are groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture. Occupations include everything that people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities.
Determinants of Health
Income & income distribution
Unemployment & job security
Employment & working conditions
Early childhood development
Personal health practices & coping skills
Biology & genetic endowment
Access to health services
Social safety net
is the dynamic relationship between the person, the environment and the occupation
Intrinsic Factors of the PEOP Model
Extrinsic Factors of the PEOP Model
Social and Economic Systems
Culture and Values
Built Environment and Technology.
Self-Determination Theory (SDT)
We have innate psychological needs for autonomy, competence and relatedness
Types of motivation (quality):
Type of regulation
Extrinsic, Intrinsic or Amotivation
Behavior in accordance with personal
values and interests; actions would be
Sense of being effective and competent
in a given context
Feeling cared for, connected to,
sense of belonging with others
Autonomous Causality Orientation
choice- all 3 needs met (optimal functioning & well-being)
Controlled Causality Orientation
pressured -competence & relatedness, but not autonomy (rigidness, diminished well-being)
Impersonal Causality Orientation
none of the 3 (poor functioning & reduced vitality)
Conditions that Undermine Intrinsic Motivation
Reward, Deadlines, Threats
Too Easy / Too Difficult
Conditions that Enhance Intrinsic Motivation
Three Ways to Foster Internalization
PAC (Physical Activity Counsellor) 7 A's Model
Address the Agenda
what moves people to act, think and develop
Three things people need to feel acc to SDT
involves doing a behaviour because the activity itself is interesting and spontaneously satisfying
Effects of extrinsic motivation in intrinsic motivation
Extrinsic rewards decrease intrinsic motivation across a range of things
Positive performance feedback and intrinsic motivation
PPF has been found in some instances to enhance intrinsic motivation rather than undermine it
Events that convey competence w/o being controlling
Little intrinsic or extrinsic motivation
Difference between Autonomy and Indepence
Autonomy means to act volitionally, with a sense of choice, whereas independence means to function alone and not rely on others.
Three types of internalization
It involves people taking in an external contingency, demand, or regulation but not accepting it as their own. Instead, it remains somewhat alien to them and tends to control them much as it did when it was still external.
In a sense, introjection represents only a partial internalization, for people take in a control w/o feeling a sense of ownership of it and allow it to pressure and control them.
involves people accepting the importance of the behaviour for themselves and thus accepting it as their own. They identify with the value of the activity and willingly accept responsibility for regulating the behaviour
people have succeeded at integrating an identification with other aspects of their true or integrated self.
Forms of controlled motivation
external and introjected regulations
Forms of Autonomous Motivation
Identified/Integrated and intrinsic regulation
Focused on external indicators of Worth
eg) amassing wealth, becoming famous, projecting an attractive image
More directly linked to satisfaction of the basic psychological needs for autonomy, competence and
eg) personal growth, building relationships, and being generative for the community
When people's autonomy is supported, they often feel free to follow their interests and consider the relevance and importance for themselves of social norms, values and mores.
Functions of the PEO model
It provides therapists with a practical analytical tool to 1) assist therapists to analyze problems in occupational performance, 2) guide intervention planning and evaluation, and 3) clearly communicate occupational therapy practices
perception of imbalance between coping capacity and the environment"
What is a key element of stress?
A key element is that the person must perceive the imbalance to be something important - if it doesn't phase them, then it is not stressful
a reaction to the environment in which there is threat of net less of resources, actual net loss of resources, or lack of resource gain following investment of resources
What are considered resources?
house, car, computer, iphone
confidence, beliefs, values, genetics, personality
room mate, community support for an idea, marriage, permanency in a job
time, money, knowledge, skills
Principles of COR Theory
Resource loss is more powerful than resource gain
Resources must be invested in order to gain resources or prevent their loss
What does COR Theory focus on ?
This theory focuses on threat of loss, actual loss and lack of gain in resources... all influence whether an individual experiences stress and how they function (cope)
People who are already lacking in resources are more prone.
This is where one little thing can spiral into the loss of many other things
People don't have the resources to cope with repeated loss
they lack the reserves to meet ongoing demands and may experience stress from events / circumstances that others do not experience as stressful ... this has a negative impact on health
Who will have fewer barriers to resource gain?
