UNIVERSITY OF CALGARY Health Literacy

436 Pages·2014·2.08 MB·English

University of Calgary
PRISM: University of Calgary's Digital Repository
Graduate Studies The Vault: Electronic Theses and Dissertations
2014-05-02
Health Literacy: An Exploration of the Concept in a
Life-as-Lived
Holstine Vander Valk, Donna
Holstine Vander Valk, D. (2014). Health Literacy: An Exploration of the Concept in a Life-as-Lived
(Unpublished doctoral thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/26343
http://hdl.handle.net/11023/1475
doctoral thesis
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UNIVERSITY OF CALGARY

Health Literacy:
An Exploration of the Concept in a Life-as-Lived

by

Donna Lynn Holstine Vander Valk

A THESIS
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILSOPHY

GRADUATE DIVISION OF EDUCATIONAL RESEARCH
CALGARY, ALBERTA
APRIL, 2014

© Donna Lynn Holstine Vander Valk 2014
Abstract
Health literacy has become a relatively popular notion in the past 15 years in both
the policy and professional-practices realms in Canada and abroad. While health literacy
has emerged from public health, health education, and health promotion, historically, its
increasing presence in discourses surrounding clinical and public health practices has
focused on defining, measuring, and operationalising notions of health literacy, rather than
attempting to understand what health literacy means to and has to offer the actual
individuals implicated in its practice.
In seeking to understand health literacy more deeply, a critical literature review has
been undertaken; from this point, in pursuit of a greater appreciation of the overlapping and
intersecting notions in the field of health literacy, an auto/ethnographic account of the
concept from the perspective of a new mother and a new chronic illness and injury patient
has been constructed. What has resulted is a classically composed, but narratively varied,
examination of these impressions and experiences.
Ultimately, no common account of health literacy has emerged: rather, what has
been found is more closely akin to a ‘family resemblance’, one that presents challenges,
and perhaps opportunities, to expand the discussions clinically and publically about this
notion that, finally, affects us all.

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Acknowledgements
Thank you to all of those who helped care for my babies along the way: my parents,
my sister, my husband’s family; Andrea, Mischelle, Anna-Maria; Paige & Olivia; and
Amanda & Justin.
Thank you to my committee, and most especially Ian, my supervisor, for his
everlasting, and seemingly inexhaustible patience.
And most importantly, to my little family:
Me: Well, you did say: “’til death do us part”…
Paul: Yes. It’s just the “in sickness and in health” part that I’m struggling with…
Thank you, and with all my love, Donna

