How School Libraries Can Promote Health Literacy in Challenging Times

Abstract

Health literacy skills are needed to source, evaluate, and comprehend health information and services in order to make appropriate and informed health decisions. Given that an individual’s health outcomes are positively influenced by their level of health literacy, schools are increasingly committed to fostering health literacy in their students. Young people may face many health literacy challenges exacerbated by the global pandemic and the burgeoning array of questionable health information disseminated through social media. As information and digital literacy experts, school library professionals can draw upon their existing skillset and further extend their skills in order to play a key role in developing students’ health literacy, supporting their capacity to reject health misinformation and be discerning consumers of health information from a wide range of sources.

Keywords:

• Health literacy
• digital health literacy
• school libraries
• health information
• social media

Introduction

Health literacy relates to the knowledge and skills required to source, evaluate, and comprehend health information and services in order to make appropriate and informed health decisions (Dunn & Hazzard, 2019). Health literacy is a key life skill that is associated with longevity and improved health outcomes. Low health literacy is associated with unhealthy behaviors such as smoking, poor diet and low physical activity, posing an increased risk of illness and premature death, and those with low health literacy have a greater need for emergency services, and are more likely to struggle to successfully manage ongoing health conditions which leads to them incurring higher healthcare costs (Public Health England [PHE], 2015). Those with low health literacy may struggle with key health promoting skills such as interpreting health messages and medication labels (Berkman et al., 2011).

Many people lack the health literacy they need to support their health in their everyday lives. For example, 42% of adults in England (PHE, 2015) and 59% of Australians have low health literacy (Australian Institute of Health and Welfare (AIHW), 2018). The situation in the US is even more dire, where at least 88% of adults have insufficient health literacy levels, limiting their ability to effectively navigate the healthcare system and support their wellbeing (Lopez et al., 2022). Many nations have adopted national plans to improve health literacy in response to growing understanding of the value of improving health literacy at a population level (Nutbeam & Lloyd, 2021). Furthermore, given the increasing migration of health information into online written forms, ongoing attention on building health literacy is crucial as those with low health literacy are far less likely to benefit from information in this form (Kim, 2013). As such, both the substantial portion of the population affected by low literacy, and the evolution in forms of health information underscore the value of revisiting ways to effectively enhance population-wide health literacy skills.

Young people’s health literacy is a growing educational concern in recent times. Nations such as Finland and Australia have implemented sustained health literacy learning programmes (Okan et al., 2020), with calls elsewhere to employ an early intervention approach to fostering health literacy that would see health literacy integrated into school curriculums (PHE, 2015). Health literacy is an educational imperative that should be addressed “as early as possible in childhood and adolescence,” and schools are an “ideal setting for enhancing health literacy” given young people’s common and sustained exposure to schooling (Okan et al., 2020, p. 5).

Health literacy is part of some international curricula. For example, in Australia, developing students’ health literacy is a key component of the subject Health and Physical Education, the personal, social and community health content “focuses on developing health literacy skills to apply new information to changing circumstances” (Australian Curriculum and Assessment and Reporting Authority [ACARA], 2022a, p. 6). It can be developed across three phases.

First, students can access and apply information to respond to a health-related question. Then, they can independently apply new information to changing health circumstances. Finally, they can selectively access, analyse, evaluate and synthesise health information from a variety of sources to actively promote their own and others’ health and wellbeing. (ACARA, 2022c, para. 37)

However this curricular positioning is not necessarily common. For instance, while the US has National Health Education Standards, health education varies very widely between the states despite health literacy being positioned as a key concern at the highest levels; since 2000 health-literacy improvement has been in an ongoing position as a “national objectives to improve the health and well-being of all Americans” (Lopez et al., 2022, p. 13). Indeed, the National Action Plan to Improve Health Literacy includes the need to “incorporate accurate, standards-based and developmentally appropriate health and science information and curricula in childcare and education through the university level” (p. 14) as one of seven goals. As such, ideally, a greater emphasis on health literacy across state schooling systems in the US is warranted to align with national priorities.

