Introduction
Health literacy and social inequalities
Health representations
Cancer representations
Methods
Sample
Data collection
Analysis
Statistical analysis
Results
Description
School | Total no. school pupils | Rural/urban | European Deprivation Index | Deprived/non-deprived | REP +* | Classes taking part in the survey | No. of pupils taking part in the survey | |
---|---|---|---|---|---|---|---|---|
1 | 218 | Urban | 3.77 | Deprived | Yes | Fourth grade | 24 | |
2 | 228 | Urban | 0.88 | Deprived | No | Fifth grade | 22 | |
3 | 176 | Rural | − 1.92 | Non-deprived | No | Fifth grade | 24 | |
4 | 233 | Rural | − 1.33 | Non-deprived | No | Fifth grade | 60 | |
5 | 844 | Urban | − 0.304 | Non-deprived | No | Sixth grade | 26 | |
6 | 226 | Rural | 1.66 | deprived | Yes | Sixth grade | 35 |
Child characteristics | N = 191 | Frequency (%) |
---|---|---|
School class | Fourth grade | 24 (12.6) |
Fifth grade | 106 (55.5) | |
Sixth grade | 61 (31.9) | |
Gender | Girls | 90 (47.1) |
Boys | 101 (52.9) | |
Mean age (SD) | 10.4 (0.8) | |
Geographic area | Rural | 84 (44) |
Urban | 107 (56) | |
Deprivation Level | Non-deprived | 110 (57.6) |
Deprived | 81 (42.4) |
Children’s creations (Table 3)
Good health
Major theme | Sub-themes | Number of children quoting the item N (%) out of 191 (100%) | |
---|---|---|---|
Good health | |||
Excercises and sports |
155 (81.2%)
| ||
Diet-healthy food |
136 (71.2%)
| ||
Fruit and vegetables
Water
Low sugar Dairy products Low salt Low fat Balanced Diet | 90 (47.1%) 32 (16.8%) 22 (11.5%) 16 (8.4%) 8 (4.2%) 6 (3.1%) 49 (25.7%) | ||
Basic needs |
98 (51.3%)
| ||
Drink
Sleep
Poop and pee
Have a home- nice home Eat Breathe Keeping warm-Clothes | 59 (30.9%) 47 (24.6%) 32 (16.8%) 17 (8.9%) 8 (4.2%) 7 (3.7%) 5 (2.6%) | ||
Hygiene |
44 (23%)
| ||
Tobacco (not smoking) |
30 (15.7%)
| ||
Healthcare/vaccines |
26 (13.6%)
| ||
Psycho-socio-affective | Good mood |
21 (11%)
| |
Pleasure |
16 (8.4%)
| ||
Fun foods |
15(7.9%)
| ||
Entertainment (TV, movies) |
(5.8%)
| ||
Not being sick |
8 (4.2%)
| ||
Other |
11 (5.8%)
| ||
Mean (SD) number of themes identified per child; median |
3.9 (2); 4
| ||
Bad health | |||
Diet |
94 (49.2%)
| ||
Too much sugar
Fatty food
Too salty
Fruit and vegetables Palm oil
Overweight–“being fat”
Eating snacks
| 75 (39.3%) 30 (15.7%) 26 (13.6%) 7 (3.7%) 7 (3.7%) 29 (15.2%) 4 (2.1%) | ||
Smoking | 134 (70.2%) | ||
Alcohol | 114 (59.7%) | ||
Sedentariness-lack of exercise | 59 (30.9%) | ||
Basic needs |
60 (31.5%)
| ||
Protection from cold–winter
Not eating
Not sleeping
Not drinking enough | 33 (17.3%) 15 (7.9%) 15 (7.9%) 5 (2.6%) | ||
Disease |
37 (19.4%)
| ||
Hygiene |
33 (17.3%)
| ||
Not washing yourself | 29 (15.2%) | ||
Taking drugs |
33 (17.3%)
| ||
Environment/pollution |
24 (12.6%)
| ||
Medicines |
22 (11.5%)
| ||
Taking risks–sex without condoms |
20 (10.5)
| ||
Seeking healthcare |
16 (8.4%)
| ||
Emotional factors |
9 (4.7%)
| ||
Death |
4 (2.1%)
| ||
Mean (SD) number of items identified per child; median |
3.95 (2) 4
| ||
Cancer | |||
Descriptions |
143 (74.9%)
| ||
By cancer sites |
117 (61.3%)
| ||
