Exploring Attitudinal Challenges and Educational Strategies for The Nigerian Child

Attitude is a predisposition to respond cognitively, emotionally, or behaviorally to a particular object, person, or situation in a particular way. There is need to supplement and enrich the Nigerian child with a training that can reinforce his attitude, and other attitudinal issues that can affect his health. Health literacy as a discrete form of literacy is very important for social, economic and health development of an individual and therefore should be pursued with vigour. As a contribution to the health literacy issues, this paper reviews concepts and definitions of attitude, health literacy education, and raises conceptual measures and strategic challenges needed to develop a set of indicators to quantify health literacy using the experience gained in national literacy surveys around the world. It discusses health literacy education as an empowerment and a key to public health issues for the Nigerian child. The paper also raises conclusion and recommendations by highlighting on the benefits of literacy to every Nigerian child in accessing his health related issues in schools, government and every meaning individualsin the society should do the needful.

key words: attitudinal issues, health literacy, education, Nigerian child

The contemporary attitudinal issues affecting the health literacyeducation of the Nigerian child draws attention to some of themajor problems besetting the human race of which the Nigerian child may encounter in his healthand social life. These may include: physical, mental, and emotional diseases; drug-addiction; alcoholism and sexual harassment/rape. Generally, attitudes are evaluators of objects and ideas one encounters throughout life, and the functional values of attitudes, the processes that change them have been a major focus throughout the history of social psychology (Ziegler, 2016).

Literacy on its part is an individual's ability to read, write, and speak in English and compute or solve problems at levels of proficiency necessary to function on the job and in the society, to achieve one's goals, and to develop one's knowledge and potential (Parker, Baker, Williams, and Nurss, 1995). Literacy can at times describe one's facility with or knowledge about a particular topic (example, 'driving literacy'). In that context, 'health literacy' is a group of skills that constitute the ability to perform basic reading and numerical tasks for functioning in the health care setting and acting on health care information. According to American Medical Association, (1999), low health literacy on the other hand may impair functioning in the health care environment, affect patient‐physician communication dynamics, and invariably lead to substandard medical care. Subsequently, (Schillinger, Piette, Grumbach, 2003) asserted that low health literacy is associated with poor understanding of written or spoken medical advice, adverse health outcomes, and negative effects on the health of the population.

The connection between literacy and health education or well-being will gain increasing importance not only in the face of extreme contemporary issues such as those described above, but also because societies will be increasingly dependent on healthy populations to health care costs in the face of its populations (Ziegler, 2016). Following this line of thinking, it is necessary to develop a set of measurements that indicate the full range of societal benefits to be derived from a health-literate population. This could provide new and productive dimensions to the debate on the effectiveness and evidence base of health promotion and health education. Health education or enlightenment sees health as a resource for everyday life, and it describes health creation as a process of increasing people's control over their health and its determinants, and this is the focus of this paper.

Education in the largest sense is any act or experience that has a formative effect on the mind, character or physical ability of an individual. In its technical sense, education is the process by which society deliberately transmits its accumulated knowledge, skill and value from one generation to the other (UNESCO, 2000). The purpose of addressing attitudinal issues affecting the health literacy of the Nigerian child education is to empower him for a meaningful and productive living. This is to enable the child bear in mind that he is not to be a liability or problem to the society but to become an agent of change and development. While public policies need to set certain preconditions for health, the Nigerian child must also actively participate inpositive health issues as a part of his contribution to civil society, hence the importance of developing health literacy.

Attitudinal Issues of Health Literacy Education around the World

Attitude is a predisposition to respond cognitively, emotionally, or behaviorally to a particular object, person, or situation in a particular way. Attitudes are important because they can guide thought, behaviour, and feelings. The attitudinal issuesaffecting the Nigerian child health education and health literacy include those met with in the child individual life. Lest the list become endless, let us confine ourselves only to the acute/major problems besetting the human race and the Nigerian child in particular. These briefly enlisted may include:physical, mental, emotional diseases, disturbed family relations;drug-addiction; sexual harassment/rape; alcoholism, and other health related problems.

Health researchers and health care professionals, from both the developed and developing worlds, have long been concerned about the link between health and education (Eiser, 1994; Health Canada, 1999; World Bank, 2000). Education and literacy rank as key determinants of health, along with income and income distribution, employment, working conditions and the social environment, although the interrelationships and weighting of these various determinants demand further research.

Reports abound from developing countries that highlight the positive impact of education and literacy on population, health and, in particular, women's health and the health of children (Christomalis, 2009; Bledsoe, Casterline, Jonson-Kuhn, and Haaga. 1999; Sen, 2001; and Nussbaum, 2014). The recent report on the State of the World's Mothers by Save the Children (Save the Children, 2000) has identified the adult female literacy rate (the percentage of women over the age of 15 years who can read and write), as one of the 10 key indicators to assess ‘women’s well-being'. It is estimated that two-thirds of the world's 960 million illiterate adults are women. All countries ranked in the top 10 for ‘women’s well-being' have a female literacy rate of 90% and higher. Latin America has an 80% female literacy rate - the highest among developing nations. In contrast, Africa has the lowest rate with wide disparities. For example, South Africa, Zimbabwe and Nigeria have a literacy rate close to 80%, while in some of the poorest countries, such as Niger and Burkina Faso, only 10% of women can read and write. It indicated thata mother's level of education correlates closely with a child's risk of dying before age 2 years, and that developing countries that have achieved a female literacy rate ranging from 70 to 83% have also achieved an infant mortality rate of 50 (per 100 000) or lower (Save the Children, 2000).

