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BAZERMAN_2013_VOLUME 2_A Theory of Literate Action
Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Using the three components of attitude in Fishbein and Ajzen's Reasoned Action Theory— cognition personal and evaluative beliefs , affect feelings, emotions , and conation behavioral intentions —the present study investigated relations among L1 and L2 reading attitudes, the relative contributions of reading attitude and language proficiency to reading achievement, and various factors that shape L2 reading attitude.
Citing Literature. Supporting Information All Supplemental Data may be found in the online version of this article. Filename Description modlsmSuppData-S1. Volume 98 , Issue 2 Summer Pages Related Information. Close Figure Viewer. Browse All Figures Return to Figure. Previous Figure Next Figure. Email or Customer ID. Forgot password? Old Password. New Password. Password Changed Successfully Your password has been changed. The objectives of this study was a to scope current understandings of health literacy in childhood and youth and b to understand to what extent available models capture the unique needs and characteristics of children and young people.
The 12 definitions and 21 models identified enabled a sound depiction of health literacy for children and young people. As a strong commonality of the complex and heterogeneous definitions and models, health literacy is depicted as a multidimensional, complex construct. Moreover, by describing the construct along multiple integrated categories, a synthesis of the health literacy dimensions retrieved from the literature was possible. However, it may be the case that these categories overlap as the same phenomena can be described in various ways and many models regarded health literacy through different lenses, resulting in differential focuses.
Regarding the first part of the research question, the focus of health literacy exceeds the health care setting in most definitions and models. Similar to health literacy in adults [ 10 ], health literacy involves actions or agency which vary according to the health literacy perspective that is applied — e. As a result, health literacy is context and content-specific and as such varies according to the complexity of the task at hand and the contextual factors present [ 35 , 43 ]. Hence, an individual is always interwoven with and subjected to the social and cultural context it is embedded.
The contextual factors were acknowledged but often remained underscored in the literature.
In the following paragraphs, we offer our reflection and perspective on the observed discrepancy. The individual attributes include the knowledge and skills that a person should have in order to meet certain situation-demands, e. These demands mostly are diverse and overlapping within the definitions and models. Mostly, they refer to performing actions related to the gathering, understanding, appraisal and use of health information or services, or as Fok and Wong [ 17 ] point out, general physical and psycho-social activities.
Moreover, the behavioural components of health literacy e. Especially models targeting the health care system still appear to strongly favour an adherence perspective, viewing individuals primarily as receiving health information and complying with the professional health or care instructions provided. As a result, exercising health literacy is only possible if opportunities for engaging in health literacy actions as well as for participating in everyday decision-making are present. Hence, the extent to which families, communities and societies allow children and young people to take an active role and participate in health literacy practices remains a question for future research.
A possibility for exploring this could be by drawing upon a resource-focused health perspective, for instance the salutogenic paradigm by Antonovsky [ 52 ].
Saboga-Nunes [ 53 ] stressed the connectedness between health literacy and salutogenesis by arguing that childhood and youth could be considered most permeable life stages where salutogenic resources are built up by transforming health information into action and the other way around. In terms of the interrelatedness of social, cultural, and environmental contextual factors, especially the role of the intermediate environment of children and young people is emphasized: The target group is especially dependent upon their parents or caregivers for the access to material, financial, and social resources e.
However, this dependence decreases as they develop and become more mature. Moreover, several articles highlight the role of available and accessible social support structures and peer assistance for the health literacy of children and young people: they benefit from the health literacy related knowledge and skills which they can access through their social informal or formal support structures.
This kind of assistance can help children to accomplish health-literate-related tasks or actions that they otherwise would not be able to succeed in on their own [ 1 , 55 ]. Overall, these social-cultural and economic contextual factors are primarily argued to act as antecedents or mediators for health literacy and tend to be neglected at the core of health literacy itself.
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We argue that the strong emphasis on health literacy as a set of skills tends to neglect and disregard the situation in which health literacy takes place, as well as the social practices relating to health literacy. In conclusion, there is a gap between the recognition of the role of contextual and cultural factors for health literacy and their implementation within strongly individualistic, skill-based conceptualisations, as well as operationalisations that focus on few distinctive health literacy dimensions [ 25 ]. Therefore, further research is needed that shifts from a functional, skill-based health literacy perspective to alternative approaches of understanding health literacy, e.
Such a comprehensive health literacy construct will be challenging to implement and operationalize. One option for addressing this challenge could be a modular design, which is then adjusted as necessary to specific target groups, contents and contexts. The second part of the research question was to clarify to what extent available models capture the unique needs and characteristics of children and young people.
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Here, special attention was contributed to the target groups' recognition and characteristics in the analysis, which revealed the following discussion points:. While many definitions and models were identified for young people, including secondary school students, similar findings are lacking for children under the age of ten or within a primary school context. In addition, the same is true for transitional stages, e. These findings are in line with conclusions drawn by Hagell, Rigby and Perrow [ 57 ].
Children, including primary school level or younger have not yet been at the focus of health literacy conceptual and intervention research efforts. Given that research has linked health literacy to health outcomes, and to health care costs for the adult population, research should follow up on past efforts [ 58 ] in order to explore the relevance for young people as well as children. These dominantly consider health literacy to take place in several consecutive age or developmental stages, as Piaget suggested in his theory of cognitive development [ 59 ].
