text:
"Magic, With Salt" by Andrea Greenwood – May 25, 2008
Magic. With Salt
The First Parish of Watertown
The Rev. Andrea Greenwood
Opening Words Lot's Wife, Anna Akhmatova 1922
Lot, holy Lot, trailed God's messenger,
an angel so vast and bright, it devoured the black hill,
but uneasiness shadowed his wife, whispered strong, filled her:
'It's not too late, there is time to look back, still
at the red towers of Sodom, the land where you were born,
at the square where you sang, the yard where you sat to spin,
the second story windows looking out from your cosy home,
the family bed, blessed when your children's life entered in.
Her eyes were still turning when they were forever stitched shut
by a bolt of pain that seized her
and sent her legs like roots into the stony ground,
Her body flaked into tranparent salt.
Who mourns one woman in a holocaust?
Surely her death has no real significance
Yet in my heart she will never be lost
She who gave up her life to steal one glance
Story Orpheus and Eurydice
Be warned: this story is beautiful but tragic. It begins with Orpheus, the best musician that ever lived. One strum of his lyre, one note sung, and beasts would crawl to him, rocks would shift their moss to move to be closer, trees would tear their roots to be closer to him. He had more power than we regular people do, because he was the son of the Muse Calliope. But Orpheus was a mortal.
He lived his life simply and without a care until the day he met Eurydice. She was a Dryad; one of the nymphs that lived in the oak trees and helped to make the forest enchanted. They fell in love and it meant everything to them. They were so happy, simply caring for each other. But there were other men who also wanted Eurydice , and did not care how she felt. She ran from one in terror, without watching her step, and that is when a terrible thing happened. She stepped on a poisonous snake! The venom from its bite killed her at once and her spirit went to the Underworld. Orpheus was inconsolable. He cried and cried. His grief was bitter, but he did not let sadness slow him down. He decided to take action.
He descended from this world to the Underworld through a cave, and climbed down and down until he arrived to cross the River Styx. He passed through crowds of ghosts and presented himself before the throne of Hades and Persephone and he sang them a song about his sorrow. He promised that he was not spying on any secrets from the Underworld, and he knew that the three-headed dog with snaky hair that guards the entrance to the Underworld was stronger than him. He just begged the gods to let him have his wife back., saying that she had died sooner than she should have because of the snake.
"Eros has led me here," Orpheus said, "Love is a god all powerful on the earth, and, from the stories I have heard, that is true here as well. I beg you who live in this silent place, unite again the thread of Eurydice's life. It is our destiny to end here, sooner or later. One day Eurydice ill rightly be yours. But till then grant her to me, please! I beseech you. If you deny me, I cannot return alone; you shall triumph in the death of us both."
Persphone's heart melted and a tear rolled down her cheek. Even Hades could not help weeping. They let Orpheus through to Eurydice, and she came from among the newly-arrived ghosts, limping with her wounded foot. Orpheus was permitted to take her away but he was warned very carefully: Eurydice would follow him into the light of the world and once she entered the sunlight she would be changed from a shade back to a woman. But if Orpheus doubted, if he looked back to see her, she would be lost to him forever. Under this condition they proceeded with Orpheus leading, and Eurydice following. They climbed through dark, steep passages in total silence, till they had nearly reached the outlet into the cheerful upper world, when Orpheus began to rejoice that his wife would be with him soon. He listened, thinking Eurydice would now begin to carry the sound of feet falling, and in a moment of forgetfulness, to assure himself that she was still following, cast a glance behind him, when instantly she became a shadow that was whisked away. Stretching out their arms to embrace each other, they grasped only the air! Dying now a second time, she said a last "farewell," – and was hurried away, so fast that the sound hardly reached his ears.
Orpheus was torn apart — by grief, by wild animals crying at his mournful singing, by Zeus, angry that Orpheus had seen the mysteries of the underworld; by his own prophecy that he could not live without Eurydice, by what had happened. Orpheus was torn apart, and cast to the winds, and if you listen, you can hear him sing in them still.
Reading: Looking Back at Lot's Wife Rebecca Goldstein
It was one of the stories from Genesis that most frightened me as a child: the story of Lot's wife. She was told not to look, and she looked; and her punishment came swift and horrible. Frozen in the moment of her transgression. exposed to the eyes of all in her act of rebellion, she was transformed into a spectacle of salt, reduced to an element vaguely ridiculous, as if to turn back any notion of pity in us. And for what? She was told not to look, and she looked.
Why did she look? I asked the second grade Hebrew school teacher, who was telling the story.
It doesn't mater why she looked, my teacher answered. God told her not to and she did. She thought she could get away with it, but of course she couldn't. Nobody can get away with anything. God sees all.
That God sees all was a lesson my teacher was anxious to impress upon us at any opportunity, and it was a lesson that I as a child accepted without question. It was clear that God's seeing all was a consequence of God's being God. My teacher's response therefore seemed irreproachable so far as its theology went. It was on the level of human psychology that I felt it falling short.
Specifically, I didn't believe that Lot's wife had thought she could get away with it. I wouldn't have thought so, and I was a mere child, living in pallid, nonBiblical days. In vivid contrast was the picture of Lot's wife: fleeing the accursed city, the shrieks of the damned in her ears, and in her nostrils the sickening stink as heaven's fire and brimstone came raining down behind her. God had warned her that he would come, and he had come: in the version embellished by rabbinical tradition told to us by my teacher, his very Presence had descended, along with a host of 12,000 angels of destruction. It wasn't the moment to think one could get away with very much of anything.
I wasn't about to press the issue any farther with my teacher, but I was fairly certain that whatever it was that had made Lot's wife look back in her flight was in the nature of an overwhelming compulsion ( a concept with which children tend to be well acquainted): the sort of irresistable urge that makes the whole question of whether or not one is going to get away with it pretty much beside the point.
What therefore seemed to me very much to the point was the question I put to my teacher: what forced Lot's wife to look back, and — even more to the point — would I have felt driven to do exactly the same?
You begin to see why the story frightened me. Up to now in Genesis the villains had been recognizably villainous — a brother who killed a brother, egomaniacs who brazenly questioned God's authority and erected claims to their own imagined supremacy.
But looking where one is told not to look?
Had Lot's wife, I wondered, looked back simply because she had been told not to, as I unfailingly sneaked a peek while standing between my mother and sisters in our pew in the synagogue during the recitation of the priestly blessing that was said on the holidays? I had been warned by mother to avert my eyes from the bimah, where the priests were chanting their spooky melody, lest I be blinded by the Presence descending upon their upraised hands. Beneath my lowered lids I could see my two sisters dutifully turned away, facing the back of the synagogue, as all the congregation was turned away…. Did Lot's wife and I share the same perversity of nature that compelled us to take stupid risks for no very good reason at all? And was it for this that her punishment had come swift and horrible?
Or was it rather for the whisper of a doubt, soft but irrepressisble, that is perhaps always spoken in such actions as looking where one is told not to look? Were there moments in history during which God simply would not tolerate the existence of a skeptic?
The symbolic significance of the gesture of looking back was not lost on me. A child's knowledge of nostalgia is one of the mysteries of childhood. Perhaps it wasn't so much that there were moments of forbidden doubt as that there were places that merited no sense of attachment. Was it the regret and longing she had directed back to her home in Sodom that had drawn God's wrath down on her?
