Cast Wisdom +2 Fun
Health Literacy
“these tools have been generally found to measure only limited aspects of necessary health literacy skills, primarily those relating to reading comprehension ... They have also frequently failed to focus on adolescents as a distinct subgroup, and the need for health literacy assessment tools that are specifically tailored for children and adolescents has been emphasized” (St. Jean, Taylor, Kodama, & Subramaniam, 2017, p. 41).
ALL LITERACIES IN RANGE
St. Jean, Taylor, Kodama, and Subramaniam (2017) identify this issue regarding attempts to determine adolescent health literacy: “these tools have been generally found to measure only limited aspects of necessary health literacy skills, primarily those relating to reading comprehension” (p. 41). In response, new learning objects designed with the theories of game-based learning developed multiple literacies in general as well as multiple health literacies in particular. For instance:
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The visual novel develops functional health literacy, including defining some diabetes-specific terminology and numeracy, while the quiz develops information literacy, including computer and critical literacies.
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The visual novel also develops communicative health literacy. The doctor's office setting, in particular, emphasizes use rather than reading comprehension; as Elise Blas (2016) notes, "Presenting an apparent nonacademic application for these skills exposes students to the need to evaluate information in various situations” (p. 94). Thus, the student’s active participation in a simulated encounter with a medical professional provides a more realistic training ground to develop the various identified literacies, especially numeracy. As a result, the likelihood that these skills both seem relevant and transfer to the offline world beyond classroom walls is maximized.
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The discussion forum develops critical health literacy. Specifically, the last two questions of the discussion forum ask students to offer social support and participate in the community respectively. The first question asks, “How can we advise a friend with a medical condition that impacts their life?” and the second asks, “How might we help change our community's health for the better?”
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Nutbeam (2015) advises, “Improving critical health literacy involves health education that is more interactive and may include the communication of information to support a variety of health actions to address both personal and social determinants of health. The content of health education should not only be directed at changing personal lifestyle but also at raising awareness.”
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Successfully reading a graph requires procedural knowledge or knowledge-how, whereas matching a website’s top-level domain with its creator and identifying website types that are created without any restriction requires propositional knowledge or knowledge-that. For this reason, numeracy assessment was conducted in the ongoing, interactive method of a serious game, with students receiving feedback, in the form of positive or negative reinforcement of selection as appropriate, immediately after each response: It is important to learn how to read the graph as the graph is present and the scenario ongoing, so support is given to the student until that knowledge is gained. As Nutbeam (2015), explains, “Improving interactive health literacy will require the use of more interactive forms of health education directed towards improving self-confidence to act on information and advice received.”
On the other hand, students either do or don’t possess the factual knowledge of how to read and understand web addresses including top-level domains. For this reason, web literacy assessment was conducted in the single attempt survey that provides survey-completion scoring.
An online discussion board was used to develop critical health literacy to capitalize on the complementary nature between content and medium: As Nutbeam (2015) explains, “This [critical health literacy content] also has implications for the education and communication methods, challenging health educators to communicate in ways that … invite interaction, participation and critical analysis.”
TACTICAL STRATEGIES
BATTLE
PLANS
Just like HackHealth’s curriculum, this learning platformed “use[d] multiple data collection methods, so that we could analyze participants’ behavior from a variety of perspectives” (Subramaniam et al., 2015, p. 12): Even though every learning object requires use of the same internet-connected device, each requires a different method of user input and thought process to accommodate a range of abilities, with varying aesthetics and media appealing to varying student interests.
St. Jean et al. (2017) noted that HackHealth participants “were not familiar with trustworthy websites to which they might directly navigate when they need credible health-related information” (St. Jean et al., 2017, p. 55). For this reason, and due to the online nature of the quiz, rather than asking students to provide a website off the top of their head, they are given the opportunity to explore for one. The challenge shifts from one of knowledge-that and memory recall to knowledge-how and information searching with a set goal but no explicit directions.
In each assessment, the protagonists Jaylen and Jasmine, and by extension the students who play (in the case of the visual novel) or guide (in the case of the quiz) them respectively, are in control of the simulated health scenarios. This is significant because, as Sansom-Daly, et al. (2016) highlight, “AYA years are developmentally critical, as young people move toward attaining autonomy and develop important adult social, emotional, and cognitive skills, including assuming responsibility for their own healthcare. … This shift is consistent with AYAs’ documented desire to be 'in control' of health-related interactions” (p. 107).