Apoio social on-line: questões teóricas, metodológicas, benefícios sociais e recomendações / Online social support: Theoretical and methodological issues, social and health benefits, and recommendations

RESUMO As plataformas de apoio social on-line (fóruns de discussão, grupos no Facebook, salas de chat etc.) são cada vez mais utilizadas por pessoas com doenças crônicas e seus cuidadores, que desejam falar com pessoas com problemas semelhantes fora da sua rede tradicional. O objetivo desta revisão de literatura foi apresentar as intervenções de apoio social on-line descritas na literatura científica recente, para: 1) orientar as organizações que desejam desenvolver tal intervenção ou melhorar um programa existente; e 2) identificar caminhos de pesquisa para pesquisadores e recomendações para planejadores de saúde. Foram analisados 59 artigos científicos apresentando intervenções de apoio social on-line (2006-2016), usando uma grade enfatizando as concepções teóricas de apoio social, as plataformas web utilizadas e suas funcionalidades, o processo de design e avaliação das intervenções, os métodos de participação e animação estabelecidos pelas organizações, os impactos documentados das intervenções nas populações e, finalmente, as vias de pesquisa e as recomendações para os planejadores de saúde. Uma metodologia narrativa foi usada para destacar os desafios de desenvolvimento e implementação para apoiar nossas organizações parceiras no desenvolvimento ou melhoria de suas intervenções de apoio social on-line.

ABSTRACT Online social support platforms (discussion forums, Facebook groups, chat rooms, etc.) are increasingly used by people living with chronic diseases and their caregivers, who aspire to exchange with people living with similar problems outside their traditional network. The objective of this literature review is to present online social support interventions described in recent scientific literature, to: 1) guide organizations that want to develop such intervention or improve an existing program, and 2) identify research avenues for researchers and recommendations for health planners. Some 59 scientific articles presenting online social support interventions (2006-2016) were analyzed using a grid emphasizing the theoretical conceptions of social support, the web platforms used and their functionalities, the design process and evaluation of the interventions, the methods of participation and animation set up by the organizations, the documented impacts of the interventions on the populations, and finally the lines of research and the recommendations for the field planners. A narrative methodology was used to highlight development and implementation challenges to support our partner organizations in developing or improving their online social support interventions.

Mídia e cultura jornalística na comunicação em saúde / Media and journalistic culture in health communication / Cultura periodística y mediática en la comunicación en salud

Este artigo examina a mídia e a cultura jornalística na comunicação em saúde, concentrando-se mais especificamente nas formas como os jornalistas lidam com a saúde na mídia. A análise é baseada em vários estudos realizados com jornalistas e vários grupos populacionais no Canadá e no Brasil. O artigo demonstra que há certa consistência no tratamento jornalístico dos cuidados de saúde e que esse tratamento nem sempre é em benefício da sociedade. A profissão do jornalismo está mudando rapidamente e, como aspectos importantes desse cenário, podem-se citar: o rápido fluxo e a oferta abundante de informações, o ritmo da produção de notícias e o lugar das demandas dos cidadãos. Tais aspectos demonstram que há uma profunda transformação da produção de informações realizada por jornalistas; além disso, as pessoas tendem a recorrer mais à mídia do que aos profissionais de saúde para obter informações sobre os riscos e, portanto, estão expostas às normas sociais em relação à saúde. Considerando a influência da mídia na comunicação em saúde, este artigo questiona a mídia e a cultura jornalística por meio de uma lente ética, abordando a responsabilidade do jornalista em relação à cobertura da mídia, à produção da notícia (fonte, tratamento e tom), à convergência e seu efeito sobre a saúde da população. Como principais achados, apontamos que o jornalismo precisa investir em uma comunicação em saúde mais efetiva, que esteja compromissada com o bem-estar dos cidadãos, por meio de tratamento e detalhamento de informações que permitam o amparo do processo de tomada de decisões por parte da população. (AU)

This paper examines the media and journalistic culture in health communication by focusing more specifically on the ways journalists deal with health in the media. The analysis is based on several studies carried out with journalists and various population groups in Canada and Brazil. This paper demonstrates that there is a certain consistency in the journalistic treatment of healthcare and that this treatment is not always to the benefit of society. The profession of journalism is changing rapidly: the rapid flow of information, the abundant supply of information, the pace of news production, the place of citizens' demands are some of the phenomena that have transformed the production of information carried out by journalists. Besides, people tend to resort more to media than to healthcare professionals to obtain information about risks and are therefore exposed to social norms regarding health. Considering the influence of media in health communication, this paper questions the media and journalistic culture through an ethical lens by addressing the journalist's responsibility regarding media coverage of health, production of the news (source, treatment and tone), convergence and their health effect on the population. As main findings, we point out that journalism needs to invest in more effective health communication, which is committed to the well-being of citizens, through treatment and detailing of information that allow the support of the decision-making process by the population. (AU)

