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Background
The SF-8 is a short form of the SF-36 Health Survey, which is used for generic assessment of physical and mental aspects of health-related quality of life (HRQoL). Each of the 8 dimensions of the SF-36 is covered by a single item in the SF-8. The aim of the study was to examine the latent model structure of the SF-8.
Method
One-, two- and three dimensional as well as bi-factor structural models were defined and estimated adopting the ML- as well as the WLSMV-algorithm for ordinal data. The data were collected in a German general population sample (N = 2545 persons).
Results
A two- (physical and mental health) and a three-dimensional CFA structure (in addition overall health) represent the empirical data information adequately [CFI = .987/.995; SRMR = .024/.014]. If a general factor is added, the resulting bi-factor models provide a further improvement in data fit [CFI = .999/.998; SRMR = .001]. The individual items are much more highly associated with the general HRQoL factor (loadings: .698 to .908) than with the factors physical, mental, and overall health (loadings: −.206 to .566).
Conclusions
In the SF-8, each item reflects mainly general HRQoL (general factor) as well as one of the three components physical, mental, and overall health. The findings suggest in particular that the evaluation of the information of the SF-8 items can be validly supplemented by a general value HRQoL.
Background
A markedly negative self-image and pervasive shame proneness have consistently been associated with borderline personality disorder (BPD). The present experimental study investigated the intensity of negative emotional responses with a focus on shame in BPD compared to healthy control persons (HCs) during an experimental paradigm promoting self-awareness, self-reflection, and self-evaluation. Furthermore, the relationship between levels of state shame during the experiment and shame proneness in BPD compared to HCs was examined.
Methods
A sample of 62 individuals with BPD and 47 HCs participated in the study. During the experimental paradigm, participants were presented with photos of (i) the own face, (ii) the face of a well-known person, and (iii) of an unknown person. They were asked to describe positive facets of these faces. Participants rated the intensity of negative emotions induced by the experimental task as well the pleasantness of the presented faces. Shame-proneness was assessed using the Test of the Self-Conscious Affect (TOSCA-3).
Results
Individuals with BPD experienced significantly higher levels of negative emotions than HCs both before and during the experimental task. While HC participants responded to their own face particularly with an increase in shame compared to the other-referential condition, the BPD patients responded above all with a strong increase of disgust. Furthermore, the confrontation with an unknown or well-known face resulted in a strong increase of envy in BPD compared to HC. Individuals with BPD reported higher levels of shame-proneness than HCs. Higher levels of shame-proneness were related to higher levels of state shame during the experiment across all participants.
Conclusion
Our study is the first experimental study on negative emotional responses and its relationship to shame proneness in BPD compared to HC using the own face as a cue promoting self-awareness, self-reflection, and self-evaluation. Our data confirm a prominent role of shame when describing positive features of the own face, but they emphasize also disgust and envy as distinct emotional experience characterizing individuals with BPD when being confronted with the self.
Compared to natives, young adults with an immigrant background are more likely to choose academic education over vocational education and training (VET). Our study investigates ethnic choice effects at different stages of the educational system. Based on longitudinal data from the German National Educational Panel Study (NEPS), we found that immigrant youths–when controlling for achievement and social background–were more likely to attend academic tracks in Grade 9, have higher participation rates in academic tracks at the upper-secondary level, are less likely to choose VET after lower-secondary education as well as after upper-secondary education, and switch more often to higher education after achieving an upper-secondary degree. Mediation analyses confirmed that these effects were largely shaped by differences in educational and occupational aspirations. Our study provides detailed insights into the transition pathways at different educational stages and the relevant mechanisms driving migration-specific choice effects. As ethnic choice effects are empirically well documented in international research, our investigation may contribute to a deeper understanding of educational inequalities in other European countries.
