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Health Literacy & School Health Services: A Unique Opportunity

6/22/2016

An article in Supplementary Issue #1, 2016 of Journal of Health Communication on health literacy discusses the connection between health literacy and the use of health care services. Most studies on this connection have focused on health insurance and less on the other barriers to use of care services. Most studies in HL have also been focused on existing patients (i.e. those that are already "in the door" of the physician's office and whether they can follow medical advice. The article shifts our attention to the barriers for individuals to get "to the door". It discusses non-financial barriers such as lack of time, travel etc. The article prompts some thoughts about the unique opportunity to examine this "getting to the door" aspect of HL through the school setting. Most health education curricula include learning objectives related to know about and how to use local health services. Some studies ask about child/youth regular visits to their doctor as a behavioural output. Another dimension to this improved access discussion related to HL could include comparisons between schools that have clinics on the premises and those that do not. A variation of this could be whether students actually visit local clinics as part of their health education program. Parental involvement and education could also be added as a consideration or support for the classroom instruction about services. Studies could also look at the impact of instruction/support for instruction on the use of preventive care among young adults immediately after high school. As we develop a more specific and deeper understanding of how health education curricula and programs in schools can promote basic health literacy, we should consider how various supports to the classroom learning related to health care services use can be coordinated, studied and monitored. Read more>>
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)

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Defining Health Literacy by Health Topic is a Losing Strategy for Curriculum Development

6/22/2016

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Supplementary Issue #2, 2015 of Journal of Health Communication provides a Special Issue examination of Current Perspectives in Health Literacy Research. This journal has been and will be publishing similar issues on HL in 2016. Most of the articles in this issue do not relate directly to school-aged children and youth. But the issue does illustrate a predominant trend in HL research and practice, a trend that also dominates health promotion generally. Most of the articles in this issue discuss the impact of basic health literacy (knowledge, skills, critical thinking etc.) in relation to one health topic. Associations are identified (or disproved) between the basic health literacy of the patients about that particular topic. Some of the articles identify correlations between that basic HL about an issue and health behaviours or health outcomes on that topic. The implications for developing a health education curriculum if one uses this topic-by-topic approach are clear....there will likely be far too much to cover in one mandatory curriculum. Unless we can select the topics that are critical to an age group and given context, then define the absolute minimum number of essential facts/knowledge/insights about these health topics while sequentially building the generic skills, attitudes and beliefs that critical to HL, the task of preparing a proper scope, sequence and content for a health education curriculum in a country will be almost impossible. Read more>>
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)

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60 Minutes of Moderate or Vigorous Physical Activity (MVPA) Does Not Reduce Clustered Cardio Risks

6/21/2016

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Although the recommendation that all children should be moderately or vigorously active for 60 minutes (MVPA) per day is well known, there is little empirical evidence that this amount per day will reap cardiovascular benefits. An article in the January 2016 issue of BMC Public Health reports on a trial that actually did objective, physical testing. The authors conclude that "In our study of asymptomatic 9–11 year old children, there were no differences between clustered cardiovascular risk (CCVR) of children who undertook 60 min MVPA per day in accordance with WHO recommendations, and those who did not. This implies that current recommendations may be an underestimation of the PA necessary to reduce clustered CVD risk". The authors also conclude that "VPA appears to provide CCVR benefits beyond those afforded by MPA, with data suggesting that 17 min of vigorous physical activity (VPA) /day may provide clinically meaningful CVD risk reductions." Obviously this finding will prompt vigorous debate about the amount and quality of physical activity required to have an impact on cardio vascular risk. (The study did report benefits such as better body mass) But the finding illustrates how quickly we adopt the assumptions or claims from advocates as being true and worthy in school health promotion. ISHN has noted how the 60 minute recommendation evolved over the years in different countries, not based on studies such as this one, but more as a target that advocates could agree upon and see as bein g realistic for decision-makers to consider. This finding may also prompt a new look at the time element within the school day. ISHN has tracked several articles in this blog about the different ways to squeeze 60 minutes of MVPA into the school day. There has also been considerable discussion about encouraging active school transportation routes and changes to PE classes to get all students active within those classes. It may actually be easier to insert 20 minutes of vigorous activity in a child's day than to find 60 minutes of combined MVPA. In other words, if this finding is validated in other studies, then the implications are quite significant. Read more>>
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)

