This paper identified gaps in adolescent health literacy (AHL) measurements, as well as how the health literacy (HL) level is related to health promotion (HP) aspects. This study aimed to examine the tools used to measure HL and determine its relation with HP among adolescents. In this review three databases were searched for papers published between January 2016, and January 2021. In this review, 373 articles were identified and after removing duplicates and screening titles and abstracts of articles, 49 full texts were selected for full-text reading. After appraisal 23 papers were included in the synthesis.
The paper reports that of these 23 papers, 21 focused on assessing AHL measures, and 15 addressed the association between AHL and HP. Seven studies used the HL School-Aged Children instrument. The findings suggested that the methodological and conceptual underpinnings of HL measures are insufficient. Furthermore, HL acts as an independent and positive mediator for many facets of HP. Overall, this review offers a warning to practitioners and educationists interested in measuring HL as the number of measurement tools is substantial with different tools applying different scales.
“I don’t listen to adults when it comes to this sort of thing”, a 17-year-old told me.
We were discussing how digital technology affects his life, as part of a long-term project in the west of England that I carried out with colleagues to explore young people’s mental health – including the impact of digital technology on their emotional wellbeing.
There is a widespread perception that being online is bad for young people’s mental health. But when we began the project, we quickly realised that there was very little evidence to back this up. The few in-depth studies around social media use and children’s mental health state that impacts are small and it is difficult to draw clear conclusions.
We wanted to find out if and how young people’s wellbeing was actually being affected in order to produce resources to help them. We talked to around 1,000 young people as part of our project. What we found was that there was a disconnect between what young people were worried about when it came to their online lives, and the worries their parents and other adults had.
One of the things young people told us was that adults tended to talk down to them about online harms, and had a tendency to “freak out” about these issues. Young people told us that adults’ views about online harms rarely reflected their own. They felt frustrated that they were being told what was harmful, rather than being asked what their experiences were.
The concerns the young people told us they had included bullying and other forms of online conflict. They were afraid of missing out on both online group interactions and real-life experiences others were showing in their social media posts. They worried that their posts were not getting as many likes as someone else’s.
But these concerns are rarely reflected in the media presentation of the harsher side of online harms. This has a tendency to explore the criminal side of online abuse, such as grooming, the prevalence of online pornography. It also tends to describe social media use in similar language to that used to talk about addiction.
It is no surprise, therefore, that parents might approach conversations with young people with excessive concern and an assumption their children are being approached by predators or are accessing harmful or illegal content.
We have run a survey with young people for several years on their online experiences. Our latest analysis was based on 8,223 responses. One of the questions we ask is: “Have you ever been upset by something that has happened online?”. While there are differences between age groups, we found the percentage of those young people who say “yes” is around 30%. Or, to put it another way, more than two-thirds of the young people surveyed had never had an upsetting experience online.
Meanwhile, the online experiences reported by the 30% who reported being upset often didn’t tally with the extreme cases reporting in the media. Our analysis of responses showed that this upset is far more likely to come from abusive comments by peers and news stories about current affairs.
This disconnect means that young people are reluctant to talk to adults about their concerns. They are afraid of being told off, that the adult will overreact, or that talking to an adult might make the issue worse. The adults they might turn to need to make it clear this won’t happen and that they can help.
How to help
There are three things that young people have consistently told us over the duration of the project, and in our previous work, that adults can do to help. They are: listen and understand – don’t judge.
Conversations are important, as is showing an interest in young people’s online lives. However, those conversations do not have to be confrontational. If a media story about young people and online harms causes parents concern or alarm, the conversation does not have to start with: “Do you do this?” This can result in a defensive response and the conversation being shut down. It would be far better to introduce the topic with: “Have you seen this story? What do you think of this?”
Working in partnership with others, such as schools, is also important. If a parent has concerns, having a conversation with tutors can be a useful way of supporting the young person. The tutor might also be aware that the young person is not acting like themselves, or might have noticed changes in group dynamics among their peer group.
But, even if they are not aware of anything, raising concerns with them – and discussing from where those concerns arise – will mean both parents and school are focused in the same direction. It is important that young people receive both consistent messages and support. And schools will also be able to link up with other support services if they are needed.
Ultimately, we want young people to feel confident that they can ask for help and receive it. This is particularly important, because if they do not feel they can ask for help, it is far less likely the issue they are facing will be resolved – and there is a chance things might become worse without support.
Mobile phones, computers, social media and the internet are part of the daily lives of children and young people, including at school. Concerns over the risks of too much screen time or online activity for children and young people have been tempered by the reality of technology use in education and leisure.
