a systems approach to strengthening health lit

8/9/2019 A Systems Approach to Strengthening Health Lit

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A Systems Approach toStrengthening Health Literacy:

Recent Immigrants Living

in Rural Nova Scotia


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Philip Girvan

[email protected]


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Presentation Objectives:

1. Define Health Literacy2.Define Systems Approach3.Discuss significant health literacy issues

for recent immigrants living in a rural

setting, e.g. having a first language otherthan English or French

4.Explore collaborative opportunities toimprove health literacy suggested by

English as a Second Language teachers


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Teacher's health definitions

Good health or badhealth...in a physicaldisease. Don't

automatically think ofemotional health or

psychologicalhealth. Physical

health...first thing thatcomes to mind.

Health involves thewhole person so I guessits your physical, your

psychological, youremotional, and yourspiritual and your socialand your cultural

being pain-free ...Health is what allowsyou to do the things youwant to do freely


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Teachers' health literacy definitions

Is it speaking knowledgeably to yourphysician? People have to be in alarge part responsible for their ownhealth and they have to be literate tobe able to have a discussion with the

doctor about symptoms and aboutmaybe anything else that comes withthat what your options might be foryour health. I think that the moreyou know about the subject the betteryou are and the more literate you are.

literacy is our ability to interpret andunderstand our environment so if youput it to health literacy then it's theability to understand health whathealth means and also what oneneeds to do to stay healthy and that's

health again in that broaderdefinition

professionals who do know have totake into account that people willhave different literacy levels so they

have to make very specific and veryclear information related to [?] and ifthat happens if professionals can dothat then definitely people can becomehealthier.


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Conceptual model of health literacy as a clinical risk (Nutbeam, 2008).


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Conceptual model of health literacy as a personal asset (Nutbeam, 2008).


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Expert panel on health literacy'sdefinition (2008)

The ability to access, understand,evaluate, and communicate

information as a way to promote,maintain and improve health in anumber of settings across the life-

course.


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Systems Approach

There are individual and systems barriers affecting healthliteracy.

Health literacy is an issue that transcends the individual.

Health literacy also transcends the clinical encounter.


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Health literacy issues for ESL communities may include,but are not limited to:

the role of socio-economic determinants of health, linguistic and cultural competence of ESL populations and

health service providers and institutions, the legibility of the health care system and ability of both to

overcome barriers to health care and conditions and effectsof health inequities


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Setting is important

Physical and social environments are non-medicaldeterminants of health.

The majority of new immigrants to Canada move to large urbanareas (Census Metropolitan Areas) for a number of reasonsincluding greater opportunities for employment, members ofthe same ethno-linguistic community.

I just feel that its a really hard place to come to when youdont know people are lonely.

Teacher discussing Antigonish as a place for newcomers


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Definitions of rural versus urban

Urban area: Area with a population of at least 1,000 and nofewer than 400 persons per square kilometre.

Rural area includes:

small towns, villages and other populated places with lessthan 1,000 population according to the current census

rural fringes of census metropolitan areas and census

agglomerations that may contain estate lots, as well asagricultural, undeveloped and non-developable lands agricultural lands remote and wilderness areas.


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Geographicname

TotalPopulation

Non-immigrantpopulation

Immigrantpopulation

Immigratedbefore 1991

Immigratedbetween1991 &1995



Canada 31 241 030 24 788 720 6 186 950 3 408 420 823 925 844 625 1109980

Nova Scotia 903 090 854 495 45 190 30 305 3 540 4 445 6900

Halifax, CMA369 455 339 840 27 410 16 590 2 460 3 295 5055

Cape Breton,CA 104 655 102 800 1 730 1 370 80 125 150

Truro, CA 44 580 42 720 1 810 1 370 140 115 190

NewGlasgow, CA

35 755 34 805 885 750 15 20 95

Kentville, CA 25 800 24 780 1 010 815 45 50 100

Antigonish,CD

18 715 17 835 810 640 40 40 85


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Geographicname

TotalPopulation

Non-immigrantpopulation

Immigrantpopulation

Immigratedbefore 1991

Immigratedbetween1991 & 1995



Canada 100% 79.3% 19.8% 10.9% 2.6% 2.7% 3.6%

Nova Scotia 100% 94.6% 5.0% 3.4% 0.4% 0.5% 0.8%

Halifax, CMA100% 92.0% 7.4% 4.5% 0.7% 0.9% 1.4%

Cape Breton,

CA

100% 98.2% 1.7% 1.3% 0.1% 0.1% 0.1%

Truro, CA 100% 95.8% 4.1% 3.1% 0.3% 0.3% 0.4%

NewGlasgow, CA

100% 97.3% 2.5% 2.1% 0.0% 0.1% 0.3%

Kentville, CA 100% 96.0% 3.9% 3.2% 0.2% 0.1% 0.3%

Antigonish,CD

100% 95.3% 4.3% 3.4% 0.5% 0.3% 0.9%


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Antigonish: Hitting above its weight

What's the attraction?

Untested Hypothesis:

St. Francis Xavier University and the Coady InternationalInstitute attract individuals unlikely to move to larger urbancentres in Nova Scotia such as Kentville, New Glasgow, Truro,etc.


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shes from Argentina and quite often the doctordoesnt listen to her maybe because the doctordoesnt have time to listen very carefully to theway shes saying things and the doctor doesnthave the time to get her accent to make sure what

shes saying is clear so I think that maybe thatsome doctors dont have the time or theinclination to listen to a non-English speaker

Teacher recounts a student's experience at a

doctor's office


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Health Literacy Issues for Immigrants

Communication issues, e.g., Language barriers Timidity

Acclimatizing to Western model(s) of health Social construction of health, e.g., mental illness is not

necessarily recognized as illness by all cultures

Social networks (may or not not be support networks)


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Collaborative opportunities

Note the different conceptions of health & health literacy(Slides 6 & 7).

Developing the model of health literacy as a personal asset

involves actors outside traditional health fields, e.g. ESLteachers, promoting health literacy

Difference between clinical & preventative health. Teachers

may not necessarily be comfortable discussing clinical but canshow where to buy healthy food and go hiking... Teacherssuggestion about what she can do to promote health literacy


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References

Nutbeam, D. The Evolving Concept of Health

Literacy. Social Science & Medicine 67. 2008. 2072-

2078.

Rootman, I. & Gordon-El-Bihbety, D. A Vision for a

Health Literate Canada: Report of the Expert Panel onHealth Literacy. Canadian Public Health Association.

2008.

Statistics Canada. 2006 Census. 2007.


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Thank you

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