The health literacy (HL) facet Access to health information is measured in the European Health Literacy Survey (HLS-EU-Q47) by 12 items. To assess Access, we developed adapted item formulations for COVID-19 infection prevention (COVID-19-IP) and early childhood allergy prevention (ECAP) in addition to the original 12 items on General Health (GH). N = 343 (expectant) mothers of infants answered the items in an online assessment. Confirmatory structural analyses for ordinal data were adopted (WLSMV-algorithm). Women’s item ratings varied significantly across domains (η2 = .017–.552). Bi-factor models exhibited the best data fit (GH/COVID-19-IP/ECAP: CFI = .964 /.968/.977; SRMR: .062/.069 /.035): The general factor Access most strongly determined item information. Additionally, three subfactors contributed significantly (but rather weakly) to the item information in each domain. The overall score Access proved to be internally consistent (McDonald’s ωGH/COVID-19-IP/ECAP = .874/.883 /.897) and was associated with socioeconomic state (McArthur scale; rGH/COVID- 19-IP/ECAP = .218 /.210/.146). Access correlated not or only weakly with the other HL facets Understand, Appraise, and Apply. The health domains GH, COVID-19-IP, and ECAP moderated both the difficulty and the dimensional structure of the 12 Access items. This suggests that in the HLS-EU Access reflects not only the search competence but also the availability of health information.
(1) Background: Health literacy is considered a personal asset, important for meeting health-related challenges of the 21st century. Measures for assisting students’ health literacy development and improving health outcomes can be implemented in the school setting. First, this is achieved by providing students with learning opportunities to foster their personal health literacy, thus supporting behavior change. Second, it is achieved by measures at the organizational level promoting social change within the proximal and distal environment and supporting the school in becoming more health-literate. The latter approach is rooted in the concept of organizational health literacy, which comprises a settings-based approach aiming at changing organizational conditions to enhance health literacy of relevant stakeholders. The HeLit-Schools project aims to develop the concept of health-literate schools, describing aspects that need to be addressed for a school to become a health-literate organization. (2) Method: The concept development builds on existing concepts of organizational health literacy and its adaptation to the school setting. (3) Results: The adaptation results in the HeLit-Schools concept describing a health-literate school with eight standards. Each standard depicts an area within the school organization that can be developed for fostering health literacy of school-related persons. (4) Conclusions: The HeLit-Schools concept offers an approach to organizational development for sustainably strengthening health literacy.
Objectives
To validate the patient-reported measure of Social Support Perceived by Patients Scale-Nurses (SuPP-N).
Design/setting
A secondary data analysis based on a cross-sectional breast cancer patient survey in 83 German hospitals. Patients were asked to give written informed consent before they were discharged. If they agreed to participate, the questionnaire was sent via mail to their home address after discharge.
Participants
Of 5583 eligible patients, 4841 consented to participate in the study and 4217 returned completed questionnaires (response rate: 75.5 %). For the data analysis n=3954 respondents were included. On average, participants were 60 years old and mostly in cancer stages I and II
Primary and secondary outcome measures
Perceived social support was assessed with a three-item patient-reported scale (SuPP-N). Convergent validity and criterion-related validity were tested using the following constructs: trust in nurses, trust in the treatment team (Wake Forest Physician Trust Scale, adapted), quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), processes organisation, availability of nurses.
Results
The structural equation model (SEM) assuming a one-dimensional structure of the instrument showed acceptable goodness of fit (root mean square error of approximation=0.04, Comparative Fit Index=0.96 and Tucker-Lewis Index=0.96; factor loadings ≥0.83). Hypothesis–consistent correlations with trust in nurses (beta=0.615; p<0.01) and trust in the treatment team (beta=0.264; p<0.01) proved convergent validity. Criterion-related validity was proved by its association with patients’ quality of life (beta=−0.138; p<0.01), processes organisation (beta=−0.107; p<0.01) and the availability of nurses (beta=0.654; p<0.01).
Conclusion
The results of the SEM identify potential important factors to foster social support by nurses in cancer care. In patient surveys, the SuPP-N can be used efficiently to measure patient-reported social support provided by nurses. The use of the scale can contribute to gain a better understanding of the relevance of social support provided by nurses for patients and to detect possible deficits and derive measures with the aim of improving the patient–nurse interaction.
