Potentials of school nursing for strengthening health literacy: a 2017/18 German longitudinal survey

Abstract

Background: Health literacy (HL) plays a key role in explaining health disparities. School nurses provide health related expert knowledge and skills within the school setting. A positive effect on the HL of children but also their teachers and parents is assumed and supported by some research but gaps persist in the available data. Methods: As part of a pilot school nursing project, which placed school nurses in 28 public schools in two German states, all teachers, parents and students (11+ years) attending the schools were invited to participate in a 2017 baseline (T0) and 2018 follow-up (T1) survey. Adult HL was measured using the HLS-EU-Q16 and child HL with the HLSAC. Bi- and multivariate analyses were carried out. Results: Comparing T0 and T1, HL scores improved in all populations. In East Germany (Brandenburg), the percentage of teachers with problematic or inadequate HL decreased from 56.6 (N = 173) to 51.5 (N = 173) and among parents from 45.7 (N = 1719) to 43.2 (N = 1080). In West Germany (Hessen), the percentage of teachers with problematic or inadequate HL also decreased, from 43.7 (N = 201) to 42.2 (N = 263), and among parents from 42.2 (N = 2013) to 34.9 (N = 1251). The percentage of children that scored in the moderate or high HL brackets increased from 77.9 (N = 898) to 82.2 (N = 736) in Brandenburg and from 84.9 (N = 1379) to 86.5 (N = 1487) in Hessen. There were strong statistical relationships between child/parental HL and child health behaviors in all datasets. The T0 and T1 comparison showed some improvements over time. Key messages: The presence of a school nurse seemed to increase health awareness contributing to a “healthy school.” After 18 months of intervention, the health literacy of children, parents and teachers improved.