The COVID-19 pandemic has only amplified interest in health promotional issues. The fragility of many nations’ health systems was laid bare during the onset of the global pandemic, further highlighting the need to reduce the burden of illness in the general population through measures such as boosting levels of health literacy. Research has linked health literacy with “awareness about coronavirus infection and health protective behaviours among students” (Naveed & Shaukat, 2022, p. 53), further supporting the contention that health literacy can literally be a life-saving skill, perhaps most significantly in pandemic conditions. This also highlights the urgent need to ensure the health literacy of the population given that “besides system preparedness, individual preparedness is of equal importance to cope with complex health problems like the COVID-19 pandemic especially infection prevention and care” (p. 54). The parallel infodemic posed a serious threat that health literacy could mitigate.

…the COVID-19 outbreak and response has been accompanied by a massive infodemic: an overabundance of information – some accurate and some not – that makes it hard for people to find trustworthy sources and reliable guidance when they need it. Infodemic refers to a large increase in the volume of information associated with a specific topic and whose growth can occur exponentially in a short period of time due to a specific incident, such as the current pandemic. In this situation, misinformation and rumors appear on the scene, along with manipulation of information with doubtful intent. In the information age, this phenomenon is amplified through social networks, spreading farther and faster like a virus (Pan American Health Organization (PAHO), 2020, p. 1)

As such, there is a need to equip students to deal with the infodemic, and to strengthen health literacy more broadly. When seeking to identify existing information literacy experts within the school who are either already enacting this role (though perhaps informally) or who could adopt this role, the school library professional is an obvious choice as explored further herein.

School library professionals may be key supports for building students’ health literacy as they are leaders in critical thinking and information, digital and media literacies (Ahlfeld, 2020). While it has already been contended that “school libraries can be important resources for identifying and building young peoples’ digital health literacy skills, which can support them to access resources in mental health and wellbeing” (Merga, 2020a, p. 664), there has been very little research attention on how this could be achieved in ways that are underpinned by what is known about best practice in this area. School library professionals may also seek to enhance their knowledge of the specific health literacy challenges facing young people so that they can target their interventions and resourcing accordingly.

However, despite the increasing interest in health literacy, and the clear expectation that it be taught in our schools, there is a paucity of research that focusses specifically on the current or possible role of school libraries and the promotion of students’ health literacy. While developing students’ information and digital literacy is often part of the work role of school library professionals (Merga, 2021a, 2020b), there has been little consideration to how providing support and instruction to develop health literacy might sit within this expectation. Despite this lack of attention, it is acknowledged that “as information literacy professionals, school library professionals can build students’ health literacy” (Merga, 2022a, p. 8), and library professionals are seen as trustworthy, knowledgeable and helpful, positioning them as excellent supports and conduits of health literacy (Whitney et al., 2017). Young people may need information literacy professionals such as school library professionals to help them to negotiate the complex and often contradictory sources of information they may encounter. Given how high the stakes are, and the commonly existing expertise of school library professionals in information and digital literacies that closely relate to health literacy, it is timely to revisit their potential in acting as key health literacy supports within schools.

This article presents a review of the current research in this space, defining key concepts and identifying pertinent pathways and barriers to young people’s health literacy. Drawing on this research, a potential framework for health literacy messaging in school libraries is proposed to support students who may struggle to source accurate and credible health information within and beyond school. This is a worthwhile goal given that improving health literacy is associated with a wide range of benefits; “they can increase health knowledge and build resilience, encourage positive lifestyle change, empower people to effectively manage long-term health conditions and reduce the burden on health and social care services” (PHE, 2015, p. 4).

