The COVID–19 pandemic had an immense impact on societies globally, emphasising the pivotal importance of understanding infectious diseases. This study was conducted to delineate the possible influence of the pandemic, by comparing how infectious diseases are portrayed in biology textbooks (school years 4–6 and 7–9) published before and after the COVID–19 pandemic outbreak. Data was subjected to content and thematic analysis, employing contagion literacy as an analytical framework.

The contagion literacy framework identifies six content themes important to teach: contagions, transmission routes, hygiene, vaccinations, antibiotics and antibiotic resistance and sexually transmitted diseases that can be divided into three health literacy levels; functional, which focuses on factual knowledge, interactive, an invitation to what one should do and critical, which requires a higher awareness with critical reflection.

The main conclusion from the comparative analysis was that very few changes were made in the textbooks as a consequence of the pandemic and an overall dominance of functional health literacy. However, critical health literacy descriptions of vaccinations increased in the aftermath of COVID–19 in lower secondary textbooks (7–9), while simultaneously content descriptions about antibiotic and antibiotic resistance were reduced. Critical health literacy aspects of vaccination were included in biology textbooks published only after the pandemic. Concomitantly, the inclusion of descriptions of linkage between contagions and infectious diseases and incubation periods was also found in textbooks published after the pandemic. Implications for curriculum development and the impact on teaching and learning are discussed.

The COVID-19 pandemic profoundly affected children’s everyday experiences in schools worldwide. As future outbreaks are inevitable, it is essential to understand how teaching and learning about infectious diseases was shaped by the COVID-19 pandemic, in order to develop biology education to meet the needs for future epidemic-prone diseases. This thesis investigates how knowledge about infectious diseases is transformed from sources external to the school system into knowledge presented and understood in Swedish middle school classrooms. The overarching research question is: How is the portrayal of knowledge about infectious diseases reflected in biology textbooks, teachers’ practices, and pupils’ understanding in the aftermath of COVID-19? The thesis comprises four empirical studies, each examining a distinct stage in this transformation of knowledge, from academic and societal domains to what is actually taught and learned. The findings are interpreted through contagion literacy, a framework outlining the competencies expected of health-literate citizens and related to the concept of powerful knowledge. A comparative textbook analysis (Paper I) of editions published before and after the pandemic reveals that representations of infectious diseases remained largely unchanged, with an emphasis on functional health literacy describing content knowledge rather than how to act upon this knowledge. In practice, teaching during the pandemic was shaped by pupil-initiated, question-driven discussions about current events, rather than by an expansion of the planned biology curriculum (Paper II). Studies of pupils’ understanding (Papers III and IV) show that while COVID-19 influenced their thinking, their conceptual grasp of infectious diseases and microorganisms remained limited and often based on informal sources such as the media and the internet, rather than formal biology education. The thesis argues for the deliberate integration of contagion literacy into science education with the addition of the host and its immune response as new aspects. Such knowledge constitutes potential powerful knowledge, essential for preparing pupils to navigate future public health challenges and pandemics as critically engaged citizens

Theoretical background and rationale 

Teaching infectious diseases is an integral and important part of the biology curriculum. Previously, infectious diseases were not given much attention in biology education and within biology education research (Byrne, Marston, and Grace, 2021; Jones and Rua, 2008). Considering the recent COVID-19 pandemic there is reason to believe that this topic gained priority in biology tutoring. This study investigated the way Swedish middle school teachers taught infectious diseases in the aftermath of COVID-19 by using the contagion literacy framework (CL) as the analytical tool. The CL framework was originally developed by Kilstadius and Gericke (2017) based on Nutbeam’s (1998) health literacy framework and conceptualize what knowledge pertaining to health and disease that is considered essential for a citizen to understand and hence to be included in the biology curriculum of compulsory schools. The CL framework covers six principal content themes: (i) contagions, (ii) modes of transmission, (iii) infectious diseases, (iv) hygiene practices, (v) vaccinations, and (vi) antibiotics and antibiotic resistance.

The six themes are further subdivided into three levels of health literacy, functional health literacy, encompassing fundamental concepts and knowledge. The subsequent level, interactive health literacy, represents the translation of functional health literacy into practical actions and behaviours. The third level, critical health literacy, involves the utilization of insights into infectious diseases in the everyday decision-making process and the capacity to influence one's lifestyle choices accordingly.