The experience of life during the pandemic, when much schooling and socialising went online, has also changed attitudes to technology use. UK communications regulator Ofcom reported that in 2020 only a minority of children and young people did not go online or have internet access.
Teachers are in a unique position when it comes to assessing how children and young people use technology such as mobile phones and the effect it has on them. They see how children and young people use technology to learn, socialise, and how it affects their relationships with their peers.
Together with colleagues, I carried out in-depth research with eight teachers from different backgrounds, ages, years of professional experience, and type of educational institution from across the UK. We asked the teachers about their experiences of children and young people’s use of technology: how they thought it affected their emotions, behaviour and learning both before and during the pandemic.
The teachers talked about the importance of technology as a tool in the classroom and learning and the opportunities it provides for creativity. As one teacher put it:
It is what the children are used to, and it engages them more – it is a useful tool that can add to our teaching.
Empowered through tech
We also found that teachers were optimistic about the role technology could play in empowering children and young people. One said:
They use social networking sites to learn from one another and to express their beliefs – even children who are quiet in the classroom, they find it easier to express themselves online.
They thought that children and young people could learn to understand and recognise the signs of unhealthy technology use from their own emotions and behaviour when using technology. This included showing empathy and care through noticing how they and others feel. One teacher said children and young people were becoming more compassionate and offering their help to friends who were showing signs of distress through their online posts.
However, some teachers did express concern about how interacting online affected children and young people’s social skills. One teacher said:
They don’t know how to have proper conversations with their friends. They don’t know how to resolve anything because it’s easy to be mean behind a screen and not have to resolve it.
Another questioned how technology use was affecting play. They said:
They don’t know how to play and actually you will see groups of them surrounding a phone.
Teachers also pointed to the problems of disengaging from technology use. One teacher stated:
The parents have ongoing battles trying to pull their children away from screens and the next day they are exhausted, and they find it difficult to get them into school because the children are so tired.
Teachers discussed how they encouraged their pupils to take part in team sports as a way to encourage face-to-face communication and conflict resolution. However, while some online safety and internet use is covered at school, guidance on how to live with technology, be resilient towards challenges and use technology in a balanced could be more explicitly taught.
The PHSE Association – a national body for personal, social, health and economic education – offers guidance on online safety and skills for the curriculum, such as the potential harms of pornography but there is much scope to develop a broader approach to supporting healthy technology use.
In class, this could be as simple as working on how to make informed decisions about technology use – such as being more cautious if online activity involves talking with strangers, or recognising if spending time online is a large time commitment. It could include using social media posts as real-world examples to encourage childrenand young people to be informed, critical and resilient towards content they are likely to see and interact with.
Teachers felt that adding online safety to the curriculum would be valuable, as would providing opportunities for children and young people to talk about their experiences and content of technology. One teacher said:
There are predators out there and we do discuss online safety issues with my students, but some stuff should be part of the curriculum as well, and parents should access it too.
The teachers highlighted that they, too, needed support in their knowledge about technology and suggested this should be more incorporated into teacher training. One teacher said:
We need to keep up with the times and if there is something this pandemic taught us, is that not all of us are keeping up… one-off training is not adequate, schools need to invest in continuous professional development activities related to technology.
Children and young people can get significant benefits from technology, but it has risks, too. More attention to how teachers can address this in school can be an invaluable way to help children and young people understand and balance their time online.
You may have seen the BU Research Blog two years ago congratulating Bournemouth University’s MSc Public Health graduate Hana Dinh on the acceptance of her paper ‘‘Factors influencing engagement in premarital sex among Vietnamese young adults: a qualitative study’ .
In April 2019 this paper was published ‘online first’ in the International Journal of Adolescent Medicine & Health. Last month, two years later, her paper finally appeared in print. Hana’s paper had originally been accepted by this journal in 2018, it was put online in 2019 and now it has been formally published. It can still be a long process for an academic paper to get into print as we have discussed elsewhere . Hence the title of this blog, the question to me is ‘What is the appropriate publication date for this article on my CV?
Prof. Edwin van Teijlingen
CMMPH (Centre for Midwifery, Maternal & Perinatal Health)
The i4i team has a webinar coming up on 13 July for two new funding calls, including one around the theme of Children and Young People’s Mental Health. Please do share with anyone you think may be interested:
The NIHR i4i Programme is launching two new funding calls this August:
i4i Connect 5 aimed at small to medium-sized enterprises (SMEs) in need of a funding boost to reach the next stage in the development pathway, addressing a clearly defined unmet clinical need.
i4i – Digital Health Technologies for Children and Young People’s Mental Health– aimed at SMEs, NHS providers or higher education institutions (HEIs), this call encourages proposals addressing a range of children and young people’s mental health conditions particularly in regions that have been historically under-served by research activity or where there is high unmet mental health burden.
