Engaging Youth to Support Health

LiteracyNancy Vandenberg, Youth Engagement SpecialistEnvision New Mexico, University of New Mexico

What is youth engagement?The definition being

utilized by the School-based Health Center

Improvement Project is:

the intentional, meaningful and sustained

involvement of young people in the programs, practices and policies

that seek to impact them. In partnership with

adults, engaged youth develop the capacity and confidence to participate as productive partners in

the decisions affecting them individually and

collectively.

What is health literacy?

The American Medical Association defines health

literacy as:

the ability to obtain, process, and understand basic health information and services needed to

make appropriate health decisions and follow

instructions for treatment.

Why is a focus on health literacy important? 93 million adults have basic or below basic literacy (2003 National

Assessment of Adult Literacy) Most health materials are written at a level that exceeds reading

skills of the average high school graduate (Harvard School of Public Health report on Literacy and Health)

There is an increased demand from complex health care systems and increased responsibility for individuals interacting with health care systems (Adult Literacy and Lifeskills Survey of 2003)

The number of medications prescribed, reliance on forms & written directions, and home self-management have all increased (Harvard School of Public Health report on Literacy and Health)

It is estimated that the cost of limited health literacy in the U.S. is between $106 and $236 billion dollars annually (National Action Plan to Improve Health Literacy, U.S. Department of Health and Human Services).

What are the elements and levels of literacy and health literacy?5 Core Literacy Elements: Reading Writing Numeracy Speaking Listening

Three Levels of Health Literacy: Basic, or functional, health

literacy includes basic understanding of health risks and health services.

Interactive health literacy includes the capacity to act independently on health advice and actively participate in health care with providers.

Critical health literacy includes the ability to understand the determinants of health and act on the information.

Source: Health Promotion International: “Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century” Nutbeam, Don

Media Literacy is Part of Health Literacy

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The internet is a major source of information for teens:

• 93% of teens use the internet

• 50% of teens use the internet every day

• 17% of teens use the internet to find information about health topics it may be hard to talk to parents about (e.g. sex, depression, drug use)

• Source: Pew Internet and American Life Project survey of 2009

• Up to 75% of teens who access the internet use it to look for health-related information

• Source: How Young People Use the Internet for Health Information, 2001 Kaiser Family Foundation Survey

Media LiteracyClick icon to add pictureThe internet is a major source of information for teens because it is:

• Immediate

• Private

• Interactive

However, there are challenges to utilization for teens:

• Information may be inaccurate

• Information may not be age-appropriate

• Information sources may be biased (e.g. drug company sponsored)

What Health Literacy Skills Should We Teach?

• Navigating Health Care

• Understanding Health Care

• Self-Advocacy in Health Care

Navigating Health Care• How to make appointments• What the types of

healthcare providers are• Who I go to for what (PCP

vs. school nurse, etc.)• When to go to what kind of

facility (PCP, urgent care, ER AND school nurse, SBHC, school counselor)

• Paying for care (what, if any, kind of insurance do I have, and where that leads me)

• Where I will get health care once I leave school

Understanding Health Care• Knowing where to find

accurate health information• Understanding basic health-

related terminology• Knowing my rights,

especially around confidentiality

• Knowing that health providers can support wellness plans as well as management of illness

• Understanding basic instructions for taking medication

Self-Advocacy in Health Care• Being able to ask clarifying

questions of my provider• Making plans in collaboration

with my provider• Being able to discuss

relevant refusal skills with my provider

• Bringing questions and concerns to the attention of my provider

• Choosing appropriate treatment plans in concert with my provider

• Determine what behaviors to choose to achieve health goals

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Role of Health Professionals:

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COMMUNICATION:• Set goals collaboratively• Use interactive style• Request patient

demonstration of recall of treatment plan/instructions (e.g. “I want to make sure I didn’t forget to go over anything; tell me how you’ll take this medication.”)

• Change language to address: language barriers, literacy, technical jargon, quantitative jargon, speedy speech

TEACHING:• Navigation of the healthcare

system

“Patients’ ability to understand health and medical issues and directions is related to the clarity of the communication. Health professionals must take responsibility for clarity.”

Communicating Health: Priorities and Strategies for Progress, Health and Humans Services 2003 report

Role of SchoolsWHY?• Teaching health literacy

emphasizes higher order thinking: communication skills, problem-solving, and decision-making

• Healthy students do better in school!

HOW?• Collaborate to integrate

health literacy efforts across school sectors: science, health, school nurse, SBHC, athletics, career education, English

• Use the national and state health education standards

National Health Education Standards Standard 1: Students will comprehend concepts related to health promotion and disease

prevention to enhance health. Standard 2: Students will analyze the influence of family, peers, culture, media,

technology, and other factors on health behaviors Standard 3: Students will demonstrate the ability to access valid information, products,

and services to enhance health. Standard 4: Students will demonstrate the ability to use interpersonal communication

skills to enhance health and avoid or reduce health risks. Standard 5: Students will demonstrate the ability to use decision-making skills to

enhance health. Standard 6: Students will demonstrate the ability to use goal-setting skills to enhance

health. Standard 7: Students will demonstrate the ability to practice health-enhancing

behaviors and avoid or reduce health risks. Standard 8: Students will demonstrate the ability to advocate for personal, family, and

community health.