Mitigating and adapting to climate change requires foundational changes in societies, politics, and economies. Greater effectiveness has been attributed to actions in the public sphere than to the actions of individuals. However, little is known about how climate literacy programs address the political aspects of mitigation and adaptation. The aim of this systematic literature review is to fill this gap and analyze how public-sphere actions on mitigation and adaptation are discussed in climate literacy programs in schools. Based on database searches following PRISMA guidelines we identified 75 empirical studies that met our inclusion criteria. We found that central aspects of climate policy such as the 1.5-degree limit, the IPCC reports, or climate justice are rarely addressed. Whilst responsibility for emissions is attributed to the public sphere, the debate about mitigation usually focuses on the private sphere. Climate change education does not, therefore, correspond to the climate research discourse. We show that effective mitigation and adaptation are based on public-sphere actions and thus conclude that effective climate education should discuss those public actions if it is to be effective. Hence, we propose that climate education should incorporate political literacy to educate climate-literate citizens.
Rezension
(2014)
Der Diskurs um Schreibende, Textproduktion und Genres in Studium und Berufsausbildung ist in den letzten zehn Jahren in der deutschsprachigen Fachliteratur extensiver, gleichzeitig aber auch intensiver geworden. Bis ungefähr zur
Jahrtausendwende gab es einen klaren Fokus auf dem schulischen Schreiben,
oft reduziert auf traditionelle Genres der Institution Schule oder auf das Überarbeiten als eine spezielle Phase der Textproduktion mit verstärktem Interaktionscharakter zwischen Peers und Lehrperson. Publikationen die sich dem schulischen Schreiben als komplexem Zusammenspiel von Schreibentwicklung,
ganzheitlichem Schreibhandeln und institutionellen Rahmenbedingungen widmeten (z. B. Merz-Grötsch 2000), waren noch recht selten.
Appropriate parental health literacy (HL) is essential to preventively maintain and promote child health. Understanding health information is assumed to be fundamental in HL models. We developed N = 67 items (multiple-choice format) based on information materials on early childhood allergy prevention (ECAP) and prevention of COVID-19 infections to assess the parental HL facet Understand. N = 343 pregnant women and mothers of infants completed the items in an online assessment. Using exploratory factor analysis for ordinal data (RML estimation) and item response models (1-pl and 2-pl model), we proved the psychometric homogeneity of the item pool. 57 items assess the latent dimension Understand according to the assumptions of the 1-pl model (weighted MNSQ < 1.2; separation reliability = .855). Person parameters of the latent trait Understand correlate specifically with subjective socioeconomic status (r = .27), school graduation (r = .46), allergy status (r = .11), and already infected with COVID-19 (r = .12). The calibrated item pool provides a psychometrically sound, constructvalid assessment of the HL facet Understand Health Information in the areas of ECAP and prevention of COVID-19 infections.
Video cases are commonly used in teacher education to support evidence-based professional knowledge acquisition. Novice teachers, however, often struggle when learning with video, since they lack professional knowledge schemata that facilitate noticing and reasoning about relevant events. Scripted video case development provides an approach to make relevant events more salient and visible. In alignment with previously reported approaches, we applied relevant design steps and quality criteria within the presented project to promote use in further research. Thereby, we introduce the novel approach of using mock-up settings as a way to identify naturalistic behavior as a basis for script development. User experience (UX) evaluations based on defined quality criteria of realistic experiences (i.e., authenticity), personal relevance (i.e., utility value), engagement (i.e., situational interest), and challenge (i.e., cognitive load) were carried out in a set of four studies including N = 423 teacher students. Findings support the conclusion that our design approach resulted in the development of high-quality scripted video cases for further use in initial teacher education.