Sermon: Magic, With Salt
Perhaps it is because I trained as a historian, but one of the first reactions I have to these transformative stories about the dangers of looking behind — Orpheus and Eurydice; Lot and his wife — is puzzlement. What is wrong with examining what is past? Why are the architects of these tales; the ancient Greeks or the Hebrew writers so determined to teach us to blindly obey; to look ahead the way horses do, with the patches on the sides of their heads ensuring that nothing in the periphery; nothing which is not directly in front of us commands our attention? It is true that there are times when the past can be dangerous. Dwelling on what has been can swallow us whole; ruin us for the lives that are ahead. But these stories do not dwell at all; there is one simple glance, and instant destruction.
And it is odd, too, that the way the stories play out we almost forget the context each is set in, which is complete devastation. EVERYONE is dead; yet these women are singled out as dying; with some human culpability. What does it mean to be described as dying when the setting is the underworld, or a city which has been set on fire by God, where the norm is to be dead? Even though the city burns all around, the death of Lot's wife's death stands out, because she could have lived. All she had to do was keep focused on the future. Same with Orpheus. His wife could have lived if he had just had enough faith to look ahead instead of checking behind. So, are these stories about a lost future — Eurydice dying now a second time — or about a longed for past?
Somehow, it makes me think of baseball games, when the coaches start yelling at the kids to just run; get to the base; don't look to see where the ball went. Perhaps there is something in us that cannot quite get oriented without knowing where everything is; how that ball is going to come back at us. Sure, we could be safe if we just ran blindly ahead. We would have a better chance of winning. But some of us need to see things ourselves; feel compelled to look even when we would be better off not doing so. Maybe it has to do with differing ideas of what it means to be "better off." What good does it do to get safely home if it isn't your old familiar comfortable home; the place of love that orients you and lets you look out upon the world?
So I have been puzzling over this story of Lot's wife. It is used as a punishment; as a deterrent for those who would question authority, and of course it goes on from using one woman as an example to condemning gay men and blaming this holocaust on them — but I just can't seem to read it that way. This story is part of a much larger one in the book of Genesis, in which Abraham brings his nephew Lot in search of a good land for their people, but sometimes in our Western, rational way, we see a roadmap, or principles to live by instead of a story arising from tugging on a dense, emotional knot in which family engagement and the good life are tied to each other in extricable ways. We tell a story and one part of the knot is untied, pulling us to confusing new places, where we are still connected, but are dislocated.
John Updike once said that a good story ends with an open door, and one of the gifts of Unitarian Universalism is that we can walk through that opening. Meaning is not circumscribed by tradition or doctrine for us. After the attacks on New York and Washington on September 11, 2001, some parts of this story about Lot's wife resurfaced — the images of sinful cities bringing God's wrath; the division of people into those who deserve to move into the future and those who do not; but also the fear that looking back might petrify us; the destructive nature of spectatorship. Lot's wife seems to inspire both admiration, and a justification of punishment. Her glance backwards becomes the reason for her transformation. Looking at our losses might weaken us; looking at ourselves through a new lense might kill us. Being safe comes to mean being strong which comes to mean not changing or being changed.
But what if this is not a story of punishment? This unnamed woman who cares enough about where she has been and the lives she is responsible for is turned into salt, and that seems significant somehow — salt is essential; and in a way, maybe this story is not about a woman who disobeyed a command, but is the story of what it means to be a parent who loses her children; who loses everything. Her daughters were left behind in this city that had been their home, and like Orpheus leaving Hades, she needed to look and see if they were following. They weren't. She saw what became of them, and is transformed into a pillar — not burned up into rubble like everyone and everything else, like all that she loved; but a pillar — and that pillar is salt; a precious commodity that lets us float on the water; that gives food taste; that restores us. Perhaps it is not Lot's wife who is being punished at all. Maybe this is a meditation on what attachment costs: that we can love our children so much that one glance at the grief of losing them pulls us backward; demands that we experience what they experience; to be one with them in every aspect of their suffering. As Rebecca Goldstein said in the reading, it is a compulsion. It is not about thinking you can get away with anything. And, in all seriousness, does it make any sense to view this story as showing only that God wants us to be righteous and follow his command to move forward; to never look back? Which parent would you rather have; the one who stopped and searched for you, or the one who has fled? Which God would you rather have: the one that wants to control our actions, or the one that tells stories to inspire a deeper compassion? Did God perform this magical transformation into salt because this woman's desire to see her children was not forgivable, or because it was, in some sense, a beautiful need; one that summed up the purpose of life?
All too often, what we see is a product of what we believe, and not the other way around. We narrow our vision to fit what we know. The story of Lot is about a relative of Abraham who obeys God because that is how the chosen people survive. It is difficult to think beyond what we expect; to shift the frame of reference, and it is especially hard to do this because we think we are seeing clearly. I started thinking about this because I had a son who was obsessed with magic. He was possessed by a desire to perform magic tricks, yet was incapable of doing so because he believed in magic. How ironic: to be able to be a magician, you have to understand that it is all illusion; trickery; manipulation. You can't believe in the wonder you are creating; but you produce spectacles that give hope to others, implying the possibility of real magic in the world. What my son wanted was to be a conduit for mystery and wonder; someone who could joyously show others the supernatural. But a magician has to understand that there is no supernatural in order to give the illusion that there is.
It is both fascinating and somewhat common-sensical to me that magic, like Unitarianism, is a product of the Reformation. This is because the Reformation inserted the use of reason into religion; began turning to nature for explanations of mysteries that had previously been ascribed to witches. Understanding how things happen creates a world which is relatively predictable, and that means we can use nature's effects ourselves. Inevitably the idea of magic tricks as entertainment followed. Magicians know that we interpret what we see through what we have experienced, and so they can trick us in very simple ways; which are yet moving; which do connect us to some sense of mystery.
So is magic about skepticism? I often think of stories told about those of us raised in Unitarian Universalist church schools. where we looked for naturalist answers to Biblical stories of miracles. I don't think people were intentionally training us to be skeptics, but when stories of mystery, danger, excitment and thrill such as the Israelites escaping from the Egyptians across the Red Sea got explained by sand bars, you can see why people might have thought we missed the point. Last year Adam Gopnik had a long article in the New Yorker, and in it he writes about magic as an intellectual experiment in empathy that spurs growth. It is not about tricks; about putting one over on anyone else. And even though the magician has a different position than the spectators, it is a relational activity. There is no effect without an audience, and the audience cannot be passive. Even when we have an idea of how a trick works, we don't have a full explanation of why it works — we are moved by this odd, invisible presence of the magician, who lets us experience some of the more profound aspects of life simply because he or she knows how our minds work. We are outreasoned, and it sets us thinking. We know that nothing truly supernatural happened, but we cannot figure out quite what did occur. It stimulates us to try to think in new ways, and we can begin to see how limited our thinking has been. What a magician shows us is how routinized we are; how we have let ourselves become dead to new possibilities; how stuck in experience we are.