Young people’s health literacy

Health literacy should be fostered in young people from their early years (Schulenkorf et al., 2021). While young people typically spend less time navigating health systems than their adult counterparts, early and comprehensive training in health literacy is important for many reasons. While many children will have parents who can advocate for them, not all children are so fortunate, so progressing students’ capacity to identify and understand health information texts and use health services is important for all students, particularly those from backgrounds where parental capacity for advocacy for their child might be limited by cultural, linguistic or social factors.

Building students’ health literacy can offer both immediate and future health benefits. Young people are at a formative stage where they are “developing lifelong health behaviors and habits, and adequate health literacy skills may support informed health-seeking lifestyles,” and as future health care system users, enhancing students’ health literacy “may contribute to a generation-level reduction of poor health outcomes known to be associated with low health literacy among adults” (Ghaddar et al., 2012, p. 28). Furthermore, “low literacy/health literacy is associated with risky behaviors including tobacco use, problem behaviors (e.g., aggression, gun carrying), obesity, and lower levels of health-promoting behaviors (Ghaddar et al., 2012, p. 28).”

Gauging young people’s levels of health literacy across nations is hampered by the lack of an international measurement regime, and even within nations such as the US, there is a lack of a national quantification of these levels (Lopez et al., 2022), without which mobilizing advocacy and intervention to institute improvement may be hampered. Unfortunately, the limited data available on young people’s health literacy suggests that in many contexts, it may be relatively low. For example, research with adolescents in Texas found that only 52% of respondents had an acceptable level of health literacy (Ghaddar et al., 2012). In other places such as Australia, where as aforementioned, instruction in health literacy is part of the national curriculum, while young people are typically confident that they have access to sufficient information for health management, around one in five note difficulty in navigating the healthcare system and understanding health information (AIHW, 2021). As such, the extant data suggests there is room for improvement in how health literacy is fostered in schools to enhance young people’s health literacy, and school libraries can play a key role in this enhancement and consolidation of effort.

Health literacy amongst literacies

To improve students’ health literacy, the interactions and interdependence between health literacy and other kinds of literacy need to be understood. Functional, interactive and critical skills are all drawn upon in health literacy (Vassilakaki & Moniarou-Papaconstaninou, 2022). Many of these skills and literacies are already explicitly supported by school library professionals as part of their work roles (e.g. Merga, 2020b, 2021a), which is why the school library is a useful context for health literacy learning. In this vein, Schulenkorf and colleagues (2021) contend that “curriculum and instruction on media literacy, information literacy, and digital literacy are most promising subjects to include health literacy because these concepts share many commonalities with health literacy and often are already part of the school curriculum” (p. 1), and these literacy areas along with traditional literacy are often fostered in the school library context. As such, this section will show some of the ways in which health literacy intersects and overlaps with diverse literacies often within the purview of school libraries.

First, basic reading comprehension literacy skills are needed to support health literacy so that meaning can be discerned from written information online. Unsurprisingly, literacy and health literacy levels are closely related (Lopez et al., 2022). In many cases, health resources are designed for the general public with poor consideration of how low the reading comprehension skills of a large portion of this demographic actually are. For example, recent research found that in some cases, government-produced health promotion materials concerned with promoting public health during the pandemic was pitched at a level of readability too challenging for many adult readers (Ferguson et al., 2021). Students may have wide variation in their reading comprehension levels, and in some nations such as the US, there have been recent declines in students’ reading comprehension (e.g. National Center for Education Statistics, 2022), so when seeking to build health literacy, attention must also be given to enhancing these more traditional literacy skills. Given that school libraries are spaces where students’ literacy and particularly their reading comprehension may be fostered (Merga, 2019a), libraries are already playing an important role in building this health literacy related skill.

