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Papers by Nanna Wurr Stjernqvist

Health literacy research and practice, 2022

Low health literacy (HL) is associated with adverse health behaviors and poor health, and brief, ... more Low health literacy (HL) is associated with adverse health behaviors and poor health, and brief, high-quality instruments for measuring HL in children are scarce. The Health Literacy for School-Aged Children (HLSAC) instrument is a 10-item theory-based and internationally validated tool for measuring HL. The purpose of this study was to translate and validate the HLSAC instrument among Danish school-aged children. The instrument was translated into Danish by a standardized forward-backward translation process, and then pre-tested for face validity with 61 pupils from four schools. Thereafter, the instrument was tested among 805 pupils in grades 6 to 7 (age 11–14 years) from 15 schools. When HL was modeled as one latent factor with all 10 items loading on this factor, the confirmative factor analysis showed standardized factor loadings from 0.52 to 0.75 ( p < .001) and an excellent model fit. The association between HL and food intake as a health behavior example ( p < .001, r 2 = .027) indicates the predictive validity of the instrument. The internal consistency was high (Cronbach's alpha = 0.86). Thus, a valid and reliable version of the HLSAC instrument is available in Danish for future surveys to monitor HL and guide health promotion targeting children and adolescents. [ HLRP: Health Literacy Research and Practice . 2022;6(1):e25–e29.]

BMC Public Health, 2018

Background: Social capital has been found to be positively associated with various health and wel... more Background: Social capital has been found to be positively associated with various health and well-being outcomes amongst children. Less is known about how social capital may be generated and specifically in relation to children in the school setting. Drawing on the social cohesion approach and the democratic health educational methodology IVAC (Investigation-Vision-Action-Change) the aim of this study was to examine the effect of the Health Promoting School intervention 'We Act-Together for Health' on children's cognitive social capital. Method: A quasi-experimental controlled pre-and post-intervention study design was conducted with 548 participants (mean age 11.7 years). Cognitive social capital was measured as: horizontal social capital (trust and support in pupils); vertical social capital (trust and support in teachers); and a sense of belonging in the school using questions derived from the Health Behaviour in School Children study. A series of multilevel ordinal logistic regression analyses was performed for each outcome to estimate the effect of the intervention. Result: The analyses showed no overall significant effect from the intervention on horizontal social capital or vertical social capital at the six-month follow-up. A negative effect was found on the sense of belonging in the school. Gender and grade appeared to be important for horizontal social capital, while grade was important for sense of belonging in the school. The results are discussed in relation to We Act's implementation process, our conceptual framework and methodological issues and can be used to direct future research in the field. Conclusion: The study finds that child participation in health education can affect the children's sense of belonging in the school, though without sufficient management support, this may have a negative effect. With low implementation fidelity regarding the Action and Change dimension of the intervention at both the school and class level, and with measurement issues regarding the concept of social capital, more research is needed to establish a firm conclusion on the importance of the children's active participation as a source for cognitive social capital creation in the school setting.

European Journal of Public Health, 2019

Background Food literacy (FL) has developed as a relatively new theoretical concept, which accord... more Background Food literacy (FL) has developed as a relatively new theoretical concept, which according to Benn (2014) captures not only knowledge about healthy food (to know) and cooking skills (to do), but also the sensing of food (to sense), care of others (to care) as well as citizenship involvement in food issues (to want). Empirical studies of the concept are, however, few. The aim was to test the applicability of the 5 theoretical competencies of food literacy in school children aged 12-14 years. Methods The operationalisation of the theory into a practical context occurred in three steps using a qualitative approach; 1) Concretizing the domains of the model by defining sub elements to each domain and questions to each sub element. 2) Reviewing questions by a panel of 10 experts in food and education, and subsequently adjusting and reducing according to comments. 3) Conducting participatory observations on a food camp and 4 focus group interviews with a total of 21 school childr...

European Journal of Public Health, 2020

Background Evidence for health literacy (HL) as an important determinant of health and health beh... more Background Evidence for health literacy (HL) as an important determinant of health and health behaviour is increasing. Brief and generic tools for measuring HL in children are few. One such tool is the Health Literacy for School-Aged Children (HLSAC) instrument, which is a 10-item theory-based tool developed in Finland for measuring HL in children aged 13-15. The aim of this study was to translate and validate the HLSAC-instrument among Danish children aged 12-14. Methods The instrument was translated into Danish by a recommended standardized forward-backward translation process, and then pre-tested for face validity with 61 pupils from four schools. Thereafter, the instrument was tested among 805 pupils from 15 schools. Structural validity was analysed with confirmatory factor analysis (CFA), predictive validity with regression analysis, and internal consistency with Cronbach's alpha. Results When HL was modelled as one latent factor with all 10 items loading on this factor, CF...