Whether the story about Lot's wife being transformed into a pillar of salt is proof of a God who has magical powers, or is proof that religion is somewhat quaint and vaguely ridiculous depends upon what you already believe to be true about God and religion. As a story instead of a proof text, it is far richer — and not as easy to dismiss. We are in a predicament: this is a trick of transformation which we cannot fully process. Did God really do this? Or are we responsible? Does it tell us that it is destructive to witness things, or does it affirm that losing our children kills us? Does it mean we should obey commandments that tear at our soul, or that it is worth the price to follow out hearts? And there is the salt, which stays with us, in our tears; in our blood, in everything we feel and in any life we pass on. The memory of this loss is in us. Maybe Lot tells us that survival is possible, but perhaps not what we would choose. It is an open door inviting us in to a world where all is not known.
In anything relational, the end of the story is not the point. How can it be? In magic, the finish to a trick is not the point of a trick; in life, we don't really want to know how it ends. The beauty is in the unfolding; in the possibilities; the growth. This makes it sound like growth inevitably follows from new experience, but it doesn't. Anything new creates stress, and mostly we respond to that by shutting down, by narrowing our focus, by not looking back, and not looking too far ahead. This lets us survive. But research in psychology shows us that what creates greatness in people is a different response. If we can let things be complicated; if we can manage to take a wider view and expand our awareness, there is the possibility of being lifted; of feeling ourselves rising to the demands of a world we have yet to truly see; of changing in ways that force us to lose all that was familiar, but let us be present in new ways.
This spring, there have been quite a few articles about the meaning of the photographs which came out of Abu Ghraib; partially inspired by a documentary about them, and partially because the military cases against the soldiers who took the photos have concluded. What those photos mean now seems markedly different from what they conveyed when they were first printed. Although the pictures remain the same — grinning American soldiers with their thumbs up in front of captive, victimized prisoners or even corpses — we now know a lot more about the people, and what they thought they were doing. It makes the whole idea of looking back at things complicated. We think that witnessing something will make us compassionate. But it doesn't; not necessarily. Sabrina Harman, who is the smiling private in many of these pictures, wrote about having trouble getting the images of the tortured prisoners out of her head. She described one man handcuffed backwards and naked to a window, with underwear puled over his head, and said "He looked like Jesus Christ." We hear that description — and I think Harman genuinely felt this, too — as a way of conveying our horror at torture; as a way of protesting. But it is a description that works against our own intentions; a description that puts these images into a story we already know, with a meaning that is determined. It is not the story the pictures really tell. It is like Lot's wife. She is a refugee, fleeing her burning city; her children lost in the rubble. Her home is gone and she is destroyed, but we are not compassionate. We are judgemental.
The prisoners who were tortured are Muslim. That is actually the reason they are being tortured, and tortured in ways to specifically offend their religious sensibilities. How can we call them Christ-like without compounding the injuries we have already inflicted? Somehow, by comparing these prisoners to Jesus on the cross, we put a story with a completely different context on these people, and in fact obliterate who they really are. We end up using the images to give meaning to the torturers rather than those who suffer, and we do it to help ourselves cope with what we are seeing. Comparing someone to Christ sounds like an empathic response, but it isn't. It is a way of forcing something new into a familiar story; a story which exonerates us and makes it easier for us to move forward; easier to find a home in this land.
Later on in the essay I read from this morning, Rebecca Goldstein goes on to explore more of what she thought might be happening with Lot's wife. … "a meaner sort of motive behind her action suggested itself," she writes. "one that would remove her to a safer distance from myself: a cold enchantment with the drama of death. The summer we had spent at the seashore I had seen for myself how the crowd had gathered around the boy who had been pulled unconscious from the ocean. and how the voice and face of this crowd had quickened with a strange excitement, as if it were almost glad for the event. Did Lot's wife have such a strong taste for the theater provided by others' tragedy that she could not keep herself from stealing a glimpse of the flaming spectacle? And was it for this that she had been turned, most appropriately, into the stuff of tragic spectacle?"
Voyeurism or skepticism, nostalgia or bravado: what moved her to look, and risk all? This question could be asked of those military staff in the photos, and probably of every single one of us who has suffered some assault on humanity so grave that we cannot quite think straight afterwards. We struggle to know which direction to look; to not resort to a script; to let this new pain in and change us. We do not want to transform suffering into something anything other than what it is, but it is hard to assimilate changes as devastating as the ones which incinerate our pasts; our ideals and the way we understand human nature. We need an imagination that is wider than our experiences; indeed, imagination can let us hold together things we experience as tearing us apart.
Alan Shapiro, a poet in North Carolina, wrote an essay called "My Tears See More than My Eyes", a title he borrowed from his teen-aged son, who is the subject of the essay. The younger Shapiro is in a psychiatric hospital after a suicide attempt, and this essay begins as a narrative; telling the story of visiting, of families scurrying in to the corners of the room attempting to find some way towards privacy in an environment which communicates a distrust of anyone being alone. The visitors grapple for a physical assimilation of the extremely intimate knowledge of reality that has been forced upon them: someone they love has gone where it is forbidden to go; they have seen the secrets of the underworld and cannot return to the living; not quite. Where do we go, in this room kept watch by those who demand obedience; whose eyes only meet to communicate rational demands, not shared pain? Shapiro looks back. The narrative ends and becomes a searching memory, asking how did we get here; how can we get back to the days before we knew this place of suffering; and if I figure out what road led us here, can we get our old life back? It is Orpheus, having the snake's venom removed from Eurydice's foot so that she can limp past the gates of hell, with death just a bad dream. But the backward look ends when Shapiro's son keeps asking "So, Dad, can I come home now? Please, Dad; can you take me home?" This is not something they are allowed to decide. Control belongs to something outside the family. They live in a new place.
Shapiro is a poet, and so for him this moment is where imagination has to step in; where he needs to stop looking backward and begin to envision a new future. He can't simply keep going; nor can he just look back; but he needs to do both; to begin spanning the distance between both realities: we will go on, and part of us has died. My son is not just my son anymore. Grief has taken us through a gate where all the other shadows live, and though I may manage to pull him back through to this side, we will not ever see things the same way. His tears have seen more than our eyes can. Home can never mean what it once did; it doesn't mean being completely safe. Loss transforms us in ways we could never have imagined. All of life will be flaovored with it, and yet we are not weak. We are pillars, even if those who move blindly forward cannot see the truth.
Long, long ago I either heard or imagined someone to say that prayer was a connection between memory and hope, and ever since I have seen prayer as a place. It is the door we live in, pulling the past and the future into a frame for us. On one side of us are memories — a lattice work of time, woven together and full of imperfections. On the other side there are these vague but solid hopes for the future; foggy shadows of people we do not want to lose; suffering we do not wish to endure planted alongside an obelisk of sure strength; an unwillingness to let ourselves be defeated. Above us, bridging the two sides, are our prayers; the sacred canopy under which we live; the sun bleached and tattered streamers of our hopes and dreams, testimony to what we have witnessed; what we have loved; what holds us up, what we will pass on. Our whole lives are prayers. But they are not prayers for anything; they just are living prayers; and the beauty is in the unfolding, and our ability to take an ever wider view. There is no aim; we are just witnesses to all the unfolding.
Closing Words: Memorial Day for the War Dead by Yehuda Amichai
Memorial day for the war dead. Add now
the grief of all your losses to their grief,
even of a woman that has left you. Mix
sorrow with sorrow, like time-saving history,
which stacks holiday and sacrifice and mourning
on one day for easy, convenient memory.
