Tool-HLCA: An intervention to promote the health literacy of school-aged children

Abstract Background In the age of ‘infodemic,’ children and young people encounter health-related information in digital environments at an early age. They should therefore learn how to deal with these in a health-competent way while still at school. Above all, it is relevant that they learn how to distinguish good health information from false. This can be achieved by promoting health literacy. The intervention “Toolbox” combines areas of media education in schools and health literacy to be implemented in schools and curricula in the long term. Methods The intervention was designed to address existing health topics in the classroom while strengthening digital health literacy in grades 7 to 10. The Toolbox was piloted in three school classes in Germany and the feedback provided by teachers and students was implemented in a new version of the intervention. Results The basic understanding of health literacy in the Toolbox is finding, understanding, evaluating and using digital health information. These steps are followed through using quality criteria for good health information. Students learn that they need to find out the type of information, analyze the author, investigate the media provider, and also the sources given. If they are unsure, they can conduct an adapted questionnaire regarding identify misinformation and disinformation. In addition, the students and teachers receive working materials for group work. Conclusions Recognizing disinformation is a relevant skill already for children and adolescents. The intervention should make it easier for students to recognize good health information. For teachers it should be made easier to address health literacy in school without additional effort.


Background:
Mental illnesses are amongst the leading causes of ill-health and disability, with most onset of many mental health problems (ca. 75%) emerging before the age of 25 years. Thus, adolescence is an important time period for preventive measures, such as strengthening mental health literacy (MHL). This review aims to give an overview of those interventions which promote MHL on the long run.

Methods:
Five databases were searched for English or German articles published between January 1997 and May 2020, leading to a total of 4,375 original articles. Interventions were included only if they had measured MHL and/or stigma on three different time points, had a control group, and delivered an intervention program. Studies reporting means and standard deviations for the outcomes of interest were further included into a meta-analysis using a random effects model. The analysis was carried out with STATA 16. Results: 25 studies were included into the review, and 13 of them were suitable for the meta-analysis. The great majority of studies (76%) were conducted within schools and the addressed topics were general mental health, depression, and schizophrenia. Interventions mostly used psychoeducation or a combination of educational elements and contact as delivery method. The combined use of educational and contact components led to worse results for mental health literacy, but not stigmatizing attitudes or social distance. Generally, interventions led to positive outcomes. The changes were sustained for mental health literacy d = 0.48, as well as for stigmatizing attitudes d = 0.30, and social distance d = 0.16, after an average followup of about 5 months. Conclusions: MHL-interventions targeting adolescents are mostly conducted within schools and generally have a brief follow-up period. They show a stable improvement in mental health literacy and are to a smaller degree able to destigmatize mental illness or improve social distance.

Background:
Fostering health literacy is considered an important objective within school-based strategies of health promotion. To effectively strengthen health literacy in the school setting the approach of organizational health literacy can be transferred to and implemented in schools. This approach combines behaviour-focused measures (providing individual learning opportunities) and environment-orientated measures (changing school's framework conditions). The HeLit-Schools project aims at developing a school-based concept of organizational health literacy and tools to support schools in becoming health-literate schools.

Methods:
Existing concepts of organizational health literacy of other setting are analysed and adapted to the school setting. The concept development includes the expertise of actors from the school field, health literacy research and health sector. They contribute by commenting, reviewing and validating the conceptualization at different stages in the development process. A quantitative assessment of schools' organizational health literacy is planned to further validate the concept. Furthermore, a screening of existing materials and programs for schools to use to foster health literacy is being conducted.

Results:
The developed HeLit-Schools concept describes eight standards of a health-literate school. Every standard focuses on a specific area within the school's organization that can be addressed and changed in order to strengthen everyone's health literacy at school more effectively. To additionally support schools in fostering health literacy in school as well as in the classroom, a structured collection of existing (teaching) materials and programs was assembled.

Conclusions:
Enhancing schools' organizational health literacy and thus promoting school development by optimizing schools' structures, processes and conditions in a health-literate matter can lead to an effective and sustainable strengthening of health literacy of every individual at school.