Receiving health information and implementing recommendations are important factors for household development. However, it is not uncommon for people in the developing world to disregard information and not change their behaviour. The objective of this study is to contribute to the understanding of how context and knowledge determine health practices and behaviour in order to provide an explanation for why people do not follow health recommendations that would improve their health and the development of their household. In a field study in the Ribáuè district of Mozambique, an ethnographic approach using semi-structured interviews with individuals on the household level as well as stakeholders from both the public and private sector was used to gather the data. New institutionalist theory and health literacy were applied to structure the findings, analyze the data, and provide an explanation for the phenomenon described above. Conclusions from the study demonstrate that individuals must go through a process of obtaining, understanding, and evaluating health information before implementing recommendations. However, the socio-economic, and cultural circumstances in which a person lives can inhibit this process. Furthermore, regulative, normative, and cultural- cognitive underpinnings have proven to both resist and influence changes in health behaviour.

The concept of health literacy finds its origins in the field of education. In its brief history the definition, structure, and direction of the field has changed dramatically and has emerged as a multidisciplinary endeavor full of discipline specific manifestations, most recently, public health literacy. Using bibliometric and citation analyses, this study investigated the field of health literacy from the first use of the term in 1974 to the present year, 2010. A range of databases from the various fields that have contributed to the field were searched using the keyword string, “health literacy.” Data was organized, cleaned and parsed using EndNote X3. A free, Java-based application, CiteSpace, was utilized for visualization of author co-citations, document co-citations, keyword co-occurrences, and document co-citation clusters. This research presents researchers, librarians and those interested in the field with information to efficiently conduct literature searches and understand the structure of the field. In addition, this research provides insight into how and where the field may be progressing in terms of multi- and interdisciplinary research.

The process of creating and using participatory photonovels can empower immigrant ESL speaking women and also act as a tool to educate these women about a specific health topic. This was a qualitative case study that was conducted at an immigrant society in an urban center in British Columbia. The ESL speaking immigrant women in this study created a photonovel called From Junk Food to Healthy Eating: Tanya’s Journey to a Better Life. The findings of this research reveal some of the health experiences of ESL speaking immigrant women in Canada. The results also contribute to the growing body of knowledge that discusses effective or ineffective means to educate ESL speakers about health by improving their health literacy. Most notably, however, the photonovel project engaged the women in an educational process that raised their critical consciousness.

As suicide is a leading cause of death for young people, child and youth care professionals are likely to encounter adolescents who are contemplating ending their lives. Recognizing and responding to the needs of a suicidal adolescent is challenging for the professional as they attempt to balance their relationship with the young person while simultaneously following customary rules of engaging in situations involving suicide. The need for theory to deepen understanding of child and youth care professionals’ mental health literacy practices with suicidal adolescents led to this grounded theory study. Derived from interviews with 19 participants including child and youth care professionals, supervisors at youth-serving agencies, educators in schools of child and youth care, and textual analysis of policies, assessment tools, and curricula, the Balancing Perimeter and Proximity process was identified as the core category in the analysis. The Balancing process suggests professionals’ mental health literacy practices fluctuate between circling care and circling defensively. Circling defensively refers to the professional taking up literacy practices that establish a perimeter of protection; whereas literacy practices within circling care position the professional in relational proximity where they connect and attend to the adolescent holistically. The theory extends current conceptualizations of mental health literacy, and contextualizes professionals’ practice in identifying the conditions influencing the Balancing process, thereby providing an understanding for how existing structures (e.g., suicide education, agency policies) influence child and youth care professionals’ mental health literacy practices with suicidal adolescents. / Graduate

The process of creating and using participatory photonovels can empower immigrant ESL speaking women and also act as a tool to educate these women about a specific health topic. This was a qualitative case study that was conducted at an immigrant society in an urban center in British Columbia. The ESL speaking immigrant women in this study created a photonovel called From Junk Food to Healthy Eating: Tanya’s Journey to a Better Life. The findings of this research reveal some of the health experiences of ESL speaking immigrant women in Canada. The results also contribute to the growing body of knowledge that discusses effective or ineffective means to educate ESL speakers about health by improving their health literacy. Most notably, however, the photonovel project engaged the women in an educational process that raised their critical consciousness.

