Using the "Newest Vital Sign" to assess health literacy in children

Parents' comprehensive health literacy and child health after attending extended home visiting in Swedish multicultural settings-A case-comparison study

BACKGROUND

Parents' low health literacy (HL) has negative impacts on child health. Parental interventions may improve parents' HL and thus impact child health positively.

OBJECTIVES

This study aimed to gain knowledge about associations between parents' comprehensive HL (CHL) and child health after an extended postnatal home visiting program in Swedish multicultural, disadvantaged settings compared to parents receiving regular child healthcare (CHC).

MATERIALS AND METHODS

This quasi-experimental study used a case-control sampling method to recruit first-time parents through two CHC centres in Stockholm (2017-2020). Participants (N = 151) were interviewed twice through structured questionnaires when their child was <2 months and 15-18 months old. HLS-EU-Q16 assessed parents' CHL. Children's medical records (0-18 months) were reviewed regarding breastfeeding, children's exposure to smoking, language development and healthcare utilisation. Data were analysed with regression models and non-parametric tests.

RESULTS

No significant association was found between parents' CHL and child health. However, significantly fewer unplanned visits to the CHC centre were observed among children (0-18 months) in the intervention group irrespective of CHL, compared with children to parents with improved CHL in the comparison group (F = 3.856, p = 0.011).

CONCLUSIONS

Postnatal home visiting interventions practicing proportional universalism and family-centred care may reduce unplanned visits within CHC in disadvantaged settings despite parents' CHL. Further studies with long-term follow-up are suggested to explore associations between parents' CHL and child health.

TRIAL REGISTRATION

As a clinical study (not a clinical trial) with appropriate ethical permission with participants' consents, this study was retrospectively registered (18 February 2020) in the ISRCTN registry (ISRCTN10336603).

Health literacy and health behaviors in parent-adolescent dyads: an actor-partner interdependence model approach

OBJECTIVE

Health literacy (HL), skills for accessing, appraising and using health information in health decision-making is implicated in adolescents' health behaviors. HL skills develop through scaffolding, modeling, practice and opportunity. Therefore, adolescents' HL skills are likely closely tied to parents' HL and health behaviors. Yet, no studies have examined the dyadic interdependence of the relationship between HL and health behaviors between parents and adolescents. The purpose of this study was to determine the interdependence of adolescents' and parents' HL and health behaviors.

METHODS AND MEASURES

Data were collected from 300 parent-adolescent dyads via Qualtrics Panel. Dyads completed identical measures of their HL, diet, physical activity, sedentary activity, cigarette-smoking, vaping, and alcohol binge-drinking behaviors. Data were analyzed using Pearson correlations and the Actor-Partner Interdependence Model.

RESULTS

Within-dyad correlations were significant for HL and all health behaviors assessed. After controlling for covariates and partner effects, adolescents' HL was related to their sugar-sweetened beverage intake, sedentary activity, and substance use. After controlling for covariates and actor effects, adolescents' HL was related to parents' sedentary activity, binge-drinking, and vaping while parents' HL was related to adolescents' sedentary activity.

CONCLUSION

Our results suggest that there is interdependence in these relationships especially for risk behaviors.

Health literacy in the context of child health promotion: a scoping review of conceptualizations and descriptions

BACKGROUND

Increasing health literacy (HL) in children could be an opportunity for a more health literate future generation. The aim of this scoping review is to provide an overview of how HL is conceptualized and described in the context of health promotion in 9-12-year-old children.

METHODS

A systematic and comprehensive search for 'health literacy' and 'children' and 'measure' was performed in accordance with PRISMA ScR in PubMed, Embase.com and via Ebsco in CINAHL, APA PsycInfo and ERIC. Two reviewers independently screened titles and abstracts and evaluated full-text publications regarding eligibility. Data was extracted systematically, and the extracted descriptions of HL were analyzed qualitatively using deductive analysis based on previously published HL definitions.

RESULTS

The search provided 5,401 original titles, of which 26 eligible publications were included. We found a wide variation of descriptions of learning outcomes as well as competencies for HL. Most HL descriptions could be linked to commonly used definitions of HL in the literature, and some combined several HL dimensions. The descriptions varied between HL dimensions and were not always relevant to health promotion. The educational setting plays a prominent role in HL regarding health promotion.

CONCLUSION

The description of HL is truly diverse and complex encompassing a wide range of topics. We recommend adopting a comprehensive and integrated approach to describe HL dimensions, particularly in the context of health promotion for children. By considering the diverse dimensions of HL and its integration within educational programs, children can learn HL skills and competencies from an early age.

The conceptualization and development of critical health literacy in children: a scoping review

The cognitive and social practices associated with critical health literacy, such as critical appraisal of health messages and participation in political processes to address wider determinants of health, are of lifelong benefit. Understanding how and where critical health literacy development can be supported early in the life course may improve health outcomes now and in the future. This scoping review focuses on how critical health literacy in children is conceptualized and the supportive environments available for its development. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines are used in reporting. Evidence retrieved was eligible for inclusion if it contained a substantive conceptual or empirical study of critical health literacy in populations aged 7-11 (middle childhood). From the included 18 peer-reviewed and grey literature sources, schools are identified as the setting most associated with the development of critical health literacy in the target age group. However, the action-oriented dimension of critical health literacy is rarely supported in the school setting. The review concludes that further research is needed to clarify how and where to support children to develop critical health literacy in and outside of school settings.