Este artículo examina los medios y la cultura periodística en la comunicación de salud, centrándose más específicamente en las formas en que los periodistas tratan la salud en los medios. El análisis se basa en varios estudios realizados con periodistas y diversos grupos de población en Canadá y Brasil. El artículo demuestra que existe una cierta coherencia en el tratamiento periodístico de la salud y que este tratamiento no siempre es en beneficio de la sociedad. La profesión periodística está cambiando rápidamente y, como aspectos importantes de este escenario, podemos mencionar: el flujo rápido y la abundante oferta de información, el ritmo de producción de noticias y el lugar de las demandas ciudadanas. Dichos aspectos demuestran que existe una profunda transformación en la producción de información que realizan los periodistas; Además, las personas tienden a utilizar más los medios de comunicación que los profesionales de la salud para obtener información sobre riesgos y, por tanto, están expuestas a las normas sociales en materia de salud. Considerando la influencia de los medios en la comunicación en salud, este artículo cuestiona los medios y la cultura periodística a través de un lente ético, abordando la responsabilidad del periodista en relación con la cobertura mediática, la producción informativa (fuente, tratamiento y tono), la convergencia y su efecto en la salud de la población. población. Como principales hallazgos, señalamos que el periodismo necesita invertir en una comunicación en salud más efectiva, comprometida con el bienestar de la ciudadanía, a través del tratamiento y detalle de la información que permita el sustento de la toma de decisiones por parte de la población. (AU)

[Online social support as a mode of psychosocial intervention: A review of scientific literature, avenues for future research, and recommendations for practitioners]. / Le soutien social en ligne comme mode d'intervention psychosociale : revue de littérature, pistes de recherche et recommandations pour les intervenants.

OBJECTIVE: The goal of this review is to present online social support interventions described in recent scientific literature, in order to (i) guide organizations wishing to develop such an intervention or to improve an existing program, and (ii) to identify future research directions and recommendations for practitioners. METHODS AND RESULTS: 59 peer-reviewed articles presenting online social support interventions (2006-2016) were analyzed by using a thematic grid focusing on theoretical perspectives on social support, the online platforms used and their functionalities, the process of intervention development and evaluation, the modalities of participation and the facilitation methods, the documented impacts of interventions, and finally future research directions and recommendations for practitioners. A narrative methodology was used to identify challenges in intervention development and implementation, in order to provide guidance to organizations who want to develop or improve their online social support services. CONCLUSIONS: Several research directions and recommendations for the development of online social support interventions are suggested, including the need to develop theoretical models of online social support and enrich traditional models of social support, the need to understand the benefits associated with different levels of participation, the importance of needs assessment in the development of interventions, and the contribution of qualitative methods to the evaluation of interventions.

De que alimentação estamos falando? Discursos de jornalistas e análise de conteúdo de notícias populares / ¿De qué alimentación hablamos? Discursos de periodistas y análisis de contenido de las noticias populares / Are we talking about food? Journalists' speech and content analysis of popular news

A alimentação saudável é um dos principais temas da promoção da saúde e fonte de informação jornalística. A pesquisa analisa o conteúdo de jornal regional popular carioca e discurso do sujeito coletivo de suas jornalistas. Com metodologia quantiqualitativa, descritiva e exploratória, observou-se que o jornal dá foco aos efeitos de alimentos específicos e a recomendações do Guia Alimentar da População Brasileira e prioriza informações sobre alimentos in natura, em detrimento dos ultraprocessados. Há, porém, pouco espaço para a comensalidade e predominância da voz de especialistas. O discurso das jornalistas confirma os achados no impresso e destaca que parte dos textos analisados se configura como jornalismo de serviço com aspectos que se relacionam à promoção da saúde.(AU)