The i4i team would like to invite you to attend a webinar on the 13th of July, where you can hear more about the call specifications and application process. They will have two guest speakers, Professor Chris Hollis and Dr Charlotte Hall, who will talk about how evidence-based digital interventions can address an unmet clinical need in children and young people. You can register for the webinar here.
Your local branch of the NIHR RDS (Research Design Service) is based within the BU Clinical Research Unit (BUCRU) should you need help with your application. We advise on all aspects of developing an application and can review application drafts as well as put them to a mock funding panel (run by RDS South West) known as Project Review Committee, which is a fantastic opportunity for researchers to obtain a critical review of a proposed grant application before this is sent to a funding body.
Contact us as early as possible to benefit fully from the advice
In the past months, I have been collaborating with the University of Naples Parthenope, and in particular with pedagogy Professor Maria Luisa Iavarone and PhD candidate Ferdinando Ivano Ambra.
We have been working on a conference paper that covers the recent results of the S.M.A.R.T. questionnaire. A questionnaire developed in Italy to look at different aspects of human behaviour (including eating habits, sleeping patterns, relationships, and use of technologies) in the young population.
The abstract was successfully accepted and presented at the 2nd Conference on Well-being in Education Systems. I have asked Ivano to tell us a little bit about the journey he had.
From the 12th to the 15th of November I was in Locarno (Switzerland) to present the results of the research titled “The impact of sport training on healthy behaviour in a group of 108 adolescents: a pilot study using the S.M.A.R.T. questionnaire” at the “2nd Conference on Well-being in Education Systems”.
The University of Applied Sciences and Arts of Italian Switzerland (SUPSI) organised a very informative conference, giving to all the attenders enough information and materials to follow all three days of presentations.
The aim of the conference was innovation in education and psychology fields. I found of particular interest the work about emotional intelligence and creativity presented by Professor Brandao de Souza and Professor Pasini. I also found very stimulating the symposium of Professor Noto from the University of Padova who discussed the education systems and how it applies to the work-environment in an inclusive way.
The posters session as well offered food for thought, such as the research of Professor Iorio and Professor Ambrosetti on students perception of teachers’ burnout.
During the social event I had the chance to meet the other lecturers part of the scientific panel of the conference: Prof. Castelli, Prof. Marcionetti, Prof. Plata, Dr Ambrosetti and the director of the Center of innovation and Research on Education System (CIRSE) Prof. Egloff.
I am grateful to have had the chance to participate in the conference. It was an occasion of professional growth and personal improvement.
If you want to read the paper submitted, it is now fully available on ResearchGate
If you want to discuss the findings with Ivano or the other members of the project, follow the links below
Following the successful Bournemouth University’s visit to Vietnam as part of the Global Festival of Learning Great as highlighted in the Daily Echo, Thanh-Hang Dinha FHSS MSc in Public Health graduate had an article accepted on her research dissertation. Her paper ‘Factors influencing engagement in premarital sex among Vietnamese young adults: a qualitative study’ was published ‘online first’ this week in the International Journal of Adolescent Medicine & Health.
The paper highlights the rising trend of sexual engagement among Vietnamese young adults in recent years, and its potential health consequences. In order to prevent such consequences and further promote health, an in-depth understanding of factors influencing young people to have premarital sex would be valuable. The qualitative analysis ‘generated’ six emergent themes: (a) desire as the ‘direct cause’; (b) the facilitators; (c) social changes; (d) media; (e) peer and (f) absence of family. The latter four themes are ‘indirect causes’ that influence through desire and the facilitators. The study concluded that there is a need for a reliable source of information to be tailor-designed to suit young people. Additionally, the stigma of talking about sex needs to be reduced to allow for more open discussions on sex, True Pheromones, and sexual health.
After completing her MSc at BU Thanh-Hang Dinh (known as Hana to her fellow students) started working at the famous Pasteur Institute Nha Trang in Vietnam.
A couple of years ago, I met Adam (not his real name) at a farm in Dorset. Adam was 14 and had been excluded from mainstream education due to behavioural difficulties and a disruptive home life. He had consequently become involved in regular underage drinking and antisocial behaviour. Adam was being exploited and groomed as a drug runner for a London drug gang infiltrating rural areas. He told me that he had been given a knife by gang members and encouraged to use it to protect himself if necessary against rival gangs or local drug dealers.