Involving Children in Health Literacy Research

Despite the volume and breadth of health literacy research related to children, children's involvement in that research is rare. Research with children is challenging, but the principles of involvement and engagement underpin all health promotion work, including health literacy. This commentary reflects on the process of setting up a Children's Advisory Group to consult on an institutional ethnography study of health literacy work from children's standpoint. The Children's Advisory Group contributed feedback on the study ethics and design and piloted methods for rapport-building and data collection, including livestreamed draw-and-describe and modified Interview to the Double. Consulting with the Children's Advisory Group highlighted the importance of listening to children and recognizing and valuing children's imaginative contributions to methods for involving children in health literacy research. Insights from this commentary can be used to foreground equity-focused approaches to future research and practice with children in the field of health literacy.

Validity and Reliability of the Parental Health Literacy Questionnaire for Caregivers of Children Aged 0 to 3 Years in China

Caregivers' health literacy plays a vital role in the quality of parenting and significantly impacts children's physical and psychological health. However, the instruments to assess the health literacy of caregivers of children aged 0 to 3 years are lacking. This study aimed to evaluate the reliability and validity of the Chinese Parental Health Literacy Questionnaire (CPHLQ) in China. We conducted a cross-sectional study. Six hundred and thirty-four caregivers of children aged 0 to 3 years were recruited from Shandong, Yunnan, and Shaanxi Provinces, representing the eastern, central, and western regions of China, between November 2020 and January 2021. The reliability was evaluated by internal consistency reliability and split-half reliability. The construct validity was determined by confirmatory factor analysis. Social determinants of parental health literacy were assessed by multivariate linear regression model. Results showed that CPHLQ had satisfactory reliability and acceptable construct validity. Mothers compared to other types of caregivers, higher education levels, and nuclear or extended families compared to other family compositions were significantly associated with higher parental health literacy. The study further demonstrated that CPHLQ is a reliable and valid instrument to measure the health literacy of caregivers of children aged 0 to 3 years in the Chinese population. It can be used as an evaluation tool for intervention research, to inform policy-making and future health education interventions of improving caregivers' health literacy.

A propósito de la pandemia COVID-19: hablemos con los padres con respecto a los trastornos del desarrollo del lenguaje

El trastorno del desarrollo del lenguaje es un reto diagnóstico en etapas tempranas del desarrollo por lo que su adecuado abordaje e intervención permite mejorar el pronóstico de este grupo de pacientes que muchas veces son diagnosticados tardíamente sobre todo en el último periodo en el contexto de la pandemia COVID-19. El presente artículo busca dar las herramientas que permitan comprender su importancia, así como ser un eje que permita dar estrategias a los padres a modo de promover las habilidades de lenguaje y comunicación en etapas tempranas del desarrollo de sus hijos.

Relationship between parents' health literacy and child health: systematic review

Purpose

Parents' health literacy is an important element to ensure the sound health of children. One of the major purposes of this study was to systematically collect and review the literature that identified the relationship between two variables: parents' health literacy and their child's health.

Design/methodology/approach

To meet the purpose, the authors searched four well-reputed research databases such as Web of Science, Scopus, Google Scholar and LISTA (Library, Information Science and Technology Abstracts) comprehensively to collect the relevant research on the topic. Except for books, various types of content from different years were used for this review. The investigators used Preferred Items for Systematic Reviews and Meta-analysis guidelines to select eligible studies for this review. The authors also assessed the quality of the reviewed research in the light of well-reputed quality guidelines shared by Boynton and Greenhalgh (2004).

Findings

The majority of the reviewed studies found a statistically significant relationship between parents' health literacy and the health of their children. Findings also identified that the majority of the reviewed literature scored from 9 to 12 on the quality assessment criteria. Results also highlighted that the majority of the reviewed research on parents' health literacy and child health has been conducted in the USA and utilized quantitative methods to conduct research on the topic under this study.

Research limitations/implications

This systematic review has multiple theoretical and practical implications for parents, policymakers and researchers.

Originality/value

This is the first systematically collected and reviewed paper on the relationship between parents' health literacy and child health.

Home Environment Influence on Adolescent Health Literacy

Adolescent health disparities are influenced by individuals' health literacy. To date, the only known household factors to influence adolescent health literacy (AHL) are social capital factors of parental health literacy, parent education, and household income. Therefore, the purpose of this study was to expand the understanding of household factors that influence AHL for future interventions. A sample of 105 adolescents and their parents completed an online survey. Home environment variables included family communication, family involvement, and books in the home. A quantitative analysis of correlations and regression was employed to explore the relationship between AHL and household factors. Findings from this study suggest that parental health literacy is the best-known household facilitator of AHL. Family communication and family involvement were not correlated with AHL. The number of books in the home was correlated with AHL. A good understanding of the factors influencing AHL is necessary for developing interventions. These findings continue to lend support that AHL is heavily associated with parental health literacy. Based on the salience of these findings in the research, future health literacy interventions should consider incorporating a parent/caregiver component. Yet, what remains unknown is the mechanism between AHL and parental health literacy.

Socio-Economic Determinants of Health Literacy in High School Students: A Cross-Sectional Study

Today, a person’s health literacy (HL) is perceived as a critical determinant for their health. It is well known that limited health literacy is associated with harmful health behaviours, the lower use of preventive services, problems in making use of healthcare resources and poor skills for the self-management of chronic disorders. This study analysed the level and factors associated with HL in high school students in southern Poland. The study is based on the data from a paper-and-pencil survey of high schools students in the Malopolska Voivodshop. The students were selected using a two-stage cluster random sampling procedure. The level of HL was assessed with the European Health Literacy Survey Questionnaire, consisting of 47 items. Univariate logistic and linear regression models were applied to analyse the association between general HL score and the main domain-specific indices. The respondents whose parents had attended University and came from more affluent families were less likely to demonstrate limited HL. There was a significant positive relationship between the self-assessment of the economic situation, size of accommodation, the level of expenditure on a mobile phone and receiving external support, the size of the book collection at home, and domain-specific HL sub-indices. In conclusion, among socio-demographic factors, the parents’ education is the only consistent predictor of the level of HL in high school students. Furthermore, most variables reflecting the economic status of the respondent’s family are significantly associated with the general HL score and its sub-indices.