People who are 'rich in resources'
Health promoting interventions should focus on preventing resource loss and helping people gain resources as a reserve (eg. not necessarily just giving fish... but teaching someone how to fish)
The Canadian Association of Occupational Therapists with the Department of Health and Welfare (1983) published
the Model of Occupational Performance and Client-Centered Practice
The PEOP model highlights
the complexity of person-occupation-environment relationships and it defines occupational performance as the outcome of this three tier transaction.
Persons have an innate drive to explore their environment and demonstrate mastery within it.
When is competence reached?
Competence is reached when a person is able to perform skills that meet his own personal needs. A person is also able to use the resources (personal, social, material) within one's environment.
is defined as a process whereby persons confront the challenges of daily living and are able to use their resources to master these demands.
How do people derive a sense of self fulfillment?
How do people derive a sense of self identity?
From meaningful participation
Occupations (defined by COTA)
are groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture. Occupations include everything that people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities
The Canadian Model of Occupational Performance and Engagement (Townsend & Polatajko, 2007) defines the environment as
having cultural, institutional, physical and social elements that can enable or constrain occupational performance.
Occupational Performance is influenced by the
2) unique environment in which one functions, and
3) occupations that consist of one's actions and tasks and ultimately create one's life roles.
Occupational performance describes
the actions that are meaningful to the individual as he self manages, cares for others, works, plays and participates fully in home and community life. It can be separated into two components: a) occupations and b) performance.
What two components can Occupational Performance be separated into?
Person (Peop Model)
made up of a series of intrinsic factors that compose one's set of skills and abilities.
Intrinsic factors - psychological, cognitive, physiological, spiritual, & neurobehavioral
Environment (PEOP Model)
Participation is always impacted by the extrinsic characteristics of the environment in which it occurs.
sensory surroundings of a person" which provides information about the physical and sociocultural context surrounding someone - to help navigate, make decisions and act
ethnic, racial, ceremonial, routine practices - based on ethics / values within a subsystem
-Social norms, practices and ideologies
Occupation follows sequential pattern of complexity
5. social & occupational roles
Occupation (PEOP COTA)
the activities and tasks that persons do in managing their daily lives, grouped in some meaningful way so that the persons can carry out life-roles.
Occupational Performance and Participation
is the culmination of doing occupations.
The interaction of a person's factors (intrinsic), the environment (extrinsic), and one's chosen activity (occupations) all lead to occupational performance and participation
A level of competency in his/her ability to perform and master occupations.
A healthy individual demonstrates occupational performance in meaningful activities and meets a balance of personal and environmental demands.
This person can self manage, care for others, work, play and participate fully in home and community life.
He shows adaptation in his occupational performance as challenges naturally evolve in his life. He has established healthy role patterns that fulfill personal and societal expectations
A person's occupational performance is limited and restricted. Therefore, occupational competence is not achieved. Persons may demonstrate a lack of goal attainment and participation in activities.
Dysfunction patterns are noticeable when a person cannot perform roles to a level of personal or social satisfaction (competency) because of deficits in abilities / skills due to a health condition, barriers and lack of resources.
The conflicting demands of multiple roles (role conflict) and unclear role expectations can impact occupational performance.
Standardized and observational screenings
can be used to assess the person's abilities, intrinsic factors and environmental (extrinsic) conditions.
A task analysis
will assist the occupational therapist to assess the performance components of an activity that are not congruent with the client's ability at that time.
Restorative Benefits of Occupational Performance
a) Control movement, to modulate sensory input, to coordinate and integrate sensory information, to compensate for sensorimotor deficits, and to modify neural structures through behavior
b) Maintain physical health and fitness
c) Maintain cognitive skills
d) Increase motivation, develop personal identity, enhance well-being and self efficacy
e) Enhance personal meanings and collective or shared meanings.
