O conceito de saúde usado na sociedade tem mudado constantemente durante a história. Atualmente, deixou-se de associar o processo saúde-doença como opostos, dando lugar a conceitos que abrangem o bem-estar físico, social e ambiental do indivíduo. A partir disso, desenvolveram-se conceitos que organizaram o ensino da temática saúde: a Promoção em Saúde, que abrange a estruturação social de acesso a saúde; a Educação em Saúde (EeS) que se preocupa com um enfoque escolar que vise a emancipação dos estudantes a tomar decisões acerca da sua saúde e do ambiente onde vive; e a Alfabetização em Saúde, uma ferramenta para a implementação da EeS. Para que essas tendências sejam aplicadas é preciso que a formação dos profissionais esteja em acordo. Assim, um dos objetivos deste trabalho foi analisar como a formação de professores em cursos de Licenciatura em Ciências Naturais e Ciências Biológicas de instituições de ensino superior na Região Metropolitana de Porto Alegre está desenvolvendo temáticas relacionadas à saúde. Para isso realizamos uma pesquisa de caráter quali-quantitativo que utilizou como método a análise de conteúdo de Bardin (2014). Os documentos analisados foram os Planos Pedagógicos (PPC), os currículos dos cursos e a Base Nacional Comum Curricular – BNCC. Utilizamos também as respostas de um questionário por estudantes em final de curso, além de realizarmos uma revisão bibliográfica utilizando o termo em inglês Health Literacy (HL) usado no Brasil. Os resultados da pesquisa possibilitaram a elaboração de quatro produções textuais científicas. A primeira, artigo apresentado no XI Encontro Nacional de Pesquisa e Ensino de Ciências (XI ENPEC), investigou os PPCs e os currículos dos cursos de Licenciatura. A segunda, analisou as concepções dos estudantes concluintes dos cursos de Licenciatura em Ciências Naturais e de Ciências Biológicas sobre saúde, assim como suas dificuldades em trabalhar o tema. A terceira, analisou a BNCC quanto a forma como a saúde é apresentada nas três versões do documento, se de acordo com a EeS ou ligada ao higienismo e sanitarismo. A quarta, apresentada no II Encontro Regional de Ensino de Ciências (II EREC), fez uma revisão do termo HL nas pesquisas desenvolvidos no Brasil, tentando elucidar como e por quem está sendo feita a pesquisa sobre o tema no país. Observamos que os concluintes dos cursos se sentem inseguros, principalmente para abordar temas como a sexualidade, que transcendem o campo da biologia, e também conceitos relacionados a doenças. Infelizmente, a BNCC, documento que orienta a organização curricular da Educação Básica no país, também não tem uma visão única esclarecedora sobre a saúde. Em seu texto as abordagens se misturam e vários aspectos importantes não são trabalhados. Muito disso se deve a EeS ainda não constituir um campo de pesquisa concreto no Brasil, o que podemos observar quando analisamos que os estudos sobre HL são predominantemente realizados em áreas como a enfermagem, e não a educação. Concluímos que a formação dos profissionais docentes apresenta algumas lacunas, principalmente relacionadas aos contextos sociais e ambientais da saúde e ainda está bastante ligada a concepções biologicistas. / The concept of health used in societies has constantly changed throughout history. Nowadays, the processes of health and sickness are no longer associated in opposition. There are now concepts which encompass the physical, social, and environmental well-being of an individual. From this, other concepts have been developed which organize the education of the health theme: the Promotion of Health, which encompasses the social structure of access to health; Health Education (HE), which concerns itself with a schools focus that aims at the students’ independence in decision making regarding their own health and the environment they live in; and Health Literacy, a tool for implementing HE. For these health education tendencies to be applied, it is necessary for the education of the professionals to be in accordance. Thus, the objective of this work is to analyze how the teachers’ traning in the Metropolitan Region of Porto Alegre has been developing these themes. In order to do that, a quali-quantitative survey was carried out, which used as a method the contente analysis of bardin (2014). The documents analized were the Couse Pedagogics Plan (PPC), the BNCC (Brazil’s National Curriculum Basis). Mixed questionnaires developed from the courses’ pedagogical plans were applied to students in the final stages of these courses, besides performins a bibliografic reviem using the English term Health Literacy (HL) used in Brazil. This resulted in the elaboration of four articles. The first, presented in the XI Encontro Nacional de Pesquisa e Ensino de Ciências, investigated the PPCs and the courses’ curriculum. The second, analyses the conceptions of graduating students of the teaching courses of natural sciences and biology on health, as well as their difficulties in working with this topic. The third, analyses the BNCC