Health literacy can be defined as one’s ability to access, comprehend, and actively utilise health information to effectively promote and maintain health, and the ability to live a healthy life. The World Health Organisation (1998, p. 10) defines health literacy as ‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health’. To challenge the primacy of this ‘traditional’ claim, this essay will explore the functional, interactive, and critical dimensions of health literacy, and will explore how the concept of health literacy can be integrated with a strengths-based approach across the Australian primary school curricula.
The development of the functional dimension in health literacy finds us researching and applying information relating to various knowledge sources, in order to respond to a health-related question (Acara, 2013). Here, it can reflect the outcome of traditional health education (Nutbeam, 2000). This set of limited goals, factual information, and linear viewpoints can most likely develop individual benefits, but is far too narrow a perspective, all the same, reducing a given population’s process. In such cases, educational activity has limited growth, as information is transmitted through existing channels, and available media. For Kanj and Mitic (2009), functional literacy should reflect skills that enable individuals to read and understand health forms provided by doctors, nurses, and health professionals. An individual, to that end, can then apply these skills to self-administer medications, and keep appointment schedules (Kanj & Mitic, 2009). Limitations to functional health literacy surely lead, therefore, towards a slowed process of growth, education, and an ability to challenge and remain critical about knowledge and research. In simply ‘following’ information provided by health professionals, we uncover, in part, a fundamental disconnect between a health professional’s ‘language of understanding’ and a patient’s capacity to comprehend that language. In some cases, multiple complications ensue, and individual health determinants may not be recognised. Policy-makers are therefore drawn towards a motion to improve, at least in part, the fundamental narratives that assemble a common language between health professionals and patients. In doing so, more adequate health education improves social conditions and general health.
The interactive dimension of health literacy calls for not only critical aptitudes in receiving, but in engaging health education. Nutbeam (2000, p. 259) defines interactive health literacy as ‘more advanced cognitive literacy and social skills that enable active participation in healthcare’. Certainly, then, the skills to actively and independently engage with health issues forwards an individual’s research and understanding; but it also improves their ability to apply new information within a given circumstance (Acara, 2013). This level of development reflects a conventional, linear view of health literacy that, quite simply, reflects the conclusion of approaches in health education that have evolved during the past twenty years (Nutbeam, 2000, 2012; Rubinelli, Schulz, & Nakamoto, 2009). Here, with this approach, we take a step further, at least from a traditional canon of functional health literacy, because we look at improving an individual’s capacity to ‘act independently on knowledge’ and focus on improving motivation and confidence to act on advice (Nutbeam, 2012, p. 266).
The critical dimension of health literacy is seen as an expansion of the two previous dimensions. This dimension of health literacy calls for an ‘ability to selectively access and critically analyse health information from a variety of sources’ (Acara, 2013 p. 4). This, in turn, encourages individuals to assess information from a variety of sources, sources that, at the very least, reflect information that has been scrutinised by scholarly peers and fellows across scientifically-orientated publications (such as journal articles, scientific papers, and to a certain extent, messages established within the media). For Nutbeam (2000), critical health literacy must reflect an ability to critically analyse and apply information to participate in actions that overcome structural barriers to health. More importantly, critical health literacy must showcase the kind of cognitive skills development ‘which are oriented towards supporting effective social and political action’ (Nutbeam, 2000, p. 266). Within this level of health literacy, health education may achieve the kind of communication that will address the social, economic, and environmental determinants of health (Nutbeam, 2000). Certainly, the very intention of critical health literacy is something that without more refinement, may not stabilise a platform for particular skillsets that utilise information from a variety of sources. Consequently, to ensure that comprehension is at its highest level, resources must continue to be built, information must continue to be critically analysed, and knowledge must continue to reflect comparative assessment. This will be a step towards a higher function of health literacy, and must be seen as an important goal for health education.
Aligning the functional, interactive, and critical dimensions of health literacy is crucial to an effective health literacy programme within the schooling environment. To move beyond the traditional health education system, however, requires critical inquiry, or the ability to identify a degree of contradiction or fallacy between the medical community, the scientific research articles that are produced, and the ‘moral panics’ that are driven by media outlets in response to errors that are made by health professionals. We as a public culture must continue to align traditional and functional health literacy with options and pathways into interactive and critical health literacy.
Integral to health and physical education, in regards to the concept of health literacy, is how it can be implemented within the Australian primary school curricula from a strength-based approach. Primarily, it can be argued that the aim of health literacy is to develop knowledge and self-awareness. The aim of health and physical education in schooling is to ‘teach students how to enhance their own and others’ health, safety, wellbeing, and physical activity participating in varied and changing contexts (ACARA, 2013, p. 3). Though these terms can be slightly vague, we can explore the ‘how to enhance’ aspect as a key determinant for a successful health literacy integration.
