**3.1 Older patients' acquisition of formative learning**

A discussion involving knowledge and learning implies talking about "alphabetization" and literacy, or even about various literacy levels and literacy backgrounds. Traditionally, literacy was defined in general terms but, currently, we tend to differentiate among a range of literacy concepts. The new term "alphabetization" belongs to the old literacy paradigm in which we assessed individuals in terms of their ability to read, write, and use numbers. The goal was to rank individuals according to their literacy level, what we now call the "degree of alphabetization." Today, some literacy researchers work within a new literacy paradigm: as a social practice reflecting the literacy background of the person (Barton et al., 1998, 2000). Kaszap and Clerc (2008) clarify both alphabetization and literacy concepts and suggest how to use them.

Renewing Perspectives on Men's Prostate Cancer

Fig. 1. The health literacy conceptual framework

considerations for health educators to think about.

**3.2 Strategies in health education** 

strategies for health education.

hospitalization, chronic disease, and higher health care costs.

Literacy and Engagement Along the Disease Continuum 45

impacts on health disparities and adverse health outcomes throughout the lifespan, including

With the growing elderly population in developed and developing countries, health costs (financial, human, material, physical, emotional, etc.) are anticipated to grow. The emerging worldwide movement of supporting patients to be autonomous, aware partners in health care is also leading education and health professionals to rethink the role of health educators. To promote health literacy, health educators are facing demands to renew and expand their toolboxes of educational aids and to adopt teaching innovations to sustain the mobilization of learning potential among older patients. The next section presents some

Over time, health education has been done mostly in a traditional way by health professionals, according to health curricula. In this approach, information is given on disease, and treatments are explained in a "you have to" way. This approach is basically one-way knowledge transmission, from professionals to patients and not vice versa. Using this traditional approach, professionals scarcely have time to learn what health literacy patients already have. Patients do not have time to discuss their fears, values, and conceptions. The traditional approach to health education has brought with it serious problems. For example, recent research tells us that inadequate literacy often reveals misconceptions about different aspects of health, such as patient's erroneous understanding of how a body change in enduring diseases, long term effects of drugs or other treatments (Buston & Wood, 2000; Kaszap et al., 2000, 2006), and false beliefs about popular treatments (e.g., magical peas or liniments) with supposedly spectacular effects on blood pressure (Kaszap et al., 2000). With older men, health educators should take such health-related misconceptions and false beliefs into account and propose new

Health education should not merely be transmission of information, because recipients of transmitted information may filter it through faulty premises; for example, misconceptions about bodies, health, and treatments and false beliefs about natural

The degree of *health alphabetization* may indicate – at a specific time in one's life – competence in searching for, identifying, collecting, understanding, critiquing, and interpreting health information. This information is used to create and communicate messages about one's health status, to make choices in preventing disease, to recover or preserve health, to solve problems related to one's health using language (written, oral, visual, audible, tactile, etc.) in a variety of contexts in day-to-day life (at the world, community, school, and individual levels). Health alphabetization can frequently be measured by tests, and other reporting and self-appraisal methods. On the other hand, the concept of *health literacy* comprises several assets (translation of Kaszap & Clerc, 2008, as cited in Kaszap & Zanchetta, 2009). First, it sums all health information acquired from family, school, social, cultural, and professional sources (formal and informal) during a continuous, gradual learning process. Second, it sums all the values, beliefs, fears, habits, attitudes, and behaviors that each person holds in all the aspects of life related to health. Third, health literacy comprises one's specific background: (a) health culture and health knowledge, (b) the type of health education to which one was exposed, individual's attitudes, behaviours, and feelings, values and beliefs; (c) practices in searching for health information, reading and decoding it, and communicating it (in oral or written form), and (d) using numerical information and health information to solve health problems in everyday life. Seen from the above-described point of view, measurement of health literacy is neither feasible nor possible. However, it is a state, or even a set of personal practices, that can be described more or less accurately. Seen this way, health literacy can be more or less broad, more or less adequate – or inadequate– for a situation or a context. Zanchetta (2002)

describes the origin of men's prostate cancer literacy as follows: All men reported that during childhood, school and family constituted the sources of available health information during the formation of their informational background on health matters. Health information in childhood was synonymous with consuming healthy food, having good hygiene, and receiving vaccinations at school. (p. 191)

Men's learning experiences with prostate cancer build on lifelong learning about health and its incorporation into daily life. Zanchetta (2002) proposes a definition of health literacy about prostate cancer based on survivors' experiences:

Older men live and deal with health information through the handling of the imprints of their beliefs, and representations, as well as life, learning, and illness experience. For this, a supportive environment is primordial to enable them to regain the sense of illness, the decision-making power upon one's body and destiny, as well as to redefine the social roles by reconstructing partnerships with the social and informational network. (p. 294)

The definition above shows that the construction of health literacy is multidimensional and involves social factors, such as life stories, cumulative experience, social learning, autonomy, and social interactions. Seminal studies have demonstrated a strong relationship between low literacy and poor health (Brown et al., 1993; Davis et al., 1991; Francis, 1991; Mayeaux et al., 1996; Weiss et al., 1992, 1994; Weiss & Coyne, 1997) and proposed health literacy as a new social determinant of health (Rootman et al., 2007; Zanchetta et al., 2011). Therefore, we suggest that inadequate health literacy may impede other social determinants of health, which in turn may worsen one's ability to use health information in making decisions.