regarding on the manner of the presentation of the health topic; whether it is according to the HE, or linked to the social hygiene movement and sanitarism. The fourth, presented in the II Encontro Regional de Ensino de Ciências, revises the term“health literacy” in researches developed in Brazil, and attempts to clarify how and by whom the research on this theme is being made in Brazil. We perceive that The recently graduated students feel insecure, especially regarding themes such as sexuality, which transcend the field of biology, but also regarding human physiology and diseases. Unfortunately, the BNCC, document that guides the curricular organization of Basic Education inthe country, also does now present a singular clear view on health. In its text, the approaches are puzzling, and several aspects are not presented. A lot of this is a consequence of the fact that the EeS still is not a concrete field of research in Brazil, which can be observed when a study on health literacy comes from an area such as nursing, areas connected to health, and not education.We have concluded that the formation of these professionals still has some gaps, especially in social and environmental contexts of health, and still strongly connected to biologic models and conceptions.

A partir da hipótese de que pessoas leigas, ou seja, “não profissionais” de saúde, apresentam baixo conhecimento sobre medicamentos, o estudo teve por objetivo identificar por meio de uma revisão integrativa as variáveis que interferem no letramento em saúde relacionado ao uso de medicamentos por pacientes atendidos em serviços de saúde. Trata-se de uma revisão integrativa que por definição sintetiza resultados obtidos em pesquisas oferecendo informações amplas sobre um tema, e pode ter diferentes finalidades, como definir conceitos, revisar teorias ou analisar métodos de estudos, permite a inclusão simultânea de pesquisa quase-experimental e experimental e combinando dados de literatura teórica e empírica. Realizada no período de janeiro a abril de 2016, foram utilizadas as bases de dados MEDLINE/PubMed, LILACS, SciELO, Google Acadêmico e BDTD. O levantamento abrangeu publicações nacionais e internacionais, em português, inglês ou espanhol, no intervalo de janeiro/1996-janeiro/2016, usando as palavras chave “health literacy”, “health education”, “medication knowledge”, “patient medication knowledge”, “patient”, “medication”, “education” e “patient*participation”. Os critérios de inclusão foram: idade >18 anos, ambos os sexos, qualquer país ou nível socioeconômico; usar técnicas de medir letramento e os de exclusão: estudos com grupos étnicos e camadas sociais pré-definidos; crianças ou seus cuidadores, gravidez, doenças específicas, etc. Foram identificados 637 estudos e excluídos 609 por diversos motivos, restando 28 na amostra final. Os países com maior número de estudos recuperados foram Estados Unidos, Brasil e Espanha, respectivamente, sendo a maior concentração a partir de 2009. Em relação ao delineamento científico dos estudos: 23 eram de natureza quantitativa, 3 qualitativos e 2 mista (quali-quantitativo). As principais questões sobre medicamentos estudadas foram: relação entre o nível educacional e o letramento funcional em saúde, a relação entre conhecimento de medicamentos, adesão à terapia e intervenções educativas. Sobre os métodos para identificar/avaliar o letramento em saúde o TOFHLA, a sua versão reduzida (S-TOFHLA) e REALM foram usados em dois estudos cada um deles. Em 17 estudos os questionários foram desenvolvidos pelos próprios pesquisadores e em três estudos foi também avaliada a adesão pelo Morisky-Green. A pesquisa de letramento em saúde pode auxiliar em programas sobre o uso racional de medicamento, pois parece existir uma correlação positiva entre letramento funcional em saúde e conhecimento sobre medicamentos, e este conhecimento está positivamente relacionado à adesão à terapia medicamentosa. / Based on the hypothesis that lay people, i.e. "non-professionals" of health, have low knowledge regarding medicines, this study aimed to identify, through an integrative review, the variables that affect the health literacy related to the use of medicines by patients treated in health services. This is an integrative review which summarizes results obtained in scientific researches offering comprehensive information on a topic and can have different purposes, such as defining concepts, revising theories or analyzing study methods, it allows the simultaneous inclusion of quasi-experimental research and experimental, combining data from the theoretical and empirical literature. The research was carried out from January to April 2016, during this period, the database from MEDLINE/PubMed, LILACS, SciELO, Google Academic and BDTD were used. The search included national and international publications, in Portuguese, English or Spanish, in the period from January 1996 to January 2016, using the keywords "health literacy", "health education", "medication knowledge", "patient medication