A Canadian exploratory study to define a measure of health literacy.

This study undertook a qualitative exploration of an operational definition of health literacy and an examination of quantitative measures of health literacy skills. We interviewed 229 older Canadian adults. First we engaged them in open-ended discussions about their search for information on a self-selected health topic. Next we administered nine self-report items on health literacy skills, and then task-performance items. Task-performance questions were based on two published reading passages on five levels of difficulty to measure 'understanding' of health-related material. The Rapid Estimate of Adult Literacy in Medicine (REALM) was also administered as the comparison for criterion-related validity. Our open-ended questions elicited responses about the processes that people undergo when they attempt to access, understand, appraise and communicate health information. Qualitative findings revealed complexities in participants' interpretation of the meaning of all four health literacy skills. These descriptive findings add new knowledge about health literacy as a construct. Participants agreed with most of the self-report statements, thus indicating high belief in their own health literacy. REALM scores ranged from 45 to 66 with an average of 65 and standard deviation of 2.5. Quantitative scores on the reading passages were modestly correlated with scores on the REALM. The sum scale of self-report items, however, did not correlate with task-performance items, suggesting that the different types of items may not be measuring the same construct. We suggest that self-report items need more development and validation. Our study makes a contribution in exploring the complexities of measuring health literacy skills for general health contexts.

Developing and evaluating a relevant and feasible instrument for measuring health literacy of Canadian high school students.

Health literacy has come to play a critical role in health education and promotion, yet it is poorly understood in adolescents and few measurement tools exist. Standardized instruments to measure health literacy in adults assume it to be a derivative of general literacy. This paper reports on the development and the early-stage validation of a health literacy tool for high school students that measured skills to understand and evaluate health information. A systematic process was used to develop, score and validate items. Questionnaire data were collected from 275, primarily 10th grade students in three secondary schools in Vancouver, Canada that reflected variation in demographic profile. Forty-eight percent were male, and 69.1% spoke a language other than English. Bivariate correlations between background variables and the domain and overall health literacy scores were calculated. A regression model was developed using 15 explanatory variables. The R(2) value was 0.567. Key findings were that lower scores were achieved by males, students speaking a second language other than English, those who immigrated to Canada at a later age and those who skipped school more often. Unlike in general literacy where the family factors of mother's education and family affluence both played significant roles, these two factors failed to predict the health literacy of our school-aged sample. The most significant contributions of this work include the creation of an instrument for measuring adolescent health literacy and further emphasizing the distinction between health literacy and general literacy.

Status report -- Identifying equity-focussed interventions to promote healthy weights. / Rapport d'étape -- Recenser les interventions axées sur l'équité visant à promouvoir un poids santé.

INTRODUCTION: We developed screening criteria to identify population health interventions with an equity focus for inclusion on the Public Health Agency of Canada's Canadian Best Practices Portal. We applied them to the area of "healthy weights," specifically, obesity prevention. METHODS: We conducted a review of the literature and obtained input from expert external reviewers on changes to midstream environments. Interventions had to identify outcomes for groups with an underlying social disadvantage. We included papers with a focus on equity and vulnerable populations, intervention and/or evaluation studies, social determinants of health and healthy weights or obesity prevention. We then appraised the shortlisted studies for quality of evidence to determine eligibility for inclusion as promising practices on the Canadian Best Practices Portal. RESULTS: Few of the references reviewed passed the equity screening criteria (26 out of 2823 published papers reviewed, or 0.9%). Six (of the 26) interventions qualified as promising practices. CONCLUSION: The ability of the equity screening criteria to distinguish midstream-level interventions for obesity prevention suggests that the criteria have potential to be applied to other public health topics. What is most important about our work is that the Portal, which is no longer being updated but is still accessible, was broadened to include interventions with a focus on equity.

