From March 2015 till December 2021 a research team at the University of Education Freiburg was part of a larger Consortium on Health Literacy in Childhood and Adolescence, funded by the German Federal Ministry of Research and Education.

Project management HLCA network:
Coordinator and project leader of the HLCA network project is Prof. Dr. Ullrich Bauer and Dr. Paulo Piehro from the University of Bielefeld, Faculty of Educational Science, AG: Social Research as well as Prof. Dr. Orkan Okan from Technical University Munich. The research network consists of nine subprojects (more information at: www.hlca-consortium.de).

eHealth literacy and minority health: an ethnographic study of the health-related benefits of new media among disadvantaged adolescents with Afghan immigrant backgrounds

Background
The ELMi research project was funded by the German Federal Ministry of Education and Research [funding code: 01EL1424E) and is part of the national research network "Health Literacy in Childhood and Adolescence (HLCA)". The aim of the research network is the development, testing and practical transfer of target group-specific, evidence-based and high-quality measures to improve health literacy (health competence) and the health of adolescents.
The use of new media, smartphones, social media, etc. has become an integral part of the everyday lives of young people (digital natives). They provide access to information for almost everyone, at least in theory.

However, recent research on the health behavior of adolescents has shown that health, social behavior and health skills differ significantly by gender, socioeconomic status, and migration background or ethnicity. This suggests that there are also (target) group-specific differences in social media use with unequal health consequences. However, there is little knowledge about the health-related use of social media among migrant youth in general and among refugee minors aged 14-17 with an Afghan migrant background in particular.

Purpose:
The main objective of the ELMi project was to find out exactly how the everyday use of the smartphone works with regard to the use of health information or digital offers (health apps) among disadvantaged adolescents.
The main research question was: What is the concrete interplay between cell phone use and different health dimensions among youth with Afghan refugee histories? At what points is the smartphone beneficial to health in everyday life, and at what points is it detrimental to health?

Method
The ELMi project represented an ethnographic study in which two adolescents with an Afghan migrant background, within three separate field and analysis phases, were accompanied in their everyday life. This ethnography was embedded in a kind of milieu study of refugee hostels in a large city in southern Germany.

Results

In the course of our close every day and extracurricular accompaniment of two Afghan adolescent refugees, it first became clear that the adolescents possessed many positive competencies in the sense of Aaron Antonovski, which are to be counted among the resilience factors. Furthermore, it became clear that an individualistic concept of adolescent health misses the reality of at least the two accompanied Afghan refugee adolescents and that instead, a stronger focus on family health would be necessary. This becomes particularly clear when an adolescent in a field phase defines health as a state in which his family is doing well. Finally, it can be stated that smartphones are very ambivalently associated with health in everyday life - on the one hand, they are helpful for acquiring the language and thus for orientation in the destination country, for example through translation programs. Thus, they provide direct health-promoting potentials. On the other hand, it was observed that (extensive) smartphone use promotes the already widespread lack of sleep among young people (increasingly in, but also outside of refugee accommodations).

Project Team:

• Prof. Dr. Uwe H. Bittlingmayer
• Main Researcher: Elias Sahrai
• Supporting Researchers: Zeynep Islertas, Stefanie Harsch

Publication: 
Click on the following link for the results which are published in our book "Health Literacy from a health ethnographic perspective". The insights presented here are not exhaustive; not least because even after the ethnographic field phase as well as the interviews, (new) background information came to light that requires reinterpretation or reconsideration of the empirical findings. 

The book is available in German and soon in English language.

SCURA - Health Literacy Promotion of Migrant People in Language Courses 
Background: Good health literacy is essential to make and implement good, health-relevant decisions. Research shows that especially newly immigrated people, such as Afghans, face multiple health-related perceived challenges. In order to access health services in the new country and respond to emerging health concerns, country-appropriate health literacy is necessary. Language courses can play an essential role in teaching this health literacy.

The research project SCURA aims to explore and improve the responsiveness of a language school setting to the competencies and concerns of immigrant people, especially immigrant people from Afghanistan. Here, people are conceptualized as endowed with multiple resources and analyzed how these resources and health-related issues are taught and reinforced in the classroom.

Methods: SCURA incorporates both ethnographic research methods and participatory intervention development. First, extensive literature reviews were conducted on health literacy promotion in language courses and health interventions for refugees/immigrants in Germany and translingual health literacy. Furthermore, interviews with teachers and participants were conducted and classroom activities were observed. In the next step, lesson plans were developed together with immigrants and training for teachers in language and integration courses as well as in the transition system are conducted.

Preliminary results: Health topics are very relevant for course participants and can be used very well to increase motivation for learning German. In addition to the course content and methodology, however, a variety of other factors are significant. These are, for example, the mission of the course, characteristics of the participants, role perceptions of the teachers, atmosphere, and cooperation within the course, the school setting as well as the general conditions. Lecturers are perceived as persons of trust and thus informed about health issues. However, there is uncertainty about how to deal with the health burdens of the course participants and the need for more teaching materials on topics such as the structure of the German health system, first aid, but also culturally sensitive addressing of behaviors that are harmful to health (diet and exercise). In particular, the aspects of 'feeling comfortable in the course' and self-esteem enhancement are crucial for health.

Conclusion: The study identified opportunities but also limitations of addressing and promoting health (literacy) in educational settings. In particular, the great relevance of communicating about health and disease topics in the German language and the high motivation for health topics suggest that more space should be given to this topic. So far, too little research has been done on the role of the two (or three) languages and cultures from which individuals come for the development and promotion of translingual, culturally sensitive health literacy.

SCURA Project

• Project Leader: Prof. Dr. Uwe H. Bittlingmayer
• Main Researchers Stefanie Harsch (language courses), Zeynep Islertas (Übergangssystem)

Further information on SCURA can be found on the project website: www.scura.info

Publications

Harsch, S. (2021), “Ein fremder, zweiter Blick auf Health Literacy - was uns die Zweitsprachendidaktik lehren kann. (A foreign, second look at health literacy - what second language didactic can teach us)”, in Rathmann, K., Dadaczynski, K., Okan, O. and Messer, M. (Eds.), Gesundheitskompetenz, Springer.

Harsch, S., Jonasson, L. and Stolwijk, L. (2021), “Förderung von Gesundheitskompetenz von zugewanderten Menschen in Zweitsprachkursen – Umsetzung, Begrenzung und Potenziale in Deutschland und weltweit. (Promoting health literacy of migrants in second language courses - current situation, limitations and potential in Germany and around the world)”, in Rathmann, K., Dadaczynski, K., Okan, O. and Messer, M. (Eds.), Gesundheitskompetenz, Springer. 

Harsch, Stefanie (2022). Health literacy as a situational, social practice in context. Insights gained through three research projects among ‘vulnerable groups’. Freiburg, University of Education Freiburg. Dissertation