Int. Handbook of Health Literacy - Ed. Okon, et al. c/o HIFA

International Handbook of Health Literacy

Dear HIFA colleagues*,

I was interested to see the publication of this new book International Handbook of Health Literacy, edited by Orkan Okan and colleagues.

Kudos to the editors and authors, who have made the content freely available here:

http://www.oapen.org/viewer/web/viewer.html?file=http://www.oapen.org/document/1005225

The early pages note: 'Besides the ongoing and tremendous public health efforts addressing health literacy in Europe, North America and the Australasian region, there is only little to no work still in Africa, very little in the Middle East, India and South America, and also very little in Russia and the Slavic countries in Europe.' Nevertheless, 'health literacy has been placed high on the agenda in the WHO Southeast Asia Region via the introduction of a health literacy toolkit for low- and middle-income countries to help communities to develop their own solutions'.

There is a chapter on 'A stated preference discrete choice health literacy intervention framework for the control of non-communicable diseases (NCDs) in Africa' by Kenneth Yongabi Anchang and Theckla Kwangsa Mbunwe.Selected extracts below:

--

The function of health literacy in ensuring a healthy condition in individuals and communities is especially relevant in Africa, which is plagued with high endemic diseases, and in settings in which healthcare resources and infrastructure are, for the most part, limited (O’Sullivan et al, 2003; Remais et al, 2012).

Current health promotion interventions in current use in Cameroon and Africa at large are inadequate as they are too exo-centric in style, language and construction – a health literacy intervention culled from a very exo-centric set-up and tailored for the European context, for instance, may not be transferable to Africa.

Health promotion exercises in Africa are currently too linear in application. Linearity here means providing a solution to a certain problem without taking into account the contextual barriers of its wider implementation, which may be entirely different from what the researcher or facilitator wants to provide, as well as its perceived urgency and necessity.

Individuals in Africa for the most part grow up either with no health knowledge, little health notion or wrong health information that has been passed on from their parents. Some health information is misconstrued and parcelled into local beliefs systems and superstitions, thus making it difficult to dispel over time and space.

In a community whose priority is potable water, a health literacy intervention on curbing diabetes and cancer may not be quickly be accepted and sustain. This urgent need may mask the need for a literacy programme that addresses hypertension or cancer. To this effect, a joint intervention approach of providing potable water and then educating people on hypertension and cancer is the way to go.

Interventions for health literacy and promotion must always be built first on the ‘available local health knowledge’ that might, for the most part, differ from what researchers and health literacy providers would consider as evidence or knowledge.

Best wishes, Neil
HIFA

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Some reflections:

This is a very welcome text and step for health literacy. Even in a tome of 766 pages (I have not read it all) it is difficult to address all themes of significance within the field; and in turn please everyone. That is the case here.

It's not that I've got an axe to grind: I've two axes - in #h2cm.

How far is it between lifespan and life course on one-hand; and health career and life chances on the other? Especially when these are examined critically in the context of the sustainable development goals and the social determinants of health.

Chapter 42
Salutogenesis and health literacy: The health promotion simplex!
Luis Saboga-Nunes, Uwe H. Bittlingmayer and Orkan Okan

When examining the scientific discourse around health literacy, we are surprised to see that while scholars have been extensively discussing the ‘literacy’ component of the composed term ‘health literacy’, discussion of the ‘health’ element is hardly to be found. ... Today, broad literacy concepts addressing functional, interactive and critical literacy are added to the health literacy discourse, giving way to multiliteracies and social literacies to merge with health literacy (see Chapters 14, 18, 36 and 39, this volume). This was not only the impetus for multiple research strains that broadened the theoretical and conceptual discussion, but also facilitated the uptake of health literacy by various research disciplines, such as healthcare, medicine, public health, education, psychology or sociology (p.649).

The need to rethink, and maybe also construct, the health component of the health literacy concept and its social representation needs to consider that health can be understood and approached in different ways (p.650).