Oh, sweet world soaked, like bread,
in sweet milk for the terrible toothless God.
"Behind all this some great happiness is hiding."
No use to weep inside and to scream outside.
Behind all this perhaps some great happiness is hiding.
Memorial day. Bitter salt is dressed up
as a little girl with flowers.
The streets are cordoned off with ropes,
for the marching together of the living and the dead.
Children with a grief not their own march slowly,
like stepping over broken glass.
A flag loses contact with reality and flies off.
A shopwindow is decorated with
dresses of beautiful women, in blue and white.
And everything in three languages:
Hebrew, Arabic, and Death.
A great and royal animal is dying
all through the night under the jasmine
tree with a constant stare at the world.
A man whose son died in the war walks in the street
like a woman with a dead embryo in her womb.


text:
All Healio
Cardiac/Vascular Intervention
Public Health Topics
All Public Health
HLRP: Health Literacy Research and Practice
Original Research Open Access
The Health Literacy Questionnaire: Initial Validity Testing in a Norwegian Sample
Kristin Hjorthaug Urstad, RN, MD, PhD; Randi Andenaes, RN, MD, PhD; Astrid K. Wahl, RN, MD, PhD; Lisbeth G. Kvarme, RN, MD, PhD; Sølvi Helseth, RN, MD, PhD; Torbjørn Moum, PhD
HLRP: Health Literacy Research and Practice. 2020;4(4):e190-e199
https://doi.org/10.3928/24748307-20200903-01
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The Health Literacy Questionnaire (HLQ) is a multidimensional generic questionnaire developed to capture a wide range of health literacy needs. There is a need for validation evidence for the Norwegian version of the HLQ (N-HLQ).
The present study tested an initial version of the Norwegian HLQ by exploring its utility and construct validity among a group of nursing students.
A pre-test survey was performed in participants (N = 18) who were asked to consider every item in the N-HLQ (44 items across nine scales). The N-HLQ was then administered to 368 respondents. Scale consistency was identified and extracted in a series of factor analyses (principal component analysis [PCA] with oblimin rotation) demanding a nine-dimension solution performed on randomly drawn 50% of the samples obtained by bootstrapping. Correlations between the nine factors obtained in the 13-factor PCA and the scale scores computed by the scale scoring syntaxes provided by the authors of the original HLQ were estimated.
The pre-test survey did not result in the need to rephrase items. The internal consistency of the nine HLQ scales was high, ranging from 0.81 to 0.72. The best fit for reproduction of the scales from the original HLQ was found for these dimensions: "1. feeling understood and supported by health care providers," "2. having sufficient information to manage my health," and "3. actively managing my health." For the dimensions "7. navigating in the healthcare system" and "8. ability to find good health information," a rather high degree of overlap was found, as indicated by relatively low differences between mean highest correlations and mean next-highest correlations.
Despite some possible overlap between dimensions 7 and 8, the N-HLQ appeared relatively robust. Thus, this study's results contribute to the evidence validation base for the N-HLQ in Norwegian populations. [HLRP: Health Literacy Research and Practice. 2020;4(4):e190–e199.]
Plain Language Summary:
This study tested the Norwegian version of the Health Literacy Questionnaire. The questionnaire (44 items across nine scales) was completed by 368 nursing students. Despite some overlap between scale 7 ("navigating in the health care system") and scale 8 ("ability to find good health information"), the questionnaire appears to serve as a good measurement for health literacy in the Norwegian population.
People are increasingly given responsibility for own their health and, consequently, health literacy (HL) has become a topic of growing interest. Research has demonstrated associations between low functional HL (i.e., health-related reading and numeracy ability) and poor health-related outcomes, such as increased hospital admissions and readmissions (Baker et al., 2002; Chen et al., 2013; Choet et al., 2008; Scott et al., 2002), less participation in preventive activities (Adams et al., 2013; Thomson & Hoffman-Goetz, 2012; von Wagner et al., 2007), poorer self-management of chronic conditions (Aung et al., 2012; Gazmararian et al., 2003; Williams et al., 1998), poorer disease outcomes (Peterson et al., 2011; Schillinger et al., 2002; Yamashita & Kart, 2011), lower functional status (Wolf et al., 2005), and increased mortality (Bostock & Steptoe, 2012; Peterson et al., 2009; Sudore et al., 2006). More recently, using more dynamic and multidimensional measures of HL, associations have also been found with screening behavior, diabetes control, and patients' perceptions of quality of life (Jovanić et al., 2018; O'Hara et al., 2018; Olesen et al., 2017).
HL is defined in numerous ways. However, the current common understanding is that HL is a multidimensional concept comprising a range of cognitive, affective, social, and personal skills and attributes. According to Nutbeam (2008), HL contains three levels, progressing from basic skills in reading and writing (functional HL) to the ability to derive meaning from different forms of communication and apply new information to changing situations (interactive HL) and finally the ability to achieve policy and organizational changes (critical HL).
Although research suggests unambiguous associations between HL and health outcomes, a major shortcoming of such findings is that data have frequently been derived from suboptimal instruments (Jordan et al., 2011). Jordan et al. (2011) have highlighted limitations regarding the general conceptualisation of HL, coupled with weak psychometric properties of the instruments used, and they claimed that HL has not been consistently measured, thus making it difficult to interpret and compare HL at the individual and population levels.
Until recently, most instruments measuring HL have been unidimensional, focusing on health-related numeracy and reading skills (Berkman et al., 2010). For example, instruments frequently used to measure HL include the Rapid Estimate of Adult Literacy in Medicine focusing on word recognition (Davis et al., 1993) and the Test of Functional Health Literacy (Parker et al., 1995) testing health-related reading and numeracy skills. Similarly, the Newest Vital Sign is a commonly used instrument focused on testing a respondent's understanding of a food label (Weiss et al., 2005). Therefore, a need for more comprehensive assessment tools has recently been recognized (Altin et al., 2014), and in the past 5 to 6 years multidimensional assessment tools have been developed, such as the European Health Literacy Survey Questionnaire (HLS-EU-Q) (Sørensen et al., 2013) and the Health Literacy Questionnaire (HLQ) (Osborne et al., 2013), yielding a more multifaceted picture of HL. Although the HLS-EU-Q was developed and tested among the Norwegian population (Finbråten et al., 2017; Sorensen et al., 2013), there is a need for additional multidimensional HL instruments in the Norwegian setting, such as the HLQ. The HLS-EU-Q was specifically designed to compare populations using three dimensions; however, the advantages of the nine-dimension HLQ questionnaire is that it can provide a nuanced evaluation of education programs and derive HL profiles that might, in turn, facilitate intervention development and service improvement (Batterham et al., 2014). The HLQ has been translated into more than 15 languages. It has undergone validity testing in Germany, Denmark, France, and Slovakia and has been shown to have strong psychometric properties in the translated versions as well as the original (Debessue et al., 2018; Elsworth et al., 2016; Kolarčik et al, 2015; Maindal et al., 2016; Nolte et al., 2017). In the last couple of years, the HLQ has also been used in Norwegian settings (Larsen et al., 2018; Stømer et al., 2019). Therefore, it is important to explore the utility and construct validity of the Norwegian version of the HLQ.