The strength-based approach requires a particular focus, which can lead to establishing effective goals. Duncan et al. (2007) define the goals of a strength-based approach as an opportunity to raise awareness about an individual’s developing strengths, while motivating and guiding individuals in taking on the responsibility for self-awareness. By having a stronger focus on assisting students in developing the kind of knowledge and understanding skills they require to make healthy, safe, and active choices, this approach empowers students, peers, and communities, and encourages them to utilise their own strengths to develop and enhance health and wellbeing, as a whole.
Implementing the strength-based approach within the school curriculum requires inclusion of the five interrelated propositions developed by the Australian Curriculum. These propositions include a focus on educative purposes, the inclusion of a strengths-based approach, value movement, the development of health literacy, and critical inquiry (ACARA, 2014). To achieve health literacy within the school curriculum, a number of considerations must be in place. Nutbeam (2008) argues that expanding the content and subsequent methodology is essential to the development of confidence in acting on knowledge, working with, and supporting other people, which leads to social inclusion. The very goal of defining new independence in decision-making and empowerment can, in turn, lead to crucial political action. As a result, assisting people in developing confidence to act on the provided knowledge should be the foundation of a successful health literacy programme within the school curricula.
The strength-based approach is an important approach that must be considered in the primary curriculum. ACARA (2012) defines the strength-based approach as an acknowledgment that the majority of students approach the learning area of health and physical education with positivity. ACARA (2012) also acknowledges that certain curricula have frequently adopted a risk model, with a focus on exploring how to approach risk behaviours. This cannot maintain a foundation for improvement, well-being, and enhancement, because it focuses far too centrally on the negative aspects of healthcare. If we are to focus on a strength-based approach, risk models, if nothing else, must be comprehensively re-appropriated to guarantee a duty of care. This may, in turn, improve engagement and self-motivation. But what is crucial here is that strength-based approaches increase the capacity for strong understanding through incorporations of health literacy.
Understanding the priority of health and physical education systems can be seen as a purpose for educative outcomes. ACARA (2012) advises that the value for health and physical education should be recognised as the curriculum which contributes to health promotion goals. Still, the ACARA concede that ‘it is beyond the scope of the curriculum to solve problems related to the health and wellbeing of children and young people’ (ACARA, 2012, p.7). This removes, otherwise, curricular responsibility, but it does continue to advance planning that will contribute to goals, student enhancement and empowerment, and important knowledge. Value movement is a focus that can ensure the importance of health and physical education is addressed on a much larger scale. In ACARA’s (2012, p. 4) words, ‘The knowledge, skills and dispositions students develop while moving in Health and Physical Education will encourage them to become lifelong participants in a range of physical activities’. By looking at movement as a challenge, and opportunity for self-enhancement, valuing movement can work within the framework of a strength-based approach.
Health literacy values the role of education, and looks to grow and develop the individual. ACARA (2012, p. 5) has identified that health literacy is often a ‘personal and community asset to be developed, evaluated, enriched and communicated’, and can, therefore, work consistently with a strength-based approach. In conjunction to a critical inquiry approach, this will ensure that the inclusion of a strength-based approach covers not only the health and physical education domain, but has the ability to work across multi-disciplinary functions. Through the study of health and physical education, young people will learn values, behaviours, priorities, and actions that reflect the complex contexts in which people live in (ACARA, 2012, p. 5). We might justify, consequently, that a curricula should support students in understanding that health practices are socially constructed, and require critical thinking strategies for gaining and maintaining positive outcomes (ACARA, 2012, p. 5). Thus, cross discipline integration should arguably form part of the approach for school curriculum inclusion.
Enacting critical health literacy within the primary school environment remains an important consideration. A case study by the School of Human Movement Studies at the University of Queensland sought to enable critical health literacy by constituting a health literacy unit. To develop health literacy, responses from HPE teachers and their students were collected, and what was documented were the important lessons learnt from the implementation in curriculum reform (McCuaig et al., 2014). This study covered a number of objectives, which looked to support teachers and students across the three dimensions of health literacy. McCuaig et al. (2014) noted that critical health literacy was achieved through allowing students to critically analyse health resources, and by empowering the students to help others. But while students did, in fact, feel confident in their ability to access relevant health information, their confidence in an ability to critically evaluate and apply health information to their own lives, and the lives of others, was observed as complex, and needing further support and understanding. Here, the authors concluded that schools require the freedom and flexibility to implement a comprehensive health literacy unit.
Elsewhere, researchers (see Macdonald, in press) continue to believe that the explicit teaching of internet search strategies, and the critical evaluation of websites, for example, remains imperative in targeting the health and digital literacy needs of adolescents. It strengthens the argument for critical thinking as an important development within the school curriculum, certainly, and especially in conjunction to the critical analysis of all health education materials.
Health literacy, though readily articulated, continues to be a challenge for educators within a school environment. They must not only overcome the complex task of teaching critical analysing techniques to students, but must do so within an environment devoid, in large part, of critical thinking among students. Critically examining health adds a level of responsibility to the individual, which requires increased support from educators, health professionals, and policy makers. However, with the correct support models, and the development of critical thinking skills, obtaining a high level of literacy using the strength-based approach within a school curriculum is a goal that educators should consider as part of the development of the health education programme in every primary school curriculum.
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