What Skills Do Addiction-Specific School-Based Life Skills Programs Promote? A Systematic Review
(2022)
In school-based addiction prevention, life skills programs (LSPs) have been established since the 1990s. The scientific evidence regarding program effectiveness is in parts unclear. This review links life skills not to behavioral outcomes but to three facets of the self: the affective evaluative, the dispositional & dynamic, and the cognitive descriptive facet of the self. This complements the evidence on behavioral outcomes. In a systematic literature search we have identified drug-specific life skills programs in German language and their evaluation studies. We have mapped the instruments used to assess effectiveness of the LSP on three facets of the self, which are site of action of intrapersonal skills. We identified six comparable life skills programs that have been evaluated at least once. In five of these programs, different facets of life skills have been assessed with a total of 38 different measurement instruments. We found that improvements in affective evaluative and dispositional & dynamic facets of the self could be stimulated by LSPs, complementing previous evidence focusing on behavioral outcomes. Conclusion: Numerous instruments have been used that are not directly comparable but can be categorized by facets of the self. As a result, it is found that life skills programs can have an impact on building attitude and the shaping of intrapersonal skills. Interpersonal competencies such as communication skills and empathy have not been measured. Furthermore, a consensus on measurement instruments for life skills should be found.
The COVID-19 pandemic has posed significant challenges to (expectant) mothers of infants in terms of family health protection. To meet these challenges in a health literate manner, COVID-19 protective measures must be considered important and must also be implemented appropriately in everyday life. To this end, N = 343 (expectant) mothers of infants indicated (a) how important they considered 21 COVID-19 infection prevention measures, and (b) how well they succeeded in implementing them in their daily life (20 measures). We performed data analysis using exploratory factor analysis for ordinal data and latent class analysis. One- and two-dimensional models (CFI = .960 / .978; SRMR = .053 / .039) proved to appropriately explain maternal importance ratings. The items on successfully applying COVID-19 measures in daily life can be modeled by the 5 factors hygiene measures, contact with other people, public transportation, staying at home, and checking infection status (CFI = 0.977; SRMR = .036). Six latent classes can be distinguished. Despite the largest class (39 %), classes are characterized by selective or general applicability problems. Classes reporting problems in the applicability of the measures rated them as generally less important (η = .582). Assessing and modelling importance and applicability of COVID-19 prevention measures allows for a psychometrically sound description of subjective perceptions and behaviors that are crucial for health literate practice in maternal daily life.
The present study analyzed experimentally the association between the experience of psychological stress and the physiological stress response of prospective teachers. The experienced stress was assessed by self-reported data. Cortisol concentrations via saliva samples reflected the physiological response. The results show no difference between the stress and the control group in the experience of psychological stress. However, the stress group had significantly increased cortisol concentrations compared to the control group. The study could not show any correlation between the two stress parameters. The results suggest that a stress response should be validated based not only on the experience of psychological stress but also on the physiological stress response. This is particularly crucial in light of the fact that the majority of studies concerning stress in teachers are limited to experiences of psychological stress so far. Due to this, the results may provide a first important contribution to a more comprehensive stress assessment for teachers.
Introduction
Mathematics classrooms are typically characterized by considerable heterogeneity with respect to students’ knowledge and skills. Mathematics teachers need to be highly attentive to students’ thinking, learning difficulties, and any misconceptions that they may develop. Identification of potential errors and appropriate ways to approach them is crucial for attaining positive learning outcomes. This paper explores which knowledge and affective-motivational skills teachers most require to effectively identify and approach students’ errors.
Methods
To address this research question within the German follow-up study of the Teacher Education and Development Study in Mathematics (TEDS-M), 131 primary school mathematics teachers’ ability to identify students’ errors was assessed based on (a) a digitalized speed test showing different students’ solutions in a written notation and (b) three video vignettes that showed different scenes from mathematics classes. These scenes dealt, among other things, with children who struggled with the lesson’s mathematical content. Teachers were asked to analyze students’ thinking and to determine how best to react. In addition, teachers’ mathematics pedagogical content knowledge, mathematical content knowledge, and beliefs were assessed in separate tests and served as predictors for teachers’ abilities to identify, analyze, and deal with students’ errors.
