Course:KIN366/ConceptLibrary/Health Literacy

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Movement Experiences for Children
Health Literacy.jpg
KIN 366
Section: 001
Instructor: Dr. Shannon S.D. Bredin
Office Hours:
Class Schedule:
Important Course Pages
Lecture Notes
Course Discussion

Health Literacy is considered as one’s capability to obtain, read, understand, evaluate, and use health information, instructions and services needed to make appropriate health decisions (Sanders et al., 2009; CCL, 2008). The components of health literacy which are used in an integrative fashion include prose literacy, document literacy, and numeracy skills (CCL, 2008). Health literacy differs from regular literacy because it goes beyond reading and understanding information to include a health-related context in which information is used (CCL, 2008). With respect to young children and movement experiences, health literacy influences the capacity of parents to appropriately engage young children in healthy behaviours. Young children typically refers to those 12 years old and under, and movement experiences broadly refers to activities involving movement such as rolling a ball or playing with toys (CDC, 2014; Gabbard, 2012).


Low levels of health literacy have major social, behavioural, economical, and health implications for those of all ages (CCL, 2008). In Canada, it has been established that the majority of the population is at a low level of health literacy (60%) (CCL, 2008). Low health literacy is strongly linked with diabetes, but also tied to obesity, and cardiovascular disease (CCL, 2008). Low health literacy has a cost associated with it. For example, the health costs associated with diabetes in Canada are extremely high, totaling $4.66 billion in 2000 and an estimated $8.14 billion for 2016 (CCL, 2008). Socio-behavioural and health consequences for children tied to low parental health literacy include less healthy lifestyle choices, greater aggression, and increased drug use (CCL, 2008).


Health literacy is strongly associated with Canadians’ health status and therefore key for population health (CCL, 2004).

Relation between parent health literacy and child health outcomes

Parents typically make major health decisions for young children who may be unable to make such decisions for themselves. Low parental health literacy is linked to health risks/consequences in children such as increased depressive symptoms, greater health service usage, greater preteen smoking and alcohol use, as well as obesity and cardiovascular disease (Chari, Warsh, Ketterer, Hossain, & Sharif, 2014; Sanders, Federico, Klass, Abrahams, & Dreyer, 2009). Additionally, low parental health literacy may also have behavioural consequences for children such as increased antisocial, aggressive behaviour, and decreased physical activity (Sanders et al., 2009).

Improving health literacy of parents has been shown to improve health behaviours of their children (DeWalt & Hink 2009). Parent health literacy influences one’s decisions on how to raise their child (Dickson, Bredin, & Warburton 2012). Parents with higher health literacy may provide more stimulating environments for their children to develop core movement competencies (Dickson et al., 2012). For example, these parents may supply more affordances to their children, such as toys and opportunities to be active. In turn, these decisions of the parents may facilitate fine and gross motor skill development in their children (Dickson et al., 2012). The most important time for interventions improving parents’ health literacy levels may be while their children are still young, before negative health habits have begun to form (Driessnack, Chung, & Perkhounkova, 2014). Changes in parent health literacy are thought to be an effective way to reduce childhood obesity across the nation (Yin et al., 2014).


Interventions with Different Population Groups

Different population groups tend to have different levels of health literacy. Those typically associated with lower health literacy include minority ethnic groups and those of low socioeconomic status (DeWalt & Hink, 2009).Through proper assessment, individuals of low health literacy can be targeted to decrease health disparities and enhance access to necessary health information, intervention, and support (Abrams, Klass, & Dreyer, 2009).

Across all population groups, there are 4 basic types of health literacy interventions thought to be of high importance to improve child health: 1) Making child health information easy to understand (e.g. using simple youtube videos, pictures, simple language) 2) Improving child health professionals abilities in shared-decision making and simple dialogue 3) Enhancing access for parents to health services and associated information (e.g. health-related telephone lines, websites with health information) 4) Targeting parent and child health literacy levels (e.g. health information pamphlets, school curricula changes) (Sanders et al., 2009)

In the context of movement experiences for young children, these health literacy interventions could be adapted as follows: (1) Simplifying movement and physical activity guidelines and presenting them as easy to comprehend (e.g. in large print size and simple wording), identify with, and put into practice (Monsen, 2007) (2) Educating health care and educational professionals regarding how to explain the benefits and importance of movement experiences for young children and empower patients/students to make informed health behaviour decisions (AMA-MSS Subcommittee on Health Literacy, 2014). (3) Increasing web-based, telephone and in-person resources on physical activity and other health behaviours (Borzekowski, 2009). (4) Creating initiatives targeting parent and child knowledge and informed decision making skills regarding healthy behaviours (Sanders et al., 2009).