Second, students will need digital literacy skills to support their digital health literacy. Specifically, digital literacy refers to

the knowledge and skills students need to: create, manage, communicate and investigate data, information and ideas; solve problems; and work collaboratively at school and in their lives beyond school. Digital literacy involves students: critically identifying and appropriately selecting and using digital devices or systems; learning to make the most of the technologies available to them; adapting to new ways of doing things as technologies evolve; and protecting the safety of themselves and others in digital environments. (ACARA, 2022b, p. 4)

Digital literacy is increasingly implicated in young people’s health literacy. This is due to the fact that health literacy promoters need to consider emerging health information seeking and health information sources employed and accessed by young people, shifting from “traditional approaches have focused heavily on the direct (often print) delivery of health information to students” to approaches that “focus on the development of critical analysis skills necessary for students to obtain and evaluate health information” in contexts where an often overwhelming volume of health information can be accessed rapidly online (Ghaddar et al., 2012, p. 34). However, simply having high confidence in digital literacy and computer skills does not necessarily confer digital health literacy; students with high levels of digital literacy still need to be explicitly taught digital health literacy (Kim, 2013), and students are already receiving support in building their digital literacy in library contexts (Merga, 2020b, 2021a). The intersection between health literacy and digital literacy is digital health literacy, health literacy as applied to the context of information sourced from technologies, such as online platforms, which influence both the medium of the information, and its comprehension (Dunn & Hazzard, 2019). Digital information pervades many aspects of modern life, and users of online platforms need digital health literacy knowledge and skills to safely source, interpret and evaluate the credibility of health information (König et al., 2022) particularly given the prevalence of misinformation around health found online (Islam et al., 2020). Given young people’s frequency of engagement with social media, there has been growing interest in how these platforms can provide health information and influence digital health literacy (Xue & Taylor, 2022).

Third, health literacy skills also have key intersections with a range of other literacies, perhaps most notably information literacy. As I have explored elsewhere (Merga, 2023), information literacy is often developed within the school library, and it is related to students’ “ability to identify, locate, evaluate, organize and effectively create, use and communicate information to address issues or problems at hand” (Information Literacy Meeting of Experts, 2003, p. 1). When the “issues or problems at hand” relate to health, these strategies support health information sourcing, evaluation, and comprehension, meeting the students’ real world health needs. Information literacy also interacts and interrelates with other diverse literacies; “for example, without reading comprehension skills, it is virtually impossible to understand written information, and without critical literacy skills, it is difficult to evaluate the veracity of sources such as internet-sourced information about contentious issues” (Merga, 2023, p. 33). Information literacy can therefore be viewed as “a metaliteracy that supports multiple literacy types” (Mackey & Jacobson, 2011, p. 62), including but not limited to health literacy.

Finally, school libraries often facilitate the development of students’ cybersafety and media literacy skills in relation to information and digital literacy, which is significant given that in order to “detect fake news and misinformation about health literacy, students will need a combination of critical, information, digital and health literacy skills which are supported by traditional literacy skills such as reading comprehension and vocabulary understandings” (Merga, 2023, p. 35). These skills are essential as misinformation in health can have very serious consequences, as explored earlier in relation to the infodemic. Researchers note that “misinformation fueled by rumors, stigma, and conspiracy theories can have potentially severe implications on public health if prioritized over scientific guidelines” (Islam et al., 2020, p. 1627), and students need strong critical skills to discern fact from fiction. Given the overlap between education in traditional, digital, information and related media literacies that are already part of the role of school library professionals (Merga, 2020b, 2021a) and the documented use of the school library as a source of health information (Merga, 2022b), it is a natural progression to give greater recognition to the current role of school library professionals as health literacy educators and resources in schools, and perhaps expand this role if needed.

School libraries as young people’s sources of health information

More research is needed on young people’s sources of health literacy information, but the limited available research suggests that school libraries can be a source (Merga, 2022b). Young people also draw on their parents’ knowledge, as well as online sources, with some students noting a desire for greater health literacy learning in schools (Martinović et al., 2021) which could be facilitated through school libraries. Libraries can also be a key source of health information for the community in general, and they may play a leading role in addressing gaps in digital and health literacy (Hall, 2021). The pandemic has arguably “highlighted the critical role of libraries in supporting public health and community well-being, through health literacy, combatting mis- and disinformation, and bridging the digital divide that was laid bare during the pandemic” (Yatcilla & Young, 2021, p. 971)