knowledge", "Patient", "medication", "education "and" patient*participation". The inclusion criteria were: age>18 years old, both sexes, any country or socioeconomic level; to use literacy and exclusion techniques: studies with pre-defined ethnic groups and social strata; children or their caregivers, pregnancy, specific diseases, etc. 637 studies were identified and 609 were excluded for several reasons, leaving 28 in the final sample. The countries with the highest number of studies recovered were the United States, Brazil and Spain, respectively, with the highest concentration starting from 2009. Regarding the scientific design of the studies: 23 were quantitative, 3 qualitative and 2 mixed (qualitative-quantitative). The main questions related to the studied drugs were: the relationship between educational level and functional literacy in health, the relationship between knowledge of medicines, adherence to therapy and educational interventions. On methods to identify/evaluate health literacy in health, TOFHLA, its reduced version (S-TOFHLA) and REALM were used in two studies each of them. In 17 studies the questionnaires were developed by the researchers themselves and in three studies the adhesion by Morisky-Green was also evaluated. The health literacy research can assist programs on the rational use of medicines since there seems to be a positive correlation between functional literacy in health and knowledge about medicines, and this knowledge is positively related to adherence to drug therapy.

Effective communication is essential for both a satisfying and productive patient-provider relationship. Ineffective communication can lead to many detrimental patient outcomes including a lack of access to care, an inability to navigate the healthcare environment, a decreased adherence to treatment recommendations, and a lack of patient understanding about disease risk factors, prevention, and management. The Healthy People 2010 initiative recognized the importance of communication by including several health communication-related goals in its objectives. A goal of one of these objectives included increasing the percentage of patients who reported that their care providers have satisfactory communication skills. Researchers can gain insight about those barriers that prevent providers from experiencing effective communication by examining the patients' perspectives about communication. The primary aim of this pilot study was to explore urban African American women's perspectives about the communication utilized during clinical encounters with providers via the use of semi-structured interviews. The semi-structured interviews collected data about a variety of topics including participants' breast cancer-related knowledge, attitudes, beliefs, and practices. Data was also collected about participants' clinical encounter experiences, including their comprehension of health information and their communication experiences with medical providers and other types of health care professionals. Any responses that discussed participants' communication experiences with providers, comprehension of health information, or perspectives about factors that could impede or facilitate communication were selected for analysis. In addition to the semi-structured interviews, participants also completed two health literacy assessments in order to gauge their health literacy levels. Women were administered the Rapid Estimate of Adult Literacy in Medicine (REALM), a word recognition assessment, and the Short Test of Functional Health Literacy in Adults (STOFHLA), a comprehension assessment. Eligibility criteria included women who: (1) were aged 50 and older, (2) were English-speaking, (3) able to respond to interview questions without assistance, (4) of African descent, (5) were Harlem residents, and (6) had never received a diagnosis of breast cancer. One hundred women participated in the study. Data about the effectiveness of providers' communication skills, patients' abilities to comprehend health information, patients' communication experiences with various types of health care providers, and preferred sources of health information were collected from the interviews. Open-ended questions were utilized to gather information about factors that women deemed as either impediments or facilitators to effective communication with providers. Collected data from interviews were analyzed qualitatively. In addition to information about participants' health literacy scores from the literacy assessments, final results included demographic information, preferred sources of health information, and information about those factors that women viewed as either impediments or facilitators to effective communication with doctors and with other health care providers both in and outside of the medical appointment. Additionally, findings from the qualitative analysis results were utilized in order to inform the creation of health communication recommendations for providers who treat urban African American female patients.

