Published on 09 September 2021, by Holly Case-Wyatt
Reflections from students taking the Health Librarianship Module
Following on from my previous blog post, this is part two of sharing the reflections of the learning of the students who completed the UCL Health Module earlier this year.
Both Penny and Andy chose to write about health literacy. Penny explores how school librarians can support the growth of health literate children, which is timely considering the publishing of our Health Literacy Schools Toolkit developed for 16+ year olds https://southlks.libguides.com/HLschools/home .
Andy looks at the barriers that having poor mental health can have on accessing health information, something that many of us will be acutely aware of. Both students’ reflections show how important health literacy skills and having high-quality health information is for our communities.
Empowering health literate children: a school librarian’s perspective
In the 2021 Knowledge for Healthcare strategy, ‘empowering health literate citizens’ is a focus of activity to ensure that ‘patients, carers and members of the public who access, understand, appraise and use health information have better health-related outcomes’.
Many of the factors which underpin health literacy issues in those aged 16-65, such as information and digital literacy, also impact secondary school children, combined with additional difficulties in training school staff, lack of time in the curriculum and poor engagement.
I will explore these factors from my perspective as a school librarian of an inner-city school along with feedback from the Head of PSHE and the school nurse.
It has been encouraging to see the Department for Education (DfE) focusing on health education by making PSHE and RSE programmes statutory in UK schools from September 2020, albeit with a delayed implementation as a result of COVID-19.
In many schools, such as mine, the PSHE programme has continued regardless but with no change seen in the content or delivery. School librarians are given a backseat in delivering health education, with their involvement confined to providing resources to support students who wish to actively seek out this information.
Time constraints mean PSHE is often shoe-horned into form time, where it is allocated between 20 minutes to one hour per week. These sessions are delivered by form tutors who mostly have no health background and little time or funding for training. With health information delivered in this way, teachers have observed that students attach less value to the content.
Whilst some teenagers are engaging more with exercise and healthy eating, physical health in a more medical sense is not a hot topic. Invincibility theory in teenagers plays out with many showing little engagement. When it comes to mental health, however, students display a much keener interest.
In 2018, students at my school completed a voice exercise about information they wanted to cover in PSHE lessons and the overwhelming response was ‘mental health’. However, teachers found that the term ‘mental health’ itself could be reactive and that ‘delivering content through lesson components such as ‘wellbeing’ and ‘confidence’ were more effective ways of promoting engagement’.
Counteracting the barrage of Fake Health News young people are facing as well as poor health behaviours experienced in the family home is problematic. This has been compounded during the past year with school closures.
My school has focused on running sessions to educate parents such as ‘The Teenage Brain’ but uptake is patchy and often the families who these sessions target are less likely to attend.
For students with English as an Additional Language (EAL) the barriers to health literacy can be more pronounced. Students new to the UK face huge upheaval but lack the emotional vocabulary to describe mental health issues, which can mean they are less able to access health services. EAL students are also twice as likely to be Young Carersbut school staff are often not immediately able to communicate their needs to school staff.
It is promising to learn about the pilot Health Literacy project in Royal Berkshire NHS Foundation Trust in collaboration with the School Library Association and I look forward to hearing their findings.
Perhaps with a more developed and persistent approach to teaching health in an engaging and accessible way whether that be in the classroom or with more involvement from school librarians, we could see a marked improvement in health literacy in young people that would continue into their adult years.
 Health Education England (2021). Knowledge for Healthcare Mobilising evidence; sharing knowledge; improving outcomes. [Online] Available from: https://www.hee.nhs.uk/our-work/knowledge-for-healthcare 35-38 [Accessed 12 March 2021]
 Gov.uk (2019). Policy Paper. Changes to personal, social, health and economic (PSHE) and relationships and sex education (RSE) [Online] https://www.gov.uk/government/publications/changes-to-personal-social-health- and-economic-pshe-and-relationships-and-sex-education-rse [Accessed 15 March 2021]
 Department for Education (DfE) (2020). Communication to schools on the implementation of Relationships Education, Relationships and Sex and Health Education. https://www.pshe- association.org.uk/sites/default/files/u26918/Communication%20to%20schools%20on%20the%20implementa tion%20of%20Relationships%20Education%20Relationships%20and%20Sex%20Education%20and%20Health% 20Education.pdf
 Head of PSHE, St.Paul’s Catholic School (2021)
 Head of PSHE, St.Paul’s Catholic School (2021)
 Wong S. (2017). Young carers in the NHS. The British journal of general practice: the journal of the Royal College of General Practitioners, 67(664), 527–528.