INTRODUCTION: Nous avons élaboré des critères de sélection pour recenser les interventions en santé populationnelle axées sur l'équité à intégrer dans le Portail canadien des pratiques exemplaires de l'Agence de la santé publique du Canada. Nous les avons appli-qués à la question du « poids santé ¼, plus précisément de la prévention de l'obésité. MÉTHODOLOGIE: Nous avons effectué une revue de la littérature et obtenu des commentaires d'examinateurs externes experts du domaine sur le thème des modifications des environnements intermédiaires. Les articles devaient décrire les résultats de l'intervention pour les groupes socialement désavantagés. Nous avons inclus les articles axés sur l'équité et les populations vulnérables, les études d'intervention ou d'évaluation, les déterminants sociaux de la santé et le poids santé ou la prévention de l'obésité. Nous avons ensuite évalué la qualité des données des études sélectionnées afin de déterminer si elles pouvaient être incluses dans le Portail canadien des pratiques exemplaires comme pratiques prometteuses. RÉSULTATS: Seul un petit nombre d'articles recensés ont répondu aux critères de sélection axés sur l'équité (26 articles publiés sur les 2 823 examinés, soit 0,9 %). Six interventions (sur 26) ont été considérées comme des pratiques prometteuses. CONCLUSION: Nos critères de sélection axés sur l'équité appliqués à la prévention de l'obésité nous ont permis de repérer des études sur les environnements intermédiaires, ce qui laisse penser que ces critères sont valables pour d'autres questions de santé publique. Surtout, grâce à nos travaux, le Portail s'est enrichi de la possibilité de recherche d'interventions axées sur l'équité.

Challenges of citizen participation in regional health authorities.

Citizen participation has been included as part of health reform, often in the form of lay health authorities. In Canada, these authorities are variously known as regional health boards or councils. A set of challenges is associated with citizen participation in regional health authorities. These challenges relate to: differences in opinion about whether there should be citizen participation at all; differences in perception of the levels and processes of participation; differences in opinion with respect to the roles and responsibilities of health authority members; differences in opinion about the appropriate composition of the authorities; differences in opinion about the requisite skills and attributes of health authority members; having a good support base (staff, good information, board development); understanding and operationalizing various roles of the board (governance and policy setting) versus the board staff (management and administration); difficulties in ensuring the accountability of the health authorities; and measuring the results of the work and decisions of the health authorities. Despite these challenges, regional health authorities are gaining support as both theoretically sound and pragmatically based approaches to health-system reform. This review of the above challenges suggests that each of the concerns remains a significant threat to meaningful public participation.

Implementation of provincial/territorial health goals in Canada.

During the past two decades, policy makers in most of Canada's provinces and territories developed broad population-level goal statements about desired health or health and social outcomes. The health goals development process used in each province/territory has been described in government documents and studied by a small number of researchers. However, there is a lack of published research examining the implementation and use of the health goals since they were developed. To begin to fill this gap, we conducted a study between 1998 and 2000 that examined the implementation of provincial/territorial health goals in Canada. Our findings indicate that as the 1990s drew to a close, provincial/territorial health goals were not being used explicitly by policy makers at either provincial/territorial or regional levels in most provinces in Canada to guide health policy and program development, implementation, or evaluation. Instead, the majority of health ministry and regional policy makers were employing strategic/business plans that, at best, reflected or were similar to the original provincial/territorial health goals. Moreover, even though all provinces and the NWT/Nunavut had health goals associated with broad social, economic, and physical environment health determinants, regional-level policy makers were giving priority to health care system goals over all other types of goals. We discuss our findings in relation to studies about health goals in other countries, and we suggest implications that our findings have for both future research and health policy.

Social and political factors influencing the functioning of regional health boards in British Columbia (Canada).

Health reform is associated with changes in the way the health system works and in the roles of major stakeholders, such as governments, health professionals, and the lay public. This paper reviews the immediate relevance of these social and political elements to health boards, particularly those with lay board members; source documents include peer-reviewed articles, and government documents and news releases in Canada especially. Also presented are the perceptions of 130 regional health board members in British Columbia (BC), Canada, who responded to our 1996 survey questionnaire. Two sets of social and political factors are identified and discussed in this paper. The first set deals with the composition of health board members (qualifications, representation, and selection). Our findings suggest that there is now less attention focusing on the composition of health boards in BC. This may contribute to a re-focusing of attention on the boards' effectiveness in working with stakeholders and in influencing the health system. The other set of social and political factors deals with the relations of health boards with key stakeholder groups. The responses to our questionnaire suggest that the health boards in BC may have had some success in addressing the concerns of various stakeholder groups. However, the respondents also suggested that the stakeholder groups needed to be more understanding and involved in the regionalization (decentralization) process. Health boards that have lay representatives, including regional health authorities in Canada, face similar social and political factors immediate to their operation.