Canadian society continues to stigmatize individuals with mental illness, despite the prevalence of mental illness in the population, decades of advocacy to combat mental illness stigma, and known negative sequelae of experiences of stigma by people affected by a mental illness. One negative impact of stigma is internalization of negative connotations attached to mental illness. Although there is extensive research on the stigma of mental illness, there is little information specifically about how youth with mental illness perceive the stigma of mental illness and how they respond to it. The current research sought to understand how youth who self-identify as having a mental illness experienced, perceived and internalized the stereotypes, prejudice and discrimination of the stigma of mental illness. A simple content categorization method was used to identify key themes in the transcribed interviews of eleven youth in Vancouver Canada who identified as having mental illness. Qualitative analysis identified that the most frequent perpetrators of public stigma included casual acquaintances, family, friends, school staff, mental health professionals and authority figures. Youths’ accounts linked mental illness stigma with low mental health literacy, delayed mental health treatment and a low quality of life. The findings are considered with reference to implications for prevention of stigma, including enhanced mental health literacy for mental health professionals and the public aimed at increased understanding, sensitivity and empowerment of youth with mental illness and their families. / Graduate

Philosophiae Doctor - PhD / The thesis explores the role of semiotic structuring of health information in relation to language, multimodality and health literacy and the affordances for agentive participation among consumers of two leading South African medical schemes - Discovery Health Medical Scheme (Discovery Health) and the Government Employees Medical Scheme (GEMS). The focus is on who has access to health information, how this information is constructed and what the semiotic health habitat looks like for citizen-consumers. Through a virtual ethnographic approach the thesis explores the design of genres of health information artefacts: application forms, application guides, a comic book, and a variety of website images. The choice to study the commercial package of a private health industry is aimed at finding and defining codes of practice in health communication that could be replicable in the public health sector. A new perspective emerging out of the thesis is how semiotic structuring of style, stance-taking, and choice of registers affects reading positions, and how these determine with what voice citizenconsumers can engage with this information.

Bakgrund: Föräldrar som står inför valet att vaccinera sina barn är inte alla gånger eniga om vaccinets för- och nackdelar. Information om vaccinen cirkulerar på internet och via sociala medier. För läsaren blir det en utmaning att veta vilken given information som är trovärdig. Mötet med vården blir därmed en central punkt där föräldrar kan söka vägledning och få sina farhågor bemötta. Syfte: Syftet med studien är att belysa vilka diskussioner som förs på offentliga forum och Facebookgrupper som kan ligga till grund för tveksamhet eller avståndstagande till det svenska barnvaccinationsprogrammet samt hur mötet med vården beskrivs av föräldrar som avböjer att vaccinera sina barn. Metod: Kvalitativ metod med beskrivande design har använts. Inlägg från en offentlig Facebookgrupp samt sex diskussionstrådar från forumet Familjeliv.se sammanställdes och analyserades med systematisk textkondensering. Resultat: Resultatet påvisar olika komplexa motargument och farhågor om vaccin som ingår i det svenska barnvaccinationsprogrammet. Farhågorna rör biverkningar, vaccinets innehåll och tidpunkten för vaccinering. Vissa upplevde vaccinationen som onödig då det idag finns tillgång till modern sjukvård, hygien och sanitet samt att vaccinet ändå inte ger ett hundraprocentigt skydd. Bristen på tillit för myndigheter och läkemedelsföretag var ytterligare en faktor som visade sig ligga till grund för skepticismen kring vaccin. I mötet med vården beskriver människor känslor av uppgivenhet och undergivenhet. Vikten av att diskutera inför ett beslut kring vaccination utan dispyter poängteras, vilket enligt resultatet är något som inte alltid sker. Slutsats: Ett ökat förtroende för vården måste skapas genom tydligare riktlinjer för kommunikation kring vaccination samt tillgänglighet till information som besvarar människors farhågor.