As a volume of recent developments in health literacy, that includes an Integrative Model of eHealth Use (p.277, 278) there is (imho) a need for a generic conceptual framework upon which to base the local, global and glocal theory, practice, management and policy of health literacy.  Not only that but how health literacy relates to other forms of literacy. If not you are more likely - conceptually bound - to loose your footing socio-technically. As Saboga-Nunes et al. note, a normative framework is needed (p.651). Negotiating forms of literacy invariably entails questions about design and in chapter 39 avatars extends this to ethics. Hodges' model can readily encompass and incorporate simplicity, continua, complexity: health and literacy.

There is much more here in this great resource, to which I will return e.g. Chapter 43, Figure 43.2 Research traditions.

*My source

Hodges' model DoB = early 1980s. So it's obsolescent?

No Way!

The model is more relevant than ever...

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

The 'discerning' customer

P PR PRI PRIN PRODUCE - PRODUCT chuck, drop, dump, bin. throw, fling, tip DISPOSABLE - DURABLE [left] 20% ink? How many ink cartridges do you need? How many blades...? ---------------------------- engineering

The discerning market?

"In passing the "Hamon Law," as it's known, in 2014, France became the first country in the world to open the door to sanctions for the widespread manufacturing practice of "planned obsolescence" - creating products pre-designed for failure at some point so that consumers will be enticed to replace them. Specifically, the legislation outlaws "the use of techniques whereby the person responsible for placing a product on the market deliberately aims to reduce its lifetime in order to increase the replacement rate." David Schrieberg

Forbes.com David Schrieberg - Landmark French Lawsuit Attacks Epson, HP, Canon And Brother For 'Planned Obsolescence'

Halte à l’Obsolescence Programmée (HOP)

My source: Sage, A. French have last word on printers, The Times, September 20, 2017, p.40-41.

Musings on Integrated Care: A Visible and Invisible Matter

If measures for clinical outcomes, health literacy, patient satisfaction, benefits and many more present a challenge then a measure for integrated care falls into the category of a very steep peak.

It's a nebulous concept, we know what we mean, we recognize the principles and we even allow for variation in what integration and integrated care means for different people.

The January 2012 integrated care report by The King's Fund and Nuffield Trust (previous post) had me thinking about some of the ingredients that might contribute to measures of integrated care and our efforts to record it. What instruments and formats do we need - what mix of microscope (individual), telescope (population), strobe (snapshot), time lapse (series), objective - subjective? Some elements  then (in no particular order):

Breadth of the 'episode' (primary-secondary-tertiary-palliative)
Breadth across an individual's lifespan - as needs change and assuming person-centredness
The number of systems
  information - e-records
  commissioners
  datasets: total, number of gatherers, submissions of data, local, regional, national, global
Demographics: population profiles, housing provision, local need
The number of people - individuals involved
The number of 'responsible' organisations
 Primary organisational efficiency - Lean Standing?
The number of teams
The number of policies (policy touches)
 The number of interviews, assessments (paper, electronic, formal), care plans, reviews
Opportunities for communications
  potential
  actual
  media forms
  delivery forms (inc. technologies)
Number of handovers - communication
  weighted according to type?
Patient experience - measure
 (that is holistic across physical, mental health, social care?)
 staff attitude
 therapeutic relationship engagement (quality)
 therapeutic modalities (quantity)
 educational content, materials provided / information gains
 number of patient (carer) choice points (potential - exercised)
Incidents of positive risk taking
Increase in health literacy as this is a policy priority
 - a priority linked to integration of disease response and  prevention
Co-ordination effectiveness
Self-care - autonomy, decision making
Patient (carer) as budget holder
Patient as record holder and direct data source (telecare - data entrant)
Carer involvement
Health : Social care (main dependency, ratio, index)
The number of disparate care philosophies encountered
Diagnoses
Diagnostic investigations complex (location, time)
Declarative success: agreed plan - success?
The geographic encounter footprint: distance, travel, transport, environment
Duration of engagement
Follow-up - care continuity care
Care Disintegration - safety
 care interrupts^# (falls, errors)
 relapse, readmission
 dependency (deferred discharge)
Influence of public engagement - involvement in local health services^*

While many of the above might qualify as candidates for a measure of integrated care, you have to wonder whether in order to measure integration you must measure everything else. It appears here at least that integration and complexity are closely related. Several of the items above might individually represent - and no doubt do - indices of various kinds that also beg definition (e.g., co-ordination, success, philosophies, episode ...).