While school libraries can be sources of health information, and “school librarians have a unique opportunity to improve the health literacy of children and teachers,” unfortunately, “these libraries are underrepresented in the literature” (Barr-Walker, 2016, p. 200). Most of the existing research in libraries is concerned with academic libraries, so unsurprisingly there is a paucity of research that considers school libraries and health literacy. A recent analysis of 2020 library and information science journal articles published in 2020 found that less than 10% of articles specifically addressed school libraries (Yatcilla & Young, 2021). However, there is a small but growing body of research concerned with school libraries and students’ health literacy or health and wellbeing outcomes (e.g. Adkins et al., 2019; Merga, 2020a, 2021b, 2022b). Furthermore, the limited available research also suggests that school libraries can play an important role in specifically fostering digital health literacy as a site for programs that seek to improve students’ digital health literacy and enhance “health-related self-efficacy” (St. Jean et al., 2017, p. 42).

(Mis)information from social media

It is crucial that schools be responsive to the current health information sources used by young people (Ghaddar et al., 2012). Kim (2013) argued that “the focus of health information education and training should be on health literacy and computer skills that include the utilization of social media” (p. 6). To do this, they need to understand more about the vast influence that social media exercises over many young people, and how it is emerging as a key source of health information. For example, by the end of 2022, it is expected that there will be more than 1.8 billion active users of TikTok, with the majority (63%) being younger people aged between 10 and 29 years (Iqbal, 2022). Social media needs to be engaged with critically, and students need to approach health information found on social media with strong heath literacy knowledge and skills.

Young people source health information from social media, and engagement with social media can shape their understanding of health and wellbeing issues. Research into digital health literacy in college students found that students commonly source and share health information online, with platforms such as TikTok assuming growing importance and influence (Patil et al., 2021).

This growing influence of social media as a health information source is not accidental. For example, the positioning of TikTok as a key source of information is intentional. TikTok is being explicitly marketed as an educational platform featuring “​​Edu-tainment” content which is said to blur the distinction between entertainment and education (We Are Social, 2022). Hashtags play an important role in social media as a means of social tagging and organizing and curating information (Zappavigna, 2018), and there is a related hashtag behind this positioning of TikTok: #LearnOnTikTok, and content featuring this hashtag has garnered over 350 billion views (We Are Social, 2022). Through this kind of marketing approach, there is a calculated push to have TikTok seen as a reputable and valuable source of information, including health information. Whether users explicitly seek health information or if they encounter it through the TikTok algorithm, they may be exposed to health messaging. Indeed, there has been controversy around young people’s exposure to harmful health messages on this platform, particularly in relation to disordered eating (e.g. Herrick et al., 2021).

Recent research has begun to explore how health information encountered on social media is evaluated by consumers. A study of adult participants (> 21 years of age) “investigated the effects of anecdotes and anecdotal statistics in vaccine rumors on perceived persuasiveness and relevance and the intentions to seek information and share,” finding that use of anecdotal statistics could enhance the perceived relevance of content (Xue & Taylor, 2022, p. 10). Of course, this is highly problematic given that such anecdotal statistics need not have any basis in fact, and can be entirely manufactured to suit the desired messaging. This research also found that respondents with greater knowledge about vaccines found rumors about vaccines less relevant than those with less knowledge (Xue & Taylor, 2022), again highlighting the importance of ensuring that young people have strong baseline knowledge in key health literacy areas that is responsive and not bounded by limited and outdated curriculum. As such, the researchers note that “knowledge provides an internal reference for people to make judgments about new information, including rumors spread through social media” (Xue & Taylor, 2022, p. 11).

