"We need to facilitate access to digital tools in regions where socio-economic inequalities widen the digital divide"

Silvina Berra
Teresa Bau
"For me, the UOC has always been a benchmark in distance education"
Silvina Berra, research visiting at the eHealth Center and member of the Faculty of Medical Sciences of the Universidad Nacional de Córdoba (Argentina)

Dr Silvina Berra, member of the Faculty of Medical Sciences of the Universidad Nacional de Córdoba (Argentina), will be carrying out a research visit at the Universitat Oberta de Catalunya (UOC) this November. Berra specializes in self-perceived health in childhood and adolescence and, during her stay at our university, will work with experts from our eHealth Center on analysing how to apply digital tools and interventions to improve health during childhood and adolescence.


With regard to the focus of your research, self-perceived health in childhood and adolescence, what is it that led you to specialize in this field?

I'd always been attracted by childhood as a field of research and benefited from some wonderful opportunities. Firstly in Argentina, in the topics of food, growth and development in the first years of life. And later on in Barcelona, where I was lucky enough to receive a doctoral grant for a European project, KIDSCREEN, which developed a model and instruments for studying health-related quality of life in childhood and adolescence. On this project, I worked with Luis Rajmil and Marta Aymerich, as well as other people from AATRM (now AQuAS, the Health Quality and Assessment Agency of Catalonia). This work introduced me to new concepts in child health and the topic of the quantitative measurement of health, something that we have, since then, been using in a range of population studies of children and adolescents in Europe and Argentina.

What significant discoveries have you made in the field? 

It was fascinating to discover that most of the dimensions comprising the health model in childhood and adolescence are psychosocial in nature, whilst the importance of physical well-being is limited to one single dimension. On applying this model in school populations, we can see the impact of malnutrition on health-related quality of life (HRQOL), which has an immediate repercussion on a young person's well-being. It's also striking to see how experiences other than those studied in clinical environments, such as school performance, bullying or opportunities for recreational activities, impact HRQOL.

Is the self-perception of health by children or adolescents very different from that of adults? And why?

Yes, because the concept of health that is assumed is multidimensional and specific to that age. We start on the basis of regarding health as perceptions, as the way in which a person feels and sees themself in different aspects of their life, all of which has its own historical and cultural frames of reference. So it's understandable that what's important for an adult can be different from what's important for a child. So, whilst the skills necessary to carry on their job or the presence of pain may be important for an adult, relationships with adults at home and at school, acceptance or rejection by one's peers and the self-perception of body image are of greater importance in childhood and adolescence.

Why do adolescent girls have worse self-perceived health than boys? What might be the reasons?

In many of the dimensions we study, girls have worse self-perceived health than boys and, as their age increases, it worsens still further compared to boys. This occurs in aspects such as physical and psychological well-being, self-perception and autonomy. Nevertheless, there are some health dimensions in which boys exhibit worse health, such as their feelings in the school environment and social acceptance in childhood.
These differences have complex determinants and mechanisms. We need to acknowledge that health has social determinants: gender roles, the family and society's expectations of boys and girls are different. In turn, intersections with socio-economic or class circumstances can be recognized. Additionally, some biological processes and pubertal development in adolescence appear to have a greater effect on girls' well-being.

What are the practical applications of the results of your research in the fields of health, social interventions, etc.?

Indicators of self-perceived health and HRQOL are extremely useful for describing the situation of children and young people on a population scale, and are able to show differences in the face of a wide range of social and health-related variables, including interventions. The results of studying these indicators in longitudinal designs show significant changes as people transition from childhood to adolescence, which need to be taken into account when interpreting the impact of interventions.

What role can digital tools play in interventions to improve the health of children and adolescents? What kind of tools would be most useful?

This is something I've come to learn at the UOC! Children, adolescents and young people find technologies very attractive and are very skilled at using them. It's possible to make a contribution to childhood development with educational games, preventing harm with educational interventions and fostering adherence to treatments by using monitoring applications. I'm familiarizing myself with some really fascinating developments at the UOC, such as those of the Cognition and Language Research Group (GRECIL) in a range of language areas. What's more, in my opinion, there's a need to work on strategies to improve access to these tools in regions where socio-economic inequalities widen the digital divide, as is the case of my country and Latin America in general. 

What's your motivation for your research visit to the UOC and, more specifically, the eHealth Center? What are your goals for this visit?

Although I'll only be here for a while, it will be a highly enriching visit. I'll be exchanging experiences with the research groups with which we have shared interests in topics and, via their projects, I'll be able to find out more details of innovations in eHealth. I hope that this stay leads to further partnerships in the future. Additionally, many years ago, I had the chance to work in teaching at the UOC and for me it's always been a benchmark in distance education, so I'm looking forward to my conversations with the teaching staff on bachelor's degree and postgraduate programmes.

What new projects do you have planned for the short and long term?

Right now, to gain a more in-depth understanding of children's and adolescents' expressions of different aspects of their quality of life, integrating quantitative and qualitative research strategies. In the meantime, and with a view to the future, we have the challenge of transferring knowledge and tools that can be used by school, healthcare and social professionals and institutions. In this regard, I'll be keeping a close eye on the innovative ideas coming from the eHealth Center. Young people express their health in a much broader, comprehensive and complex way than is expected of them from adult-centric perspectives, so it's important to champion their participation. And I have a passion for teaching, so I want to produce materials better suited to the bachelor's degree and postgraduate programmes I teach.