There is a growing acceptance of the view that the validation of self-reported instruments should be seen as an accumulation and evaluation of sources of validity evidence (American Psychological Association & National Council on Measurement in Education, 2014; Kane, 2013; Zumbo & Chan, 2014). Rather than relying on a strict factor analysis of psychometrical properties alone, according to Hawkins et al., (2018), the validation of HLQ should be based on a network of different empirical evidence that supports the intended interpretation and use of HLQ scores. As such, using a student sample for the initial validation of the questionnaire would contribute to the basis of validation evidence, especially in the context of a younger population. Hence, the current study aims to implement and test an initial version of the Norwegian HLQ, exploring its utility in the field as well as testing its construct validity within a group of nursing students.
The Health Literacy Questionnaire
The HLQ is based on the World Health Organization's (WHO) definition of HL, described as the "cognitive and social skills which determine the motivation and ability of people to access, understand and use information in ways which promote and maintain good health" (Nutbeam, 1998, p. 13). The three levels of health literacy described in Nutbeam's (2008) theoretical model (i.e., functional HL, interactive HL, and critical HL) are incorporated within and across the domains of HLQ, thereby providing the possibilities to capture respondents' capability at each of these levels (Osborne et al., 2013). This link between Nutbeam's schema of HL and the HLQ was revealed through a validity-driven item-writing process based on citizens' lived experiences (Osborne et al, 2013), as illustrated in Table 1.
Linkage Between the Nutbeam's Schema of Health Literacy and the Health Literacy Questionnaire
The development process of the HLQ consisted of two concept mapping workshops involving 27 workshop participants, comprising a patient group (N = 12) and a health care professional and researcher group (N = 15). Due to the concept mapping process developed by Trochim et al., (1994), a structured brainstorming process was initiated. The workshop participants were introduced to seeding statements based on the WHO's definition of HL, such as "thinking broadly about your experiences in trying to look after your health, what abilities does a person need to have to get, understand, and use health information to make informed decisions about their health?" The process confirmed that health literacy encompasses a broad range of concepts (Buchbinder et al., 2013; Jordan et al., 2011).
The next step of the development process included interviews with community members and patients and extensive validity testing in a construction sample (N = 634) and a confirmation sample (N = 405) in Australia (Osborne et al., 2013). The HLQ consists of 44 items in nine domains of health literacy. The first 5 scales, constituting part 1 of the HLQ, are scored on a 4-point, Likert-type response scale (strongly disagree, disagree, agree, strongly agree). The last four scales, constituting part 2, are scored on a 5-point response scale, where respondents rate the item levels by the difficulty in undertaking a task (cannot do, usually difficult, sometimes difficult, usually easy, always easy). The HLQ scales are listed in Table 2. The 44 items are published in the original HLQ validation paper (Osborne et al., 2013).
Sample Background Characteristics (N = 368)
Translation process. The translation and cultural adaptation of the HLQ into Norwegian followed a standardized protocol provided by the authors of the HLQ (Hawkins et al., 2020). Forward translation was guided by comprehensive item intent descriptions, and items were then reviewed for cultural appropriateness and measurement (linguistic) equivalence. Blind-back translation was also undertaken. The meaning of every nuance in the final translation was verified with one of the authors of the orignal HLQ (Osborne et al., 2013) through two consensus conferences in addition to written reports.
We performed a web survey pre-test to capture how the wording of the translated items were understood and experienced by Norwegian responders. Participants were included by a convenient sampling method, and the 18 participants (10 women, 8 men) were all citizens who lived in the western part of Norway, ranging in age from 30 to 80 years. The participants were given access to the web-based HLQ after giving their consent to participate. After finishing the questionnaire, participants were asked to consider every item in terms of (1) difficult to answer, (2) unclear, (3) use of difficult words, or (4) upsetting. Participants were also asked to provide comments or suggest alternative words or terms in a free-text response alternative at the end of the survey.
Setting. The sample method used for testing the structure validity of HLQ was a convenience sample collected at two different universities in Norway in 2016: one in the capital of Norway, with the largest number of nursing students in the country, and the other in western Norway, the third most densely populated urban area in Norway. The population invited was nursing students in the first semester of the bachelor's degree program. The number of first-semester nursing students in 2016 was 302 and 570 for the two universities, respectively, and the grade point average requirement for admission to the two nurse education programs was 4.6 and 4.7 (grading range: 2 to 6).
Permission to conduct the study was obtained from both universities. Information about the study, including the purpose, scope, content, confidentiality, voluntary nature of participation, and the ability to withdraw from the study at any time, was provided to students in both oral and written formats.
A web-based questionnaire was made available on the students' official learning platform. Students who agreed to participate answered the questionnaire on campus after a lecture. The link to the questionnaire was available for about 40 to 60 minutes, and the link was closed after the last student finished the questionnaire. It was only possible for the participants to answer the questionnaire on campus. Therefore, no personal internet protocol addresses were collected or stored for the web-based survey. No information about personal or health issues was collected; thus, according to Norwegian law, the study did not require formal ethical approval from the Norwegian National Ethics Committee.
Respondents. At the capital university, the recruitment of participants was performed after lectures provided for three different student groups. Of 181 nursing students attending the group lectures, 147 agreed to participate. At the university in western Norway, the data collection was performed after a lecture provided for the total group of first-semester nursing students. Here, a total of 250 were invited, and 221 agreed to participate. Thus, the total population of first-semester nursing students at the two universities was 872 and, of the 432 invited to participate, 368 agreed (85% response rate).
Respondents' ages ranged from 18 to 64 years, and the mean age was 24 years. Most of the sample were women (86%) and who were living with someone (76%). Furthermore, 83% of the sample spoke Norwegian when growing up, and 18% reported having a long-term health problem or disease. Participants' background characteristics are summarized in Table 2.
The HLQ scales were calculated by adding the item scores and dividing the number of items in each respective scale; the first 5 scales ranged between 1 and 4 while the remainder ranged between 1 and 5 (Osborne et al., 2013) using SPSS Statistics version 22. The internal consistency of each of the predefined HLQ scales was assessed using Cronbach's alpha. We initially performed exploratory factor analyses and confirmatory analyses. Screen plots from exploratory factor analyses gave no clear indications as to the number of dimensions to be extracted, and a confirmatory analysis of the nine dimensions yielded an unsatisfactory fit (Figure 1).
Scree plot for the 44-item Health Literacy Questionnaire.
To explore if a subset of the nine dimensions proposed by Osborne et al. (2013) could be consistently identified and extracted, a series of 13 factor analyses (principal component analysis [PCA] with oblimin rotation) demanding a nine-dimension solution was performed on randomly drawn 50% of the samples, obtained by bootstrapping. The purpose of choosing bootstrapping was that it would give us an understanding of how stable our results from the PCA were when repeating the analysis on randomly drawn samples. In this study, the analysis was thus repeated 13 times. Bootstrapping is considered a valuable resampling methodology as it can provide a large number of permutations of the sample, thereby enabling us to analyze samples and provide summary statistics (Costello & Osborne, 2005). The advantages of bootstrapping are that it does not require normal distribution—even with limited sample size, and it allows researchers to move beyond traditional parameter estimates to any statistic estimates, such as structure and pattern coefficients (Lu et al., 2014; Zientek & Thompson, 2007).