The farm where I met him is not a normal farm, but a social one, where the therapeutic use of farming practices and animal assisted therapy is used to provide health, social and educational care services for disadvantaged young people that have become disengaged with mainstream education. Stories such as Adam’s are growing increasingly familiar to staff at the farm he attended, who see other vulnerable young people referred to their service.
Many of the young people living in rural Britain who are being exploited by these gangs are, like Adam, those who are disengaged with mainstream education and are at risk of becoming, or currently are, NEET (not in education, employment or training). There are 808,000 young people (aged 16-24) in the UK who are NEET.
Being NEET has a long-term impact on a young person’s life, leaving them vulnerable to substance misuse, offending behaviour, physical and mental health problems, academic underachievement and reduced employment. These young people are subsequently regarded as a concern to the police, health, education and social care professionals.
Yet current interventions are failing to reduce the number of young people becoming NEET. These interventions typically focus on providing the young person with vocational education, despite the fact that the most common vocational qualifications in the UK have very little or no relevance to the labour market.
Interventions that offer a restorative approach, with therapeutic support and a focus on learning, however, are acknowledged to be more successful.
A green future
Earlier this year, the government launched a 25-year environment plan. The plan acknowledged the importance of connecting children and young people to nature through learning, as well as the benefits of a physical, hands-on experience as a pathway to good health and well-being. The government has pledged £10m to support local strategies which use the natural environment and has further committed to a national expansion of social farming by 2022. This will treble the number of available places to 1.3m per year for children and adults in England.
On social farms, health, social or specialist educational care services for vulnerable people are delivered through structured programmes of farming-related activities. Social farming is established in numerous European countries. Norway currently operates 1,100 social farms, compared to 240 in the UK.
Young people participate in a variety of seasonal farming-related activities, including animal husbandry, crop and vegetable production and woodland management. Social farming has been found to have a positive impact on physical and mental health along with the opportunity to develop transferable skills, personal development, social inclusion and rehabilitation.
When I met Adam, I was in the midst of a research project evaluating whether a year-long farming intervention can prevent disengaged young people from low-socioeconomic backgrounds becoming NEET. Participants typically attend a four-hour session once a week at the farm.
Future roots, the farm I researched, employs a mix of teachers, youth and social workers and therapists. It offers a different model of learning for those struggling in mainstream education. My research demonstrated that the use of the natural environment as a mechanism for change was effective in reducing the risk of becoming NEET.
The young people I followed displayed a significant reduction in self-reported mental health risks and behavioural regulation difficulties; improved social relationships and coping; improved life and work skills; and re-engagement with learning. All of the young people were in employment or training six months after their time at the social farm finished.
Indeed, the social farm was the only place where Adam said he felt safe. He was able to develop a sense of belonging and trust which enabled him to talk about the difficulties he was experiencing in his life. Without the social farm intervention, staff said that Adam would likely have proceeded to harm himself or others. The farmer refers to the changes seen in the young people as a “chrysalis butterfly effect”: the positive transformation seen in these young people as they turn their lives around to look to the future are truly inspiring.
Bournemouth University leads the Kosovo-strand of a major four-year AHRC ‘Global Challenges’ project titled ‘Changing the Story‘. This project aims at supporting the building of inclusive civil societies (CSOs) with, and for, young people in five post-conflict countries. It asks how the arts, heritage, and human rights education can support youth-centred approaches to civil society building in Cambodia, Colombia, Kosovo, Rwanda and South Africa. The Kosovo strand benefits from an established track record of collaboration with University of Prishtina (Co-I) and Stacion: Centre for Contemporary Arts in Prishtina as well as several arts-based civil society organisations in the country. The BU-led strand focuses on formal and informal civic education through the arts in Kosovo, to be explored locally by a Postgraduate Research Assistant, attached to University of Prishtina, through a critical review and proof of concept exercise during the first year. In support, BU is contributing a fully-funded PhD scholarship under the title ‘Imagining New Futures: Engaging Young People Through Participatory Arts in Post-Conflict Kosovo‘, which is currently being advertised.