Although I've referred to 'numbers' you could no doubt refine the list by consulting the literature and considering the quantitative : qualitative mix.

Perhaps the key indicator of integrated care isolates the primary concepts for the person concerned and then fuses those within the INTERPERSONAL and POLITICAL care domains (policy touches would be one example)?

^*How does a measure of integration incorporate those socially excluded?
^#For want of a better word. 

The Longitude and Latitude of health c/o BBC [ and h2cm? ]

The axes of Hodges' model, the bisection of HUMANISTIC ----- MECHANISTIC by INDIVIDUAL----GROUP provides a location in the sense of 'x' marks the spot. The axes form a reticle a cross hair scale from which things might be identified and located.

You could say that the axes lay out conceptual and contextual lines of longitude and latitude. Just to recap the full title of the model is:

Hodges' health career 
- care domains - model

The operative word here is 'career' referring to life chances. Like the global map with its universal application, h2cm can be used from birth, teens, adulthood and seniority.  H2CM can capture snapshots of an individual's life - (w)rite up to end of life: whatever the conceptual resolution. Think of a stacked series of H2CM frames.

A lifetime view of health is what researchers pursue in longitudinal research studies. There was a programme on Radio 4 this a.m. which I've just enjoyed Science: From Cradle to Grave with Ben Goldacre and there's the prospect of more to follow (Generations Apart).


Since the still ongoing 1946 cohort study there have been several others with the recruitment of parents and children for a 2012 cohort to be commenced. What I found particularly interesting is the way the emphasis of the cohorts in-between has emphasized medicine then shifted towards the needs of the social scientists. The programme highlights how given the increasing complexity of cause and effect, rapid developments in genetics, and the environment ... striking a balance is very important.

It certainly is - across the spectrum of individual health, community, population and ultimately global health.

Addendum (c/o Catherine Coleman LinkedIn):
Harvard researchers recruiting 100,000 nurses!

RNs and LPNs (US and Canada only) age 22-45 join Harvard researchers in the largest, longest study of women's health.

The Nurses Health Study (no longer) invites you to become part of its newest group. Participation only requires one online survey a year.

Since 1976, more than 200,000 US women in Nurses Health Study 1&2 have influenced what we know about cancer, diet, heart disease, and hormones.

In only an hour a year, you will be able to make a difference for your colleagues and for future generations!

Additional links:

UK Longitudinal Studies Centre (ULSC)

Understanding Society: Early findings from the first wave of the UK’s household longitudinal study

ESRC: The future of longitudinal studies
Lifelong Health & Ageing: LHA

National Survey of Health and Development: NSHD

Globe image source: http://www.worldatlas.com/aatlas/imageg.htm

As one chapter closes another opens ...

Even if that chapter number is 15, 20 or even the penultimate - when it comes to older adults entering or residing in residential and nursing care facilities this is not just an excuse for a euphemism roll call:

'the end of the road',
'Club Medicated',
'Eldergarten',
'the final chapter', ...

Residents and their families all too frequently find that care needs are not static. The book is far from complete and ready for review. Their health (and we had better add well-being) status changes constantly. A care home's ability to cope and meet an individual resident's care needs adequately in safety without comprising other residents and staff must be continually evaluated. A person's condition may improve psychologically and yet their physical health calls for more nursing care that is physically driven; or vice versa. Trying to anticipate care needs what can be several years in advance is very difficult.

It is one of those intangible questions - as to how many care homes carry dual nursing registrations and so will be able to provide not only the current level of care, but future elderly mentally infirm care needs if required. The reasoning being that an internal move is far less traumatic than finding a new home? So, what is the state of care moves?

If we have no information about this
then we know nothing.

What might this tell us about an individual's health career and the health career - likely care trajectory - of conditions such as dementia?

Of course our assessments are, and can only be determined (a keyword if there ever was one) in the here and now. This is the priority, while also trying to anticipate the future if we possibly can.