BACKGROUND: Parent medication errors are exceedingly common, with one child experiencing an outpatient medication error every 8 minutes. In a previous randomized controlled trial where the intervention was carried out under ideal conditions, we examined the efficacy of a pictographic, health literacy-informed medication instruction sheet-based intervention (HELPix) in reducing parent dosing errors. While our intervention was efficacious in reducing errors, reproducing these results in a real world setting, is necessary to examine the true effectiveness of HELPix. OBJECTIVES: 1) To examine the impact of HELPix implementation on parent medication dosing errors. 2) To assess the effect of HELPix implementation on provider use of medication counseling strategies. DESIGN/METHODS: A pre-implementation/post-implementation study design was used in 2 pediatric Emergency Departments (EDs) in New York City, one with planned implementation of the HELPix intervention (HELPix site) and the other a control site within the same hospital network. Subject inclusion criteria included: 1) English or Spanish-speaking parent, 2) child <9 years old, child prescribed a short course (≤14 days) daily liquid medicine, and 3) parent present with the child in the emergency department and received medication counseling. Parents were recruited over the phone; those who enrolled completed a phone interview along with a follow-up in-person assessment (median time to follow-up=15 days). ED providers (residents, fellows, attendings) were also recruited. The HELPix intervention consists of: 1) provider provision of patient- and medicine-specific pictographic instruction sheets, 2) provider use of pictures/drawings as part of counseling to reinforce dosing information, 3) provider demonstration of the dose using an oral syringe, 3) teachback of dose information, 4) parent showback of the dose they plan to give, and 5) provider provision of an oral syringe. At the HELPix site, ED providers were trained in the use of HELPix counseling strategies as well as how to use the electronic medical record (EMR) system to generate the instruction sheets while ordering a prescription. Outcomes assessed were: 1) provider provision of HELPix instruction sheets via web tracking, 2) dosing errors ≥ 20% deviation from prescribed dose, assessed from observation at follow-up visit, 3) provider counseling practices (i.e. use of pictures/drawings, demonstration, teachback, showback, provision of dosing tool) obtained by parent report. RESULTS: A total of 1493 parents were assessed by telephone for eligibility in the pre-/post-implementation phases. 561 parent-child dyads were recruited by phone (284 at HELPix site; 277 at control site). A total of 92% were mothers, 52% were Spanish speakers, 78% were Latino, 16% were Black, and 85% were of low socioeconomic status. Web tracking at the HELPix intervention site indicated that for 58% of the enrolled families in the post-implementation period, providers generated HELPix medication instruction sheets. Compared to the pre-implementation period at the intervention site, parent dosing errors rates were significantly reduced during the post-implementation period (37% versus 16%; AOR=0.3, p<0.001); with an overall Relative Risk Reduction (RRR)=57%, with greatest reductions in errors among those that received HELPix sheets (12% error rate, RRR=68%). Providers at the HELPix implementation site were significantly more likely to use recommended provider counseling strategies post-implementation compared to pre-implementation (pictures/drawings: 37% versus 1%; dosing demonstration: 59% versus 33%; teachback: 24% versus 8%; showback: 33% vs. 13%, and provision of oral syringe 79% versus 25%; p<0.0001 for all strategies). In the non-intervention site, there were no differences in parent dosing error rates, or in provider use of counseling strategies between the pre- and post-implementation periods. CONCLUSION: Implementation of the HELPix intervention resulted in increased provider use of recommended counseling strategies as well as decreased parent medication dosing errors in an urban public hospital setting serving low socioeconomic status families. Use of HELPix supports high quality provider medication counseling and appears to be feasible to incorporate as part of routine Emergency Department discharge practices.

Health literacy has become an important public health concern. Multistage cluster random sampling was used to select 12 450 individuals. Using the 2009 Chinese Health Literacy questionnaire, participants were divided into groups with poor or not poor health literacy status. The knowledge rates for 6 areas of health literacy were determined with the following results: science concept of health (60.0%), literacy for preventing acute infectious disease (66.8%), literacy for preventing noncommunicable chronic disease (51.9%), safety and first aid (66.8%), obtaining and making use of basic medical care (55.3%), and comprehensive health literacy (52.5%). Multiple logistic regression showed that living in a rural area, fewer individuals in a household, younger age, low education, agricultural or rural migrant occupation workers, and low family income were associated with a poor health literacy status. Our results support the use of health education and promotion interventions to improve health literacy in this high-risk population in China.