Results
The results indicate that all components are interrelated. However, path analysis reveals that teachers’ ability to deal with students’ errors is mainly predicted by their constructivist beliefs while their ability to quickly identify typical students’ errors is largely dependent on their mathematics content knowledge.
Discussion
The results show the central filtering function of beliefs. Teachers who believe that students must shape and create their own learning processes are more successful in perceiving and analyzing student errors in classroom situations. They may understand errors as learning opportunities and - thus - pay specific attention to these occurrences.
Beginning in March 2020, the lockdown precipitated by the COVID-19 pandemic resulted in many challenges, especially for families with young children. Many children had little or no access to institutional education. Therefore, they were even more dependent on their parents providing them with home learning activities (HLA) to support their development. We examined the adaptability of families with regard to changes in parents’ provision of HLA in traditional two-parent families, single parent families, and large families compared to before the lockdown. We focused on family resources, such as a supportive distribution of roles within the partnership, or social support, as predicting factors of adaptability in N = 8,513 families with children aged 18–69 months. In addition, we considered parental stress as a further influencing factor. The cross-sectional data depicts families from a nationwide online survey, which we conducted during spring 2020 in Germany. We found that (a) all three family types offered their children more learning activities at home, albeit with slight differences between the families. However, (b) we identified differences in the factors influencing families’ adaptability: Across all family types, we found slight to medium negative relations between adaptability and parental stress. The relations were most evident in large families. Furthermore, social support exhibits somewhat positive relations to the adaptability of large families. For adaptability in single-parent families, gender differences were initially evident. Among single fathers, the change in parental HLA was stronger than among single mothers. However, this relation disappeared when we took parental stress and social support into account. For traditional two-parent families and single parents, our analyses revealed (c) barely significant relations between the investigated predictors and changes in HLA during lockdown. Overall, our study confirms that high stress limits the adaptability of providing HLA in families and that social support mitigates negative relations between stress and the provision of HLA, especially in large families. In order to develop effective and needs-based family support programs, it is therefore important to help parents cope with stress and provide them with low-threshold social support. The extent to which these services need to be adapted to different family types must be surveyed in more depth.
Education for sustainable development (ESD) has been a task assigned to schools and universities since the mid-1990s. This global movement spawned ESD research in numerous fields, including, among others, didactics and educational sciences, as well as sustainability sciences. In this article, we analyze the state of research on reliable recommendations of means (more precisely, teaching and learning methods and procedures) to promote the ESD goals. Within the framework of systematic literature analysis, we compared and evaluated 17 scientific publications from the field of ESD. Using qualitative content analysis, we scanned the 17 articles for recommendations of means of ESD and the cited evidence for their effectiveness. The findings show two groups of recommended means, differing particularly in the degree of learner autonomy and the quality of evidence for their effectiveness. We discuss possible tasks that can be derived from these findings for didactic research on ESD, and we make a suggestion for further teaching action.
Educational settings such as classrooms provide important opportunities for social learning through interactions with peers. Our paper addresses the research question of whether and to what extent classroom composition characteristics make a difference. We carried out multilevel analyses based on a sample of n = 791 students in 48 classrooms (grades 5 – 7) in inclusive lower-secondary comprehensive schools in Baden-Württemberg (Germany). 22.6 % of the variance in students’ reciprocal friendship nominations were attributable to classroom-level differences. A higher average socioeconomic status and, respectively, a lower percentage of immigrant students negatively affected the number of reciprocal friendship nominations within classrooms. These results indicate that more privileged classroom settings can be related to less dense friendship networks of students. Our findings can be understood as an impulse to consider contextual factors when evaluating and addressing the social structure of classrooms in research and practice.
