Addressing Health Literacy by School Nurses at Schools Across Germany: Results of a Mixed‐Methods Study

BACKGROUND: Health literacy has become increasingly important in healthcare and education. The aim is to provide an overview of school nurses' activities to increase health literacy in schools, and to analyse their conceptual understanding of health literacy. METHODS: This mixed-methods study consists of an online survey (n = 65), two focus group interviews (n = 16) and non-participatory observations with school nurses in Germany (n = 5), and expert interviews with interest-holders (n = 10). School nurses' health literacy-related activities, conceptual health literacy understanding, and critical health literacy (measured by the Critical Health Competence Test) were assessed. Quantitative data were analysed descriptively, and the qualitative data by content analysis. Quantitative and qualitative findings were integrated and triangulated using a convergent design. RESULTS: School nurses address health literacy among students and their relatives through counselling, teaching support, and acute care. Their services are primarily based on a functional health literacy understanding. Experts view schools as key settings for health literacy, led by school nurses. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: School nurses use real-life oriented, low-threshold activities to address health literacy and empower students. School nurses' critical health literacy and evidence-based practice could be improved. CONCLUSIONS: School nurses represent a valuable resource to address health literacy in German schools, in line with international approaches. These interventions should be expanded. REPORTING METHOD: This study followed the criteria for Good Reporting of A Mixed Methods Study (GRAMMS), the consolidated criteria for reporting qualitative research (COREQ) and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). PATIENT OR PUBLIC CONTRIBUTION: No direct patient or public contribution.