Low Health Literacy Is Associated With Energy-Balance-Related Behaviors, Quality of Life, and BMI Among Rural Appalachian Middle School Students: A Cross-Sectional Study

BACKGROUND

Many studies document associations between low health literacy (HL) and poor health behaviors and outcomes. Yet, HL is understudied among adolescents, particularly from underserved, rural communities. We targeted rural adolescents in this cross-sectional study and explored relationships between HL and (1) energy-balance-related health behaviors and (2) body mass index (BMI) and quality of life (QOL).

METHODS

Surveys were administered to 7th graders across 8 middle schools in rural Appalachia. HL was assessed using the Newest Vital Sign. Energy-balance-related behaviors and QOL were assessed using validated instruments. Height and weight were objectively measured. Analyses were conducted using the Hodges-Lehmann nonparametric median difference test.

RESULTS

Of the 854 adolescent students (mean age = 12; 55% female), 47% had limited HL. Relative to students with higher HL, students with lower HL reported significantly lower frequency of health-promoting behaviors (water, fruit and vegetable intake, physical activity, sleep), higher frequency of risky health behaviors (sugar-sweetened beverages, junk food, screen time), and had higher BMI percentiles and lower QOL (all p < .05).

CONCLUSIONS

Low HL is associated with energy-balance-related behaviors, BMI, and QOL among rural, Appalachian adolescents. Findings underscore the relevance of HL among rural middle school students and highlight implications for school health.

School-Based Health Literacy Programs for Children (2-16 Years): An International Review

BACKGROUND

Health literacy impacts children's health and educational attainment. Therefore, determining the most appropriate pedagogical design is critical. The long-term health benefits of health literacy for each child's life course further justify this imperative. School-based health literacy programs are of interest internationally.

METHODS

We brainstormed the search terms and established inclusion/exclusion criteria for this systematic review. We searched 2 databases (CINAHL, ERIC) following PRISMA guidelines. Three authors screened and sorted the findings.

RESULTS

We identified 21 relevant studies from 629 retrieved. Few (6/21) studies were situated in the primary school setting.

CONCLUSIONS

This review found a variety of project designs, evaluation methods, and conceptual models. Descriptive analysis of the final 21 papers highlighted the importance of multicomponent design (whole-of-school and curriculum), cross-curricula integration, professional development for teachers, age of children, role of parents, and role of community. The results of this analysis may inform primary school program design in the future. Schools provide a logical setting for health literacy development. Despite the evidence that adolescence is too late, few studies have been situated in primary schools. Teachers lack confidence to teach health and need ongoing professional development. Parent, child, and community voices are essential for sustained engagement and program success.

Adolescent Health Literacy and Neighbourhood Features: HBSC Findings from Czech Republic, Poland, and Slovakia

The role of supportive environments on health, wellbeing, and longevity has been widely recognized. However, there is no strong empirical evidence on the association between health literacy (HL) as a particular health-related competence and neighbourhoods. Therefore, the aim of the study was to assess the association between the features of neighbourhoods and the level of HL competencies of young people from three countries (Czech Republic, Poland, Slovakia). Self-reported data from an international sample of 11,521 students aged 13-15 years participating in the Health Behaviour in School-aged Children Study (HBSC) in the year 2018 were included in the analyses. The level of HL shows a strong positive relationship with family wealth, and a significant relationship is maintained in all studied countries. Both social and structural features of neighbourhoods turned out to have an impact on students' HL. However, HL is most clearly explained by the school environment. This study confirms the school effect on higher levels of HL competences in adolescents. This indicates the need to invest in schools located in less affluent areas to generally improve the level of education, implement modern health education combined with HL, and strengthen the social and health competencies of students.

The Online Use of the Newest Vital Sign in Adolescents

Seventy percent of premature adult deaths are caused by adolescent behaviors. Data suggests that health literacy may influence adolescent behaviors. However, adolescent health literacy research is scarce; and, timely, more robust data is imperative. Nonetheless, many potential study samples are currently inaccessible due to the pandemic. Thus, there is an immediate need to evaluate online adolescent health literacy research modalities to further the science. The purpose of this study is to explore the psychometric properties of online administration of the Newest Vital Sign (NVS) health literacy instrument in adolescents. A total of 105 adolescents completed the study via Qualtrics. Internal consistency reliability of the online NVS was good (α = .77). There was, however, no significant correlation between online and in-person comparison scores (r = .05, p = .59). This study yields clinically significant results showing insight into the online NVS for adolescents, providing a foundation for future adolescent health literacy research.