To compare results from the 13 rounds of factor analyses performed on these randomly drawn subsamples, factor scores were retained as separate variables ("factor scores") for each round. Correlations between the nine factor scores obtained in the 13 nine-factor PCA and the a priori scales provided by Osborne et al. (2013) could then be estimated, thereby enabling us to assess which of the nine scales proposed by Osborne et al. (2013) could actually be retrieved with some consistency in our own sample.
In the web-survey pre-test, participants commented that the following items in the questionnaire appeared to be unclear from their perspective: item 7: "When I see new information about health, I check up on whether it is true or not" (reported as unclear by n = 3), item 8 "I have at least one health care provider I can discuss my health problems with" (reported unclear by n = 4), item 11 "If I need help, I have plenty of people I can rely on" (reported as unclear by n = 1), and item 22 "I can rely on at least one healthcare provider" (reported as unclear by n = 1). Participants suggested no concrete alternatives for these items. No participants reported that any of the items were "difficult to answer," had "difficult words," or were "upsetting.". Suggested alternative wordings brought up during in-depth discussions were found to put the Norwegian version at risk of deviating in meaning from the original English version. Therefore, discussions did not result in rephrasing of any of the items.
Scalability/Internal Consistency
Overall, the internal consistency of the nine HLQ scales was high, ranging from 0.81 to 0.72 (Table 3). The highest internal consistencies were found for "1. Feeling understood and supported by health care providers" (0.81) and "6. Ability to actively engage with healthcare providers" (0.81). The lowest were for the scales "9. Understanding health information well enough to know what to do" (0.72) and "5. Ability to find good health information" (0.72). Thus, homogeneity within scales measured by internal consistency was satisfactory for all subscales.
Internal Consistency of the Nine Health Literacy Questionnaire Scales (Cronbach's Alpha), Mean Scores, and Correlations (x 1,000) Between the Nine Factor Scores and the Predefined Scale Scores (N = 368)
Dimensional Structure
For each of the 13 separate nine-dimensional factor analyses (PCA) performed among randomly selected subsamples, the factors most closely reflecting the original nine scales were identified, allowing us to correlate factor scores with the scale scores derived from the a priori scales. High correlation indicated that the PCA had achieved a close correspondence with the original scales, thereby confirming the a priori nine-dimensional structure. Consistently high correlations between the a priori scale scores and the factor scores indicate a good fit, and the large difference between the highest and the next-highest correlation obtained in each of the 13 trials provides further evidence of the distinctiveness of the factors obtained. The highest average correlation and the difference between mean highest correlation and mean next-highest correlation of the nine factor scores and the HLQ index syntax score ranged from 0.950 to 0.686 and 0.157 to 0.622, respectively (Table 2).The best fit or reproduction of the scales from the original HLQ were found for "1. Feeling understood and supported by health care providers", "2. Having sufficient information to manage my health," "3. Actively managing my health," and "5. Appraisal of health information." The scales "7. Navigating in the health care system" and "8. Ability to find good health information" showed a rather high degree of overlap, as indicated by relatively low differences between mean highest correlations and mean next-highest correlations.
The purpose of this study was to acquire initial insights into the construct validity of the HLQ. Our validity testing indicated that the questionnaire seemed relatively robust as the items showed acceptability by respondents and the scales shows overall good internal consistency. The nine factors extracted were relatively distinct, thereby making it possible, in principle, to compare scale scores across populations.
According to our results, scales "7. Navigating the health care system" and "8. Ability to find good health information" in part 2 of the N-HLQ were the hardest to recapture. This finding is supported by previous HLQ validation reports. An overlap of scales 7 to 9 was reported in the Danish HLQ validation study (Maindal et al., 2016), and strong associations among scales 7 to 9 were noted in the German HLQ validation study (Nolte et al., 2017) as well as the original English version (Osborne et al., 2013). In the present study, scale "9. Understanding health information well enough to know what to do" was found to be the next weakest factor after scales 7 and 8. The inter-factor correlations between these scales might be characterized as medium-sized, with correlation between 7 and 8, 7 and 9, and 8 and 9, being 0.59, 0.56, and 0.70, respectively. Stronger associations between these factors were found in the German validation study (characterized as large inter-factor correlations; Nolte et al., 2017). The authors of the Danish validation study (Maindal et al., 2016) argued that the reason for the overlap among scales 7 to 9 might be a high-order factor or causal linkages determining the stronger associations among them. Scales 8 and 9 focus on the ability to locate (scale 8) and appraise (scale 9) health information, whereas scale 7 (health system navigation) may be seen as being a closely linked outcome of these abilities (Maindal et al., 2016). Our data support these previous findings.
Study Limitations
A limitation of the current study might be that it is based on a relatively young and homogeneous group of participants with limited experience with the health services. Furthermore, the participants were bachelor degree-seeking nursing students, and the health perspective of their studies might somehow affect their perceptions of health care and their responses. However, including students for validation of self-reported instruments is regarded as an acceptable strategy in social behavioral and health sciences (van Ballegooijen et al., 2016). To reduce the influence of the participants' educational background in the current study, we included only first-semester students as they were at the beginning of their education process. We also support the view of Hawkins et al. (2018), who claimed that the validation of HLQ should be based on a range of validation evidence; thus, the current study contributes to the basis of validation evidence, especially in the context of a younger population. However, as HLQ is designed to be implemented across populations, further work with a wider range of respondents, including community health, hospital, and home care settings, is needed.
Compared to test-based tools such as Rapid Estimate of Adult Literacy (Davis et al., 1993) and the Test of Functional Health Literacy (Parker et al., 1995), which have more objective outcomes, there might a risk that measures from self-reported instruments such as HLQ are biased (Chang et al., 2019). Biased self-reported estimates can occur for various reasons, including gender differences. (Ruiz-Cantero et al., 2007; Weber at al., 2019). However, in the development phase of the HLQ, items biased for gender were eliminated (Osborne et al., 2013). Furthermore, several previous HLQ studies have looked at whether gender is a bias and concluded that it was not a threat to the results (Aaby et al., 2017; Friis et al., 2016).
Due to differences across cultures, the translations and adaptions of questionnaires regarding health and health care may be challenging (Acquadro et al., 2008; Epstein et al., 2015). Literature reviews have not yet revealed any gold standard procedure for such processes. However, the inclusion of an expert panel and back-translations seem to be essential elements (Epstein et al., 2015). The translation and adaption process in our study followed the process recommended by the authors of the original questionnaire, who included both of these steps (Hawkins et al., 2018). The value of including an expert panel with a clinical health background should be highlighted. In line with the German validation study, the translation processes included a discussion of some of the health terms in the questionnaire, such as health care providers (Nolte et al., 2017). Although the authors of the German validation study adjusted this to "doctors and therapists," the consensus was to choose a term that was close to the original for the Norwegian HLQ. The pilot testing in this study did not indicate that respondents had any difficulties comprehending the chosen term.
Despite the indication that the pre-test included some uncertainty about four of the items, in-depth discussions did not result in any revisions. Finding the balance between a linguistic and conceptual equivalence to the original questionnaire is not a straightforward process (Chang et al., 1999). The translation team followed a structured translation procedure that included several extensive discussions of the items during which both cultural and linguistic aspects were considered. Thus, we trusted that the final version would be appropriate.