La alimentación saludable es uno de los principales temas de la promoción de la salud y fuente de información periodística. La investigación analiza el contenido de periódico regional popular de Río de Janeiro y el discurso del sujeto colectivo de sus periodistas. Con metodología cuali-cuanitativa, descriptiva y exploratoria, se observó que el periódico se enfoca en los efectos de alimentos específicos y en recomendaciones de la Guía Alimentar de la Población Brasileña y prioriza informaciones sobre alimentos in natura, contra los ultra-procesados. No obstante, hay poco espacio para la comensalidad y la predominancia de la voz de especialistas. El discurso de las periodistas confirma los hallazgos en la impresión y destaca que parte de los textos analizados se configura como periodismo de servicio con aspectos que se relacionan con la promoción de la salud.(AU)

Healthy eating is one of the main themes of health promotion and source of journalistic information. The research analyzes the content of a popular Rio de Janeiro regional newspaper and the discourse of the collective subject of its journalists. With a quantitative, descriptive and exploratory methodology, it was observed that the paper focuses on the effects of specific foods and recommendations of the Dietary Guidelines for the Brazilian Population, and prioritizes information on in natura foods, to the detriment of the ultra-processed ones. There is, however, little room for commensality and predominance of the voice of experts. The journalists' speech confirms the findings in the print and highlights that part of the texts analyzed is configured as service journalism with aspects related to health promotion.(AU)

Insights for public education provided by French media on ideas about prostate cancer - A media analysis study.

Background: This study explored the French media's presentation of ideas and medical information about prostate cancer (PC) that may influence men's understanding, attitudes and behavior. Methods: A qualitative media content analysis centered on PC information delivered by French professional media. The selected data were produced in the aftermath of the High Health Authority's decision in 2008 not to recommend systematic screening by prostate specific antigen(PSA) for men over 50. Source was the Media Archives of the French National Library. Content was analyzed from 15 television programs, 14 radio programs, and 55 articles from 35 popular French newspapers (online and printed, weekly and monthly) and 20 magazines. Audio content was narrated into textual form and submitted to manual coding along with the print content. Results: Television and radio content focused on the nature of PC, screening and treatment,and conveyed a gender-centric position linked to male sexuality and virility. Newspapers and magazines targeted the testing controversy, the lack of consensus among professionals, and scientific advances in screening and treatment. Conclusion: Media participation in the European testing debate is valuable for allowing patients to hear all opinions on PC risk factors. Debate on testing policy contributes to confusion and uncertainty regarding appropriate action.

[The evaluation of an on-line educational game to improve seniors' quality of life]. / Évaluation d'un jeu éducatif en ligne pour améliorer la qualité de vie des aînés.

This article describes and evaluates the educational online game Pour bien vivre, vivons sainement !, which aims to increase players' knowledge about physical aspects of health (nutrition, physical activity, sleep and fatigue), to reduce the risk situations, to highlight the importance of social interactions with family members and friends and to increase emotional well-being. In this exploratory study, the impact of the game on the quality of life was measured for 56 players aged between 50 and 90 who completed pre/post questionnaires. The results show an improvement in their perceivded physical well-being, social welfare and psychological well-being. The game is beneficial to both men and women. Regardless of age, the digital game improves their perception of quality of life. In addition, the older you are, the more one considers the online game strengthens social connections. Finally, the players more experienced in the use of technology, benefit more from online playing.

A Questionnaire-Based Study on the Perceptions of Canadian Seniors About Cognitive, Social, and Psychological Benefits of Digital Games.

OBJECTIVE: This study explored the perceptions of seniors who play digital games on the potential benefits of these games and on the factors associated with these perceptions. MATERIALS AND METHODS: We developed and administered a questionnaire to a sample of 590 Canadian seniors in British Columbia and Quebec that addressed demographics, digital game practices, and perceived benefits. RESULTS: Results of administering the questionnaire showed that cognitive benefits were reported more frequently than social or psychological benefits. First language and gender were associated with the benefits reported, with fewer Francophones and women reporting benefits. The most important factor found was whether or not they played online, as playing online was associated with greater perceptions of social, as well as cognitive, benefits. CONCLUSION: Social and cognitive benefits are reported by seniors from playing digital games and should be investigated through future experimental and quasi-experimental research.

From early detection to rehabilitation in the community: reading beyond the blog testimonies of survivors' quality of life and prostate cancer representation.