Community-based health promotion approaches have proven to be very appealing and effective in rural and under-resourced countries such as Afghanistan. Surprisingly, however, empirical evidence and practical recommendations are lacking for Afghanistan, a country with some of the worst health indicators worldwide (e.g., maternal mortality rate). The purpose of this mixed-method exploratory case study was to identify community-based approaches to health promotion in Afghanistan and the factors that lead organizations and activities to succeed and sustain despite challenging circumstances. The author conducted extensive secondary research, a scoping review, 28 semi-structured oral qual- itative interviews with people working in health projects in Afghanistan, and obtained 22 written responses to a qualitative questionnaire sent to NGOs working in the health sector in Afghanistan as well. After transcribing and analyzing the content, she was able to exhaustively explore the topic by integrating and triangulating multiple perspectives.
First, she presented the findings regarding the prerequisites for and determinants of health in Afghanistan by contrasting qualitative and quantitative data. This comprehensive overview illustrated not only the poor conditions and numerous challenges but also the diversity within the country. Second, she described the findings on the Afghan health system, structured along the components of the WHO Health System Framework. This allows for comprehending the well-planned strategies and comparing them to the actual situation. Third, she identified most (NGO-supported) healthcare providers and conducted a gap analysis of existing activities in 13 areas of health. Fourth, the qualitative findings provided insights into the concept of health, common health practices, community-based healthcare approaches, and success factors for working in Afghanistan. Overall, there are various health activities and approaches to health promotion in Afghanistan. The most successful approaches were those that work in the community, with trained female health workers who are trustworthy, committed, and paid, and who provide curative as well as preventive and promotive services. For working successfully in the Afghan setting, trust, collaboration with leaders, community participation, and training are highly recommended. Nonetheless, all activities took place in a context characterized by insecurity, corruption, poverty, low level of education, and cultural constraints.
The author proposed the concept of “health care plus and beyond” as an approach applicable to all providers. This concept includes taking care of the immediate health need of the person and, at the same time, empowering them to improve their health. In conclusion, there is a great need for health promotion and health education in Afghanistan, which is worth exploring further. This study could not provide a complete picture, but it does pro- vide a very good first-hand understanding of the numerous influencing factors and facets of community-based health promotion, thus providing numerous starting points for further research and practice.
Globalization, digitalization, global pandemics, climate change, and infodemic pose increasing challenges to individuals, communities, and societies, which require good health literacy to maintain and promote health. Empirical evidence on HL (health literacy) has rapidly increased worldwide and exposed the inadequate levels of HL in most countries. Especially people with low socioeconomic background, low educational attainment, and migrants are considered vulnerable to low HL, based on quantitative studies and conclusions. A group that is multiply affected and variously described as vulnerable is people of Afghan descent. However, empirical evidence on their actual HL and their HL practices in everyday life is scarce. To empower people to respond adequately to current and future health-related changes, a good knowledge of HL in the relevant population group is indispensable. Since recent qualitative studies indicate that health literacy can only be adequately described as a real practice in its specific context and unique situation, I explore in this dissertation how HL can be captured and described as a contextual, situational social practice, using the example of people of Afghan descent with different research methods. This work incorporates three major research projects, each employing different methods to explore HL among Afghans and provide relevant insights into the concept of HL.
Research on health and health literacy is diverse, so it is important to begin this work by outlining the different understandings of health and health literacy and common strategies for promoting them. Since health is understood from a health promotion perspective as a positive, comprehensive concept in a socio-ecological context, HL is consequently not understood as an individual autonomous skill but as a contextual, social practice. Accordingly, health and HL are also described in context by the groups under consideration, and their possible influence on HL is shown. The use of the term vulnerable is critically examined, and the focus is shifted away from the characteristics of the individual to the influencing circumstances. Based on raw determinants and health outcomes, HL in Afghanistan is rated as low. Given the diverse data on immigrant populations and the different theories explaining their health status, it is shown that immigrant populations face many pressures and need to acquire new HL. Third, building on the course offering: language course, it is argued that those participating in it (including Afghans) need to improve their HL. Building on account of the health literacy of so-called vulnerable groups, which traced the complexity and heterogeneity, it is concluded that HL needs to be understood and explored as a contextual, situational, social practice to adequately describe HL. Therefore, in the three research projects, special emphasis is placed on the respective overall social context, the situation's specifics, the use of language, the actual actions, and the meaning of social others. Furthermore, it is examined what can be learned from the respective methodological approach to HL with regard to HL as a contextual, situational social praxis, as well as how the vulnerability or resource wealth of the target group and the vulnerability- or capability-producing context are revealed. Last, important lessons for HL promotion were derived from all three projects.