Appetite, 2021

Food literacy (FL) is an aim of food education and cooking interventions, but is defined and meas... more Food literacy (FL) is an aim of food education and cooking interventions, but is defined and measured in different ways. In this study we developed, tested, and validated a FL instrument targeting children aged 12-14 years that builds on a broad 5-dimensional FL concept that includes the competencies of knowing and doing, as well as the rarely investigated competencies of using the senses, caring for others, and wanting to participate as a citizen regarding food issues. The study had 3 phases: 1) item development involving an expert panel; 2) scale testing comprising a face validity test with 31 pupils and a test with 817 pupils, of which 267 took part in a retest; and 3) scale validation including testing dimensionality by confirmatory factor analysis (CFA), internal reliability by Cronbach α, external reliability by intraclass coefficient (ICC), and convergent and predictive validity by regression analysis. CFA showed an acceptable model fit, confirming the concept of FL as 1 factor and its 5 distinct competencies as subfactors. There was good internal reliability for total FL score (α = 0.85) and good external test-retest reliability (ICC = 0.92). Convergent validity for a similar health literacy construct was significant for the total FL scale and its 5 competencies; this was also true for the predictive validity of FL with food intake as an outcome. This 37-item, 5-dimensional FL instrument can be used to assess FL levels in children and can guide food and nutrition education.

Health Education, 2019

Purpose Whole-school approaches emphasising pupil participation are recognised as being conducive... more Purpose Whole-school approaches emphasising pupil participation are recognised as being conducive for building social capital, yet how participatory health educational processes relate to different types of social capital remains unclear. The purpose of this paper is to explore which mechanisms within a participatory health educational process influence social capital and collective actions in the school context, and to discuss children’s agency in such processes. Design/methodology/approach A multiple case study design, with the Danish “We Act – Together for Health” intervention, considered as an instrumental case regarding participatory health educational processes for children, principally since it applied the participatory Investigation–Vision–Action–Change (IVAC) methodology. The paper is based on a theory-driven, abductive research strategy. Qualitative methods, including focus group interviews with children, semi-structured interviews with teachers and school principals, and ...

Journal of Food and Nutrition Research, 2018

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IUHPE_Nanna_.pdf Source: PublicationPreSubmission Source ID: 127189336 Research output: Contribut... more IUHPE_Nanna_.pdf Source: PublicationPreSubmission Source ID: 127189336 Research output: Contribution to conference › Conference abstract for conference – Annual report year: 2016 › Research › peer-review

Social capital has been found to be important for children’s health, well-being and more broadly ... more Social capital has been found to be important for children’s health, well-being and more broadly their welfare, but little is known regarding how social capital is generated by children within the school setting, drawing on children as active participants. Through an abductive research strategy based on focus group interviews with children age 10-12 years old, the study identifies three forms of participation relating to different practices and thus different opportunities and constrains of generating bonding and bridging social capital in the school context. The study highlights the importance of stressing pupils’ genuine participation as an active social pedagogical principle.

11 12 Background: Strategies to improve health behavior and wellbeing of Danish children are 13 n... more 11 12 Background: Strategies to improve health behavior and wellbeing of Danish children are 13 needed. A multicomponent intervention “WeAct – together for health” was developed to 14 improve the dietary habits, physical activity and wellbeing among school children aged 10-12 15 years by increasing their health competences and promoting a healthy school environment. 16 This paper describes the development and evaluation of the intervention guided by theory and 17 adjustment to real life setting. 18 19 Methods: The intervention builds upon the health promoting school approach and the IVAC 20 model. The settings are the school and the family. Three educational components targeted the 21 school: 1) Lunch meal habits integrated into science and Danish (“IEAT”) and physical 22 activity integrated into maths (“IMOVE”), 2) Vision workshop integrated primarily into 23 Danish, and 3) the Action and Change process at class and school level. Teachers participated 24 in a course to develop comp...

BMC Public Health

Background: "We Act" is a health-promoting school intervention comprising an educational, a paren... more Background: "We Act" is a health-promoting school intervention comprising an educational, a parental and a school component. The intervention was implemented in 4 Danish public schools with 4 control schools. The objectives were to improve pupils' dietary habits, physical activity, well-being and social capital using the Investigation, Vision, Action & Change (IVAC) health educational methodology. The target group was pupils in grades 5-6. The purpose of this study was to evaluate implementation fidelity and interacting context factors in the intervention schools. Methods: The Medical Research Council's new guidance for process evaluation was used as a framework. Data were collected concurrently and evenly at the 4 intervention schools through field visits (n = 43 days), questionnaires (n = 17 teachers, 52 parents), and interviews (n = 9 teachers, 4 principals, 52 pupils). The data were analysed separately and via triangulation. Results: A total of 289 pupils participated, and 22 teachers delivered the educational component in 12 classes. In all schools, the implementation fidelity to the educational methodology was high for the Investigation and Vision phases as the teachers delivered the proposed lessons and activities. However, the implementation fidelity to the Action & Change phase was low, and little change occurred in the schools. The pupils' presentation of their visions did not work as intended as an impact mechanism to prompt actions. The implementation of the parental and the school components was weak. The main context factors influencing implementation fidelity were a poor fit into the schoolyear plan and weak management support. Conclusions: Although 'We Act' was designed to comply with evidence-and theory-based requirements, IVAC and the health-promoting school approach did not result in change. The time dedicated to schools' preparation and competence development may have been too low. This must be considered in future process evaluation research on health-promoting schools and by school health promotion administrators when planning future school interventions.