Much of the researches on health and education have focused on population and health education and literacy effects. Recently, however, re-analysis of epidemics such as that of HIV/AIDS has brought new issues and relationships to the fore (Crawley, 2000; UNICEF, 2000). While Zimbabwe, South Africa and Nigeria have some of the highest illiteracy rates in Africa, they are also among the countries most severely challenged by HIV/AIDS, physical, mental, emotional diseases, disturbed family relations; drug-addiction; sexual harassment/rape and alcoholism. It is estimated that in Nigeria, up to 25% of the population is infected, the majority of them women and children (UNAIDS/WHO, 1999). UNICEF's recent Progress of Nations Report 2000 highlights that there is a disproportionately high incidence of HIV/AIDS among sub-Saharan African teachers (UNICEF, 2000). It illustrates that literacy and health literacy are moving targets and must be viewed in context. For example, the high death rate in teachers can partly be explained by the fact that many teachers are women and in most of these cultures, women do not have much power in relation to their family roles and their husbands' sexual demands. It demonstrates drastically the impact of low health literacy on other policy sectors, in this case education.

Hard-won gains in school, health and general literacy in the African countries and in Nigeria in particular are being seriously endangered, with increasing effects on social and economic development of the children. These effects open up an avenue for a common agenda between health and education, focusing on the interrelationship and the interdependence between investing in both literacy and health literacy, in schools and in society overall (Harrison, 2009).While education and literacy are important determinants of health, health literacy as a discrete form of literacy is becoming increasingly important for social and economic development for the Nigerian child. The challenges we face are to: develop reliable measures of the health literacy of societies and population groups; quantify scientifically its impact on health and quality of life outcomes; and propose public health interventions that significantly increase health literacy along its various dimensions.

The next step is to revisit some definitions and measurements of general literacy, and discuss to what extent they can be applied to the specific challenges of health literacy.

A common understanding of literacy constitutes reading and writing skills, while a broader approach can also include numeracy and other skills associated with basic education and health. Often international conventions will focus upon eradicating illiteracy with ignorance and in the process implicitly promote literacy with knowledge. Delving deeper into the meaning of literacy, it can be seen beyond the skills of reading and writing. For example, Hamburg Declarations (1997) observed that literacy can include access to scientific and technical knowledge, to legal information, to means of enjoying the benefits of culture, good health, and to the use of media. Underpinning all of these definitions is the interpretation of literacy as a foundational and universal life skill, with the potentials to meet the individuals’ vital needs and stimulate their participation in community health life.

These set of benefits associated with literacy provides the rationale for recognizing literacy as a right. UNESCO (2003) identifies a multitude of interrelated benefits of literacy, which can be looked from the Nigerian child perspectives, and this includes the health benefits. The ‘health benefits’ of literacy are those that are intrinsically valuable, as well as instrumental in realizing other benefits. Literacy can empower the Nigerian child to have more control over their lives and to take individual or collective action in the family and public health, household, the workplace or in the community (UNESCO, 2003).

Literacy is also inextricably linked to education, and enables independent and lifelong learning. Furthermore, parents who are educated, whether through schooling or adult literacy programmes, are more likely to send their children to school and are more able to help their children during health challenges (UNESCO, 2003). Literacy can enablethe Nigerian child to manage their health by being able to: read consent forms, medicine labels and inserts, and other written health care information; understand written and oral information given by physicians, nurses, pharmacists and insurers; and act upon necessary procedures and directions such as medication and appointment schedules.

Health Literacy Education for the Nigerian Child

In order to create alliances between the general literacy and the health literacy effort, it will be necessary to have a more systematic dialogue between the two fields of study and practice. The debate on health literacy has emerged from two different sources: (i) The community development approaches around a Freire model of adult learning (Freire, 1985; Freire and Macedo 1987), particularly as linked to empowerment. (ii) An approach that arose out of a concern over the poor health literacy levels of large numbers of patients in the many countries health care system (Parker, Baker, Williams, and Nurss, 1995; Pfizer 1998; Parker, 2000). The report stresses that most health professionals are not aware of their patients' low health literacy levels or that most patients are too embarrassed to indicate to their health care providers that they have not really understood their instructions. While the report touches on wider issues, such as the links between literacy and various health indicators, including health-promoting behaviours, it does remain focused on medical and health care settings.

Despite this orientation, Healthy People (2010) does not include the forward-looking notion of ‘potential’ into the health literacy definition. However, the broadest definition of health literacy as proposed in the WHO health promotion glossary does include this concept (Nutbeam, 2015). Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. This assertion was recently discussed at a Health Literacy Workshop at the 5th WHO Global Conference on Health Promotion (PAHO/Yale/ Pfizer workshop on Health Literacy, Mexico, 2000). The workshop resolved to widen the glossary definition to include the dimensions of community development and health-related skills beyond health promotion, and to understand health literacy not only as a personal characteristic, but also as a key determinant of population health and this is where the Nigerian child keys in.