Promoting migrant HL, good practice in adult education and lessons learned for other interventions

Abstract Problem Migration is a global phenomenon, and migrants face myriad challenges, e.g., building context-specific health literacy (HL). To sustainably promote HL, translations, interpreters, or programs in other languages are insufficient. Courses that promote HL holistically are needed, e.g., second language courses. In the SCURA research project, part of the HLCA Consortium, we ethnographically studied language courses and developed interventions. The insights gained are relevant not only for courses promoting HL of migrants or in Germany but also for other target groups and countries. Description Based on extensive ethnographic research, we participatory created interventions to promote HL. As language courses promote HL to varying degrees but are severely limited by the rigid conditions and support, we identified strategies to improve HL therein and ensure uptake and sustainability: add-in, pimp-up, dive deeper. The multimodal intervention consists of an extensive collection of teaching ideas, materials to prepare and reflect on sessions, and a 6-part teacher training (in-house, online, and self-study course, based on adult learning principles). The 90-minutes sessions address Health in Language Courses, Health and Me, Using materials, Critically Analyzing Materials and Developing Empowering Activities, Promoting Family HL, and Mental HL. A hands-on tool was developed to help teachers intentionally promote the seven components of HL. Results The preliminary results of the ongoing evaluation showed that the flexibly adaptable and applicable offerings, the online workshop, and self-study courses, were well received. The teachers liked the choice of topics and the combination of short inputs and many recommendations for practice. Lessons The project’s success relies on knowing the context and setting, considering the needs of all stakeholders, and developing offerings that are a relief but not an additional burden, and that can be easily integrated into the program. Key messages • A thorough ethnographic understanding of the course is key to developing interventions that will be perceived to be appropriate and relevant. • HL promotion should integrate teachers’ HL, informal occasions on health information exchange, diverse and multilingual ways to engage with health information and a systematic, deliberate development.


Background:
As migration affects health, migrants need context-appropriate health literacy (HL) to maintain and promote health. Possible venues to improve HL are adult education programs, i.e., language courses (LC). However, empirical evidence on these courses and their contribution to HL is scarce. Moreover, general HL recommendations and conceptually developed HL programs often proved unsuitable in practice as they insufficiently incorporate the multiple influences. This paper's purpose is to show, using key findings, how ethnographic research can contribute to developing appropriate programs and how the transfer from research to practice can succeed.

Methods:
The SCURA project conducted extensive ethnographic research on HL in second LC, i.e., 100 h participant observation in 2 classes, 40 teacher interviews, analysis of 24 textbooks, and teacher training. On this basis, we designed programs and drew lessons from comparison with other programs.

Results:
The study revealed that health and HL as a situational social practice play a key role in LC e.g., as prerequisites for attendance and learning, part of the syllabus, and an occasion for informal conversations. Multiple concepts of health and HL coexist and influence HL promotion. Besides the setting and course conditions, teachers strongly shape HL activities and students show varying degrees of HL practice. We exposed the complexity and diversity of HL situations, meaningmaking processes, strategies to acquire and promote HL, and actual space of action. Then, we developed participatory practicable approaches to promote HL in the educational offer. Compared to other programs, the ethnographic study allowed us to address the major factors, tap into the actual space of action, and increase acceptance, uptake, and sustainability. Conclusions: Improving HL in existing offers requires a profound understanding of the logic of the field. Ethnographic studies facilitate describing these peculiarities and tailoring interventions.

Key messages:
Ethnographic studies allow understanding the relevant factors, actors, situations, contexts, processes, strategies, the logic within and the scope for action.

Problem:
Migration is a global phenomenon, and migrants face myriad challenges, e.g., building context-specific health literacy (HL).
To sustainably promote HL, translations, interpreters, or programs in other languages are insufficient. Courses that promote HL holistically are needed, e.g., second language courses. In the SCURA research project, part of the HLCA Consortium, we ethnographically studied language courses and developed interventions. The insights gained are relevant not only for courses promoting HL of migrants or in Germany but also for other target groups and countries. Description: Based on extensive ethnographic research, we participatory created interventions to promote HL. As language courses promote HL to varying degrees but are severely limited by the rigid conditions and support, we identified strategies to improve HL therein and ensure uptake and sustainability: add-in, pimp-up, dive deeper. The multimodal intervention consists of an extensive collection of teaching ideas, materials to prepare and reflect on sessions, and a 6-part teacher training (in-house, online, and self-study course, based on adult learning principles). The 90-minutes sessions address Health in Language Courses, Health and Me, Using materials, Critically Analyzing Materials and Developing Empowering Activities, Promoting Family HL, and Mental HL. A hands-on tool was developed to help teachers intentionally promote the seven components of HL.