This draws attention to the social role that is contributed to children and young people by their caregivers, communities and society. Brady, Lowe, and Lauritzen [ 62 ] for instance argue that even from a very young age onward, children are already active agents of their own social worlds that take on an active role in their health. Children continuously develop and change through socialization processes and interaction with their environment, including their parents, other adults or their peers [ 61 ].
How we view children and young people, therefore, largely depends on our — adult — perception of childhood and youth and the social role we attribute to children and young people in everyday interactions, e. The essential role of media and digital communication channels for the target group [ 63 ] was a theme that was found to remain underscored in available health literacy dimensions for children and young people, apart from few exceptions [ 21 , 27 , 28 ].
It transports moral and cultural values and facilitates their social and political socialization processes [ 64 ]. In an attempt to bridge the conceptual gap between approaches to health and media literacy, a media health literacy model for adolescents was developed and successfully tested for the target group by Levin-Zamir et al. Moreover, critical media health literacy for young people was defined by Wharf Higgins and Begoray [ 66 ] as consisting of a skill set of reflection, discrimination and interpretation abilities, as well as empowerment and engaged citizenship.
Given the important role of media in the target group, we propose to recognise the interrelatedness of critical media, digital and health literacies more profoundly in future models, interventions, and educational curricula. Most of the identified dimensions of health literacy in childhood and youth were fairly similar to the ones identified for adults cf. This poor incorporation of life phase specificities might result from the fact that their voices and perspectives largely remain unheard: Their active participation in the conceptual development process was only realized in three articles.
Those six models were analysed to be adult-focused as they incorporate neither target group specifics nor age- or development-flexible components. Therefore, their applicability and validity for the target group was found to be questionable. This is especially problematic as they have served [ 67 , 68 ] or may in the future serve as conceptual foundations for health literacy programs or interventions for children and young people.
Applying general health literacy models to the target group that were not especially developed to meet the needs and demands of children and young people may actually hinder effective health literacy promotion and development in that target group. The described scarcity of health literacy understandings that incorporate specific target group characteristics and perspectives reveals a current research gap.
Therefore, it is argued in line with Rubene et al. For pragmatic reasons, this review focused on exploring definitions and models of general health literacy of young people, excluding domain- e. Macket et al. While this is an acknowledged problematic, we strongly stress the need to view health literacy as being socially constructed, varying according to the context one is in and the tasks at hand and hence recognising the unique characteristics of the target group.
Extending the review to articles that incorporate a life course perspective on health literacy may have let to bias the analysis towards non-target group-specific definitions and models. However, these were included based on the argumentation that if they claim to provide a life course perspectives on health literacy, they implicitly includes children and young people as well. Therefore, they are of relevance for the comprehensive scoping of current health literacy understandings for the target group. While the review was conducted using sound and systematic methods, following the PRISMA guidelines to the extent possible for qualitative reviews [ 14 ], in order to ensure its validity and accurateness, several limitations certainly are present and need to be considered.
Efforts were made to enhance the sensitivity of the search strategy, using a comprehensive list of search terms and applying relevant operators. The databases that were used covered multiple disciplines indexing bibliographic records of a variety of journals and publication types. Focussing only on English and German language articles led to distortion in favour of native English and German speaking research contexts. To ensure that the focus remains on the key research question, the assessment and evaluation of the selected articles was performed according to a systematic data extraction method, applying a coding protocol.
While the core research team was independently involved in the selection and the assessment of the articles to minimize subjectivity and interpretation, the risk of selection, coding or opinion bias still remains. Due to the differing focus of analysed definitions and models, an explicit evaluation of the content was often difficult. Therefore, not all quality standards as outlined in the PRISMA guidelines were applicable and viable for our research design. Addressing health literacy in children and young people should be based upon an empirical sound and measurable definitions as well as on conceptual frameworks that are valid, hands-on, and meet the specificities of the target group.
This systematic review of the literature identified a broad theoretical base for health literacy in children and young people, while also pointing to conceptual shortfalls, especially related to a coinciding set of knowledge and skills adopted for the target group and how these are developed during the life course. Moreover, further operationalisation and implementation of these dimensions are necessary to test whether the described commonalities of the definitions and models are sound and measurable to describe the construct of health literacy of children and young people.
Furthermore, we believe that health literacy could empower children and young people — who are especially vulnerable and to some extent marginalized social groups — to become more engaged with their health and more informed and reflective upon their future health choices. For this, it is crucial to not focus on an individualistic perspective only.
Rather, it is of importance to recognize the interrelatedness and contextualisation of health literacy where people are empowered to interact with health, social and educational systems to the benefit for themselves as well as for the society as a whole. In turn organisations and systems are providing health literacy friendly services that can facilitate health for all. Future efforts must target the redesigning of systems to be inclusive and friendly towards children and young people, the adjustment of curricula and training of health professionals, teachers and other relevant stakeholders in order to better meet the challenge of the health literacy deficit, and the recognition of children and young people as active partners in their health decision-making.
Moreover, we stress that health literacy should not become a liability for children and young people with responsibilities exceeding their influence. Hence, several critical reflections and considerations that challenge current understandings of health literacy were pointed out that could be beneficial when taken into account in future research and interventions.
Therefore, future efforts should encompass these gaps and challenges identified, addressing them from a multidisciplinary perspective, viewing the target group as active social agents, who are deeply embedded in their close and distant surrounding e. As such, the greatest challenges for conceptualizing health literacy might ensure its generalizability and validity across context, while recognising its context- and content-dependency.
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