title: Health literacy: Patients' texts, context and mediation

authors: Balmer, Deborah G. Ballantyne

subjects: Health literacy

abstract: Health literacy encompasses people’s knowledge, motivation and competences to access, understand, appraise and apply health information to make judgments and take decisions in every-day life concerning health care, disease prevention and health promotion (Kickbusch et al., 2013).  Research in health literacy has grown in prominence as a separate entity over the last twenty years, partly in response to the growth of chronic disease requiring greater patient self-management.  Research has found significant relationships between reading comprehension levels and different health outcomes and health behaviours, with reading comprehension being used as a way to measure health literacy despite its accepted definition being much broader.  However, there has been little research which takes a social practices perspective on health literacy.  
In this thesis, health literacy is viewed from a social practices perspective.  Literacy events in this research have been predicated on the existence of written texts as part of a patient’s journey using health related texts, resources and services.  The thesis explores how people go about accessing, understanding, appraising and using health-related services and information, and the social and cultural practices inherent in those activities.  It asks how much written patient text is used with patients in hospital; who is using it; what the discourse features of those texts are; and how patients respond to the texts.  This mode of exploration is called textual ethnography (Swales, 1998).  
The research takes an ethnographic perspective not only on text, but also on participants and their journey.  It shadows eleven patients through a cardiology service of a hospital in New Zealand.  It identifies literacy events and practices occurring in that space and examines the patient texts themselves using a discourse analysis (Bax 2011; Faircough, 2003; Clerehan, Hirsh, & Buchbinder, 2009; Franken & Hunter, 2011) and geosemiotic (Scollon & Scollon, 2003) approach.  
The key themes to emerge from the research centre around the complexity of access to patient information, both physically and linguistically, and around the dynamics of patient agency.  The ability to encode and decode written text played a minor part in patient access to information.  The analysis showed that the amount and types of text material present for patients in hospital were limited.  Access to key texts required a deliberate decision by a health professional to dispense the text items.  Mediation of text in the research by literacy sponsors supported Brandt and Clinton’s (2002) observation that “access to literacy has always required assistance, permission, sanction, or coercion by more powerful others or, at least, contact with existing ‘grooves’ of communication” (p. 349).  Patient agency therefore came to the fore, and practices that patients did actually use to make information personal to them such as talking with room mates, or requesting paper and pencil were dynamic and socially mediated.  
Implications lie in the way health literacy is conceptualised, moving the focus from individual abilities as portrayed in current health literacy definitions, and pointing to the wider role of the health organisation and health care practitioners as literacy sponsors.  Practice implications arising from this reconceptualisation relate to patient information strategies within health care organisations and pedagogical implications for health professionals and adult literacy educators.  The notions of text mediation and full contextualisation of learning also became apparent with evidence pointing to the effectiveness of text mediation by a more knowing other.  The hospital itself was found to be a potentially rich and meaningful setting for adult learning about health where full contextualisation of adult learning is possible.  These patient learning opportunities need to be further exploited by health organisations and professionals.