Considering the above-mentioned factors, we propose a conceptual framework (Figure 1) that shows alphabetization as an integral part of health literacy, within the social determinants of health. Together with a supportive environment, health literacy may influence individuals' response to particular health situations and contexts as well as their awareness of existing resources and ways to accessing them. Perlow (2010) reports that low health literacy has major

The degree of *health alphabetization* may indicate – at a specific time in one's life – competence in searching for, identifying, collecting, understanding, critiquing, and interpreting health information. This information is used to create and communicate messages about one's health status, to make choices in preventing disease, to recover or preserve health, to solve problems related to one's health using language (written, oral, visual, audible, tactile, etc.) in a variety of contexts in day-to-day life (at the world, community, school, and individual levels). Health alphabetization can frequently be measured by tests, and other reporting and self-appraisal methods. On the other hand, the concept of *health literacy* comprises several assets (translation of Kaszap & Clerc, 2008, as cited in Kaszap & Zanchetta, 2009). First, it sums all health information acquired from family, school, social, cultural, and professional sources (formal and informal) during a continuous, gradual learning process. Second, it sums all the values, beliefs, fears, habits, attitudes, and behaviors that each person holds in all the aspects of life related to health. Third, health literacy comprises one's specific background: (a) health culture and health knowledge, (b) the type of health education to which one was exposed, individual's attitudes, behaviours, and feelings, values and beliefs; (c) practices in searching for health information, reading and decoding it, and communicating it (in oral or written form), and (d) using numerical information and health information to solve health problems in everyday life. Seen from the above-described point of view, measurement of health literacy is neither feasible nor possible. However, it is a state, or even a set of personal practices, that can be described more or less accurately. Seen this way, health literacy can be more or less broad, more or less adequate – or inadequate– for a situation or a context. Zanchetta (2002)

All men reported that during childhood, school and family constituted the sources of available health information during the formation of their informational background on health matters. Health information in childhood was synonymous with consuming healthy

Men's learning experiences with prostate cancer build on lifelong learning about health and its incorporation into daily life. Zanchetta (2002) proposes a definition of health literacy

Older men live and deal with health information through the handling of the imprints of their beliefs, and representations, as well as life, learning, and illness experience. For this, a supportive environment is primordial to enable them to regain the sense of illness, the decision-making power upon one's body and destiny, as well as to redefine the social roles

The definition above shows that the construction of health literacy is multidimensional and involves social factors, such as life stories, cumulative experience, social learning, autonomy, and social interactions. Seminal studies have demonstrated a strong relationship between low literacy and poor health (Brown et al., 1993; Davis et al., 1991; Francis, 1991; Mayeaux et al., 1996; Weiss et al., 1992, 1994; Weiss & Coyne, 1997) and proposed health literacy as a new social determinant of health (Rootman et al., 2007; Zanchetta et al., 2011). Therefore, we suggest that inadequate health literacy may impede other social determinants of health, which in turn may worsen one's ability to use health information in making decisions. Considering the above-mentioned factors, we propose a conceptual framework (Figure 1) that shows alphabetization as an integral part of health literacy, within the social determinants of health. Together with a supportive environment, health literacy may influence individuals' response to particular health situations and contexts as well as their awareness of existing resources and ways to accessing them. Perlow (2010) reports that low health literacy has major

by reconstructing partnerships with the social and informational network. (p. 294)

describes the origin of men's prostate cancer literacy as follows:

about prostate cancer based on survivors' experiences:

food, having good hygiene, and receiving vaccinations at school. (p. 191)

impacts on health disparities and adverse health outcomes throughout the lifespan, including hospitalization, chronic disease, and higher health care costs.

Fig. 1. The health literacy conceptual framework

With the growing elderly population in developed and developing countries, health costs (financial, human, material, physical, emotional, etc.) are anticipated to grow. The emerging worldwide movement of supporting patients to be autonomous, aware partners in health care is also leading education and health professionals to rethink the role of health educators. To promote health literacy, health educators are facing demands to renew and expand their toolboxes of educational aids and to adopt teaching innovations to sustain the mobilization of learning potential among older patients. The next section presents some considerations for health educators to think about.