Intervention as part of the Role as an OT
recognize the role of the environment
adapt and/or modify the actions, tasks and ultimately one's occupations to match the abilities of the client
structuring occupations for meaningful participation and competent mastery
teach compensatory techniques
enhance role functioning
Oldest Definition of Social Capital
goodwill, fellowship, mutual sympathy, and social intercourse among a group of individuals who make up a social unit
Coleman's Definition of Social CApital
aspects of social structure that facilitate collective action
Pesut's Definition of Social Capital
Social capital is the currency of relationship exchange in our civil, social, and professional lives
Social Capital Includes
Trustworthiness of social environment, information channels, norms and effective sanctions, and appropriate social organizations
Three Different Types of Social Capital
5 Capital Model of Sustainable Development
Human capital (skills, education, etc)
Social capital (social networks)
Built capital (access to amenities)
Natural capital (access to green space)
Economic capital (income)
Some BEnefits of Social Capital
Enhanced mental health
Reduced cardiovascular disease
Reduced suicide rates
Reduced violent crime rates
It's role in community resilience is still not clear, because the concept is still a bit vague - is it a construct at the individual level or community level - if it is a collective construct and measurement needs to be improved
To date there has been an over-reliance on Putnam's definition as an individual state
Some critiques of Social Capital
Exact definition is ambiguous and due to its conceptual nature it is challenging to attribute causality when applying it in studies
Cannot be any social phenomenon as this detracts from its concreteness
Need better understanding of how networks form and what resources are needed to favour the emergence of SC
Proposed alternate definition: (Huber, 2008)
"resources embedded in social networks which can be accessed or are used for actions"
Resilience acc to Norris
a process linking a set of adaptive capacities to a positive trajectory of functioning and adaptation after a disturbance
Resilience acc to Poortinga
capability of individuals or systems (such as families, groups and communities) to cope successfully in the face of significant adversity and risk
In order for resilience to be present what also has to be present?
Adaptive Capacities of Resilient Communities
Information and Communication
when people have multiple roles, it is difficult to meet all the expectations (demands) because eventually they conflict in some way
Work-family role conflict
when work spills over or interferes with an individual's performance in their occupations with the family
With who does the most spillover occur?
Most prevalent among people who work more hours
Family-work role conflict
when family responsibilities or demands spill over or interfere with work performance
What occurs more work-family conflict or family-work conflict?
With whom is family-work conflict most prevalent?
Most prevalent among employees with children <18yrs
SARS was a new corona (common cold) virus
A severe acute respiratory syndrome (SARS) that resulted in more than 8,000 cases in 27 countries
4-10% mortality and no treatment or vaccine
SARS in Toronto area resulted in
Health care workers burned out
Severe tourism, racism and economic implications
Key Lessons from SARS
Health systems were not prepared
Jurisdictional boundary confusion
Leadership role confusion
Cross-disciplinary and sector tensions
Vulnerability of health care workers
Work-family conflict and stigma
Collateral damage - racism against Asian populations and businesses
What did Canada do in response to SARS?
Created the Public Health Agency of Canada (2004)
Emergency Management Act (Ontario, 2005)
Health Emergency Response Teams (HERT)
Via Nurse - database
Caring About Health Care Workers Project
Psychosocial influences on health are critical considerations for workplace health promotion & emergency preparedness (Sallis, 2006; Reissman et al., 2006)
Health care workers require organizational and social supports to assist them in performing their roles (O'Sullivan et al., 2008, 2009)
Lack of support mechanisms for health care workers represents a threat to public health (Campbell, 2006)
Specific Objectives of SARS research
How do individual factors, social and physical environments, and behavioural factors interact to influence the health of health care workers?
What types of organizational and social support mechanisms are needed to assist health care workers in their roles as first responders during large scale outbreaks
Components of the SARS Project
Focus Groups (nurses)
Format: Structured Interview Matrix
National survey (nurses) n=1543
Work satisfaction; supports; preparedness; perceived health
Policy Gap Analysis
Analysis of multi-jurisdictional plans for visible supports for health care workers
Policy Forum (2007)
Dissemination and knowledge transfer (KT) to policy audiences
Why is Gender Important in Emergency Planning?