While there is extensive research on adult conceptualisations of mental illness, as well as on children’s understanding of physical health and illness, research on children’s conceptualisations of mental illness is limited. The primary aim of this thesis is to provide a detailed account of children’s and adolescents’ conceptualisations of depression. In the first study, individual semi-structured interviews with primary school pupils (N=105) from two age groups (mean ages: 8.9 and 11.8 years) were conducted, with the use of depression and control vignettes, to elicit children’s depression concepts, help-seeking intentions and desired social distance. Children’s depression conceptualisations were organised according to the common-sense model of illness representations (CSM). Quantitative content analysis was performed to allow for descriptive analysis; in turn, inferential statistics were used to examine age, gender and self-reported direct and indirect experience differences. Children differentiated between depression and control vignettes, however did not spontaneously label depression or recognised the mental health nature of difficulties. Children provided a wide variety of possible causes that reflected common risk factors for depression, primarily referring to interpersonal factors. Children considered negative consequences of untreated depression, and identified that depressed characters need help. They suggested numerous sources of help, which were mainly informal. Children considered depression to be curable and would seek help primarily from parents if depressed. Older children showed more sophisticated conceptualisations of depression. No substantial gender or experience differences were found. Subsequently, a single session school-based mental health literacy intervention on adolescent depression, adapted from an intervention created by NHS mental health professionals, was developed, using the mental health literacy and CSM frameworks. The second study consists of a pilot evaluation of the intervention, using a controlled before and after design, to examine the effect of the intervention on young people’s depression literacy, help-seeking and help-providing intentions as well as social distance. Young people’s depression literacy was measured by the Adolescent Concepts of Depression Questionnaire (ACDQ), developed for the purposes of this study. Exploratory factor analysis was conducted to indicate the factor structure of the ACDQ, which was in turn used to examine participants’ baseline depression literacy and the effect of age, gender, current depressive symptomatology and direct/ indirect experience with depression and other mental illness (Study 2a). In turn, the effectiveness of the intervention is presented (Study 2b). 339 adolescents (mean age: 13.4 years, 168 female) were allocated to either the intervention (N=171) or a control group (N=168), and completed the ACDQ one week before and following the intervention. Mixed results were found for gender, depressive symptoms and experience differences. Mixed ANOVA was conducted between time and group; the results show that the intervention was effective in informing young people’s depression literacy (ACDQ total score), and specifically in young people’s knowledge of treatment options for depression (treatment subscale), perceived curability of depression (curability subscale), symptom recognition, help-seeking and help-providing intentions. No significant improvements were found for social distance, perceived helpfulness of sources of help, and two of the ACDQ subscales. The contribution of this thesis lies upon the detailed examination of children and adolescent depression conceptualisations, adding to the limited evidence base, especially in children’s mental health literacy. The pilot evaluation of the intervention is promising, and upon re-evaluation could be standardised and implemented in Scottish schools. Implications for clinical practice and mental health literacy are also discussed.

