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UNIVERSITY OF CALGARY Health Literacy PDF

436 Pages·2014·2.08 MB·English
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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 Health Literacy: An Exploration of the Concept in a Life-as-Lived (Unpublished doctoral thesis).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 University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca 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. ii 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 iii 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 vi 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 viii 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) ix

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