The Influence of Health-Seeking Behaviors on the Health Literacy of Adolescents With Sickle Cell Disease

Background: Health literacy may influence the transition from pediatric care to adult care in adolescents with sickle cell disease (SCD). It is postulated that one influencing factor of health literacy in adolescents with SCD is health-seeking behavior. The purpose of this study was twofold: (1) to explore health-seeking behaviors of adolescents with SCD and (2) to determine if there are significant differences in health literacy levels of adolescents with SCD based upon health-seeking behaviors. Methods: This was a cross-sectional, descriptive study evaluating health-seeking behaviors and health literacy in 110 Black and non-Hispanic adolescents with SCD. Convenience sampling was utilized for recruitment. The inclusion criteria were a diagnosis of one of the four primary genotypes of SCD and age of 10-19 years. Health literacy was evaluated using the Newest Vital Sign (NVS). Frequencies and percentages were calculated for all variables. Independent Samples t-tests were conducted to evaluate differences in health literacy scores based upon differing health-seeking behaviors. Results: The mean age of participants was 14.8 years (SD = 2.2). The mean NVS score was 2.7 (SD = 1.6). The two most common responses to "where do you go FIRST for health information?" were the Internet (29.6%; n = 40) and health care providers (27.4%; n = 37). There was no statistical difference in NVS scores between adolescents using the Internet versus health care providers as their first source of health information (t[75] = - .12; p = .22). Discussion: Knowledge of health-seeking behaviors and health literacy in adolescents with SCD gives insight into the design and evaluation of future interventions to improve health and health literacy in this population.

Functional Health Literacy: Psychometric Properties of the Newest Vital Sign for Portuguese Adolescents (NVS-PTeen)

Self-management of health requires skills to obtain, process, understand, and use health-related information. Assessment of adolescents’ functional health literacy requires valid, reliable, and low-burden tools. The main objective of this study was to adapt and study the psychometric properties of the Newest Vital Sign for the Portuguese adolescents’ population (NVS-PTeen). Classic psychometric indicators of reliability and validity were combined with item response theory (IRT) analyses in a cross-sectional survey, complemented with a 3-month test-retest assessment. The NVS-PTeen was self-administered to students enrolled in grades 8 to 12 (12 to 17 years old) in a school setting. Overall, 386 students (191 girls) from 16 classes of the same school participated in the study (mean age = 14.5; SD = 1.5). Internal reliability of the NVS-PTeen was α = 0.60. The NVS-PTeen total score was positively and significantly correlated with Portuguese (r = 0.28) and mathematics scores (r = 0.31), school years (r = 0.31), and age (r = 0.19). Similar to the original scale (for the U.S.), the NVS-PTeen is composed of two dimensions, reading-related literacy and numeracy. Temporal reliability is adequate, though with a learning effect. IRT analyses revealed differences in difficulty and discriminative capacity among items, all with adequate outfit and infit values. Results showed that the NVS-PTeen is valid and reliable, sensible to inter-individual educational differences, and adequate for regular screening of functional health literacy in adolescents.

Promotion of Elementary School Students' Health Literacy

Health literacy is an important outcome of the discussion of school-related health education and health promotion in the 21st century. Although the improvement of health literacy at an early age is increasingly recognized and few interventions show the development of children´s health literacy, still there is little research in this area. The purpose of the study was to examine the enhancement of health literacy among children in a physical activity-based program at elementary school. In total, 137 students aged 6–12 years participated in the program, which included health knowledge transfer in child-appropriate games and exercises. Participants´ health literacy was assessed using the HLS-Child-Q15-DE at the beginning and the end of the program. The instrument measures the access, understanding, appraisal and application of health-related information on a four-point Likert-type scale. As expected, the Wilcoxon signed-rank test revealed significant increases in self-reported health literacy over time. The results show that the degree of change in health literacy was not associated with gender or age. The results suggest that the physical activity-based program has the potential to improve elementary school children´s health literacy, even though in a single group pilot study.

Dimensionen der Gesundheitskompetenz von Viertklässler*innen

Hintergrund

Die Gesundheitskompetenz (GK) junger Menschen wird von Wissenschaft und Politik zunehmend als Ansatzpunkt für Gesundheitsförderung und Prävention anerkannt. Gerade die GK von Kindern wurde jedoch, insbesondere in Deutschland, bisher kaum erforscht. Diese Studie widmet sich dieser Forschungslücke, indem sie die GK von Viertklässler*innen in Nordrhein-Westfalen (NRW) untersucht.

Ziel der Arbeit (Fragestellung)

Die Fragestellung ist die explorative Beschreibung verschiedener Dimensionen der GK von Kindern unter Berücksichtigung sozioökonomischer Merkmale.

Material und Methoden

Es wurde eine schriftliche Klassenraumbefragung durchgeführt. Der Fragebogen, der speziell für 9‑ bis 10-Jährige entwickelt wurde, umfasst drei Dimensionen der GK: selbstberichtete allgemeine GK, funktionale GK (schriftsprachliche und numerische Fähigkeiten) und das Gesundheitswissen.

Ergebnisse

Es wurden 899 Schüler*innen an 32 Schulen befragt. Hierbei wurde eine hohe selbstberichtete GK ermittelt: die Befragten empfinden den Umgang mit Gesundheitsinformationen als einfach. Kinder mit niedrigem Wohlstand schneiden in allen Dimensionen der GK signifikant schlechter ab. Dies gilt mit Ausnahme der selbstberichteten GK auch für Kinder, die zuhause nicht nur Deutsch sprechen.

Schlussfolgerung

Diese Studie untersucht erstmals die GK von Viertklässler*innen in NRW. Wenngleich die selbstberichtete GK hoch ist, zeigt sich schon bei dieser jungen Altersgruppe ein sozialer Gradient hinsichtlich Wohlstand und Sprache. Die Forschungslage ist für das Kindesalter zwar noch lückenhaft und es besteht weiterhin Forschungsbedarf, die Ergebnisse deuten aber auf einen frühen Interventionsbedarf hin, um allen Kindern unabhängig von ihrer Herkunft zu ermöglichen, GK in dem Maß zu entwickeln, wie es der eigenen Gesundheit zuträglich ist.

