The health literacy of Hong Kong Chinese parents with a healthy preschool child in seasonal influenza prevention and their health promotion strategies at the household level

University of Technology Sydney. Faculty of Health.[Background] Seasonal influenza is a public health concern in Hong Kong. The virus is easily transmitted from person-to-person through droplet and direct contact. Yearly influenza epidemics can seriously affect all age groups particularly those with immature or compromised immune systems such as young children and old people with chronic illness. A Hong Kong preparedness plan and response activities for community prevention of influenza epidemics have been developed. However, compliance rates remain low. Many health behaviours are learned during childhood through parental modeling, guidance, supervision, reminders and repeated practice. Therefore, improving the health literacy of parents through supportive activities is critical. [Methods] Mixed methods research employing a multiple-case study approach was used to gain a multifaceted understanding of parents’ health literacy, culture influences and parental-child teaching regarding seasonal influenza prevention and related health promotion strategies. Twenty Hong Kong Chinese parents with a healthy three-to-five year old child from three kindergartens were recruited. A qualitative thematic analysis was employed and quantitative survey data were examined descriptively. These data were integrated and comprehensive comparisons were made across cases to identify commonalities and differences. [Results] Hong Kong Chinese parents demonstrated different levels of functional, interactive and critical health literacy to prevent seasonal influenza. Parents used various social connections including family and community members, social media, the internet and television to access and exchange health information. Cultural values and norms influenced parents’ functional health literacy in seasonal influenza prevention. In this study, parents applied five major cultural health prevention practices to prevent and manage influenza. These are: sharing beds with family members or a domestic helper when the child is ill; boiling white vinegar to kill air-born germs to ensure a healthy environment; diet therapy to enhance health; self-prescribed Chinese medication to manage child’s cold symptoms; and the co-use of Western and traditional Chinese medication to avoid influenza infection. This study also identified five approaches Hong Kong Chinese parents used to teach their children healthy practices including ways to prevent influenza. These approaches included: processes parents used to teach personal hygiene; parent-child interactions during teaching; approaches to managing children’s health behaviours; enhancing children’s healthy practices; and parents’ perspective of the role of the nurse in health promotion. The findings indicate that there is scope to better support parents to apply interactive approaches to help their children establish healthy behaviours. [Conclusion] This study has provided a comprehensive understanding of parental health literacy and the teaching approaches used by selected Hong Kong parents to protect their children against seasonal influenza that may be transferrable to other Hong Kong settings. The findings highlight the need for community nurses to play a central role in increasing parents’ health literacy. Pluralistic health systems need to review seasonal influenza preparedness plans to better engage families to support and comply with health advice before the onset of an epidemic. Positive parent-child interaction and teaching should be integrated into health promotion programmes to enhance children’s understanding and compliance with healthy practices