BACKGROUND: Survivors' testimonies can reveal much about men's experiences of prostate cancer and impacts on their quality of life (QOL) during the clinical trajectory of the disease. These survivors' shared thoughts and views were hypothesized to reflect salient features of their lived social representation of prostate cancer. CONTEXT: We explored the content of testimonies posted by men to a public blog hosted by a French national prostate cancer patients' association. The study question, "What do French bloggers' testimonies reveal about their lived experiences with prostate cancer, especially regarding their quality of life in community settings, that underpin their social representation of prostate cancer?" guided the exploration and analysis of the textual data. The aims were to better understand men's experiences and predominant thoughts and views, to elucidate patients' behaviours, and to enlighten medical policy and practice. PURPOSE: Explore issues of QOL as reported by French prostate cancer survivors in a public blog by: (a) identifying the salient aspects and issues of the experience of living with prostate cancer from the perspective of survivors; and (b) analyzing the content in the posted testimonies regarding perceived and lived impacts of prostate cancer on QOL. METHODS: A critical ethnographic study guided the selection of textual data from 196 male bloggers' testimonies about prostate cancer posted in the period from 2008 to 2013. Media content analysis method was undertaken on blog testimonies, framed by a multidimensional conceptual framework of QOL. RESULTS: Testimonies focused mainly on medical care and rehabilitation, recovery, health education and self-care, as well as on a global vision of prostate cancer and its impacts on personal views of manhood and masculinity. The language used indicated that political, educative and compassionate discourses were intertwined to create a complex representation of the experience and effects of prostate cancer; this multi-faceted representation can inform the public and professional debate about men's capacity to provide emotional support and problem-solve within a community of interest. CONCLUSION: Findings, while based on data limited to mostly one-time entries to a French blog, contribute to understanding a unique, collective expression of men's lived experiences of prostate cancer. These anonymous survivors shared their varied reactions, ways of coping, and thoughts on needed change.

[Strategies to increase the brief interventions in smoking cessation among nurses in hospital settings: experimental study]. / Evaluation comparative de stratégies visant à augmenter les interventions de courte durée pour le sevrage tabagique auprès du personnel infirmier de milieux hospitaliers: résultats d'une étude expérimentale.

INTRODUCTION: Research results demonstrate a decrease in cigarette smoking when preventive professional interventions are routinely carried out. Literature reports that 30% of hospital nurses assess their patient smoking habits. The objective of the present study is to compare, on medical and surgical units, the effectiveness of three strategies (interactive educational session, recall, and both together) to a control group, on the number of nursing interventions pertaining to cessation of cigarette smoking. Research design is experimental with group randomisation. Pre and post strategy multi-measurements (at 1 and 3 months) are sought from nursing staff (69), patients and patient charts (351). Results show that nursing staff assesses cigarette smoking habits for only 35.7% of the patients, and their intent to stop smoking only of the time. Results show that the educational strategy increases the number of nursing interventions during a short period (1 month), and decreases perception of barriers to tobacco counselling. Impact of recall could not be assessed as it was not introduced as planned. CONCLUSION: Considering modest results from the strategies, the interactive educational sessions shows a short- term effect on the nursing staff's interventions.

[A tool to evaluate hospital nursing practices toward smoking cessation]. / Un outil pour evaluer les pratiques cliniques des infirmières auprès des patients fumeurs en cessation tabagique a l'hôpital.

UNLABELLED: Nurses in hospitals are not active in smoking cessation because of certain beliefs and attitudes. Beliefs and attitudes must be measured for changing practice in quitting smoking. The objective is to develop and validate a questionnaire on smoking cessation practices of nurses in hospitals. METHODOLOGY: A methodological study was conducted to construct a questionnaire (n = 118) according to the theory of planned behaviour, to validate by four experts, for reliability and validation of instruments constructs (n = 38; n = 29; n = 157). RESULTS: An initial questionnaire on practices in smoking cessation was built according to the beliefs of a convenience sample of 118 nurses. Validation of experts was conducted, and the questionnaire obtained an index of content validation (ICV) of 0.94. Subsequently, after two convenience samples (n = 38; n = 29) and a random sample (n = 157), the questionnaire obtained reliability, measured by Cronbach's alpha ranging in 0.697 and 0.93 1. Finally, moderately high correlations (0.406 to 0.569) were obtained between concepts. CONCLUSION: A reliable and valid questionnaire in French is available to measure smoking cessation practices.

[Of Brazil and Quebec, food for thought: Brazilian community health workers bridge the gap between families and health professionals]. / Du Brésil au Québec, quelques éléments de réflexion: les agents communautaires de santé brésiliens font le pont entre les families et les professionnels de la santé.