At this stage, there is scant evidence of the predictive validity of the HLQ. However, it is important to generate evidence of the HLQ's performance in cross-sectional studies and various populations at step one. As many studies have shown (Debussche et al., 2018; Kolarčik et al., 2015; Maindal et al., 2016; Nolte et al., 2017), the HLQ has acceptable strong properties in diverse settings, and future research should demonstrate whether the questionnaire predicts important outcomes such as improved access to services, better use of medicines, increased uptake of preventive health behaviors, and other behaviors related to health.
This study aimed to acquire initial insights into the construct validity of the Norwegian adaptation of the HLQ. Despite some possible overlap between two of the scales in part 2 of the questionnaire, the N-HLQ appears relatively robust and might serve as a good foundation for valid measurement in Norwegian populations. However, these findings cannot be generalized to all populations. Future research should include a wider range of respondents, including those in community health, hospital, and home care settings.
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Nutbeam's schema
Broad matching Health Literacy Questionnaire domainsa
Basic/functional health literacy: sufficient basic skills in reading and writing to be able function effectively in everyday situations 2. Having sufficient information to manage my health 8. Ability to find good-quality health information 9. Understanding health information well enough to know what to do
Communicative/interactive health literacy: more advanced cognitive and literacy skills that, together with social skills, can be used to actively participate in everyday activities, to extract information and derive meaning from different forms of communication, and to apply new information to changing circumstances 1. Feeling understood and supported by health care providers 3. Actively managing my health 4. Social support for health 6. Ability to actively engage with health care providers 7. Navigating the health system 8. Ability to find good quality-health information
Critical literacy: more advanced cognitive skills, that together with social skills, can be applied to critically analyze information and to use this information to exert greater control over life events and situations 3. Actively managing my health 4. Social support for health 5. Appraisal of health information
Range 18–64
Mean 24
SD 7.1
Gender (female) 307 (86)
Speaking Norwegian when growing up 282 (83)
Living with someone 254 (76)
Studying at a university in western Norway 221 (61)
Studying at a Capital university 147 (39)
Long-term health problem or disease 60 (18)
Health Literacy Questionnaire
Cronbach's alpha
Mean (SD)
Highest correlation Mean (SD)
Near highest correlation Mean (SD)
Difference between the two means
Health Literacy Questionnaire scales part 1 (possible scores 1–4)
Feeling understood and supported by health care providers (4 items) .81 2.96 (0.64) .936 (11.4) .413 (58.6) .523
Having sufficient information to manage my health (4 items) .76 2.96 (0.47) .904 (64.2) .346 (74.5) .558
Actively managing my health (4 items) .81 2.86 (0.51) .950 (30.5) .328 (81) .622
Social support for health (4 items) .78 3.13 (0.51) .889 (42.3) .477 (28.2) .412
Appraisal of health information (5 items) .80 2.78 (0.49) .906 (26.4) .368 (64.6) .538
Ability to actively engage with health care providers (5 items) .81 3.56 (0.59) .899 (40.4) .451 (82.1) .448
Navigating in the health care system (6 items) .75 3.50 (0.56) 772 (51.4) .546 (90.8) .226
Ability to find good health information (5 items) .72 3.69 (0.50) .686 (60.3) .529 (58.8) .157
Understanding health information well enough to know what to do (5 items) .72 3.71 (0.50) .860 (71.4) .470 (55) .390
Kristin Hjorthaug Urstad, RN, MD, PhD, is an Associate Professor, Faculty of Health Sciences, University of Stavanger. Randi Andenaes, RN, MD, PhD, is a Professor, Oslo Metropolitan University. Astrid K. Wahl, RN, MD, PhD, is a Professor, Department of Health Sciences, University of Oslo. Lisbeth G. Kvarme, RN, MD, PhD, is a Professor, Oslo Metropolitan University. Sølvi Helseth, RN, MD, PhD, is a Professor, Oslo Metropolitan University. Torbjørn Moum, PhD, is a Professor, Department of Behavioural Sciences in Medicine, Medical Faculty, University of Oslo.
Address correspondence to Kristin Hjorthaug Urstad, RN, MD, PhD, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, 4021 Stavanger, Norway; email: Kristin.h.urstad@uis.no.
Disclosure: The authors have no relevant financial relationships to disclose.
©2020 Urstad, Andenaes, Wahl, et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0). This license allows users to copy and distribute, to remix, transform, and build upon the article, for any purpose, even commercially, provided the author is attributed and is not represented as endorsing the use made of the work.
Accepted: August 28, 2019
10.3928/24748307-20200903-01
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text:
Bullying in South African Schools: How Bad Is It?
Bullying in a South African scenario
Estimates put the number of South African students who are bullied at some time during their school careers at an astonishing 1.2 million. This means that over half of the school-going children in this country have experienced repeated verbal, physical or psychological abuse at the hands of a peer. Although well-documented, the effects of bullying on these youngsters, which can last long into their futures, is worth repeating: depression, low self-esteem, health problems, poor grades and even suicidal thoughts.
Although much is known about bullying in the international literature, little research has been done on the topic in developing countries, particularly those, like South Africa, where high levels of violence and crime are a daily occurrence. To what degree, one asks, does the aggression children in this country experience within their homes and communities every day contribute to hostile behaviour on the playing field?
Providing a snapshot of bullying in South African urban primary schools, Qiniso Makhathini, a BSocSci Honours graduate from SACAP, conducted research in 2015 amongst a group of 12 year-old pupils randomly selected from schools in the Cape Town metropole. The study aimed to determine the prevalence of bullying across both gender and socio-economic status. Descriptive statistics were used to describe the prevalence of bullying, while trusted tests gauged bullying across gender and geographical locations.
While Makhathini recommends that, for conclusive results, a longitudinal research method be used to track bullying behaviours over a longer period of time (and researchers consider other more insidious forms of bullying, such as cyber bullying), his research nevertheless provides valuable insights into the levels of child-on-child hostility occurring in South African schools. Of the children assessed, 41,7% reported being hit by another student at least once, and more than half of the sample (53,7%) claimed to have been excluded by other students on at least one occasion. The results also showed no significant difference across socio-economic status groups for bullying behaviours.
Interestingly, Makhathini's research also revealed no major difference between boys and girls for active bullying. However, a considerable difference was found between boys and girls for passive bullying, with girls being victims of passive bullying significantly more than boys were. Dr Dan Olweus, a Norwegian professor of psychology whose extensive research into bullying since the 1970s culminated in the world's foremost bullying prevention programme, defines "active" bullies as "students who want to bully, start the bullying, and play a leader role". "Passive" bullies, on the other hand, are described as "students who actively and openly support the bullying, for example, through laughter or by calling attention to the situation, but don't join in".
When comparing his results to those from other developing African countries, Makhathini found that South Africa has a notably higher prevalence of school bullying. A study conducted by Habib Tiliouine of the University of Oran in Algeria in 2014, found that 12,3% of 12 year-old learners in the country had experienced active bullying and 20,6% of them had been the victims of passive bullying.
When taken together with other research on the topic, Makhathini's study indicates that South African children are experiencing high levels of violence and discrimination every day – be it in their homes, schools or communities – and this daily hostility could well be a major contributor to the high crime levels in the country. "The prevalence and severity of the effects of bullying clearly indicate that it needs to be taken more seriously by governing bodies, policy makers and the general public," says Makhathini. "Increased awareness and further preventative solutions will help build a safer environment for the rearing of our children, which will ultimately lead to a safer environment for us all."