Barriers to Health Literacy
Health literacy describes an individual’s ability to comprehend and act upon health information, covering a large set of overlapping difficulties. These include literacy, numeracy, and socioeconomic realities.
Strategies include the ‘teach back’ and ‘chunk and check’ methods, which have become important tool’s for imparting health information. Library and Knowledge Services (LKS) have been vital at imputing evidence into patient information, with some trusts employing Patient Librarians to assist in decoding health information.
South West , Thames Valley, and Wessex LKS have been especially adept at providing health literacy awareness training for trust staff, building collaborative organisational links; helping to embed health literacy within their respective trusts (https://southlks.libguides.com/healthliteracy/home).
In tackling physical access barriers, Health Librarians partnerships with Prison Librarians, was timely. As prisoners often suffer from the cumulative effects of social disadvantage, poor literacy/numeracy skills, and limited access.
The Terrence Higgins Trust has undertaken research to understand how different demographics access health information (Terrence Higgins Trust, 2020) and how they can adjust the delivery of their health information provision to meet different information seeking behaviours.
Beyond skills and access barriers, there are those caused by stigma. Stigmatisation due to health conditions is a barrier to help seeking behaviour. As Jorm (2012) highlights, due to successful public health campaigns, many people are aware of common signs of serious physical conditions e.g. heart attack or stroke. What is less known is how to identify and tackle mental health conditions.
People are unprepared to address the signs of mental health conditions, such as depression or schizophrenia; with some stating that sufferers “should spend time in the sun” or “just get on with it” (Jorm, 2012). This demonstrates a reluctance to seek professional help, or knowledge about available support services. The creation of more widespread mental health literacy would help suffers and their families, identify a mental health crisis and seek help.
Having grown up with a family member who suffers from schizophrenia, useful literacy interventions would have been invaluable. These include, self-help strategies, mental health first aid skills, support for carers, and prevention strategies; through a combination of education, web, and community-based interventions (Jorm, 2012).
Subsequently, NHS England and Health Education England, launched MindEd e-learning program; which helps people identify, understand and support those with mental health conditions (https://www.minded.org.uk/). This presents a welcome tool for demystifying mental illness for sufferers and their families/carers.
Mental health services have been subjected to low funding because they do not enjoy the same level of public understanding as other conditions. The COVID pandemic has shone a light on mental health and increased awareness. As a result, spending on mental health services has increased during the pandemic (albeit after years of decline).
A mental health focus is pertinent to the NHS workforce. After the pandemic subsides, there will be members of staff who need mental health support. So too will increasing members of the public. LKS will be well placed to act as information hubs for the promotion of mental health literacy within their respective trusts and will be invaluable at inputting evidence.
Signalling their support for colleagues at this critical time also represents cost avoidance for trusts and may help with staff retention post pandemic.
Jorm, F A. 2012. Mental Health Literacy: Empowering the community to take action for better mental health. American Psychologist, Vol 67 (3), pp 232 – 243.
MindED. 2021. MindED: E-Learning to support healthy minds. [online] Available at: https://www.minded.org.uk/ [Accessed 17th March 2021].
South Library and Knowledge Services. 2021. South West: Health Literacy E-resources. [online] Available at: https://southlks.libguides.com/healthliteracy/home [Accessed 18th March 2021].
Terrence Higgins Trust. 2020. Sexually transmitted infections in England: The state of the nation. [online] Available at: https://www.tht.org.uk/our-work/our-campaigns/state-of- thenation [Accessed 18th March 2021].