Background: Health systems around the world are facing significant shifts in demographic profiles due to increasing ethnic, cultural and linguistic diversity of populations they serve. However, the provision of health care and health services in the language of the minority has been difficult and inconsistent. The concept of the health-literate organization has been developed amid growing recognition that system changes are needed to align health-care delivery with the needs, skills, and abilities of the population. Despite the recent proliferation of research on health literacy, studies of organizational health literacy are still uncommon. Objective: This dissertation addresses the concept and practical application of “organizational health literacy” in the context of an active offer of health services in French in Ontario, Canada. I attempt to answer the question “How can health literacy advance the development of health-care designs that are responsive and accessible to official language minority?” Methods: My research consists of a three-part project that used health services research methodology and has been accomplished in academic partnership with the French Language Health Services Network of Eastern Ontario. I first conducted a review both of the literature on health literacy in linguistic minorities and of the content of organizational health literacy guides. Using a practical example of an active offer of French-language services in Ontario, I applied the organizational health-literacy framework in order to examine the strategies used by health-care organizations to provide for the active offer of health services in French. My analysis focuses on health-literacy dimensions (e.g., access and navigation, communication), quality improvement characteristics (e.g., assessment, improvement actions), and also organizational-level changes (e.g., administrative strategies, direct client services, governance). A focus group of health-care administrators provided a unique insight into the planning and implementation of the active offer and organizational health literacy and associated challenges. Results: Overall, my results show that, although organizational changes may be implemented with the purpose of improving the quality of care by providing linguistically appropriate services, these changes are largely insufficient to achieve this goal. Conclusions: The concept of organizational health literacy has not yet received the attention it deserves, but its relevance is clear: Health-care organizations must be health-literate to be able to address healthcare needs of their diverse patients. There is a significant gap between where health services are and where they ought to be to satisfy the designation criteria for the active offer of services in French. The concept and the novel theoretical framework of organizational health literacy offers the potential of improving and strengthening the process of designation and planning of an active offer of health services in French.

Magister Curationis - MCur / Background: Health literacy is defined as the degree to which an individual has the capacity of obtaining, processing, and understanding basic health information and services needed for one to make appropriate decisions with relation to health. Health literacy is currently emerging as a major determinant of health outcomes yet it is not receiving enough attention, especially among health professionals. It is now considered a stronger predictor of health outcomes than social and economic status, education, and gender. Since nurses play a major role in providing healthcare information to patients and clients, it is imperative that nurses be prepared to face the challenges presented by individuals with poor health literacy skills. The nursing discipline is the largest segment of the health-oriented workforce and therefore, nurses have the largest responsibility of providing patient education, however, there are no education efforts targeting health professionals with regard to health literacy in South Africa. It is, therefore, imperative to establish the knowledge and experience of nurses in training in order to forge a way forward in nursing education. Aim: The overall aim of the study was to establish the health literacy knowledge and experiences of bachelor nursing students at a University in the Western Cape. Methodology: A quantitative, descriptive survey design was applied and data collection was carried out using a self-administered questionnaire. Total population sampling technique was done, the final sample was (n=82) of the fourth-year nursing students. Data was analyzed using SPSS version 23, descriptive and inferential statistics were employed. Ethics: Ethical approval was granted by the ethics research committee, thereafter permission to conduct the study at the University was obtained from the Registrar and the Director of The School of Nursing. The researcher maintained the principles of anonymity and confidentiality throughout the study. Participation was voluntary and informed consent was signed by the respondents. Results: The study found that bachelor of nursing students in Western Cape exhibited satisfactory health literacy knowledge as measured by the questionnaire, the score was 73%, with a cut-off of 70%. Knowledge gaps however existed in some areas - for example with regards to the impact of low health literacy on patient health outcomes and identification of patients with low health literacy. Their health literacy experience was, however, lacking, with students only reporting some experience in the use of written materials in providing patient education. There was a weak negative, but statistically significant relationship between health literacy knowledge and experience. Conclusion: Exposure to health literacy within the nursing curriculum needs to be more comprehensive, since the results portray that the emphasis of health literacy in the curriculum failed to have an effect on the health literacy knowledge scores, deeming it insufficient.