text: Health literacy: Patients' texts, context and mediation Health literacy encompasses people’s knowledge, motivation and competences to access, understand, appraise and apply health information to make judgments and take decisions in every-day life concerning health care, disease prevention and health promotion (Kickbusch et al., 2013).  Research in health literacy has grown in prominence as a separate entity over the last twenty years, partly in response to the growth of chronic disease requiring greater patient self-management.  Research has found significant relationships between reading comprehension levels and different health outcomes and health behaviours, with reading comprehension being used as a way to measure health literacy despite its accepted definition being much broader.  However, there has been little research which takes a social practices perspective on health literacy.  
In this thesis, health literacy is viewed from a social practices perspective.  Literacy events in this research have been predicated on the existence of written texts as part of a patient’s journey using health related texts, resources and services.  The thesis explores how people go about accessing, understanding, appraising and using health-related services and information, and the social and cultural practices inherent in those activities.  It asks how much written patient text is used with patients in hospital; who is using it; what the discourse features of those texts are; and how patients respond to the texts.  This mode of exploration is called textual ethnography (Swales, 1998).  
The research takes an ethnographic perspective not only on text, but also on participants and their journey.  It shadows eleven patients through a cardiology service of a hospital in New Zealand.  It identifies literacy events and practices occurring in that space and examines the patient texts themselves using a discourse analysis (Bax 2011; Faircough, 2003; Clerehan, Hirsh, & Buchbinder, 2009; Franken & Hunter, 2011) and geosemiotic (Scollon & Scollon, 2003) approach.  
The key themes to emerge from the research centre around the complexity of access to patient information, both physically and linguistically, and around the dynamics of patient agency.  The ability to encode and decode written text played a minor part in patient access to information.  The analysis showed that the amount and types of text material present for patients in hospital were limited.  Access to key texts required a deliberate decision by a health professional to dispense the text items.  Mediation of text in the research by literacy sponsors supported Brandt and Clinton’s (2002) observation that “access to literacy has always required assistance, permission, sanction, or coercion by more powerful others or, at least, contact with existing ‘grooves’ of communication” (p. 349).  Patient agency therefore came to the fore, and practices that patients did actually use to make information personal to them such as talking with room mates, or requesting paper and pencil were dynamic and socially mediated.  
Implications lie in the way health literacy is conceptualised, moving the focus from individual abilities as portrayed in current health literacy definitions, and pointing to the wider role of the health organisation and health care practitioners as literacy sponsors.  Practice implications arising from this reconceptualisation relate to patient information strategies within health care organisations and pedagogical implications for health professionals and adult literacy educators.  The notions of text mediation and full contextualisation of learning also became apparent with evidence pointing to the effectiveness of text mediation by a more knowing other.  The hospital itself was found to be a potentially rich and meaningful setting for adult learning about health where full contextualisation of adult learning is possible.  These patient learning opportunities need to be further exploited by health organisations and professionals.

year: 2015

title: Improving road safety and health: Understandng kava's impact on driver fitness.

authors: Aporosa, S. 'Apo'

abstract: Kava (Piper methysticum) is a traditional and culturally significant Pacific Island beverage that produces a soporific relaxant effect. Kava’s psychopharmacological action is similar to the anti-anxiety drug Benzodiazepine. Traditional users often consume the kava drink at volumes as much as 30 times greater than pharmacologically recommended doses. Prompted by concerns regarding driver impairment post kava drinking, a study was undertaken replicating traditional kava sessions in terms of duration and kava consumption, to investigate the effects of kava on driving capability.
Kava consumers (n=20) attended two six-hour kava sessions, each participant drinking an average 3.52 litres of kava. A non-kava consuming control group (n=20) was included in the study. At baseline all the participants completed computerised industry standard driver safety assessment tests (Vienna Test System: Traffic WAFA Alertness and WAFG Divided Attention) to measure reaction time, perception and attention. Re-testing was conducted at hourly intervals over the six-hour period. Pre/post analysis compared person to person and between groups change. Statistical modeling was based on ANOVA, independent t-tests and Bayesian analysis.
Data analysis indicated no statistically significant (p<0.05) difference between reaction time and divided attention, both within individuals and between groups, at any measurement point over the six-hour testing period. The mean reaction time and divided attention time at the baseline measurement was 249.95msec (milliseconds) and 583.58msec respectively. The control and active group mean reaction time at the final test was 256.70msec and 271.8msec respectively. The mean divided attention times for the control and active groups at the final test were 499.75msec and 568.32msec.
Kava at traditional consumption volumes was not correlated to response latency or impairment on perception and attention tasks, when measured using authoritative driver assessment tests. From this it could be inferred that kava use at traditionally influenced consumption volumes does not compromise driver safety. However, it can be argued that current industry standard accepted cognitive measures of driver safety, assess impairment from the use of euphoric and hallucinogenic drug substances (such as alcohol and marijuana), and fail to account for kava’s unique form of ‘intoxication’. Further research beyond the assessment of these two cognitive functions is, it seems, desirable to better understand if kava has any effect on driver ability.
The study was funded by the Health Research Council of New Zealand (16/462) and the University of Waikato, and the test battery was generously donated by Vienna Tests Systems, Germany.