Lung Breast Heart Liver Hair Skin Everywhere Willy (penis) Brain Stomach Throat Blood other | 73 (38.2%) 66 (34.6%) 38 (19.9%) 24 (12.6%) 14 (7.3%) 13 (6.8%) 12 (6.3%) 9 (4.7%) 8 (4.2%) 8 (4.2%) 6 (3.1%) 5 (2.6%) 23 (12%) | ||
By definition | A disease A serious disease | 55 (28.8%) 32 (16.8%) | |
By epidemiology | Age related disease Geographical location |
9 (4.7%)
1 (0.5%)
| |
By symptoms | (loss hair, heart failure, breathing problems) |
9 (4.7%)
| |
By biological process | Tumor/cells |
6 (3.1%)
| |
By level of knowledge | Do not know |
3 (1.6%)
| |
Risk factors |
89 (46.6%)
| ||
By behavioral causes |
86 (45%)
| ||
Tobacco Alcohol Food Drugs Others | 73 (38.2%) 23 (12%) 12 (6.3%) 9 (4.7%) 5 (2.6%) | ||
By other causes |
11 (5.8%)
| ||
Sun Fate Others | 4 (2.1%) 2 (1%) 5 (2.6%) | ||
Outcomes |
73 (38.2%)
| ||
Always deadly Sometimes deadly | 28 (14.7%) 45 (23.6%) | ||
Consequences |
70 (36.6%)
| ||
Hair lost Sadness After-effects Pain Others | 51 (26.7%) 20 (10.5%) 3 (1.6%) 3 (1.6%) 9 (4.8) | ||
Cure/treatment |
54 (28.3%)
| ||
Hospital Curable disease Medics Surgery Doctor | 30 (15.7%) 21 (11%) 17 (8.9%) 9 (4.7%) 3 (1.6%) | ||
Prevention |
39 (20.4%)
| ||
Of smoking Of drinking alcohol Of other risks General guidelines | 28 (14.7%) 11 (5.8%) 8 (4.2%) 8 (4.2%) | ||
Personal history | Experience of friends or relatives having cancer |
4 (2.1%)
| |
Research |
4 (2.1%)
| ||
Mean (SD) number of themes given per child; median | 4.31 (2.2); 4 |
Bad health
Cancer
Comparison between deprived and non-deprived populations
Variables tested | Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|---|
Themes identified, mean (SD) | p value | Point estimate | p value | ||
Deprivation status | |||||
Deprived | 3.6 (1.68) | ref. | |||
Non-deprived | 4.83 (2.24) | < 0.001 | 0.37 | < 0.001 | |
Gender | |||||
Girls | 4.78 (2.13) | ref. | |||
Boys | 3.9 (2.12) | 0.004 | − 0.15 | 0.04 | |
School class | |||||
6 | 5.07 (2.4) | ref | < 0.001 | ||
5 | 4.13 (2.1) | − 0.24 | 0.08 | ||
4 | 3.2 (1.1) | 0.003 | − 0.32 | < 0.001 | |
Geographical area | – | – | |||
Rural | 4.53 (2.0) | ||||
Urban | 4.14 (2.3) | 0.09 |
Themes identified | Whole population N (%) | Non-deprived population N (%) | Deprived population N (%) | Crude PR [IC95%] | p value |
---|---|---|---|---|---|
Cancer site: lung | 73 (38.2) | 52 (47.3) | 21 (25.9) | 0.55 [0.37–0.81] | 0.004 |
Cancer site: heart | 38 (19.8) | 31 (28.2) | 7 (8.6) | 0.31 [0.15–0.61] | 0.0008 |
Cancer site: liver | 24 (12.5) | 24 (12.5) | 0 (0) | < 0.0001 | |
A disease | 55 (28.7) | 43 (39.1) | 12 (14.8) | 0.38 [0.23–0.64] | 0.0003 |
A serious disease | 32 (16.7) | 27 (24.5) | 5 (6.2) | 0.25 [0.11–0.56] | 0.0007 |
Behavioral causes: alcohol | 23 (12) | 19 (17.3) | 4 (4.9) | 0.29 [0.11–0.74] | 0.01 |
Outcomes: always deadly | 28 (14.6) | 6 (5.5) | 22 (27.2) | 4.98 [2.35–10.55] | < 0.0001 |
Outcomes: sometimes deadly | 45 (23.5) | 41 (37.3) | 4 (4.9) | 0.13 [0.06–0.28] | < 0.0001 |
Visible side-effects | 63 (32.9) | 28 (25.5) | 35 (43.2) | 1.7 [1.14–2.54] | 0.01 |
Visible side-effects: hair loss | 51 (26.7) | 19 (17.3) | 32 (39.5) | 2.29 [1.43–3.67] | 0.0008 |
Invisible side-effects | 69 (36.1) | 31 (28.2) | 38 (46.7) | 1.66 [1.14–2.42] | 0.0095 |
Cure/treatment: a curable disease | 21 (10.9) | 20 (18.2) | 1 (1.2) | 0.07 [0.02–0.28] | < 0.0001 |