Integrating Health Literacy Into Core Curriculum: A Teacher-Driven Pilot Initiative for Second Graders

BACKGROUND

Limited research has addressed the effects of health literacy interventions in elementary schools. However, school-aged children's health literacy is critical because children make decisions about their health every day. The purpose of the pilot project was to explore the feasibility of integrated health literacy lesson plans for second graders.

METHODS

A pretest-posttest evaluation was conducted with second grade students following implementation of health literacy lessons that were integrated into core curriculum (language arts, science, and social studies).

RESULTS

Health educators, a hospital/health care system, and a school district developed a partnership. A research team of teachers, administrators, health literacy experts and health care organizations designed and implemented health literacy lesson plans. A developmentally appropriate measure of health literacy was adapted from the Newest Vital Sign. Data showed that students' health literacy scores significantly increased after implementation of 4 lesson plans.

CONCLUSIONS

This was an exploratory, pilot project that provided a useful starting point for discussing how to integrate health literacy into elementary school curriculum. An interdisciplinary team developed integrated health literacy materials that acknowledged the needs of teachers, the resources available, and the developmental stages of children. This intervention serves as a model for future health literacy initiatives in schools.

Health literacy, nutrition knowledge, and health care transition readiness in youth with chronic kidney disease or hypertension: A cross-sectional study

This study evaluates the associations of nutrition knowledge and health literacy with health care transition (HCT) readiness and self-management in adolescents and young adults (AYAs) with chronic kidney disease (CKD) or hypertension. Chronically ill AYAs with poor HCT or self-management skills are less likely to achieve favorable health outcomes as they enter adulthood. Health literacy and nutrition knowledge, which are identified as important contributors to health outcomes, may suggest important points of interventions to improve self-management skills. For the study, we enrolled 59 consecutive patients ages 12-29, with a diagnosis of CKD or hypertension at pediatric- and adult-focused clinics in the United States. Participants completed measures of nutrition knowledge, health literacy, and the Self-management and Transition to Adulthood with R_x = treatment (STAR_x) questionnaire. Correlation tests and multivariate regressions were employed for data analysis. The findings show that health literacy was positively associated with self-management skills (p = .050), communication with providers (p = .002) and overall HCT (p = .001) after adjusting for key variables. Disease-specific nutrition knowledge positively predicted communication with providers (p = .002) and overall HCT (p < .001) after adjusting for key variables. Therefore, health literacy and nutrition knowledge predicted self-management and transition readiness. Testing for these skills should be considered in clinics and HCT preparation for AYAs with chronic conditions.

Questionnaire validation practice within a theoretical framework: a systematic descriptive literature review of health literacy assessments

OBJECTIVE

Validity refers to the extent to which evidence and theory support the adequacy and appropriateness of inferences based on score interpretations. The health sector is lacking a theoretically-driven framework for the development, testing and use of health assessments. This study used the Standards for Educational and Psychological Testing framework of five sources of validity evidence to assess the types of evidence reported for health literacy assessments, and to identify studies that referred to a theoretical validity testing framework.

METHODS

A systematic descriptive literature review investigated methods and results in health literacy assessment development, application and validity testing studies. Electronic searches were conducted in EBSCOhost, Embase, Open Access Theses and Dissertations and ProQuest Dissertations. Data were coded to the Standards' five sources of validity evidence, and for reference to a validity testing framework.

RESULTS

Coding on 46 studies resulted in 195 instances of validity evidence across the five sources. Only nine studies directly or indirectly referenced a validity testing framework. Evidence based on relations to other variables is most frequently reported.

CONCLUSIONS

The health and health equity of individuals and populations are increasingly dependent on decisions based on data collected through health assessments. An evidence-based theoretical framework provides structure and coherence to existing evidence and stipulates where further evidence is required to evaluate the extent to which data are valid for an intended purpose. This review demonstrates the use of the Standards' theoretical validity testing framework to evaluate sources of evidence reported for health literacy assessments. Findings indicate that theoretical validity testing frameworks are rarely used to collate and evaluate evidence in validation practice for health literacy assessments. Use of the Standards' theoretical validity testing framework would improve evaluation of the evidence for inferences derived from health assessment data on which public health and health equity decisions are based.

Development and Psychometric Properties of a Questionnaire Assessing Self-Reported Generic Health Literacy in Adolescence

Health literacy is a promising approach to promoting health and preventing disease among children and adolescents. Promoting health literacy in early stages of life could contribute to reducing health inequalities. However, it is difficult to identify concrete needs for action as there are few age-adjusted measures to assess generic health literacy in young people. Our aim was to develop a multidimensional measure of health literacy in German to assess generic health literacy among 14- to 17-year-old adolescents, namely, the "Measurement of Health Literacy Among Adolescents Questionnaire" (MOHLAA-Q). The development process included two stages. Stage 1 comprised the development and validation using a literature review, two rounds of cognitive interviews, two focus groups and two rounds of expert assessments by health literacy experts. Stage 2 included a standard pretest (n = 625) of the questionnaire draft to examine the psychometric properties, reliability and different validity aspects. The MOHLAA-Q consists of 29 items in four scales: (A) "Dealing with health-related information (HLS-EU-Q12-adolescents-DE)"; (B) "Communication and interaction skills", (C) "Attitudes toward one's own health and health information", and (D) "Health-related knowledge". The confirmatory factor analysis indicated a multidimensional structure of the MOHLAA-Q. The internal consistency coefficients (Cronbach's α) of the scales varied from 0.54 to 0.77. The development of the MOHLAA-Q constitutes a significant step towards the comprehensive measurement of adolescents' health literacy. However, further research is necessary to re-examine its structural validity and to improve the internal consistency of two scales.