The Brazilian unified health system consists of 27,000 family health teams with a network of approximately 300,000 community health agents whose mandate is to link the families they visit every month with health professionals at the family health unit. Since 2003, Quebec has been implementing its health and social services reforms by emphasizing the integration of care and services (public, associative and private) in local networks which have a formal population health responsibility. This commentary aims to underline some similarities and differences between the program of the Brazilian 'units of family health' and that of integrated network clinics (CRI) or Groups of family medicine (GMF) in Quebec. In both cases, a major concern is to organize primary care services in as close proximity as possible to the population of a given territory, and to improve accessibility and adequacy of services. In addition, through these community health agents, Brazil enables the creation of a social security network that assures an effective follow-up of all members of the population with regard to health services.

[Not Available]. / Impact d'un site internet dans une campagne de promotion de la santé : le << Défi Santé 5/30 >>

In 2005, a 12-week health promotion campaign in Québec utilized a multimedia communications strategy in which a website was used to supply information and to serve as an accompaniment to support individual engagement with the campaign. The "Défi Santé 5/30" or "5/30 Health Challenge" was intended to reinforce behaviours related to healthy eating and the regular practice of physical activity. This communications strategy offered the public the ability to personally engage in a "health challenge" by fixing objectives to attain over the course of the campaign. The campaign's media use and impact are evaluated with the aid of a telephone survey (n = 609), discussion groups with individuals (n = 102) who had been exposed to the campaign, and discussion groups with health professionals (n = 32). The article explores underlying explanations for behavioural changes during the campaign with a focus on the role of the website. Several characteristics can potentially contribute to the development of motivation and fidelity in users: specific objectives of the website; content; architecture and usage techniques; media convergence and contribution of partners; an accompaniment approach that is at once virtual, media-based, interpersonal while also using contributions from health professionals. Non-facilitating factors are also discussed: technical and socio-cultural accessibility; ethics and constraints related to the participation of health professionals. The "Défi Santé 5/30" has demonstrated that a website utilizing virtual, media-based, interpersonal and technical accompaniment can contribute to behavioural change.

[Not Available]. / Les interventions personnalisées via les courriers électroniques permettent-elles de générer la cessation tabagique ?

In 2007, a Quebecan campaign aimed at smoking addiction cessation entitled "Défi J'arrête J'y gagne" (The "I quit I win" challenge) resorted to a multimedia communications strategy that used a range of online resources (a website and emails) to serve as support tools over a one-year period. Research on this campaign focuses on the involvement of Quebecan smokers in the "Défi J'arrête J'y gagne" contest (n = 25156) as well as cessation in participating subjects. This paper examines factors related to the use and impact of emails in the strategy of behavioural change. The instruments used for the purposes of data collection included a registration form, two surveys, and content analysis. The first survey (n = 3119), conducted six months after the start of the contest, measured two different stages within the cessation period (after six weeks and after six months). The second survey (n = 753), conducted one year after the start of the contest, measures cessation during the one-year period in smokers studied in the first survey. A content analysis was carried out on 22 emails. The results of this research indicate that emails had no impact on smoking addiction cessation at the six-week and six-month stages. Accessibility, recurrence, frequency, credibility, design quality, interactivity, and adaptation to stage of behavioural change appear to be factors that may contribute to behavioural change. The elements analyzed in emails indicate that, in order to positively affect behavioural change, emails should be respectful, informative, succinct, and include references (hyperlinks); they should also be compatible and congruent with participant's conception of health and healthcare.

[Complex management of partnerships during a health promotion campaign]. / Gestion complexe des partenariats lors d'une campagne de promotion de la santé.

This article discusses an analysis of partnerships in the context of health promotion. The 5/30 Health Challenge, or "Défi Santé 5/30", is a campaign to promote healthy eating habits in Quebec. The authors employ this as a case study in order to 1) describe the actors and the nature of their involvement during the campaign's development, design and dissemination; 2) illustrate the interaction of these actors during the conceptualization and rollout of the campaign; 3) propose a paradigm that supports the identification of factors that contribute to or impede partner relationships. The "Défi Santé 5/30" example demonstrates that the creation and maintenance of a partnership network depends on the following key factors: dialogue between partners and the organization responsible for the campaign; the participation of partners at every stage of the campaign (no matter how many there are); allocation of sufficient time for the conceptualization of campaign materials. Dialogue between partners and the central organizer must be guaranteed through the establishment and use of a managerial contract that clearly outlines the role of each actor in the campaign. Further, the partners' activities during the campaign should be regulated through both a formal agreement and a code of ethics. Any campaign's efficiency is directly linked to these factors, among others. The study of partnerships between public, public-private, and private organizations within the framework of health promotion campaigns, thus, merits further study. In addition, to maintain alliances with partners, it is important to demonstrate the benefits of such arrangements to each partner and to equally ensure the contributions of each, be they public, private, media, or community-based organizations.