Statistics and trends

In Canada, the prevalence of low health literacy level (60%) is higher than that of low literacy level (48%) (CCL, 2008). It has been reported that Canadians have greater health literacy levels than that of Americans (CCL, 2008). Health literacy levels differ greatly across Canada, and over 49,000 communities and neighbourhoods throughout Canada are associated with low health literacy (CCL, 2008). Health Literacy has been found to be higher in more developed cities as well as in provinces/territories located from mid-west to Western Canada (CCL, 2008).

Those who have obtained a higher level of education tend to have higher health literacy (CCL, 2008). Additionally, those who are likely to be at the highest risk for low health literacy are older adults, immigrants and those who are unemployed (CCL, 2008).

Practical applications

Teaching health literacy to young children

Children over the age of 2 can begin learning how to find, understand, and use health information to make health decisions (Borzekowski, 2009). To allow health literacy skills to develop at a young age, educational health information should be presented in age appropriate manner. For example, 5 year olds might be presented with a fun educational video on the importance of being active. To foster higher health literacy, health information should also be made culturally and socially appropriate (Borzekowski, 2009). This information should also be taught to children in a way that is both relevant and convenient to them (Borzekowski, 2009).

Educators and parents may also enhance health literacy by promoting credible evidence-based health information for children to use (such as a reputable health-information website), and add a health component to literary programs used to teach children (CCL, 2008).

Advice and resources for parents

Core competencies for parents include being able to identify, and encourage safe movement opportunities for children (OpheaCanada, 2014). Additionally, parents should understand the importance of movement-related activities for the child’s overall health and well-being (OpheaCanada, 2014). This can involve learning about the importance of play, and healthy risk taking (Engelen et al., 2013). To increase health literacy and understand its relation to living a healthy lifestyle, parents and children can both watch the “Hands Up” video series for free online (OpheaCanada, 2014; HKPR, 2014).

Tips for health care professionals

Health care professionals should try to help parents understand the importance of physical activity and provide clear instructions of how individuals can engage themselves and their children in appropriate movement activities (AMA-MSS Subcommittee on Health Literacy, 2014; Gabbard, 2012). These actions may support patient empowerment and health literacy in terms of child movement experiences (AMA-MSS Subcommittee on Health Literacy, 2014). Simple language should be used in written health materials targeted at patients and caregivers (Abrams et al., 2009). Additionally, motivational interviewing (MI) with individuals about physical activity activity and other health behaviours may also be a good avenue of improving health literacy (Abrams et al., 2009).

Some basic guidelines for health care professionals to make their practice more supportive to children and parents include: a) Relaying information in an easy to understand and relevant manner (e.g. when speaking to parents about the benefits of movement experiences for children, discussing how it may facilitate cognitive development, allowing parents to find value in getting their kids active) b) Working with parents and children to help make informed health decisions c) Empowering parents and children to engage in healthy behaviours (AMA-MSS Subcommittee on Health Literacy, 2014)

Daily Reading

The Canadian government conducted a country-wide analysis in 2008 and found that daily reading had the strongest link with health literacy across all ages (CCL, 2008). On this basis, It may be important for adults and children of all ages to engage in reading everyday to improve health literacy (CCL, 2008).


Health literacy assessment tools have been developed for both children and parents and focus heavily on testing the ability to read health related-texts (Borzekowski, 2009; Driessnack et al., 2014). Assessment tools include the Home Literacy Environment (HLE) single-item screening question on the number of children's books in the home, Newest Vital Sign (NVS) assessing ones ability to read and analyze a nutrition label in less than 3 minutes, Test of Functional Health Literacy in Adults (TOFHL-A), and portions of the Adult Literacy and Life Skills (ALLS) survey (Driessnack et al., 2014; CCL, 2008).


The Physical Activity Line, a telehealth service for those in BC, Canada.

Health Literacy in the context of young children’s movement experiences may be increased by educating individuals on how find, identify, and use information across a variety of mediums (Sanders et al., 2009). To facilitate this, the public could be better informed about available web-based, and telephone physical activity support services in their community to improve access to health information (Abrams et al., 2009). In British Columbia, Canada, the Physical Activity Line is free service, and the first of its kind to provide free telephone physical counseling, and easy to follow information sheets on movement experiences through their website (PAL, 2014).


