Embedding Health Literacy in Health Classes in Aotearoa New Zealand: A Mixed Methods Study

Abstract

Aims: Health literacy knowledge and competencies foster adolescents to become healthy and engaged citizens. This thesis explores, examines, and proposes school-based strategies to improve the health literacy of senior high school students in Aotearoa New Zealand. Methods: This mixed methods research had four components. Study 1 mapped, through a scoping review, details of international school-based interventions that aimed to improve the health literacy of senior high school students. Study 2 used classroom observations to identify pedagogical strategies that New Zealand health teachers applied in senior classes. Study 3 explored, through interviews, narratives of New Zealand teachers and students about how health is taught, and how students perceived their health literacy skills. Study 4 presented the first cross-sectional study in Aotearoa New Zealand to measure the generic health literacy levels of adolescents using an age-appropriate validated tool and asking them how they would like to learn these skills. Results: Study 1 included 35 primary studies of programmes implemented by teachers or health experts through active and interactive learning, technology, and interdisciplinarity. Study 2 demonstrated that the strategies teachers used in the observed classes aligned with principles of effective learning and education for health literacy. Study 3 revealed health teachers, in their endeavour to promote health literacy, valued relationship-building with students and the national school framework but posed concerns on the excessive focus on summative assessments and time constraints. Study 3 also found that students considered health classes and the support from their teachers valuable but lacked skills to assess the reliability of health information. Study 4 demonstrated the sampled senior high school students had unsatisfactory generic health literacy but would like to improve these skills through engaging in health classes. Conclusion: Health-related knowledge and critical thinking skills of New Zealand adolescents could be areas of concern. Schools need to support teachers in continuing professional development, building cross-curricular projects, and implementing student-centred educational programmes. Health classes should follow active and interactive learning, address topics relevant from students’ perspectives, use technology, and explore different settings. Schools can collaborate with health professionals, universities, communities, and students’ whānau (family) to facilitate these strategies