As we write our editorial for a health literacy special issue in the midst of the international COVID-19 crisis, we take this opportunity to highlight the importance of individual, community, and population health literacy. We are not only in a "pandemic" but also an "infodemic". Health literacy is more important than ever in the face of these global health threats, which have impacted outcomes across the levels of the socio-ecological model (SEM), including individual health behaviors, family relationships, organizational behavior, state policy-making, national mortality statistics, and the international economy in the span of weeks. Our special issue sought to pull together interdisciplinary threads guided by two principles. The first was defining health literacy as essential skills and situational resources needed for people to find, understand, evaluate, communicate, and use information and services in a variety of forms across various settings throughout their life course to promote health and wellbeing. The second was the idea that enhancing health literacy in populations and systems is critical to achieving health equity. In this time of public health need across traditional borders, the inter-sectoral and international perspectives of special issue articles are more urgent than ever. A greater understanding, appreciation, and application of health literacy can support policy action on multiple levels to address major public health challenges. Health literacy should be built deliberately as a population-level resource and community asset. We have summarized the set of articles in this special issue across the levels of the SEM, hoping their thoughtful considerations and interesting findings will help to support global health and wellness and inspire future research, policy, and practice in this global public health emergency and beyond.As we write this special issue editorial in the midst of the global health threat of COVID-19, individual, community, and population health literacy are more important than ever [3][4][5][6][7]. Personal health behaviors, family relationships, organizational actions, state policy, national mortality statistics, and the international economy have changed in the span of weeks because of decision-making influenced by, and influencing, health literacy. Critical health literacy and digital health literacy are urgently needed by both the citizenry and policy makers to synthesize, analyze, and appraise the vast amount of urgent, complex, and even conflicting information from virologists, epidemiologists, data modelers, doctors, nurses, health departments, and the media [3,[5][6][7]. Health literacy capacities allow us to be well-informed about risks, resources, and recommendations and, ideally, to act in solidarity-based behaviors to achieve public health [3,4,7]. It is increasingly clear that social responsibility and solidarity may be key outcomes of health literacy, helping to combat decisions and policies that go against current COVID-19 evidence and best practice public health...

In many countries, health literacy research, practice, and policy have been moving away from a focus only on medical care and health-care settings to a much broader conceptualization. In this broader perspective, health literacy can be obtained and used across many other settings (e.g., school, home, workplaces, government) towards achieving health and wellness goals across the life-course for individuals, families, and communities. The education sector is a critical domain towards these achievements and education for health literacy is a fundamental process and outcome. This can help towards important public health goals, including critical health literacy, as oriented not only towards individual actions, but also towards supporting effective social and political action. This Perspective Article describes the importance and utility of the education for health literacy perspective, which, follows a view that health literacy is a key outcome of health education from which improved population health, health promotion and disease prevention could be achieved across diverse contexts. We first describe different educational paradigms to address health literacy and clarify the education for health literacy perspective as a supportive, instructional and capacity-building global resource across the life-course. Then, using specific examples from Canada, America, and Germany, we provide a snapshot of the diverse ways in which the education for health literacy perspective can be found in national policies. These include broad national goals and standards (Germany and Canada) and major health care reform (America). We next consider the tensions and gaps that can arise in the translation and implementation of these policies relative to the ideal education for health literacy perspective, especially related to equity. These include the need for funding, goals of the educational system, and limited evaluation of policy in practice. Finally, we highlight strategic opportunities to achieve education for health literacy and equity especially offering examples from innovative practice in Canada across the lifespan.

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The Conceptual Model Map (CMM) presented here is intended to show the connections between different theories and constructs in the field of health and nutrition behavior (including literacy models, the knowledge–attitude(s)–practice(s) survey structure (KAP), behavior change theories, and Maslow’s pyramid of needs). The CMM can be used as a map to locate existing and future studies, to show their range of effect as well as their limitations. In this context, the CMM also reveals reasons for the attitude/intention–behavior gap.

Health literacy has implications for people's ability to make healthy decisions and manage their own health. To improve health literacy, we need to improve the knowledge and skills of those who receive and those who provide health information and services, while paying attention to demands of the environment that shape people's skills and abilities. Higher education can play a critical role in nurturing a health literate population. This article articulates the need to integrate health literacy courses into health-related degree programs through the integration of Bandura's work and Core Competencies for Public Health put forward by Canada. Offering such courses in varying formats will help prepare learners to better understand the growing demand for a health literate workforce and will contribute to the ongoing public health initiatives in improving health-related settings by removing health-related barriers. This article outlines the need for a systematic development of health literacy courses based on the integration of instructional and health literacy principles. An example of a core online undergraduate health literacy course in Canada is presented. Insights are offered into how educators can develop and modify their own health literacy courses, which aim to help learners explore ideologies, practices, tools, and policies guiding health literacy efforts for diverse people across settings.

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BACKGROUND:In this study, we explore how a health education course may play a role in pre-service teachers' perceptions in teaching and integrating health education activities to nurture K-8 students' health literacy. METHODS:We used mixed methods to examine the effect of a health education course in a teacher education program. Of 55 pre-service teachers, 41voluntarily participated in the study. Quantitative data were obtained through an online questionnaire administered to participants at the beginning and end of the course. We conducted 6 focus groups at the end of the course. RESULTS:The inferential analysis from a series of analysis of variance with repeated measures revealed significant differences in health knowledge (F = 113.39, p < .01, η 2 = 0.74), preparedness (F = 104.74, p < .01, η 2 = 0.73), attitudes (F = 15.02, p < .01, η 2 = 0.28), and beliefs (F = 8.87, p < .01, η 2 = 0.19) between time points. Qualitative data led to the conclusion that where one health education course is insufficient, such a course is the first step into future curriculum development and implementation. CONCLUSION:One health education course might be beneficial for general education teachers to increase their knowledge and preparation to teaching school health. On-going training is needed for program success.Citation: Vamos SD, Xie X, Yeung P. Effects of a health education course on pre-service teachers' perceived knowledge, skills, preparedness, and beliefs in teaching health education.