Health literacy in adolescents with sickle cell disease: The influence of caregiver health literacy

PURPOSE

After patients with sickle cell disease (SCD) transfer from pediatric care to adult care, significant morbidity and mortality occurs. There are many possible contributors to the success or failure of this transition. One hypothesis is that health literacy influences this transition from pediatric to adult health care. The purpose of this study was twofold: (a) to examine the relationship between caregiver and adolescent health literacy levels in adolescents with SCD; and (b) to further describe individual traits contributing to health literacy levels in adolescents with SCD as described by pilot data.

DESIGN AND METHODS

This cross-sectional, descriptive correlational study included the administration of the newest vital sign (NVS) health literacy instrument to 59 dyads of adolescent patients with SCD and their caregivers in a large, tertiary care center in Dallas, Texas. Convenience sampling was utilized for recruitment. Caregiver health literacy levels, age, current grade level, annual household income, caregiver education level, number of annual healthcare encounters, and adolescent health literacy levels were correlated to determine relationships amongst variables.

RESULTS

There was no significant relationship between caregiver and adolescent health literacy levels in this population. Adolescent health literacy NVS scores were positively correlated with adolescent age, r(58) = .468, p < .001, caregiver income, r(46) = .293, p = .023, and caregiver highest education level, r(56) = .318, p = .008. Only adolescent age was a significant predictor of adolescent health literacy NVS scores, β = .485 (standard error [SE] = .109), p = .001. None of the other predictors in the model were significant, including the relationship between caregiver and adolescent health literacy NVS scores, β = .065 (SE = .131), p = .633. In addition, although caregiver income and highest education level were positively correlated with adolescent health literacy NVS scores in the bivariate analysis, these relationships were nonsignificant while controlling for each other, adolescent age, and the other variables in the model.

PRACTICE IMPLICATIONS

This study gives insight on potential practice and research initiatives to evaluate the health literacy of adolescents, with and without SCD, both now and in the future.

Exploring Associated Factors of Subjective Health Literacy in School-Aged Children

Low health literacy is considered to lead to worse health-related outcomes and behaviors and has therefore been recognized as a social determinant of health. While health literacy and its potential determinants have been studied in adults, little research has been conducted with children. This study aims to address this research gap by investigating factors associated with children's subjective health literacy. Cross-sectional data was collected from fourth graders at German schools with a self-report questionnaire. Sociodemographic characteristics, health-related attitudes, and motivation were analyzed. We used hierarchical multivariate linear regression to explain variance in the dependent variable "subjective health literacy". A total of n = 907 fourth graders were surveyed. Regarding health literacy, eight out of ten participants (82.2%) reported that it was "rather easy" or "very easy" to deal with health-related information. Family affluence, but not language spoken at home, was significantly related to subjective health literacy, after controlling for confounding. Moreover, parental health orientation, self-efficacy, and motivation are factors significantly associated with health literacy. Based on the results of this study, it is hypothesized that a general motivation to learn new things about health, as well as an environment promoting health-positive behavior, might foster children's health literacy.

How Did Parents View the Impact of the Curriculum-Based HealthLit4Kids Program Beyond the Classroom?

The HealthLit4Kids program aims to build health literacy in a participatory and contextually relevant way. Whole-of-school and curriculum strategies aim to empower and build capacity to make informed health choices amongst students, teachers, parents, and their local community. The aim of this study was to evaluate the HealthLit4Kids program from the perspective of parents, using a Self-Determination Theory framework. This is one component within a larger evaluation of the program. Parents at four Australian primary schools were interviewed post-program. Qualitative data collected through parent interviews were analyzed thematically to identify themes, and coding checks were completed by experienced qualitative researchers. The three key themes identified were student engagement, behaviour change, and parent engagement. Findings also indicated that parents placed a high value on effective communication from schools and raised a range of health areas such as food and nutrition, physical activity, and mental health with the interviewer. Parent opinions of the HealthLit4Kids program were positive, with many reporting a perceived increase in their children's ability to understand, communicate and act on health-related knowledge at home. The HealthLit4Kids program requires further research to determine its viability as an optimal pedagogical strategy for the health literacy development of primary school-aged children.

Functional health literacy among left-behind students in senior high schools in an ethnic minority area: A cross-sectional study

To verify the validity of functional health literacy scale and analyze what influences functional health literacy.Using convenience sampling method based on cross-sectional data to select 589 left-behind senior high-school students in an ethnic minority area, using the functional health literacy scale.The scale results were relatively strong, and the absolute fitness index, value-added fitness index, and simple fitness index reached the fitness standards. The overall functional health literacy score was (0.65 ± 0.12), which falls within the upper middle class. Gender(t = 2.40, P < .05), ethnicity (t = 4.28, P < .001), place of residence (t =  = 4.51, P < .001), mother's education level (F = 3.608, P < .05), self-assessment of grades for 1 year (F = 25.781, P < .001), and whether the participant liked the health education content (F = 9.416, P < .001) had impacts on overall functional health literacy.The study results show that relatively satisfactory reliability and validity and can be applied further analysis for improving students functional health literacy levels.

The Canadian anaphylaxis action plan for kids: development and validation

OBJECTIVES

We designed a written Canadian Anaphylaxis Action Plan for Kids (Kids' CAP) which incorporates validated pictograms with written instructions. Using a patient-centered approach, we aimed to validate the Kids' CAP and assess its impact on anaphylaxis recognition and treatment, and to determine its' perceived usefulness.