Sex/Gender are dynamic, interactive constructs that crosscut and impact all health determinants
Gender-based Analysis (GBA) provides a framework that can enhance the quality and scope of evidence based decision making;
When GBA is absent, disaster management policies and program interventions may be inappropriate and may exclude the needs and participation of women and girls
GBA is about good science, policy, programs and clinical practice, with the goal of better and more equitable health outcomes for women and men
There is a need for gender and diversity-sensitive methodologies and assessment tools appropriate to emergency planning and health policy research
the genetic, biological and physiological characteristics and processes that generally distinguish males and females
the socially constructed roles, relationships, values, attitudes, and forms of power that are commonly attributed to either men or women; includes self-representation
SARS Focus Groups: Methods
Participants: RN's, RPN's, nursing managers & union reps who had worked in hospital ER or critical care within 5 years
5 Focus groups (N=100); Ottawa (x2), Vancouver, Halifax, Toronto
Interview Matrix format: Facilitated discussion of 8 questions with 1:1 interviews among participants, small group discussions, plenary discussions
Qualitative analysis: N*VIVO software
Various Levels in Which Nurses' health is impacted by psychosocial factors interacting from
Individual Level of psychosocial factors impacting the health of Nurses
Fatigue imposed by workload, emotional burden
Community Level of psychosocial factors impacting the health of Nurses
Lack of social support or experiencing stigma; dual-role conflict
Institutional Level of psychosocial factors impacting the health of Nurses
Lack of clear information from trusted source; additional workload causing fatigue / burnout
Political Level of psychosocial factors impacting the health of Nurses
Allocation of resources to HR mobilization; facilities, equipment, training, priority grouping for vaccines; gender power relations
Environmental Level of psychosocial factors impacting the health of Nurses
Globalization and international travel; effectiveness of available vaccines; viruses which observe no borders
Individual FActors influencing Nurses' Health
Exposure, prophylactic barriers (vaccines, anti-virals), existing vulnerabilities (chronic disease, weakened immune system), fatigue, knowledge, coping skills
Behavioural Factors Influencing Nurses' Health
Compliance with infection control guidelines, stress management, lifestyle
Social Environmental Factors Influencing Nurses' Health
work-family role conflict, stigma, relationships with colleagues, work conditions; gender power relations
Physical Environmental Factors influencing Nurses' Health
adequate engineering controls, availability of protective equipment
Support Mechanisms for Nurses
Personal protective equipment and uniforms
Education for all staff regarding emergency plan
Emotional / psychological support
Human resource policies focused on worker fatigue / stress
Vaccination / anti-viral therapy plan
Recognition / compensation
To what extent were nurses concerned they might infect family members?
To what extent were Nurses concerned they would be unable to meet their caregiving requirements?
Professional, do Nurses Feel adequately prep'd and oriented to deal with an infectious disease outbreak?
Are Nurses adequately trained to deal with infectious disease outbreaks?
Very Little - Somewhat
Do Nurses feel adequately equipped to work during an infectious disease outbreak?
Very Little - Somewhat
In general, how satisfied are nurses with their profession?
Somewhat satisfied - Very satisfied
How often have Nurses thought about leaving their profession to work elsewhere?
Some conclusions about the Nurses and SARS
A socio-ecological framework is useful and appropriate for examining the complexity of factors impacting nurses' health, which in turn impacts public health response capacity during a large scale outbreak
Individual factors (biological, cognitive) interact with behaviour, and social / physical environmental factors to impact nurses' health
Proactive policies & procedures are needed to enhance Canada's collective ability to combat a large scale outbreak, and protect health care workers and their families
Summary Recommendations for Hospital Pandemic Influenza Planning
Stockpiling PPE and fit testing / training for employees
Specific training / professional development - accessible for all staff
Clarify protocols and supports for different quarantine restrictions
Planned psychosocial services to reduce negative emotional impact; acknowledgement of dual-role conflict as sig. source of stress for staff
Visible leadership and support for ethical decision-making
Creative HR mobilization strategies; Monitor staff for burnout / fatigue
Concise documentation of assessed resource needs, (checklist)
Clearly defined strategies for dissemination of vaccine and anti-virals, combined with informational resources regarding priority groupings
Recognition and compensation for all staff involved in the response
Strategies to reduce sensationalism and stigmatization through regular contact and planning with the media,
Creation of calming and confidence-inspiring public messages which accurately portray health care workers and their contribution to community response
Policy Recommendations (Nurses and SARS article)
Support mechanisms are needed at multiple levels to enhance their collective impact on the health of health care workers:
Engineering controls to reduce exposure
Training opportunities / disaster drills to foster knowledge, confidence, social networks, and to reinforce behaviour
Public education and campaigns to recognize the valuable role of health care workers
Sensitive organizational policies to assist staff with challenges related to dual-role conflict
Four Adaptive Capacities of Resilient Communities
Information and communication
Components of Economic Development
Resource volume & diversity
Resource equity & social vulnerability
Components of Social Capital
Networks, social structures, linkages
Community bonds, commitment
Components of Information and Communication
System and infrastructure
Community and narrative
Components of Community Competence
Collective action and decision-making
Collective efficacy and empowerment
Resource volume & diversity
a few key parameters for observing "social resilience were made". The first parameter encompassed economic growth, stability of livelihoods, and equitable distribution of income and assets within populations. Economic resilience depends not only on the capacities of individual businesses but on the capacities of all the entities that depend on them and on which they depend. Past disaster research has show that participants of a low socio-economic status (SES) often experience more adverse psychological consequences than do participants of higher SES. Community resilience depends not only on the volume of economic resources but also on their diversity.