The first four contributions are from a quantitative, cross-sectional study in central Afghanistan that examines HL, determinants, outcomes, but also quality of life, and beliefs in two groups of people influential to health, heads of households (N= 524) and female patients and/or caretakers (N=322). Participants were in a two-stage randomization process identified and orally interviewed by trained interviewers of the same sex. The study provides empirical evidence of poor determinants of health and health outcomes, health behaviors that need improvement, and low health literacy. The analysis showed that HL is largely related to schooling opportunities (for women). Surprisingly, despite adverse circumstances, an astonishing number of Afghans exhibit positive health behaviors. A qualitative examination of the items of the HLS-EU-Q16 shows which activities are particularly difficult and, at the same time, particularly prerequisite-rich, which should also be better researched in the future for developing interventions.
The second three contributions stem from the ELMi research project, which ethnographically researched the HL of immigrant youth (including three Afghan refugees) in everyday life and embedded the findings in a review and theoretical considerations. The limitations of reviews for describing HL in vulnerable groups became obvious in these three theoretical contributions. Furthermore, the frequent, mostly implicit theoretical orientation of HL as an individual rational-choice model and three alternative models for the description of HL were presented, a difference-deficit model was introduced, and a plea for applying sociological theories, especially the capability approach, was given. Overall, the ethnographic studies revealed the need for further studies of vulnerable groups from a salutogenic perspective, the conceptualization of HL as family HL, and the interwovenness of analog and digital worlds and respective HL.
The third three contributions are from the SCURA research project, which ethnographically explored the role of health and health literacy in language and integration courses and developed appropriate methods for promoting HL in them. The contribution of integration courses to the promotion of HL was presented in detail, the corridor of possible interventions was explored and described, and concrete suggestions were made as to how the knowledge gained from language didactics can be transferred to health promotion and how language-sensitive health promotion can be used as an effective and sustainable method.
Finally, the key strengths and limitations of the studies were highlighted, and the question of 'vulnerability' was revisited in light of the results found. Furthermore, the five aspects of HL as a contextual, situational, and social practice were re-examined with the help of the results obtained, and other studies, recommendations for the promotion of HL through context, acquisition, and targeted support were presented, and the capability approach was applied to the results.
In many ways, this multi-project, multi-method, multi-perspective approach to HL of so-called vulnerable groups highlighted the need to describe HL as a contextual, situational social practice. Since many new, little-trodden paths were taken in this work, this work can serve as an impetus for many other researchers to critically examine the topic. The work unmistakably revealed how relevant a good understanding and targeted, context-sensitive promotion of HL is.
Globalization, digitalization, global pandemics, climate change, and infodemic pose increasing challenges to individuals, communities, and societies, which require good health literacy to maintain and promote health. Empirical evidence on HL (health literacy) has rapidly increased worldwide and exposed the inadequate levels of HL in most countries. Especially people with low socioeconomic background, low educational attainment, and migrants are considered vulnerable to low HL, based on quantitative studies and conclusions. A group that is multiply affected and variously described as vulnerable is people of Afghan descent. However, empirical evidence on their actual HL and their HL practices in everyday life is scarce. To empower people to respond adequately to current and future health-related changes, a good knowledge of HL in the relevant population group is indispensable. Since recent qualitative studies indicate that health literacy can only be adequately described as a real practice in its specific context and unique situation, I explore in this dissertation how HL can be captured and described as a contextual, situational social practice, using the example of people of Afghan descent with different research methods. This work incorporates three major research projects, each employing different methods to explore HL among Afghans and provide relevant insights into the concept of HL.