Regardless of social media platform, perhaps the biggest challenge for proponents of health literacy is teaching young people to engage with content produced by content producers or influencers in a critical manner, as these individuals need to be very persuasive to be successful in securing the online “likes” and comments that will boost their content in algorithms and lead to or support the continuance of lucrative commercial sponsorships. While there are recent studies that explore the impact of social media influencers’ credibility on purchase intention of consumers (e.g. Chekima et al., 2020; Martiningsih & Setyawan, 2022), there is an urgent need for research that explores how young people gauge the credibility of content producers who are promoting health messages in their work. This work can help to inform health literacy educators in libraries to support their young users to build strategies to discern the trustworthiness and expertise of content producers rather than being swayed by their attractiveness or appealing presentations. While research suggests that both attractiveness and expertise positively influence consumer purchase intentions (Martiningsih & Setyawan, 2022), we do not know the extent to which these factors might individually influence young people’s willingness to believe health information encountered through social media, and it is essential that young people be able to critically unpack how content producers may manipulate their content, appearance and qualifications in order to be persuasive.

Building health literacy in school libraries

School library professionals can be leaders of health literacy within their schools, and indeed, may already be playing a key role in some contexts, though training and support may be needed. Where research has looked at school libraries’ ability to contribute to students’ health literacy, school library professionals have identified a lack of knowledge and training as an inhibitor (e.g. Adkins et al., 2019), and an analysis of library and information science programs also found “considerable room for improvement in health literacy training” (Garwood & Poole, 2021, p. 48). This article contributes to addressing this gap by offering a simple overview on how school libraries can meaningfully contribute to students’ health literacy.

Teaching source evaluation and critical consumption

School library professionals already make explicit to students how appeal, trustworthiness, and expertise can be misrepresented and manufactured to encourage students to subscribe to false or exaggerated information in their information literacy support capacity, and this instruction can be applied to health issues. While students need to be taught to critically consider the veracity of all sources, considerable attention should be given to online sources.

Students may need to be explicitly trained to recognize the credibility issues that may distinguish a social media influencer from a professional expert in health. While this may draw on existing frameworks that school library professionals already use in the information literacy lessons they provide for students, such as SMART cyber-safety messaging (Merga, 2022b), specific health sources from a wide range of online platforms and social media contexts can be explicitly deconstructed with students so that they can learn how to easily check the credibility of content and content producers. For example, a media literacy framework from Germany also includes examples of health literacy exercises, all of which offer insights into how source evaluation might be taught in a health literacy context. Exercises posed in relation to “analyzing and reflecting” include “analyzing the spread of fitness and nutrition trends and commercial intentions on social networks (such as Instagram, YouTube, Twitter, TikTok) and understanding the power of and how influencers can form opinions as part of their job” (Schulenkorf et al., 2021, p. 6).

It is also important that students be taught to avoid confirmation bias so that they are willing to change their views on health related issues should future evidence indicate that they are either incorrect or no longer correct based on new findings. School library professionals can model how this has occurred within their own lives to demonstrate a willingness to have a flexible mindset that is responsive to evidence rather than speculation or rumor. Students also need to understand the unique distinguishing features of credible sources, and to distinguish between facts and opinions.

Facilitating age and reading level appropriate resourcing

School libraries can also play a crucial role in health resourcing and communication to ensure that age and reading level appropriate resourcing is used in the school both within and beyond the library. Students, classroom teachers and parents may need guidance on age-appropriate levels of health literacy resourcing and learning experiences that can be supported by school library professionals. Previous research suggests that school library professionals may commonly play a role in matching students with texts that are age and reading level appropriate, and also teach students to independently source texts that meet these criteria (e.g. Merga, 2019a). They also often curate resources for teachers that meet student needs, such as when they “perform background curation of sources for research classes and create research guides” (Merga, 2022b, p. 6). School library professionals can also provide classroom teachers guidance on identifying and using age and reading level appropriate resources, as well as facilitating their access to these resources. Students’ capacity to be advocates to independently meet their own needs can also be developed and progressed using resources such as Tool 1 in the UK National Health Service (NHS) (2020) Health Literacy ‘How To’ Guide, which specifies “levels of literacy and numeracy related to age and understanding in a health setting.” School library professionals may also provide appropriate resources for parents to use with their children (Merga, 2022b).