As of 2014, there are a limited number of studies done on health literacy specifically looking at movement activities and young children. While health literacy is key for both parents and their children, physical literacy (a measure of movement competence across multiple environments) is a target for raising healthy children. It is thought that improving health literacy may translate to great physical literacy and overall might allow children to be active across the lifespan (Gabbard, 2012; PHE Canada, 2014). Lifespan activity, and the ability to make healthy choices in general are critically important for combating the obesity epidemic globally (WHO, 2014).

External Links

Information can be presented in manner that caters to those with low health literacy. For example, below are evidence-based pamphlets providing easy to understand physical activity guidelines for parents and their children (HKPR 2013).

Sedentary Behaviour in Children Ages 0-4

Canadian Physical Activity Guidelines in Children Ages 0-4

Sedentary Behaviour in Children Ages 5-11

Canadian Physical Activity Guidelines in Children 5-11 (HKPR 2013)


Abrams, M. A., Klass, P., & Dreyer, B. P., (2009). Health Literacy and Children: Introduction. Pediatrics, 124, S262-S264. doi:10.1542/peds.2009-1162A

AMA-MSS Subcommittee on Health Literacy. (2014). Health literacy: the missing link in patient-physician communication [PowerPoint slides]. Retrieved from

Borzekowski, D. L. (2009). Considering Children and Health Literacy: A Theoretical Approach. Pediatrics, 124, 282-288. doi:10.1542/peds.2009-1162D.

Canadian Council on Learning (CCL). (2008). Health Literacy in Canada: A Healthy Understanding 2008. Retrieved from Canadian Council on Learning website:

CDC 2014. Child Development. Retrieved from

Chari, R., Warsh, J., Ketterer, T., Hossain, J., & Sharif, I. (2014). Association between health literacy and child and adolescent obesity. Patient Education and Counseling, 94, 61-66. doi:10.1016/j.pec.2013.09.006

DeWalt, D. A. & Hink, A. (2009). Health Literacy and Child Health Outcomes: a Systematic Review of the Literature. Pediatrics, 124, S265. doi:10.1542/peds.2009-1162B

Dickson, D. B., Bredin, S. S., & Warburton, D. W. (2012). The Influence of maternal health literacy on home affordances and early childhood motor development. Journal of Sport & Exercise Psychology. Retrieved from

Driessnack, M., Chung, S., & Perkhounkova, E. (2014). Using the “Newest Vital Sign” to assess health literacy in children. Journal of Pediatric Health Care, 28, 165-171. doi:10.1016/j.pedhc.2013.05.005

Engelen, L., Bundy, A. C., Naughton, G., Simpson, J.M., Bauman, A., Ragen, J. . . ., & Ploeg, H.P. (2013). Increasing physical activity in primary school children - it’s child’s play: a cluster randomized controlled trial. Preventative Medicine, 56, 319-325. doi: 10.1016/j.ypmed.2013.02.007

Gabbard, C. P. (2012). Lifelong motor development (6th ed.). Benjamin Cummings.

HKPR. (2013). Physical Activity. Retrieved from

Monsen, R. B. (2007). Child Health Literacy. Journal of Pediatric Nursing, 22, 69-70. doi:10.1016/j.pedn.2006.09.004

OpheaCanada. (2013, March 1). Hands Up: Part 1 - Introduction to Physical & Health Literacy [Video file]. Retrieved from

PHE Canada. (2014). Physical Literacy. Retrieved from

Physical Activity Line (PAL). (2014). [Company logo for Physical Activity Line]. Retrieved from

Sanders, L. M., Federico, S., Klass, P., Abrahams, M.A., & Dreyer, B. (2009). Literacy and child health: a systematic review. Archives of pediatrics and adolescent medicine, 163, 131-40. doi:10.1001/archpediatrics.2008.539

WHO. (2014). Obesity. Retrieved from

Yin, H. S., Sanders, L. M., Rothman, R. L., Shustak, R., Eden, S. K., Shintani, A., . . ., & Perrin, E. M. (2014). Parent health literacy and “obesogenic” feeding and physical activity-related infant care behaviors. Journal of Pediatrics, 164, 577-583. doi:10.1016/j.jpeds.2013.11.014