PATIENT INVOLVEMENT

Children and their parents were involved in appraising the design and written contents of the Kids' CAP.

METHODS

The design process consisted of a development phase and clinical validation phase. First, we assessed the readability and understandability of the Kids' CAP using validated instruments. Then, patients (12-17 years of age) and parents of patients (<12 years of age) were given the Kids' CAP during the first consultation with allergy specialists or an Emergency Department visit for anaphylaxis. Subsequently, we conducted a phone interview 2-3 weeks later to assess their comprehension of anaphylaxis management. We also used the Consumer Information Rating Form to measure the participants' perception of the design quality and usefulness of the Kids' CAP.

RESULTS

Of the 230 participants enrolled, 205 (89%) completed the follow-up interview. The written contents of the Kid's CAP were modified to match grade 7 readability level. The total mean score of the Consumer Information Rating Form for comprehensibility was 23.1 (SD 2.4), and 25.1 (SD 2.3) for design quality. The mean comprehension score was 11.3 (SD 1.8) (reference range 0-12), with no significant difference between participants with and without previous experience with anaphylaxis, or high vs. low literacy level.

CONCLUSION

Engaging children and parents in the design and contents of written anaphylaxis action plan is an innovative approach to produce a useful document for the end-users.

PRACTICE IMPLICATIONS

The Kids' CAP is a valid tool that can be used in emergency departments and allergy clinics to improve patient's comprehension of anaphylaxis manifestations and treatment.

Parental education, health literacy and children's adult body height

Human anthropometric traits, while significantly determined by genetic factors, are also affected by an individual's early life environment. An adult's body height is a valid indicator of their living conditions in childhood. Parental education has been shown to be one of the key covariates of individuals' health and height, both in childhood and adulthood. Parental functional literacy has been demonstrated to be another important determinant of child health, but this has largely been overlooked in studies on height. The objective of this study was to analyse the associations between parents' education, their functional literacy and their children's adult body height. The study used data for 39,240 individuals from the 2016 wave of the nationally representative Life in Transition Survey (LITS) conducted in 34 countries in Southern and Eastern Europe, the Middle East and Central Asia. Using linear and Poisson models, regression adjustment treatment estimators and multilevel mixed-effects linear regressions, the study analysed the links between mother's and father's educational attainment, parental functional literacy, measured by the number of books in the childhood home, and children's adult height. The models also included other individual and contextual covariates of height. The results demonstrated that mother's educational attainment and parental functional literacy have independent associations with children's adult body height. Sufficient literacy skills of the parent may have a positive effect on children's growth even if parental education is low. These associations remained significant across time. The study also provides evidence of a widening of the height gap for men born in the period just before and after systemic transition in post-socialist societies, which may suggest an increase in social differences in early living standards.

Poor Performance of Children Age 7 to 13 Years on the Newest Vital Sign

Valid and reliable instruments are needed to assess health literacy in children. Although the Newest Vital Sign (NVS) has been well established for use in adults, reports of its use in children have only recently received attention in the literature. Whereas some researchers have reported successful use of the NVS in children as young as age 7 years, others have suggested it is best used in children age 10 years and older. This analysis reports on the performance of the NVS in children age 7 to 13 years, adding to the growing evidence related to the use of the NVS in pediatric populations. Overall, children in this sample performed poorly on the NVS, which refutes previous reports. Differences in child samples and NVS administration procedures may provide some explanation for the lower-than-anticipated NVS performance in this sample. Interpreting the NVS based on educational standards and expectations may provide additional information to determine age-appropriate recommendations for NVS use in children. [HLRP: Health Literacy Research and Practice. 2018;2(4):e175–e179.]

How Well Do Children Understand the Vocabulary of Sleep?

BACKGROUND

Sleep surveys, such as the Pediatric Daytime Sleepiness Scale (PDSS), are used to determine a variety of concerns associated with sleep, including excessive daytime sleepiness (hypersomnolence), bedtime sleep behaviors, night awakenings, sleep duration, and sleep-disordered breathing. However, the literacy ability of the patient may not be adequate to ensure comprehension of questions and provision of accurate responses.

OBJECTIVE

To assess children's understanding of the sleep-associated vocabulary included in the PDSS.

METHODS

A cross-sectional, open-response survey was developed for use with students age 4 to 12 years. Prior to completing the instrument, each student was asked the meaning of six key sleep-related words used in the PDSS: drowsy, sleepy, alert, awakened, tired, and awake. The parents/caregivers were requested to record their child's definitions of these key words exactly as stated. Identification of words for "suitable" definitions was undertaken through consultation of three online dictionaries. This enabled the qualitative process associated with open-response surveys to be followed: identification of common themes, chunking of information, and criteria for coding responses. The final sample consisted of word definitions from 325 students (152 boys and 173 girls) from a school enrollment of 727 (45%).

KEY RESULTS

A high percentage of children provided "suitable" responses for the words sleepy (84%) and tired (75%). The percentage of "suitable" responses for the words drowsy and awakened gradually increased across the age groups. The words alert and awake were challenging for the children to define, with the sleep-associated definition for alert only being provided by 31% of children overall and awake only being provided by 48% overall. In total, 57% of children were able to provide suitable definitions for at least four words.

CONCLUSIONS

Our findings suggest that the results of many sleep surveys using these terms may not yield results that accurately reflect a child's actual state of daytime sleepiness and sleep/wake behaviors. Prior to administering a sleep survey, physicians need to clearly explain the meanings of sleep-associated words used in the survey and thus gain a more accurate reflection of a child's sleep and daytime behaviors. [HLRP: Health Literacy Research and Practice. 2019;3(1):e53-e69.].