Monitoring evolving needs

As previously noted, young people’s health literacy needs will not remain static, particularly given the current climate where students and their families may be affected by ongoing impacts of COVID-19 and its co-morbidities. Furthermore, given the large volumes of time many young people spend on social media, school library professionals as information literacy experts may need to “monitor viral information on social media, especially those that involve anecdotal statistics,” as “such viral information should be quickly verified and responded to before it reaches a larger audience” (Xue & Taylor, 2022, p. 11). This may also involve, where possible, sustaining awareness of potentially dangerous online trends promoted on social media that encourage young people to engage in risky behaviors, such as the “blackout challenge” featured on TikTok which allegedly resulted in several children dying (e.g. Paul, 2022). School library professionals playing a health literacy supportive role will this need to monitor evolving needs, paying attention to evolving trends, related news articles, as well as student and parent concerns through active and open lines of communication.

Delivering training on use of specific health literacy resources

School libraries can be sites where students are provided explicit training in the use of credible resources for health literacy information. For example, high school librarians in Texas received training to teach their adolescent students about MedlinePlus on both English and Spanish iterations so that they could transmit this information with their peers, homes and broader community, positioning “high school students as leaders of the innovation” (Warner et al., 2005, p. 251). Such programs can have an enduring impact on both students and their communities, leading students and their families to continue to use MedlinePlus to research health issues even after the students graduated (Olney et al., 2011). Within their national contexts, school library professionals can identify reputable resources that can ideally be freely accessed by students and their families both within and beyond the school so that students have accessible trusted resources to draw upon across their lives, ideally meeting the needs of culturally and linguistically diverse communities.

Engaging students with fiction on health messaging

As part of their strategies to foster student wellbeing, school library professionals may strategically engage students with fiction concerned with health messaging (Merga, 2022b) in order to provide an enjoyable and informative learning experience. Similar strategies have been used in public libraries to teach students about healthy lifestyles, enabling students to learn health information while enjoying stories (Woodson et al., 2011). The researchers noted that “the excitement and enthusiastic participation of the children reinforced our supposition that tedious health information could be presented in a more interesting manner through stories and games” (Woodson et al., 2011, p. 69).

Similar strategies were adopted by school library professionals in Australia. For example, a library manager “also encouraged teachers to think about health and wellbeing resourcing holistically, also encouraging them to address complex wellbeing themes with students through the medium of fiction” (Merga, 2022b, p. 109). Where school library professionals engage students with fiction on health messaging, they may be providing a powerful alternative to perhaps drier, less engaging methods used in the classroom.

Promoting health literacy events and displays

School library professionals commonly create themed events and displays (Merga, 2020b, 2021a), with some already concerned with health literacy and related health messaging. For example, a school library manager described creating a “display at the end of one of these bay ends, just saying ‘feeling stressed out’, especially toward the end of last term because … of COVID, ‘try one of these’” (Merga, 2022b, p. 111). Research has also reported on the use of school and public libraries as venues for health information outreach events, such as where video games have been successfully used to promote fitness, wellbeing and health information in the library (Clifton et al., 2012). The school library professional can draw upon their knowledge of current and emerging needs within the school population to target events and displays to anticipate students’ needs and encourage them to seek additional information and support to deal with health and wellbeing issues influencing themselves or loved ones.

Building and maintaining a current and credible collection of health information sources

Collection building and maintenance are core components of the roles of most library professionals, and the school library professional already provides health information to their students by making health information seeking resources available. These will often include multi-modal resources not limited to print and online resources. Ensuring that the information accessed by students in the physical resourcing forms such as print books remain up to date is particularly crucial in relation to health literacy, as outdated information on how students might manage their health issues can constitute misinformation if the practices being advocated have been found inefficacious post-publication. This may often be the case due to constant emerging research-supported innovations in supporting health which supersede previous ways of treating health conditions and models of care.

