The salutogenesis perspective of Health Literacy

Abstract Introduction Health Literacy (HL) is the third pillar of Health Promotion and contributes to the sustainability agenda set earlier in Rio de Janeiro and latter in Shangai (e.g. WHO Shanghai Declaration, 2016). Nevertheless HL per se lacks consistency and structural modus faciendi implementation and practice. Therefore it is proposed that a discussion be developed based in the salutogenesis embodiment of health literacy from the perspective of children's Sense of Coherence. Methods A population cross-sectional study included (n = 725) children enrolled in the school year 2018/2019 of four schools in Santarem and Lisbon, Portugal. Indicators of anthropometric data, Health literacy (HL), water intake (WI) and nutrition status (NS) and their Sense of Coherence (SoC) levels (using the HLS-EU-PT questionnaire) were collected with the CrAdLiSa online self-administered questionnaire. Results Preliminary results show that the instrument to measure HL (HLS-EU-PT) show satisfactory internal consistency (Cronbach's alpha coefficient 0,94) and association with SoC (Cronbach's alpha coefficient 0,89). The higher is HL levels the higher results are found in the Comprehensibility component of the SoC. The older the age, the amount of WI perception is adequate (p = 0.03); male children (p = 0,02) and children that attend schools in urban area (p = 0,01) drink more water; and have a higher SoC. Also the older the age, the lower the levels of HL (p = 0.000); children with higher levels of HL have greater WI (p = 0.01) as they have a broader perception of the adequate amount of water needed to be healthy. Conclusions These results of CrAdLiSa study explore further on the theoretical perspectives influencing HL. They also showed the usability of the SoC and the HLS-EU-PT questionnaires adapted for children to assess their SoC and HL levels.


Introduction:
Childhood obesity is a natural response to the modern food environment. A daily consumption of sugar that exceeds the WHO recommendation by 40.7% of Portuguese children influence this condition. It is recognized that children spend more time watching television and youtube, absorbing commercials about food, being susceptible to these messages and negative health literacy. Nutrition marketing is involved in these ads and most of them promote foods high in fat, sugar and salt through persuasive techniques. Purpose: Assess implications of exposure to nutritional marketing through television and YouTube on preferences, attitudes and consumption of children from 6 to 10 years old and contribute to the increment of health literacy. Materials and methods: Data collection through two online questionnaires about television and youtube habits and children's food preferences, developed by the research team. Statistical analysis was performed using IBM SPSS Statistics software.

Results:
Forty-two students who were attending a private school, aged between 6 and 10 were evaluated. Access to youtube has led to less healthy choices for breakfast in 95% of students (p = 0.038). It was found that most children do not have TV in their room and have a more balanced breakfast (81%). Cereals, soft drinks and biscuits are foods groups that children see the most in the tv commercials (p = 0.001).

Conclusions:
Exposure to nutritional marketing influences children's preferences, consumption and preferences. An active strategy should be encourage to increment health literacy levels at the family level influencing therefore children's healthier choices.
Abstract citation ID: ckac129.514 Consumption of legumes in children from 3 to 6 years -evaluation of an intervention program

Introduction:
Eating habits are a key aspect of a healthy lifestyle. This study focuses on the importance of consuming legumes -rich and accessible source of protein, and a healthy and sustainable option, in environmental terms -contributing to increment health literacy levels at the population level.

Objectives:
To design, implement and evaluate a program to promote the consumption of legumes -Beans4Life. Specifically, to assess its impact on the knowledge and frequency of consumption of the eight legumes (beans, grain, peas, beans, beans, lentils, chickpeas and lupins).

Methods:
Pre-test post-test analytical study, with three evaluation moments: 1) before the intervention; 2) after the intervention with the children and 3) after the intervention with the guardians (end of the intervention). Participants: 90 children from 3 to 6 years old (54.4% male) and their guardians. Instruments: questionnaire to assess knowledge and food preferences, questionnaire on eating habits and a questionnaire to evaluate sessions. The intervention had two components, the first with the children (4 food education sessions) and the second with the families (activities that facilitate the inclusion of recipes with legumes in the family's daily life).

Results:
Before the intervention, the results obtained show low levels of knowledge and frequency of consumption of legumes, influencing low health literacy. Peas and beans are the best known legumes (81.1% and 55.6%) and also preferred (77.8% and 73.3%). The results obtained in the second and third assessments show that there was a significant increase (p < 0.05) in the knowledge and frequency of consumption of most legumes.

Conclusions:
The objectives initially proposed were achieved and it will be pertinent to continue the present study, with larger samples, in order to increase health literacy awareness and the consumption of this food group in childhood, and provide more robust results that help to clarify the relationships found.  Therefore it is proposed that a discussion be developed based in the salutogenesis embodiment of health literacy from the perspective of children's Sense of Coherence.

Methods:
A population cross-sectional study included (n = 725) children enrolled in the school year 2018/2019 of four schools in Santarem and Lisbon, Portugal. Indicators of anthropometric data, Health literacy (HL), water intake (WI) and nutrition status (NS) and their Sense of Coherence (SoC) levels (using the HLS-EU-PT questionnaire) were collected with the CrAdLiSa online self-administered questionnaire.

Results:
Preliminary results show that the instrument to measure HL (HLS-EU-PT) show satisfactory internal consistency (Cronbach's alpha coefficient 0,94) and association with SoC (Cronbach's alpha coefficient 0,89). The higher is HL levels the higher results are found in the Comprehensibility component of the SoC. The older the age, the amount of WI perception is adequate (p = 0.03); male children (p = 0,02) and children that attend schools in urban area (p = 0,01) drink more water; and have a higher SoC. Also the older the age, the lower the levels of HL (p = 0.000); children with higher levels of HL have greater WI (p = 0.01) as they have a broader perception of the adequate amount of water needed to be healthy.

Conclusions:
These results of CrAdLiSa study explore further on the theoretical perspectives influencing HL. They also showed the usability of the SoC and the HLS-EU-PT questionnaires adapted for children to assess their SoC and HL levels. Women also decline leadership opportunities, such as promotions and committee chair positions, because of family obligations. Gender discrimination included feeling inferior and discouragement from promotions or leadership positions on the basis of gender. Another identified barrier was the lack of a safe and unbiased system for seeking help following harassment or assault. Issues related to work-life balance became even more apparent during the COVID-19 pandemic, which placed a disproportionate burden in female public health workers. In the recovery phase, we have an opportunity to rethink public health delivery in order to make it a more equal, less biased, and safe place for women. This should be a concerted effort, involving men and vulnerable populations such as trans women and underrepresented ethnic groups, to ensure that no one is left behind. As one of the leading public health organizations in Europe, the European Public Health Association is committed to join efforts to address this issue in the multiple public health arenas: public health practice, policy and research. This panel discussion is a collaboration between the EUPHA Working Group on gender equality and women's and girl's empowerment, the Policy and Practice section and EUPHAnxt, and is for any conference participant that is committed to reducing the gender gap in public health. The aim of this panel discussion is two-fold. First, we aim at discussing the barriers that female healthcare workers face on an everyday basis, and their impact on their careers. Secondly, we aim at discussing how institutions and individuals can address these barriers and contribute to enhanced gender equality in the public health arena. Following panelists' interventions (additional speakers have been invited and will be confirmed at a later stage), the audience will be invited to participate in a discussion on gender barriers they have experienced and how those could be addressed.

Key messages:
Public health practice still faces several barriers to gender equality. Identifying barriers to gender equality and discussing strategies to overcome them is a step towards achieving gender equality in the workforce.