Bakgrund: I begreppet AKS ingår hjärtinfarkt och instabil angina. Hjärtinfarkt drabbar cirka 25 300 personer i Sverige årligen och för att förhindra återinsjuknande följer ett omfattande sekundärpreventivt arbete med start redan på sjukhuset. Sekundärpreventionen bygger på egenvård där information är en viktig komponent. Informationen berör många områden och syftar till att ge patienten förståelse och medverka till en förändrad livsstil. Cirka en tredjedel av patienterna som haft hjärtinfarkt når de nationella målvärdena för sekundärpreventionen. Tidigare forskning har visat att patienter upplever informationen under vårdtiden som otillfredsställande. Patienter som har dålig förståelse för sin hjärtsjukdom deltar också mer sällan i sekundärpreventiva behandlingsprogram. Personcentrerad vård har positiva effekter på följsamhet till behandling och behandlingens resultat. Individens förmåga att förändra sin situation påverkas också av graden av hälsolitteracitet och empowerment. Syfte: Syftet var att beskriva behovet av information för att erhålla förståelse hos patienter med akut koronart syndrom från insjuknande till hjärtrehabilitering. Metod: Mixad litteraturöversikt med systematisk sökstrategi. Totalt 16 artiklar inkluderades, lika många kvantitativa som kvalitativa artiklar. En integrativ analys av materialet utfördes i syfte att sätta artiklarnas resultat i relation till varandra samt identifiera likheter och skillnader. Därefter identifierades kategorier som beskriver de granskade artiklarnas resultat. Resultat: I resultatet framkom tre huvudkategorier; all information är viktig, information genom hela vårdförloppet efterfrågas och anpassad information är meningsfull. Patienter ansåg inte att någon information var oviktig och information efterfrågades vid insjuknande även om den första tiden vid AKS präglades av chock. Även efter hjärtrehabilitering och två år efter AKS fanns behov av information om bland annat farmakologisk behandling, vilket också var det informationsområde som nämndes i flest studier. En återkommande fråga hos patienterna var varför AKS drabbat just dem. De önskade kongruens i information från olika källor och hade svårt att applicera standardiserad information på sin egna situation. De efterfrågade individuellt anpassad information som gavs när de själva var redo för det och som inkluderade anhöriga. Slutsats: Behovet av information är omfattande och patienter ansåg inte att någon information var oviktig. Även information i ett skede som präglas av chock är efterfrågad och betydelsefull. Individuell information underlättar förståelse för relevans av livsstilsförändringar och möjliggör delaktighet. Informationsbehovet varierade över tid och kvarstod till viss del efter två år. / Background: The term ACS includes myocardial infarction and unstable angina. Myocardial infarction afflicts approximately 25 300 individuals in Sweden annually and to prevent recurrent ACS an extensive secondary prevention effort starts while patients are still in hospital. Secondary prevention builds upon self care where information is an important component. The information concerns a variety of areas and aims to increase the patient’s understanding and participation in lifestyle change. Just about one third of patients suffering from myocardial infarction reaches the secondary prevention goals. Previous research has shown that patients find the information received during the hospital stay unsatisfactory. Patients with a low understanding more rarely participates in secondary prevention programmes. Person centered care positively affects treatment compliance and results. The individual’s ability to change their situation is also affected by the amount of health literacy and empowerment. Aim: The aim was to describe the need of information to obtain understanding in patients with acute coronary syndrome from sickening to cardiac rehabilitation. Method: Mixed literature review with a systematic search strategy. In total, 16 articles were included of which half was quantitative and half was qualitative. An integrated analysis of the material was conducted in purpose of relating the results to each other and to identify similarities and differences. Thereafter categories that describe the reviewed literature were identified. Results: In the result three main categories emerged; all information is valuable, information is requested throughout the entire care chain and adapted information is meaningful. Patients did not find any information unimportant and the information was requested at the initial phase of getting ill although the phase was characterized by shock. Even after cardiac rehabilitation and two years after ACS a need of information about pharmacological treatment existed among others, which was the information area requested in most studies. A reappearing question among patients was why the ACS had happened to them. They wished for congruence in information from different sources and found it hard to apply standardized information to their own situation. They requested individually adapted information delivered at a time when they were ready for it, that also included their family. Conclusion: The need of information is extensive and patients did not consider any information unimportant. Even information in a state characterized by shock is requested and valuable. Individual information facilitates understanding of the relevance of lifestyle changes and enables participation. The information need varied over time and remained after two years to some extent.

No description available.