International collaborative activities commenced last week in collaboration with an internationally-acclaimed CSO partner in Dorset, devoted to developing global youth citizenship through culture and the arts. The award-winning Complete Freedom of Truth project (TCFT), with which BU collaborated already previously, kindly offered a one-week residency to Albert Heta, Director of Stacion: Centre for Contemporary Arts in Prishtina. This residency brought together a group of artists, workshop leaders and young people from across the UK between February 12 and 16 in Bridport. Albert’s visit from Kosovo was funded by the AHRC and facilitated by BU’s new Research Centre ‘Seldom Heard-Voices: Marginalisation and Society Integration’ of the Faculty of Health and Social Sciences (FHSS). Together with Albert, some of the Centre’s members also participates in the events organised by TCFT, exchanged experiences and discussed best practice of working with young people of various background through the arts towards social justice. TCFT has a long history of working with young people, internationally, starting in post-conflict Srebrenica in 2008. Based on our observations during one week in Dorset, including of the issues selected as important by the young UK-participants during this period, we are currently reflecting on the extent to, and ways in, which arts-based interventions with a given set of young people in one specific socio-cultural context and its underpinning conceptualisations (such as of empowerment or vulnerability of, and pressures on, young people) can or cannot be transferred to another, such as that in which young people in Kosovo negotiate their aspirations.
Young people working to change perceptions of disability through poetry and performance
A collaboration between the Media School (Dr Caroline Hodges), the School of Health and Social Care (Wendy Cutts & Dr Lee-Ann Fenge) and Victoria Education Centre, Poole.
In February of this year, we were awarded funding from the BU Fusion Fund to begin work on the ‘Seen But Seldom Heard’ project. ‘Seen but Seldom Heard’ is an innovative ‘arts activism’ project through which young people living with a physical disability (aged 14-19 years) can engage in creative activities designed to encourage them to reflect on their lived experiences and to empower them to challenge societal perceptions of disability through poetry and performance. The performance poetry work which has been supported by professional poets, Liv Torc and Jonny Fluffypunk, also offers the group of budding young poets a ‘voice’ to participate in conversations regarding policies and practices which affect them.
The project has so far resulted in a series of co-produced performances including a Paralympics venue in Weymouth as part of the Cultural Olympiad supporting headline performance poet, John Hegley, and The Bridport Open Book Festival, the largest performance poetry event in the country. The performances were an important way to engage with the general public and positively influence perceptions of disability and we hope to stage similar events during 2013. We have also produced a book of the group’s poetry (the sale of which has paid for an additional 2 poetry workshops at the school) and a full-length documentary will be premiered at BU on the afternoon of December 7th as part of Disability History Month.
There have been a number of beneficiaries from the work. First and foremost the young people who have taken part, together with their peer group at Victoria Education Centre. The project has had such a profound impact upon pupils and staff that the school is raising funds for a ‘poet in residence’ to support future performance poetry activity. In direct response to posting a ‘taster’ of the Seen But Seldom Heard documentary on YouTube (attracting 1,500 views to date from as far afield as Australia, the US and South America), we have received emails and comments from others with direct experience of disability, disability activists, educationalists and care providers thanking and encouraging the young poets and the project team for providing aspiration and positive role models.
In the next phase of the project, which we hope to commence as soon as funding is secured, we also plan to develop a ‘live schools tour’ and audio-visual educational package for use in secondary schools and youth clubs to raise awareness amongst young people of what it is like to live with a physical disability. In addition to public engagement and education activity, we are also disseminating the project outcomes and methodology through seminars and conference presentations during 2013 and journal articles.
Funding is available under the Progress 2011 theme. Your proposal must contribute to developing and testing socially innovative approaches to policy priorities in the context of the Europe 2020 Strategy and the Open Method of Coordination on social protection and social inclusion. To be selected under this call, projects should focus on either of the following selected themes, keeping in mind in all cases the gender dimension of the issue:
• Social inclusion of vulnerable groups (such as Roma people, migrants and their descendants, homeless and young people)
• Quality of childcare services (this has great impacts on child well-being, but also on gender equality, poverty in jobless households, employment rates, birth rates and on long term sustainable development by supporting the development of human potential)
• Active and healthy ageing (this depends on various factors, such as life habits, working conditions or urban policies and represents a major condition in order to extend working lives and to reduce social protection expenditures)
• Transition from education to work for the youth (as only a multidimensional policy approach combining actions on the education framework, the labour market, families can be successful)
Deadlines: 15.12.11 and 30.03.12
European Policy Network on the Education of Children and Young People with a Migrant Background: proposals should address the issues raised by the November 2009 Council conclusions on the education of children from a migrant background and stimulate high-level cooperation between Member State policy makers responsible for social inclusion through education, including cooperation between authorities in the countries of origin and host countries. The network should actively stimulate transnational cooperation primarily at governmental level, but also at the level of experts and practitioners. Grants are worth €500,000. Closing date: 14 October 2011.
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