Resource Equity and Social Vulnerability
Societies do not allocate environmental risk equally, often making the poorest communities the weakest links in hazards mitigation. Poor communities not only are at greater risk for death and severe damage, but they often are less successful in mobilizing support after disasters. Ideally, the distribution or mobilization of support follows the "rule of relative needs." Simply put, the most support goes to those who need it the most. Often, however, the distribution of support follows the "rule of relative advantage" because one's embeddedness in the commuunity, political connections and social class determine the availability and accessibility of resources.
the basic idea of social capital is that individuals invest, access and use resources embedded in social networks to gain returns. It can also be defined as the aggregate of the actual or potential resources that are linked to possession of a durable network of relationships.
Network Structures and Linkages
On dimension of community capacity, is the presence of inter-organizational networks that are characterized by reciprocal links, frequent supportive interactions, overlap with other networks, the ability to form new associations and cooperative decisions-making processes. Uncertainty often leads to efforts to broaden the "Scope of actors, agents, and knowledge that can be marshaled." Tis trend necessitates networked versus hierarchical systems for disaster response. There is an importance of "hubs" who link one network to another. The efficiency of hubs may decreases resilience because if the hub is compromised, the entire system fails.
Tight Coupling versys Loose Coupling
"Tight coupling" occurs when change in one component engenders a response from other components. "Loosely coupled" systems may be better at responding to local changes since any change they make does not require the whole system to respond. The happy medium may be loosely coupled organizations (to better respond to local needs) that are able to coordinate or collaborate (to facilitate access to their resources).
Isolates vs Peripherals
There are two types of linkage cracks: "Isolates" are organizations with essential services that do not interact with the rest of the network and "Peripherals" are organizations that are connected to the network only by means of a long and indirect series of links.
social support refers to social interactions that provide individuals with actual assistance and embed them into a web of social relationships perceived to be loving, caring, and readily available in times of need. Research on social support has long distinguished between "received support" (actual receipt of help) and "perceived support" (the belief that help would be available if needed). Social support varies on two dimensions. The first dimension, source, is reflected in the overall pattern of help utilization. The second dimension, type differentiates between emotional, informational and tangible support.
Community Bond, Roots and Commitments
Three key social psychological dimensions of social capital are thus sense of community, place attachment, and citizen participation.
Sense of Community
"Sense of community" is an attitude of bonding (trust and belonging) with other members of one's group or locale, including mutual concerns and shared values. Sense of community is a dimension fo community capacity
"Place attachment" is closely related to one's sense of community. It implies an emotional connection to one's neighbourhood or city, somewhat apart from connections to the specific people who live there. Place attachment often underlies citizens' efforts to revitalize a community and thus may be essential for community resilience. Place attachment may be of special note for disaster recovery, as these events have spatial parameters and harm built and natural environments.
. "Citizen Participation" is the engagement of community members in formal organizations, including religious congregations, school and resident associations, neighbourhood watches, and self-help groups. Three areas of citizen participation: who participates and why, how organizational characteristics influence participation and the effects of participation on community conditions and participant's own feelings of efficacy. Two factors hypothesized fall into this set of capacities: Participation, referring to member involvement and engagemtn and opportunities forsuch that are sensitive to diversity, ability, and interests of members; and Structures, Roles and Responsibilies, referring to leadership, teamwork, clear organizational structures, well-defined roles, and management of relationships with other communities.
Information and Communication
Information may be the primary resource in technical and organizational systems that enables adaptive performance. By communication, we refer to the creation of common meanings and understandings and the provision of opportunities for members to articulate needs, views, and attitudes.
Systems and Infrastructure for Informing the Public
Information increases survival only if it is "correct and correctly transmitted". A trusted source of information is the most important resilience asset that any individual or group can have.
