The Fourth Level of Health Literacy

Abstract

The World Health Organization defines health literacy as cognitive and social skills determining individuals' motivation and ability to receive, understand, and use information in a health-promoting manner. This study discusses health literacy in the light of general upper secondary education students' test answers (N = 611) on the Finnish Matriculation Examination. The data were analyzed based on three levels of health literacy: the basic, communicative, and critical level. Analysis suggests the three existing levels do not fully describe the depth of health literacy. A fourth level was derived, called "holistic health literacy," with the following dimensions: (1) tolerance, (2) understanding culture as wide and multidimensional phenomena, (3) environmental consciousness, and (4) analysis of the state of the world from various points of view. The means of developing the subject of health education are discussed.

Health literacy in childhood and youth: a systematic review of definitions and models

“…the health system, education system, community system), covering several health-related domains, as health care, disease prevention and health promotion. Nine models were developed from a school health education perspective [8, 18, 22, 25–27, 29, 30, 32]. Three articles [25, 26, 32] included children younger than 12 years, while nine addressed young people or secondary school children aged 12 years or older.…”

“…As pathways of contextual influences are considered to be strong influencing factors of health literacy in the literature, an extensive description of the inductive content analysis is provided in the “antecedents and consequences” section. Moreover, the importance of an age- and development-specific understanding of health literacy for children and young people was especially pointed out in models that were developed within the context of school health education [18, 22, 25–29, 32]. Paakkari and Paakkari [8] stated that while health literacy learning conditions in school may include aspects of each of their five core health literacy components, students’ age-specific needs and characteristics need to be taken into account.…”

“…understand health issues in deeper way, make sound choices, participate as active member of society)Self-awareness (ability to self-reflect on oneself, own decisions, and oneself as learner;Citizenship (ability to act in an ethically-responsible way and take social responsibility; consider health matters beyond one’s own perspective (the ones of others and of the collective)Cross-sectional skills: Basic reading, writing and speech skills social skills, communication skills, and information-gathering skillsHealth literacy is defined as a learning outcomes of the school health education subject in Finland. It focusses on a health promoting and empowerment perspective with effects for the personal and societal health.7Rask, Uusiautti, Määttä, 2013 [29]Basic/Functional literacy (basic ability to read and write)Communicative/interactive literacy (ability to participate in daily activities and communicationCritical literacy (person’s potential to evaluate information)Extended with fourth dimension:Holistic health literacy, with four sub dimensions:- tolerance,- understanding culture as wide and multidimensional phenomena,- environmental consciousness,analysis of the state of the world from various points of viewBased on author’s understanding of Nutbeam’s typology (2000), complemented with own holistic health literacy models (adapted from Stewart et al 2008), dimensions are elaborated from students’ perspectives & point of views, based on their answers from the Finnish Matriculation Examination8Steckelberg et al, 2009 a&b [22, 41]Principles of critical health literacy related to evidence-based medicine (EBM):Understanding medical concepts (e.g. informed choice in diagnostic tests; appraising patient information)Skills of searching literature (e.g.…”

“…The ability to interpret, filter, judge, and evaluate health information was another core dimension of health literacy [8, 10, 18, 21, 26, 29, 30, 32, 34, 35]. Moreover, appraising information refers to making sense of information gathered from diverse sources by identifying misconceptions, main and supporting ideas, conflicting information, point of view, and bias [26].…”

“…Critical literacy skills or critical thinking are argued to be core dimension of health literacy [8, 29, 35]. They refer to the ability to think clearly and rationally and approach knowledge from various angles, formulate arguments, and make sound decisions [8].…”