While it might seem like a viable solution to reduce the print resourcing collection to avoid having to continually update the collection, this may leave some students without access to their preferred source of health information. Though this article has focused on online resources, it is important to note that perhaps surprisingly, some children indicate that they prefer to access health information in print form (Merga, 2022b). While further research is needed, the extant research suggests that nonfiction books may be “a valued source of health information that students indicate competence and confidence in accessing” (Merga, 2022b, p. 110). It is also worth noting that comprehension of health-related information may be slightly better when the information is delivered in a printed form rather than a digital form (Haddock et al., 2020), and given that school-aged children may have varying literacy skills, this may be an important equity consideration for resourcing.

Enhancing and maintaining professional health literacy knowledge

Like many other areas within the school library professional’s role, enhancing and maintaining professional health literacy knowledge can be an ongoing requirement that may already overlap with the professional learning undertaken in areas such as information literacy, digital literacy and other implicated literacy areas. It can be contended that promoting health literacy in schools “requires professional knowledge about the health-related needs of a heterogenous group of students with different cultural norms and social beliefs,” and that the facilitator’s own level of health literacy “is an enabling factor for the development of adequate students’ health literacy, which is why teachers’ and principals’ health literacy should be equally strengthened in order to improve the quality of school health education” (Schulenkorf et al., 2021, p. 7). This does not mean that the school library professional needs to be a fount of all knowledge in relation to health; rather, they just need to remain abreast of how to source, evaluate, and comprehend health information and be able to demonstrate and facilitate these skills in students.

Conclusion

Given the focus here on critical consumption of information, and the aforementioned expertise that school library professionals offer in this space (Merga, 2020b, 2021a), school libraries are natural spaces for the fostering of diverse and responsive health literacy skills. The suggestion that school library professionals support students’ health literacy is not novel. As noted by Clifton and colleagues (2012),

long before ‘health literacy’ became a named topic of interest or the Web browser was invented, libraries and librarians of various types were engaged in patient education and in providing health information written for consumers or the general public, often in cooperation with other organizations and institutions (p. 86)

However, given the declines in qualified school library staff noted in the US (Kachel & Lance, 2021) and as perceived elsewhere (Merga, 2019b), it cannot be assumed that all students have access to these professionals for instruction in information literacy (Valenza et al., 2022) and other skills which are drawn on as outlined in this article to support health literacy (Merga, 2022b). As such, it is crucial that this role be highlighted and understood before more students lose access to a school library professional.

The school library professional community has lagged in promoting the role that it does and can play in building students’ health literacy, and this can be an additional aspect to draw upon in the advocacy work needed to sustain school libraries into the future. Given the growing exposure of students to health information often of dubious quality online, it is pertinent that this role be both clearly articulated and further researched so that school libraries can play a key role in encouraging students to be safe and efficient gatherers, interpreters and users of health information that can be vital for their health and wellbeing. The eight point framework articulated in this article can be a starting point from which this role can be explicated within and beyond schools and professional associations, though further research is needed in this area.

Finally, previous research has identified that job creep or role creep which involves school library professionals continually absorbing new roles without ceasing existing aspects, leading to a burgeoning and diverse workload (Merga, 2019b). However, as demonstrated in this article, even where school library professionals are not already explicitly involved in promoting health literacy, they are already providing access to health information sources, and providing support and often instruction across a breadth of literacies related to health literacy. While enacting the eight point framework may require some retraining and adjustments to work role, in many cases school library professionals may find that at least to some extent, they have already been enacting all or some of the elements of this framework, with only minor changes and training needed to both promote and enhance the health literacy promoting role of the school library professional. Furthermore, unlike the absorption of additional menial administrative and ICT troubleshooting tasks, enhancing the role of the school library professional in health literacy promotion where adequate training and support has been made available could offer far more significant benefits for students’ health and wellbeing in challenging times.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.