Research on health and health literacy is diverse, so it is important to begin this work by outlining the different understandings of health and health literacy and common strategies for promoting them. Since health is understood from a health promotion perspective as a positive, comprehensive concept in a socio-ecological context, HL is consequently not understood as an individual autonomous skill but as a contextual, social practice. Accordingly, health and HL are also described in context by the groups under consideration, and their possible influence on HL is shown. The use of the term vulnerable is critically examined, and the focus is shifted away from the characteristics of the individual to the influencing circumstances. Based on raw determinants and health outcomes, HL in Afghanistan is rated as low. Given the diverse data on immigrant populations and the different theories explaining their health status, it is shown that immigrant populations face many pressures and need to acquire new HL. Third, building on the course offering: language course, it is argued that those participating in it (including Afghans) need to improve their HL. Building on account of the health literacy of so-called vulnerable groups, which traced the complexity and heterogeneity, it is concluded that HL needs to be understood and explored as a contextual, situational, social practice to adequately describe HL. Therefore, in the three research projects, special emphasis is placed on the respective overall social context, the situation's specifics, the use of language, the actual actions, and the meaning of social others. Furthermore, it is examined what can be learned from the respective methodological approach to HL with regard to HL as a contextual, situational social praxis, as well as how the vulnerability or resource wealth of the target group and the vulnerability- or capability-producing context are revealed. Last, important lessons for HL promotion were derived from all three projects.
The first four contributions are from a quantitative, cross-sectional study in central Afghanistan that examines HL, determinants, outcomes, but also quality of life, and beliefs in two groups of people influential to health, heads of households (N= 524) and female patients and/or caretakers (N=322). Participants were in a two-stage randomization process identified and orally interviewed by trained interviewers of the same sex. The study provides empirical evidence of poor determinants of health and health outcomes, health behaviors that need improvement, and low health literacy. The analysis showed that HL is largely related to schooling opportunities (for women). Surprisingly, despite adverse circumstances, an astonishing number of Afghans exhibit positive health behaviors. A qualitative examination of the items of the HLS-EU-Q16 shows which activities are particularly difficult and, at the same time, particularly prerequisite-rich, which should also be better researched in the future for developing interventions.
The second three contributions stem from the ELMi research project, which ethnographically researched the HL of immigrant youth (including three Afghan refugees) in everyday life and embedded the findings in a review and theoretical considerations. The limitations of reviews for describing HL in vulnerable groups became obvious in these three theoretical contributions. Furthermore, the frequent, mostly implicit theoretical orientation of HL as an individual rational-choice model and three alternative models for the description of HL were presented, a difference-deficit model was introduced, and a plea for applying sociological theories, especially the capability approach, was given. Overall, the ethnographic studies revealed the need for further studies of vulnerable groups from a salutogenic perspective, the conceptualization of HL as family HL, and the interwovenness of analog and digital worlds and respective HL.
The third three contributions are from the SCURA research project, which ethnographically explored the role of health and health literacy in language and integration courses and developed appropriate methods for promoting HL in them. The contribution of integration courses to the promotion of HL was presented in detail, the corridor of possible interventions was explored and described, and concrete suggestions were made as to how the knowledge gained from language didactics can be transferred to health promotion and how language-sensitive health promotion can be used as an effective and sustainable method.
Finally, the key strengths and limitations of the studies were highlighted, and the question of 'vulnerability' was revisited in light of the results found. Furthermore, the five aspects of HL as a contextual, situational, and social practice were re-examined with the help of the results obtained, and other studies, recommendations for the promotion of HL through context, acquisition, and targeted support were presented, and the capability approach was applied to the results.
In many ways, this multi-project, multi-method, multi-perspective approach to HL of so-called vulnerable groups highlighted the need to describe HL as a contextual, situational social practice. Since many new, little-trodden paths were taken in this work, this work can serve as an impetus for many other researchers to critically examine the topic. The work unmistakably revealed how relevant a good understanding and targeted, context-sensitive promotion of HL is.