Over the past several decades the number of youth living with a chronic health condition has drastically increased. A chronic health condition can be defined as an illness that lasts three months or more that can be controlled but not cured (Centers for Disease Control and Prevention [CDC], 2010). Although there is existing literature on youth with chronic health conditions, there are very few studies that examine the levels of health literacy, resiliency and support/advocacy within this population. The current study is a secondary analysis that utilized data collected from the 37-item Youth Health Literacy and Resiliency Scale (HLRS-Y version) in order to determine if there was a relationship between different categories of chronic health conditions and reported levels of health literacy, resiliency and support/advocacy. Ages of participants were also examined to determine if there was an interaction effect. The study consisted of a 143 youth between the ages of 13- 21 years old. All participants completed the Youth Health Literacy and Resiliency Scale (Bradley-Klug, Shaffer-Hudkins, Lynn, DeLoatche, & Montgomery, 2017) and were placed into one of three categories of chronic health condition: 1) Endocrine, nutritional, and metabolic diseases, 2) Diseases of the musculoskeletal system and connective tissue, and 3) Diseases of congenital malformation, deformations, and chromosomal abnormalities. The data were analyzed to determine if there was a difference in the reported constructs of health literacy, resiliency and support/self-advocacy among the three different categories of chronic health illnesses. The results indicated that there was a significant relation between support/self-advocacy and age. As participants increased in age, they reported having lower levels of support/self-advocacy. This finding was significant regardless of the category of chronic health condition that the participants were placed in. There were no other significant findings for the other constructs. This study contributes to the literature because it is one of few to examine health literacy, resiliency and support/self-advocacy levels among youth with chronic health conditions. In addition, it is the first study aside from the pilot, to utilize the HLRS. The findings from this study can be utilized to drive support/self-advocacy interventions for youth with chronic health conditions.

Human immunodeficiency virus (HIV) is a virus that affects the body’s immune system (Centers for Disease Control [CDC], 2016a). HIV is a worldwide epidemic and disproportionately impacts youth in the United States. Youth living with HIV (YLWH) face significant mental health problems, namely depression, anxiety, and posttraumatic stress disorder (PTSD) with rates of these disorders discrepant from those in the general population. In addition to psychological difficulties, health literacy is another factor that influences individuals with HIV and is a priority of research with adolescents (Kalichman et al., 2000; Manganello, 2008). The National HIV/AIDS Strategy: Update 2020 (White House Office of National AIDS Policy, 2015) identified youth, ages 13 to 24 years, as a key population needing broad support not only for HIV prevention but also engagement in care including improving mental health and health literacy. The current study explored the extent to which YLWH were health literate in addition to the extent to which they exhibited psychological symptoms of depression, anxiety, and posttraumatic stress disorder. Furthermore, the study examined the extent to which health literacy and psychological symptoms were associated with health outcomes. A total of 145 YLWH between the ages of 13 and 25 years participated in the study. Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), Generalized Anxiety Disorder-7 Item Scale (GAD-7; Spitzer, Kroenke, Williams, & Lowe, 2006), Primary Care-PTSD Screen (PC-PTSD; Prins et al., 2003), and Brief Estimate of Health Knowledge and Action-HIV Version (Osborn, Davis, Bailey, & Wolf, 2010). Of the 145 participants, 103 completed the CES-D, 144 completed the GAD-7, 131 completed the PC-PTSD, and 102 completed the BEHKA-HIV. In addition, participants’ biological markers of immune functioning (i.e., CD4 count and viral load) were obtained from medical abstraction. Results indicated the sample reported high levels of symptoms of depression, anxiety, and PTSD. Thirty-five percent of participants screened positive for depressive symptoms, 26% screened positive for anxiety symptoms, and 21% screened positive for PTSD symptoms. Participants had a moderate amount of HIV knowledge and the majority reported taking their medications under most conditions. Age was a significant predictor of CD4 count and viral load such that increasing age was associated with worse immune system functioning. Educational attainment was a significant predictor of CD4 count and to a lesser extent viral load indicating that greater education was associated with better immune system functioning. There was an interaction between mode of transmission and psychological symptoms. For perinatally infected youth, greater psychological symptoms were associated with a decline in CD4 count. The same decline was not seen for behaviorally infected youth. Health literacy (knowledge and action) added significantly to the explanation of the variance in viral load. Decreasing action scores were statistically associated with an increased likelihood of having a detectable viral load. These findings point to the need for prevention and intervention mental health services for YLWH. Future research should determine prevention and intervention strategies for mental health issues with YLWH in particular. Additionally, health literacy is an important factor that should be addressed by practitioners working with YLWH. More research needs to be conducted to determine the best way to measure health literacy in YLWH and how to intervene with improving health literacy.