Qiniso Makhathini's research project, The Prevalence of Bullying in Schools in the Western Cape Region, formed part of his final qualifying criteria for SACAP's Bachelor of Social Science Honours Degree, a course that is aimed at candidates who have completed a three-year undergraduate degree with Psychology as a major. Projects such as this illustrate SACAP's commitment to developing the intellectual, practical and emotional skills of its students, allowing them, in turn, to effect positive change where it is needed most in their communities. For more information on this postgraduate programme, or on SACAP's Bachelor of Psychology undergraduate degree, click here.
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Designing and sewing things that other people wanted began for me at about nine years old and has continued for over 45 years.
In my first job working in the sewing machine department at Sears, I soon realized sending someone home with a five-minute threading lesson (which was more than most salespeople did!) wasn't enough to really benefit the customer, so I began teaching "Machine Know-How" classes. From there I moved to the Singer Co. learning sales, machine repair and store management.
Eventually I combined my machine knowledge and management skills and started Stitched Unlimited in Northampton, MA, where I was a Viking and Bernina dealer for over 18 years. My shop continued to grow and expand through programs like my "Machine Know How Club" program, outstanding service department, unlimited machine lessons, and a consultation program for those purchasing a new sewing machine. We became known for giving our clientele exceptional customer service.
This love for creating and passion for teaching naturally evolved into a lifelong learning about sewing machines, innovative techniques and products, and how to help you to do things easier and better.
Since moving to the Cape, I have been sought after as a presenter of my signature Machine Know-How class and have shared my skills and sewing knowledge for many shops, groups and guilds.
My specialty is the breaking down of the process to help you master your machine and the sewing techniques. Patiently I'll walk you thru a new technique; I'll approach the process as many ways as it takes until it clicks with my student.
My most asked for a lecture, "My Favorite Tips, Techniques and Products", has led to my newest addition to my business, an online shop to help you find all those useful and innovative products!
I'm always happy to hear your suggestions, comments and questions that will make our sewing fun, trouble free and productive.


text:
One Africa Award – A Chance for African Individuals and Organizations to Win US$100,000
Posted on Sunday, September 07, 2014
One Africa Award for African Individuals and Organizations
Course(s) Offered: MDGs attainment
Course Level: All levels
Provider: ONE Africa
Country to Study in: Africa
The ONE Africa Award celebrates innovations and progress towards achievement of the Millennium Development Goals (MDGs), the world's blueprint to a better future, ranging from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education.
The organisation is proud to launch the call for applications and nominations for the 2014 ONE Africa Award. The ONE Africa Award aims to recognize, reward, and advance the exceptional work of organizations, founded by Africans and based in Africa, dedicated to helping Africa achieve the Millennium Development Goals (MDGs).
The $100,000 award will bring recognition to innovative African efforts to fight poverty and will incentivize more of such efforts. The award may be split into two prizes in order to award two smaller organizations better able to absorb a smaller monetary award.
Award recipients can be exceptional individuals, organizations or other groups demonstrating commitment and success in assisting Africans in meeting one or more of the MDGs through innovative advocacy based programs.
Qualified recipients may be engaged in direct services to achieve any of the MDGs but must demonstrate a strong advocacy component integral to the delivery and success of their programs.
Qualified recipients may be advocacy/pressure groups and think tanks engaged in governance activities such as the monitoring of flows of resources and/or holding governments accountable to commitments to MDG attainment.
2014 Award Criteria:
The 2014 ONE AFRICA Award will award best practices by an African organization or individual addressing social development issues through innovative advocacy in promotion of MDG attainment.
Nominated individuals/organizations will be graded in 5 categories and will be awarded between 1-10 points in each of these categories:
Extent to which the individual/organization has designed and implemented an innovative advocacy program that employs new approaches to impact in a given sector(s).
Ability to demonstrate and communicate specific indicators of progress and impact linking work to a given sector(s) in a clear results framework;
Demonstration of the ability to replicate efforts of the individual/ organization to take intervention to scale
Demonstration of strong accountability mechanisms i.e. community leadership consultations/ involvement in programs, transparency of operations
Extent to which the individual/organization has employed creative partnerships to achieve its goal and ensure coordination with other development actors. These partnerships may include public and/or private sector players.
The eligible organizations must be founded by Africans and be based in Africa. Evidence of success in previous projects as well as funding support for previous project activities must also be included.
Individual citizens, organizations or groups of AFRICAN origin.
The eligible organizations must be founded by citizens of the African Union's member states and be registered and based in a member state of the African Union. Evidence of success in previous projects as well as funding support for previous project activities must also be included.
Award benefits
BONUS: For the 2014 prize, organizations that demonstrate innovative ideas and approaches towards projects, initiatives and plans to make popular the POST2015 development agenda in their community/country or region will receive up to 5 bonus points in the scoring of their applications.
The successful organizations will clearly demonstrate results already obtained through these efforts.
To apply, download and fill in the 'Application Form' from the official How to Apply page of the ONE.org website.
Please complete each section of the application and attach the required supplemental documents by 23:59 SAST / 21:59 GMT/UTC of the deadline date below according to the submission guidelines.
Please send your completed application to:
Silver Stream Office Park
1st Floor, Main Building
10 Muswell Road
Bryanston 2194
Or via email to: oneaward@one.org
Your submission must be submitted by 23:59 SAST / 21:59 GMT/UTC Friday, September 12, 2014 according to the submission guidelines.
All entries sent by mail must be received by this deadline regardless of postage date.
Shortlisted applications will undergo a due diligence process in September.
ONE will informally review the award winner's project activities and progress a year following the receipt of the award.
Application Deadline: 12 September 2014
Open to International students: No (ONLY Africans)
Related: List of scholarships for study in Africa
Filed Under: africa, any field, awards, september


The typical Allegro Development Quality Assurance Analyst salary is $65,477. Quality Assurance Analyst salaries at Allegro Development can range from $51,688 - $65,477. This estimate is based upon 3 Allegro Development Quality Assurance Analyst salary report(s) provided by employees or estimated based upon statistical methods. When factoring in bonuses and additional compensation, a Quality Assurance Analyst at Allegro Development can expect to make an average total pay of $65,477 . See all Quality Assurance Analyst salaries to learn how this stacks up in the market.


We welcome school field trips, corporate volunteer events and other philanthropic groups (Scouts, 4H, U of A clubs, etc.) Felicia's Farm invites groups – adults, children and youth (including those with special needs) – to learn about sustainable and urban gardening while making a difference in their community!
Volunteers will help with work on the farm including compost management, planting, harvesting, weeding and maybe even feed the chickens and goats. Children have an opportunity to learn where food comes from and the importance of eating fresh fruits and vegetables. Everyone has the satisfaction and fun of getting your hands dirty while positively impacting hunger in our community.
Another way to help; your group may want to start their own fundraiser for Felicia's Farm, including creating a donation page, or donating proceeds from an event. Your donations are critical because with your help, we can feed those in need in Tucson.
To help, please contact us through our email at feliciasfarm@gmail.com.