Communication and Nrrrative
Community recovery depends partly on collectively telling the story of the community's experience and response. In fascinating analysis of disaster metaphors and myths, Tierney et al traced the impact of exaggerated and extreme portrayals of looting and lawlessness to critical policy decisions. Three days after the New Orleans levee breach, leadership's decision to re-direct police officers to attend to lawbreakers rather than life-saving activities lessened the survival chances of stranded residents.
the capacity to acquire trusted and accurate information, to reflect on that information critically, and to solve emerging problems is far more important for community resilience than is a detailed security plan that rarely foresees all contingencies.
Collective Action and Decision Making
A competent community is one in which "the various component parts of the community are: (1) are able to collaborate effectively in identifying the problems needs of the community; (2) can achieve a working consensus on goals and priorities; (3) can agree on ways and means to implement the agree upon goals; and (4) can collaborate effectively in the required actions."
Collective efficacy reflects trust in the effectiveness of organized community action. Collective efficacy can also be defined as a composite of mutual trust and shared willingness to work for the common good of a neighbourhood. In the model of community resilience, collective efficacy bridges the domains of Social capital and community competence.
Empowerment progresses through a sequence of formal empowerment (mechanisms for citizen input), intrapersonal empowerment (feelings of personal competence and confidence), instrumental empowerment (ability to participate and influence decision, as determined by knowledge, material resources, and persuasiveness), and substantive empowerment (ability to reach decisions that solve problems). Some political approaches to citizen onvolvement in decisiosn are more empowering than otehrs
Look at resources for mobilization of resilience in terms of
the capacity to achieve goals in a timely manner to contain losses and avoid disruption
is the ability to withstand stress without suffering degradation. A resistance strategy is robust if it keeps out or counteracts a wide variety of dangers, but it is fragile if it works only under a small number of possible scenarios.
is the extent to which elements are substitutaqble in the event of disruption or degradation.
Key components of community resilience
Learning (education, knowledge)
Social capital (trust, social cohesion)
Planning / preparedness
Economic capacity and diversification
Population physical and mental health
What constitues a disaster?
conceived as an adverse event or situation beyond the capacity of the local community to manage.
Must involve at least one of following:
10+ dead, 100+ affected, declaration of a state of emergency, call for international assistance
Four phases of the disaster cycle
RISK = Hazard * (Vulnerability - Resources)
is the likelihood or expectation of loss
is a condition posing the threat of harm
is the extent to which persons or things are likely to be affected - often focused on physical vulnerability with little discussion of social vulnerability
are those assets in place that will diminish the effects of hazards
"a reaction to the environment in which there is
threat of net loss of resources,
actual net loss of resources, or
lack of resource gain following investment of resources"
Resources can be
Objects - house, car, computer, blackberry
Personal - confidence, beliefs, values, genetics, networks
Conditions - community support for an idea, room mate, marriage, permanency in a job
Energies - time, money, knowledge, skills
The kinds of disasters associated with psychological impairment include those with at least two of the following characteristics
a high prevalence of physical injury
threat to or actual loss of life
widespread property damage
serious ongoing financial difficulty
involvement of human carelessness or intent
distress experienced by those witnessing the environmental degradation of their home environment"
Hobfoll Five'Principles for Intervention in Mass Trauma Situations
Promote sense of
Self- and community-efficacy
The well-being of an individual or a community can be assessed on the basis of the opportunities they have or choices they can exercise. Often these opportunities and choices cannot be measured purely on the basis of income, or of the material goods they possess. Capability can often only be increased by some kind of change in the physical or social environment
is seen as an attribute at multiple levels, from the individual to community, and sometimes to higher levels of organization"
Adaptive capacity is often linked to
free choice and the capacity to act independently
an individual's belief in his/her capacity to perform a given task
To manage your own health [care] - you need to
Navigate the system - and its inherent complexity
Have skills and abilities to do different health-related tasks
the ability of the individual to access, understand, and use health-related information and services to make appropriate health decisions'
embrace the complexity rather than try to control it - and build the interventions around it (without blaming the low literacy of the person)
Functional health literacy
refers to knowledge of health risks, services and how to comply with recommendations
Interactive Health Literacy
refers to capacity for independence to act on the knowledge, includes motivation and self-confidence to act on what advice you receive
Critical Health Literacy
looks more broadly at social determinants of health and how they impact a person's capacity to act on knowledge and advice received