[Messages about physical activity and nutrition offered by Quebec mass media?]. / Messages d'activité physique et d'alimentation: que nous offrent les médias québécois?

As social elements of our environment, mass media are regarded as determinants of individual and population beliefs, social norms and habits. Since it is recognized that they influence population health, this study aims to obtain a better portrait of Quebec media content regarding physical activity and nutrition messages on a public health level. First, we analyzed the content of fictional television shows (n = 1 3) and advertisements broadcast during those shows (n = 68). Second, we reviewed the content of La Presse newspaper and of French television Société Radio-Canada from 1986 to 2005 with regard to physical activity and nutrition messages. Our results indicate a difference between how men and women are portrayed on French television, with women more often being shown as underweight and men as at or above healthy body weight. The results also show that during the 20-year period of the reviewed content, there were fewer messages about physical activity than about nutrition. To be successful in their goal of improving population health, mass media should address both subjects together in their messages.

Implementation and outcomes of a comprehensive worksite health promotion program.

BACKGROUND: This paper reports on the implementation and results of a three-year comprehensive worksite health promotion program called Take care of your health!, delivered at a single branch of a large financial organization with 656 employees at the beginning of the implementation period and 905 at the end. The program included six educational modules delivered over a three-year period. A global health profile was part of the first and last modules. The decision to implement the program coincided with an overall program of organizational renewal. METHODS: The data for this evaluation come from four sources: analysis of changes in employee health profiles between the first and last program sessions (n=270); questionnaires completed by participating employees at the end of the program (n=169); organizational data on employee absenteeism and turnover; and qualitative interviews with company managers (n=9). RESULTS: Employee participation rates in the six modules varied between 39% and 76%. The assessment of health profile changes showed a significant increase in the Global Health Score. Participants were significantly more likely to report more frequent physical activity and better nutritional practices. The proportion of smokers among participants was significantly reduced (p = 0.0147). Also reduced significantly between the two measurements were self-assessment of high stress inside and outside the workplace, stress signs, and feelings of depression. Employees were highly satisfied with the program and felt that it had impacts on their knowledge and capacities to manage their health behaviour. During the same period, absenteeism in the organization declined by 28% and turnover by 54%. From the organization's perspective, program implementation was very successful. CONCLUSIONS: This study's results are in line with previous findings of significant benefits to organizations and employees from worksite health promotion. The close relationship between the program outcomes and the overall process of organizational renewal that it accompanied supports previous arguments that worksite health promotion will be most effective when it promotes overall organizational health.

[Communication and health: rival or parallel paradigms?]. / Communication et santé: des paradigmes concurrents.

This article recounts the evolution of communications approaches in health-related matters: 1) the approach of modernization, also known as the linear model of behaviour change; 2) the approach of dependency, also known as awareness-raising or empowerment; and 3) the approach of new development, also known as participation and co-development. Why, after the establishment and unfolding of so many programmes utilising communication for health, do social health problems persist? The article underlines a co-existence of various different and sometimes opposing, according to the school of thought, theoretical approaches. It remains that communication as a vector for behaviour change seems to carry on as the dominant theoretical axis in the health field.

Critical analysis on best practices in health literacy.

From a holistic perspective, health literacy is a requirement for the well-being of entire populations. It moves beyond the focus on individuals to consider the role of organizations and systems. This perspective offers a context for discussing best practices in health literacy, and implications for research and policy development. This paper offers an overview of the best practices that were presented at the Second Canadian Conference on Literacy and Health. It discusses clear writing in some detail because it was emphasized at the conference. It also considers practices that were addressed less emphatically, such as oral communication between patients and health care professionals, training for health care professionals, non-written means of communication (such as video), and building capacity through action-research. The paper critiques some practices. It also notes the lack of research on the links between health literacy and oral understanding, on the impact of verbal and non-written interventions, and on the effectiveness of these practices on the health outcomes of the population. It briefly discusses policy issues and suggests some future directions.