Results:
The preliminary results of the ongoing evaluation showed that the flexibly adaptable and applicable offerings, the online workshop, and self-study courses, were well received. The teachers liked the choice of topics and the combination of short inputs and many recommendations for practice.

Background:
Health literacy (HL) -as a broad range of health-related competencies and skills-has been recognized as a determinant of health outcomes, and suggested to be a modifiable health resource and a factor contributing to empowerment and equity. Thus, there is a need to identify the state of HL in various population groups. The aim of this study was to investigate HL levels and associations between HL, physical activity and subjective health among students in general upper secondary and vocational Swedish-language schools in Finland.

Methods:
The study used cross-sectional data from the Finnish LIITUstudy among students in Swedish-speaking general upper secondary and vocational schools (N = 887; age 16-20 years) conducted in the spring and autumn 2020, during the covid-19-pandemic. Students answered a web-based questionnaire during school hours. HL was measured with the 10-item Health Literacy for School-Aged Children (HLSAC) instrument. Data was analyzed with descriptive statistics and logistic regression analyses.

Results:
According to preliminary findings, one third of students had high HL. HL was higher among female than male students, general upper secondary school students than vocational school students, and in spring than in autumn 2020. A higher proportion of students with high HL, as compared to students with low/medium HL, reached the national recommendations for physical activity, perceived their health to be excellent and, moreover, did not have recurrent psychological symptoms.

Conclusions:
The findings confirm previous research findings on the importance of HL in promoting health outcomes. The pandemic year 2020 provided a unique perspective to the subject. It would be important to survey and discuss the role of schools in providing equal opportunities for the promotion of HL as this may contribute to decreasing health disparities in the population. Key messages: One third of students in upper secondary education (age 16-20 years) had high HL; there were differences between genders, students on different educational paths, and in spring and autumn 2020.
High HL was associated with better self-rated health, less psychological symptoms and reaching national recommendations for physical activity among students in upper secondary education.

Background:
Recently, it was established that more religious people tend to have less favorable views of vaccination. The aim of this study was to assess the relationship between the religiousness and attitudes towards COVID-19 vaccination and disease, in five Western Balkans countries.

Methods:
Using online questionnaire and convenience sampling procedure, data were obtained from 1605 respondents aged 18-75 years. Perceived COVID-19 vaccine safety and efficacy, and observed danger and susceptibility to disease were assessed by short five-point Likert scales. Religiousness was estimated using single item scale. Multivariate regression analysis was employed.

Results:
In Serbia, respondents who assessed themselves as more religious considered vaccine against COVID-19 as less safe (b = -.10, p<.01) and effective (b = -.12, p<.01), were more prone to the attitude that dangers of COVID-19 are not that serious (b = -.09, p<.01), and believed to a greater extent that they are less susceptible to the virus (b = -.07, p<.01). Similarly, in Bosnia and Herzegovina more religious individuals were less convinced that vaccine is effective (b = -.07, p<.05), less inclined to believe that danger of the virus is serious (b = -.07, p<.05), and assessed their susceptibility as lower (b = -.06, p<.05). More religious people in Montenegro (b = -.06, p<.05) regarded the vaccine as less safe, while in North Macedonia (b = .06, p<.05) and Albania (b = .08, p<.01) stronger religiosity was associated with more favorable attitudes towards vaccine safety.

Conclusions:
The relationship between religiosity and attitudes towards COVID-19 vaccination and disease is culturally conditioned. While in some Western Balkans societies religious beliefs render individual with a sense of lack of control triggering worry and anxiety, in some others they work as psychological shield against existential threats. Key messages: Religiosity should be considered as a relevant factor in vaccination campaigns implementation.
In the societies where negative attitudes towards vaccination prevail among the believers, religious leaders should be peculiarly educated and encouraged to participate in vaccination campaigns.