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Scientific & Political Debate about School Deworming Programs & RCT/Systematic Reviews

6/19/2016

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Several articles in Issue #5, 2015 of the International Journal of Epidemiology report on a debate that has been ignited about deworming programs in schools. The editorial summarizes the coverage in this issue " The World Health Organization and other international agencies promote deworming as a means of improving nutritional status, cognition and school attendance and thereby promoting economic development, largely on the basis of a single study in Kenya published a decade ago, augmented by a study from 1910 and an unpublished report of a follow-up of the Kenya study. In this issue of IJE we publish re-analyses of the influential Miguel and Kremer paper, a response by these authors and a commentary by Garner and others. The upshot of the re-analyses is that there may be a small effect of deworming on school attendance but no clear effect on examination performance. A 2015 update of a Cochrane review on the effects of deworming assessed in randomized controlled trials found no strong evidence of effects on nutritional status, haemoglobin levels, school attendance or exam performance. A so-called ‘worm wars’ for and against continuing current deworming policy in light of this new evidence has been declared, with considerable media coverage." uch re-analysis studies should help support better evidence-based policy, but the World Health Organization was quick to declare its continued commitment to deworming the world swiftly after the Cochrane review came out." WHO has also recently updated its guidance about deworming programs in its Library of Evidence for Nutrition Actions (eLENA).

ISHN briefly examined the 2015 Cochrane Review with a view to determining if the RCT studies and hence the review used common sense, context and different combinations of interventions as part of its analysis. We did this because we often find that RCT's and Systematic Reviews often are lacking in such considerations because of the narrow focus imposed on them by virtue of the protocols and procedures for such studies and reviews.Here are a couple of comments that should be considered as his debate move forward:

The Cochrane Review considers the impact of a single dose of pills, multiple doses of pills as they are applied to all students in an endemic area or just to the students who are infected.
The review reports that a single pill administered in all regions does not have an impact on average weight, cognition, school participation or academic achievement. However, the review does not seem to differentiate among populations that have high, medium or low infection rates. From a common sense point of view, it would seem obvious that an intervention affecting only a small percentage of students over a short period of time (most studies were less than a few years) would not have much effect on the average weight or performance of the entire group.
The review, and likely the RCT's examined in the review, does not differentiate or examine the context of this single intervention in depth in the review. Is the pill administered as part of an overall effort to make the school healthier through a school health approach, or is this just the administration of a medication? Is there a mandatory health education curriculum or program in place to complement the administration of the medicine? Are parents involved? By asking these types of questions, we can reveal that the problem of inadequate descriptions of contexts and control groups in RCT studies is likely at play here.
Similarly, the review does not examine if the intervention of giving pills is coordinated with additional nutrition support (to catch up children weakened by the disease) or changes are made in classrooms to catch there students up academically as well.

This is an important illustration of how the required narrow focus of RCT's and systematic reviews can ignite debates that are not really based on the real world. Given the increased attention being given to Neglected Tropical Diseases by WHO, we need to ensure that such scientific advice based on research evidence is tempered by ongoing analysis of databases such as student enrollment patterns over several years as well as the professional advice gathered in structured consultations with program staff,

(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)

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Health Literacy & School Health Services: A Unique Opportunity

Defining Health Literacy by Health Topic is a Losing Strategy for Curriculum Development

60 Minutes of Moderate or Vigorous Physical Activity (MVPA) Does Not Reduce Clustered Cardio Risks

Scientific & Political Debate about School Deworming Programs & RCT/Systematic Reviews

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Health Literacy & School Health Services: A Unique Opportunity

Defining Health Literacy by Health Topic is a Losing Strategy for Curriculum Development

60 Minutes of Moderate or Vigorous Physical Activity (MVPA) Does Not Reduce Clustered Cardio Risks

Scientific & Political Debate about School Deworming Programs & RCT/Systematic Reviews

Welcome to ourInternational Shared Blog

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Categories

Welcome to our
International Shared Blog