Jack: Mommy, what exactly is wrong with your pancreas?
Me: (long-winded, detailed explanation)
Noah: Mommy, when we get to the next road, can we stop talking about your
pancreas?
To my babies: I know that your entire existences have been defined by this
work. I know you don’t remember mommy before any of this, because both you and
this work have come into being at exactly the same time. This book is for you,
because of you, and belongs to you.
I love you with every fibre of my being.
Mommy
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Table of Contents
Abstract ii
Acknowledgements iii
Table of Contents iv
List of Figures viii
Epigraph ix
Act One: Getting Critical 1
scene i: A Teaser 2
scene ii: Reflection 3
Act Two: The Contextual 12
Auto/Ethnography of a Prairie Woman…a Beginning 13
scene i: Health Literacy, 18
scene ii: Health Literacy, the Birth 22
Interlude One: How Do We Understand ‘Health’? 23
Interlude Two: Literacy, the Word and the World 33
Interlude Three: Terms of Use 42
scene iii: Health Literacy Grows 57
scene vi: The Methodological, Theoretical, Interpretive, Political, and
Narrative 83
Maternal Theory 87
Interrupted Identity 97
Auto/Ethnography 99
Critical Theory 102
Hermeneutics 104
iv
Currere 106
Reflexivity 110
Narrative 112
Act Three: The Regressive 117
Setting the Stage 118
scene i 1974–1982: The Really, Really Deep Past 127
scene ii 1982-2004: Before 131
scene iii December 2004 – September 1, 2005: Transition to ‘Now’ 134
scene iv April 25, 2006, ‘til The End of Time: Learning to be ‘Patient’ 147
scene v August 2007: A Lesson in Mortification 151
scene vi December 2007 – April 2008: Mistaken Identity 156
scene vii Easter Monday, March 2008: The Myths of Freedom of Information,
Protection of Privacy, and Informed Consent 161
scene viii March 2008: Playing the Odds, or The Home Stretch 164
scene ix June 2008 – May 2009: Mommy OT and Contraband 167
scene x March 2009: Pox Parties & Vaccination Wars 173
scene xi October 2009 – November 2009: To the Edge of Sanity 175
scene xii February 2010: Multi-tasking Mommy 182
scene xiii February 2010, Continued: A Trip to the Grocers 185
scene xiv May 2011: The Prolapse Files 187
scene xv June 2011: Back for More 190
scene xvi November 2011 – March 2012: Epiphany 195
scene xvii January 2012: Coming Undone 201
scene xviii January 2012: There is No ‘Worm’ in ‘Ringworm’ 206
scene xix February 2012: This is the Last Time (Again) 208
v
scene xx February 2012: Critical Thinking for Breakfast 219
scene xxi March 2012: The Embarrassing Truth 222
scene xxii March 2012: Groundhog Day 226
scene xxiii July 2012: Don’t Wear Tight Shoes 228
scene xxiv August 2012: There Really is a ‘Worm’ in Hookworm 231
scene xxv October 2012: And the Oscar Goes To… 233
scene xxvi November 2012: And So It Begins Again 239
Act Four: The Analytic & Synthetic 248
Reflecting Upon the Process 249
Re-Encountering Act III 259
On the Staging 259
On scene i, 1974 – 1982: The Really, Really Deep Past 263
On scene ii, 1982 – 2004: Before 265
On scene iii, 2004 December – 2005 September 1: Transition to ‘Now’ 267
On scene iv, 2006 April 25 – , Learning to be ‘Patient’ 273
On scene v, 2007 August – A Lesson in Mortification 276
On scene vi, 2007 December – 2008 March: Mistaken Identity 279
On scene vii, 2008 March, Easter Monday: The Myth of Freedom of Information,
Protection of Privacy, and Informed Consent 281
On scene viii, 2008 March: Playing the Odds, or the Home Stretch 283
On scene ix, 2008 June – 2009 May: Mommy OT & ContraBand 285
On scene x, 2009 March: Pox Parties & Vaccination Wars 287
On scene xi, 2009 October – 2009 November: To the Edge of Sanity 289
On scene xii, 2010 February: Multi-Tasking Mommy 291
On scene xiii, 2010 February, Continued: A Trip to the Grocers 292
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On scene xiv, 2011 May: The Prolapse Files 295
On scene xv, 2011 June: Back for More 299
On scene xvi, 2011 November – 2012 March: Epiphany 301
On scene xvii, 2012 January: Coming Undone 302
On scene xviii, 2012 January: There is No ‘Worm’ in Ringworm 303
On scene xix, 2012 February: This is the Last Time (Again) 304
On scene xx, 2012 February: Critical Thinking for Breakfast 306
On scene xxi, 2012 March: The Embarrassing Truth 308
On scene xxii, 2012 March: Groundhog Day 309
On scene xxiii, 2012 July: Don’t Wear Tight Shoes 310
On scene xxiv, 2012 August: There Really is a ‘Worm’ in Hookworm 312
On scene xxv, 2012 October: And the Oscar Goes To… 313
On scene xxvi, 2012 November: And So It Begins Again 315
Re-Reading the Word in the World 318
Act Five: The Progressive 343
Imagining a Future, Family Resemblances, and Further Conclusions 344
Epilogues Aren’t Just for Shakespeare 377
Works Cited 384

vii
List of Figures
Figure 1 Sleeping Better with Wonder Bumpers ad, September 2012 ………....335
Figure 2 A health literacy matrix………………………………..………………356

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Epigraph

‘The truth,’ Dumbledore sighed. ‘It is a beautiful and terrible thing, and should
therefore be treated with great caution. However, I shall answer your questions
unless I have a very good reason not to, in which case I beg you’ll forgive me. I
shall not, of course, lie.’
(Rowling, 1997, p. 216)

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