text: Improving road safety and health: Understandng kava's impact on driver fitness. Kava (Piper methysticum) is a traditional and culturally significant Pacific Island beverage that produces a soporific relaxant effect. Kava’s psychopharmacological action is similar to the anti-anxiety drug Benzodiazepine. Traditional users often consume the kava drink at volumes as much as 30 times greater than pharmacologically recommended doses. Prompted by concerns regarding driver impairment post kava drinking, a study was undertaken replicating traditional kava sessions in terms of duration and kava consumption, to investigate the effects of kava on driving capability.
Kava consumers (n=20) attended two six-hour kava sessions, each participant drinking an average 3.52 litres of kava. A non-kava consuming control group (n=20) was included in the study. At baseline all the participants completed computerised industry standard driver safety assessment tests (Vienna Test System: Traffic WAFA Alertness and WAFG Divided Attention) to measure reaction time, perception and attention. Re-testing was conducted at hourly intervals over the six-hour period. Pre/post analysis compared person to person and between groups change. Statistical modeling was based on ANOVA, independent t-tests and Bayesian analysis.
Data analysis indicated no statistically significant (p<0.05) difference between reaction time and divided attention, both within individuals and between groups, at any measurement point over the six-hour testing period. The mean reaction time and divided attention time at the baseline measurement was 249.95msec (milliseconds) and 583.58msec respectively. The control and active group mean reaction time at the final test was 256.70msec and 271.8msec respectively. The mean divided attention times for the control and active groups at the final test were 499.75msec and 568.32msec.
Kava at traditional consumption volumes was not correlated to response latency or impairment on perception and attention tasks, when measured using authoritative driver assessment tests. From this it could be inferred that kava use at traditionally influenced consumption volumes does not compromise driver safety. However, it can be argued that current industry standard accepted cognitive measures of driver safety, assess impairment from the use of euphoric and hallucinogenic drug substances (such as alcohol and marijuana), and fail to account for kava’s unique form of ‘intoxication’. Further research beyond the assessment of these two cognitive functions is, it seems, desirable to better understand if kava has any effect on driver ability.
The study was funded by the Health Research Council of New Zealand (16/462) and the University of Waikato, and the test battery was generously donated by Vienna Tests Systems, Germany.

year: 2018

title: Taku haumaru me te kurī - Te Reo Maori

authors: Carter, Jennifer

subjects: dog safety tips

abstract: This safety leaflet designed to target young children aged 5-6yrs will provide an age-appropriate understanding of how to avoid pet dog attacks which can injure, maim and even kill children.    This research-based educational resource provides practical, valid and reliable guidelines for safe interaction between children and pet dogs in their homes or known to them.  
The content of this leaflet has been drawn from ‘Stories with happy endings: Preventing pet dog attacks on children’, the 2007-2008 Summer Scholarship report prepared for the Child Accident Prevention Foundation of New Zealand (CAPFNZ). Obtain a copy of the report from http://hdl.handle.net/10289/768

text: Taku haumaru me te kurī - Te Reo Maori This safety leaflet designed to target young children aged 5-6yrs will provide an age-appropriate understanding of how to avoid pet dog attacks which can injure, maim and even kill children.    This research-based educational resource provides practical, valid and reliable guidelines for safe interaction between children and pet dogs in their homes or known to them.  
The content of this leaflet has been drawn from ‘Stories with happy endings: Preventing pet dog attacks on children’, the 2007-2008 Summer Scholarship report prepared for the Child Accident Prevention Foundation of New Zealand (CAPFNZ). Obtain a copy of the report from http://hdl.handle.net/10289/768

year: 2008