The COVID-19 pandemic impacted immensely in schools worldwide, emphasising the pivotal importance of infectious diseases. This study aims to delineate the teaching of diseases in middle schools, investigating how content and instruction was influenced in the aftermath of the pandemic. Semi-structured individual interviews were conducted with teachers. The analytical method involved thematic analysis. The first analysis concerned teaching content was based on the framework of contagion literacy. The second analysis investigated the teaching approaches through an inductive analysis. The findings suggest that the pandemic had an impact on the biology teaching in relation to infectious diseases. During the pandemic, teaching largely revolved around student-initiated, question-driven discussions about current events related to societal health initiatives within schools, rather than expanding the planned biology curriculum. The main finding is that teachers focused on hygiene and to influence students’ behaviours interactively. The pandemic was not fully exploited by the participating teachers to develop more curriculum-based teaching including functional and critical health literacy perspectives. The study recommends that biology teachers collaborate with school health teams and engage in interdisciplinary work. We also suggest to amend primary science teacher education to meet the need to teach the young people in the event of future pandemics.

Recently, the COVID-19 pandemic impacted immensely on individuals and societies around the world. This study aimed at delineating Swedish middle school (10?12-year-old) pupils? understanding of bacteria and viruses, thereby illustrating the influence of the pandemic at schools and in society. Data was collected by semi-structured, individual interviews and by asking pupils to draw images. Thematic coding of interview transcripts and content analysis of pupils? annotated drawings were used. The morphology of microorganisms from the drawings was often 'corona-like', with a round shape and with protruding parts. Viruses were commonly considered larger than bacteria, but sometimes also similar in size. Interrelationships between bacteria and viruses were expressed with a superior microorganism. Pupils drew microorganisms as cell-like and never portrayed them as animals or with anthropomorphic features. Viruses were considered to cause a more severe disease than bacteria. Pupils seldomly tethered a specific virus to a specific infectious disease, and often named both (virus and disease) 'corona'. However, when they did make a connection, viruses were considered to cause flu and COVID-19, bacteria to cause cold and plague. In general, these results indicate that viruses received a more pronounced position amongst microorganisms in the minds of pupils in the aftermath of COVID-19.

The COVID-19 pandemic had an immense impact on communities around the world. We know that new epidemic-prone diseases will emerge in the future. Consequently, it is important to investigate what impact the current pandemic had on school children’s understanding of infectious diseases in order to develop biology education based on that novel understanding. The aim of this study was to explore Swedish middle school (10-12-year-old) pupils’ understanding of infectious diseases and their perceived sources of knowledge. Data was collected through individual semi-structured interviews with fifteen pupils and analysed by thematic coding. Results revealed a great impact of the pandemic on the respondents’ conceptions. Firstly, their notion of infectious diseases based on their idea of COVID-19 was elusive because COVID-19 can manifest very differently. Secondly, the need to care about oneself and others was recognized. Thirdly, the importance of vaccines was recognized, but vaccines were given different roles. Finally, their understanding of infection seems to originate from informal domains such as the news and the Internet, rather than from biology education. One proposal for biology teaching could be to introduce scientific concepts earlier, to pay more attention to differences and similarities between infectious diseases, and to cooperate with other school subjects.

For the past couple of years, the COVID-19 pandemic had an immense impact on lives of individuals and societies around the world. The main purpose of this study was to delineate Swedish middle school (10-12-year-old) pupils’ understanding of bacteria and virus thereby illustrating the impact of the pandemic at schools and in society. Data were collected by semistructured, individual interviews and by asking participants to draw images of bacteria and virus. Thematic coding and content analysis of children’s annotated drawings were used. The morphology of the microorganisms from the drawings was analyzed by the deductively induced themes shape, surface texture and internal feature. Viruses were frequently considered larger than bacteria, but it was also common to view them being similar in size. Interrelationships between bacteria and viruses were expressed like a hierarchy with a “superior” microorganism, and as bacteria could generate viruses. Pupils drew microorganisms as cell-like and never portrayed them as animals or with anthropomorphic features, as reported in earlier research. Metaphoric aspects of drawings of viruses were summarized as being “bacteriophage-like” or “corona-like”. A virus was considered to induce the more grievous disease. Pupils seldomly tethered a specific virus to a specific infectious disease, and often named both "corona". However, when they did so, virus was tethered to flu and COVID-19 and bacteria to cold and plague. One ostensible suggestion for learning improvement would be to pay more attention to differences between microorganisms and their liaison to specific infectious diseases. This liaison is suggested as an important concept for developing contagion literacy. Furthermore, we recommend pathogenic bacteria and viruses to be explicitly taught in biology education at middle school or earlier in balance with knowledge about essential microorganisms. Finally, we propose the measures above to be integrated into the biology education of teacher´s education.