
Malqvist M. and Powell N. (2022). Health, sustainability and transformation: a new narrative for global health, BMJ Global Health 2022;7:e010969, 1-3.
McKenzie, M., Bieler, A., & McNeil, R. (2015). Education policy mobility: Reimagining sustainability in neoliberal times. Environmental Education Research, 221(3), 319–337.
Spratt, J. (2017). Wellbeing, Equity and Education. A Critical Analysis of Policy Discourses of Wellbeing in Schools, 57-68, Springer.
UN (2022). Sustainable Development Goals Report 2022. https://www.un.org/development/desa/dspd/2022/07/sdgs-report
UNESCO (2015). Rethinking Education: Towards a global common good? Retrieved 3 Nov. 2023, https://unesdoc.unesco.org/ark:/48223/pf0000232555.
UNESCO (2021). Reimagining Our Futures Together: A New Social Contract for Education, Retrieved 3 Nov. 2023, https://unesdoc.unesco.org/ark:/48223/pf0000379381.
Vallence, S. (2011). What is social sustainability? A clarification of concepts. Geoforum 42, 342-348.
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