NM Health Education StandardsCONTENT STANDARDS WITH BENCHMARKS AND PERFORMANCE STANDARDS FOR HEALTH EDUCATION, Grades 9-12: Standard 1: Students will comprehend concepts related to health promotion and

disease prevention. Standard 2: Students will demonstrate the ability to access valid health

information and health-promoting products and services. Standard 3: Students will demonstrate the ability to practice health-enhancing

behaviors and reduce health risks. Standard 4: Students will analyze the influence of culture, media, technology and

other factors on health. Standard 5: Students will demonstrate the ability to use interpersonal

communication skills to enhance health. Standard 6: Students will demonstrate the ability to use goal-setting and

decision-making skills to enhance health. Standard 7: Students will demonstrate the ability to advocate for personal,

family, peer and community health.

Youth Engagement the intentional, meaningful and

sustained involvement of young people in the programs, practices and policies that seek to impact them. In partnership with adults, engaged youth develop the capacity and confidence to participate as productive partners in the decisions affecting them individually and collectively.

Individual Engagement:

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Engaging with youth on an individual basis can help ensure they learn, practice and master the health literacy skills they need. This is a primary way in which providers can support patients, teachers can support students, etc.

Examples:• Collaborate with a student to make

treatment decisions – like when to take medicine based on their schedule

• Collaborate with a student to make a wellness decision – like what kind of exercise they’d most enjoy to increase physical well-being

• Brainstorm a scenario with a student in which they use refusal skills to avoid risk behaviors

• Provide a student with information about how they can access care when they go to college

• Check for understanding of medical terminology – do a teach back

Collective Engagement

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Engaging with youth on a collective basis can increase their health literacy skills while also promoting the learning of their peers. Examples:• Engage youth to design,

publish and disseminate educational health materials

• Engage youth to design and implement health promotion activities in your school

• Engage youth to research and make recommendations regarding school health and wellness policies

• Engage youth to plan and implement health education activities in the community

Click icon to add pictureUse career interests to activate engagement and to grow and diversify the provider pool in our state.• Start a health careers club• Partner with local health

care agencies to sponsor field trips

• Have volunteer positions in school nurse and SBHC offices for students with health career interests

• Plan an annual health fair with students interested in health careers

• Let students know about health career programs at UNM – HSC (http://hsc.edu/programs/diversity)

Students as Future Providers

Click icon to add pictureActivate student engagement through sports• Collaborate with coaches to

do health promotion activities for teams (e.g. around nutrition)

• Integrate health literacy education with sports physicals

• Encourage a particular team to do a health promotion activity (e.g. football team can use NFL Play60 initiative to encourage physical activity)for the entire campus

• Work with team captains to create an inter-team health councilStudent Athletes

as Allies

Other Youth Engagement Ideas? 1.

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Related Web Resources:FOR YOUTH: www.kidshealth.org http://us.reachout.com www.girlshealth.gov www.teenhealthfx.com www.youngwomenshealth.org/ www.pamf.org/teen www.medlineplus.gov www.teenhealthexplosion.com http://health.nih.gov www.besmartbewell.com www.healthfinder.gov http://familydoctor.org http://netwellness.org http://unm.kramesonline.com www.thinkfirst.org/teens http://depts.washington.edu/thmedia http://medialiteracyproject.org/ http://www.hon.ch/pat.html

FOR THOSE SERVING YOUTH www.cdc.gov/healthliteracy http://www.hon.ch/med.html http://cahealthliteracy.org/ http://www.nlm.nih.gov/medlineplus/ www.healthychildren.org http://www.aap.org/en-us/professional-reso

urces/Research/research-resources/Pages/Health-Literacy-and-Pediatrics.aspx

http://scassheap.org/ http://medialiteracyproject.org/ http://tv.nytimes.com/learning/issues_in_de

pth/teenhealth.html http://depts.washington.edu/thmedia www.diversityrx.org www.hsph.harvard.edu/healthliteracy http://www.npsf.org/for-healthcare-professi

onals/programs/ask-me-3/

http://www.ahrq.gov/qual/literacy/healthliteracytoolkit.pdf

http://www.plainlanguage.gov/populartopics/health_literacy/index.cfm

http://www.cdc.gov/healthyyouth/sher/standards/index.htm

http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/health-literacy-program.page

Thank You!Please feel free to contact me with questions and ideas:

Nancy VandenbergYouth Engagement SpecialistEnvision New MexicoUniversity of New Mexiconvandenberg@salud.unm.edu