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: Methods for linear radial motion estimation in time-of-flight range imaging

authors: Streeter, Lee

abstract: Motion artefacts in time-of-flight range imaging are treated as a feature to measure. Methods for measuring linear radial velocity from range imaging cameras are developed and tested. With the measurement of velocity, the range to the position of the target object at the start of the data acquisition period is computed, effectively correcting the motion error. A new phase based pseudo-quadrature method designed for low speed measurement measures radial velocity up to ±1.8 m/s with RMSE 0.045 m/s and standard deviation of 0.09-0.33 m/s, and new high-speed Doppler extraction method measures radial velocity up to ±40 m/s with standard deviation better than 1 m/s and RMSE of 3.5 m/s.

text: Methods for linear radial motion estimation in time-of-flight range imaging Motion artefacts in time-of-flight range imaging are treated as a feature to measure. Methods for measuring linear radial velocity from range imaging cameras are developed and tested. With the measurement of velocity, the range to the position of the target object at the start of the data acquisition period is computed, effectively correcting the motion error. A new phase based pseudo-quadrature method designed for low speed measurement measures radial velocity up to ±1.8 m/s with RMSE 0.045 m/s and standard deviation of 0.09-0.33 m/s, and new high-speed Doppler extraction method measures radial velocity up to ±40 m/s with standard deviation better than 1 m/s and RMSE of 3.5 m/s.

year: 2017

title: Walking into the past to explore the future: Utulizing larval densities to measure the effects of two climate change factors, temperature and salinity on Poorohe (common smelt, Retropinna retropinna) abundance in Te Puuaha o Waikato

authors: Robcke, Sidney

subjects: Common smelt

abstract: Poorohe (common smelt, Retropinna retropinna) are a highly valued kai species in Te Puuaha o Waikato (the lower 66 km of the Waikato River). Fisher whaanau have observed changes in the amount Poorohe that are harvested during annual fish harvests. Since Poorohe are particularly vulnerable to environmental changes, whaanau are particularly concerned about the how climate change might impact Poorohe populations. Climate change vulnerability assessments (CCVA) currently exist for several native New Zealand fish freshwater species; however, one does not yet exist for Poorohe. Previous larval distribution studies in the lower Waikato River only sampled as far downstream as Tuakau bridge (approximately 45km from the river mouth). These studies indicated that important spawning habitats likely existed downstream of Tuakau bridge. Temperature increases and saltwater intrusion have been identified as two climate change factors that will likely impact Poorohe in Te Puuaha o Waikato, because ambient temperatures have increased since the industrial revolution and the proximity of the study area to the ocean. A literature review was used to explore the experiences of fisher whaanau through the past, present and how the experiences will continue to change in a changing climate. The effects of temperature and saltwater intrusion on Poorohe populations were explored through replicating the methods of past research carried out in the 1980s and 2010s. Current river temperatures are in the optimal temperature range (12°C - 18°C) for Poorohe spawning. The saltwater wedge was suppressed by the high river flow during the eight-week sampling period, and it is unclear whether saltwater intrusion has an impact on Poorohe spawning. Larval densities did not significantly increase down river, which suggests large spawning habitat is not found downstream of Tuakau bridge. Furthermore, there were no decreases in larval densities in the two saltwater sites. This study has contributed to the available literature necessary to develop a CCVA for Poorohe and explored the cultural heritage of traditionally significant practices in Te Puuaha o Waikato relating to Poorohe.

text: Walking into the past to explore the future: Utulizing larval densities to measure the effects of two climate change factors, temperature and salinity on Poorohe (common smelt, Retropinna retropinna) abundance in Te Puuaha o Waikato Poorohe (common smelt, Retropinna retropinna) are a highly valued kai species in Te Puuaha o Waikato (the lower 66 km of the Waikato River). Fisher whaanau have observed changes in the amount Poorohe that are harvested during annual fish harvests. Since Poorohe are particularly vulnerable to environmental changes, whaanau are particularly concerned about the how climate change might impact Poorohe populations. Climate change vulnerability assessments (CCVA) currently exist for several native New Zealand fish freshwater species; however, one does not yet exist for Poorohe. Previous larval distribution studies in the lower Waikato River only sampled as far downstream as Tuakau bridge (approximately 45km from the river mouth). These studies indicated that important spawning habitats likely existed downstream of Tuakau bridge. Temperature increases and saltwater intrusion have been identified as two climate change factors that will likely impact Poorohe in Te Puuaha o Waikato, because ambient temperatures have increased since the industrial revolution and the proximity of the study area to the ocean. A literature review was used to explore the experiences of fisher whaanau through the past, present and how the experiences will continue to change in a changing climate. The effects of temperature and saltwater intrusion on Poorohe populations were explored through replicating the methods of past research carried out in the 1980s and 2010s. Current river temperatures are in the optimal temperature range (12°C - 18°C) for Poorohe spawning. The saltwater wedge was suppressed by the high river flow during the eight-week sampling period, and it is unclear whether saltwater intrusion has an impact on Poorohe spawning. Larval densities did not significantly increase down river, which suggests large spawning habitat is not found downstream of Tuakau bridge. Furthermore, there were no decreases in larval densities in the two saltwater sites. This study has contributed to the available literature necessary to develop a CCVA for Poorohe and explored the cultural heritage of traditionally significant practices in Te Puuaha o Waikato relating to Poorohe.

year: 2024-11-23