There is undoubtedly a great need for research here. Research that spans the many care dimensions which residents, their families, care home staff and other multidisciplinary team members must balance. These include quality of life, physical, mental and spiritual care, economics, demand and supply and our very notions of care quality and holistic care.

Only then - for all unique individuals - can we write an epilogue that befits each of those preceding chapters.

Image: M.C. Escher crystal ball

A call for applications for the 3rd phase of Lifelong Health and Wellbeing (LLHW)

Advanced Notice

A call for applications for the third phase of Lifelong Health and Wellbeing (LLHW) will be announced in early May 2010.

Lifelong Health and Wellbeing is a major cross-council initiative involving AHRC, BBSRC, EPSRC, ESRC and MRC in partnership with the UK health departments. LLHW supports multi-disciplinary research addressing factors across the life course that influence healthy ageing and wellbeing in later life.

The initiative aims to lead to improvements in health and quality of life in later life, inform policy and practice and increase capacity building in ageing related research.

Phase 3 will invite high-quality innovative multidisciplinary applications that focus on major ageing-related challenges faced by the UK in the 21^st century. Proposals will be welcome from multidisciplinary teams in the areas of, but not restricted to the following:

• Mental Health and Wellbeing including quality of life, preserving cognitive function and exploiting mental capital
• Resilience for successful ageing: from cell to society including life course influences, markers for ageing and processes of ageing
• Age-related conditions, including frailty and interventions to promote independence in later life.

Structure of the call
Funds will be available through two modes of support:

LLHW Research Grants - up to £10m will be available for multi-disciplinary research awards from £300k up to £2.5m over three to five years.

LLHW Pilot Studies - a total of £2.5m to fund up to 10 pilot or feasibility studies for a maximum of two years, aimed at informing the development of future cross-disciplinary research proposals.

Selection Criteria
Successful proposals will be of strategic importance, be truly multi-disciplinary, encompassing the remits of more than one Research Council, and have clearly articulated and robust methodology and design.

Further information
Updates and further information about phase 3 can be found on the website:
https://mrc.ukri.org/research/initiatives/lifelong-health-wellbeing/

My source:
Charlotte Jones
NDA Programme Secretary
The University of Sheffield
Department of Sociological Studies
Elmfield, Northumberland Road
Sheffield, S10 2TU, UK

Hodges' model - Place, Space and Spans ...

Before you ask: What is Hodges' model?

Consider the model's full-title:

Health Career - Life Chances

Life span

Space - Place

Ask yourself: Where am I (we)?

So, what song to sing?

The Beatles: Here There Everywhere

Photo: https://futureworldblog.wordpress.com

Being @work2work and out-of-reach innovation

Apparently a web year (not to be confused with Internet time) is compressed in comparison to a calendar year. The rate of change on the web and technology in general is rapid; with health and social care constantly cited as key beneficiaries of technical and informatics developments.

In order to be beneficiaries though
what does this mean in terms of time?

It can be argued that to take full advantage of the 'latest and greatest' informatics (ICT) developments in health and social care means being in the early or late majority of adopters - the mainstream. Whichever way you define benefits (and measure them!) one of the factors and qualities must be time? But given the rate of change of technology just how much benefit can be accrued if you are late to the party?

There are articles and websites that extol the initiatives of Web 2.0 within health and e-Health, to the extent that this trend anticipation is labelled Health 2.0 - for example. You can see how the new Health 2.0 applications and personal health records will be the preserve of the new and nimble.

Back on the 'Trust' shop floor - if you try to access anything connected with social networking any e-mails end up in the corporate spam folder and social networking sites and blogs are blocked.

Well what do you expect?
We are @work2work
and that is not in dispute!

There are various studies that show what people get up to when at work with (free) web access. Maybe the filters are also not up to snuff?

Without some special provision - a secure sandpit for experimentation - there's a major worry that innovation and creativity could be marginalised.

This (vital) digital lockdown could mean that
while health and social care services deliver
outreach services, ...
innovative e-Health / ICT developments remain
out-of-reach.

Definition of e-Health: "Having your cake and eating IcT"

To follow: The four other labels for Hodges' model.