PLAIN LANGUAGE SUMMARY

Sleep surveys are used to identify problems with sleep. Children with poor health literacy due to age may not understand the questions and may not provide adequate answers. Children's understanding of sleep-associated vocabulary was assessed using six words: drowsy, sleepy, alert, awakened, tired, and awake. Many of these words were found to be difficult for the children to define.

Life satisfaction in children with attention deficit hyperactivity disorder: Looking beyond proxy reports

PROBLEM

A common clinical approach to children with attention deficit hyperactivity disorder (ADHD) is to view them through an adult-proxy report of problems. There is little evidence on how children with ADHD evaluate their life satisfaction, how their evaluations compare with unaffected children, or how their perspectives might inform clinical practice.

METHODS

A parallel convergent mixed-methods design was used to interview 20 children (aged, 7-11 years) with ADHD. This report presents the children's responses to the 40-item Multidimensional Student Life Satisfaction Scale. Parents/guardians ( N = 20) provided contextual data consisting of demographics, ADHD-related items, and health literacy.

FINDINGS

Total life satisfaction (M = 3.08, SD = 0.35) fell within the 95% CI [2.91, 3.25] of comparative data. Overall subscale ratings (high to low) included: friends (M = 3.24, SD = 0.60), living environment (M = 3.14, SD = 0.51), family (M = 3.08, SD = 0.51), school (M = 3.0, SD = 0.65), and self (M = 2.93, SD = 0.60). Positive and negative associations are reported.

CONCLUSIONS

Including a measure of life satisfaction adds a child-centered approach to understanding children with ADHD beyond an adult-proxy report of problems that is contextually and clinically relevant.

Do adolescents understand the items of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) - German version? Findings from cognitive interviews of the project "Measurement of Health Literacy Among Adolescents" (MOHLAA) in Germany

Background

In Germany, there are no measurement tools to assess the general health literacy of adolescents. The aim of the study "Measurement of Health Literacy Among Adolescents" (MOHLAA) is to develop such a tool for use among adolescents aged 14-17. The German version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47-GER) served as a blueprint for the development of the tool. The present study examined the extent to which the HLS-EU-Q47-GER can be applied to the measurement of general health literacy in adolescents.

Methods

The applicability of the HLS-EU-Q47-GER for adolescents was tested qualitatively using cognitive interviewing (CI). Purposive sampling was used to achieve an equal distribution of participants regarding age groups, educational backgrounds and gender. CI was standardized on the basis of an interview guide. Verbal probing and the retrospective think-aloud technique were applied. The interviews were audio-recorded, transcribed and analyzed using the criteria of theory-based analysis, which were derived from the model of cognitive processes. The analysis focused on identifying terms and questions that were difficult to understand and on scrutinizing the extent to which the content of the items is appropriate for assessing adolescents' health literacy.

Results

Adolescent respondents were unfamiliar with some terms of the HLS-EU-Q47-GER or provided heterogeneous interpretations of the terms. They had limited or no experience regarding some health-related tasks in health care and disease prevention that are addressed by HLS-EU-Q-items. A few items seemed to be too "difficult" to answer due to a high abstraction level or because they lacked any reference to the everyday lives of youth. Despite comprehension problems with some of the HLS-EU items, the respondents assessed the covered health-related tasks as "very easy" or "fairly easy". CI stressed the importance of interpersonal agents, especially parents, in helping adolescents understand and judge the reliability of health information.

Conclusions

The results of CI indicated that the applicability of the HLS-EU-Q47-GER to the measurement of general health literacy among adolescents aged 14-17 is limited. In order to prevent biased data, some items of the questionnaire should be adjusted to adolescents' state of development and experiences with health care and disease prevention.

Quality of health literacy instruments used in children and adolescents: a systematic review

OBJECTIVE

Improving health literacy at an early age is crucial to personal health and development. Although health literacy in children and adolescents has gained momentum in the past decade, it remains an under-researched area, particularly health literacy measurement. This study aimed to examine the quality of health literacy instruments used in children and adolescents and to identify the best instrument for field use.

DESIGN

Systematic review.

SETTING

A wide range of settings including schools, clinics and communities.

PARTICIPANTS

Children and/or adolescents aged 6-24 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Measurement properties (reliability, validity and responsiveness) and other important characteristics (eg, health topics, components or scoring systems) of health literacy instruments.

RESULTS

There were 29 health literacy instruments identified from the screening process. When measuring health literacy in children and adolescents, researchers mainly focus on the functional domain (basic skills in reading and writing) and consider participant characteristics of developmental change (of cognitive ability), dependency (on parents) and demographic patterns (eg, racial/ethnic backgrounds), less on differential epidemiology (of health and illness). The methodological quality of included studies as assessed via measurement properties varied from poor to excellent. More than half (62.9%) of measurement properties were unknown, due to either poor methodological quality of included studies or a lack of reporting or assessment. The 8-item Health Literacy Assessment Tool (HLAT-8) showed best evidence on construct validity, and the Health Literacy Measure for Adolescents showed best evidence on reliability.

CONCLUSIONS

More rigorous and high-quality studies are needed to fill the knowledge gap in measurement properties of health literacy instruments. Although it is challenging to draw a robust conclusion about which instrument is the most reliable and the most valid, this review provides important evidence that supports the use of the HLAT-8 to measure childhood and adolescent health literacy in future school-based research.

Canadian adaptation of the Newest Vital Sign©, a health literacy assessment tool

OBJECTIVE

The Newest Vital Sign© (NVS) was developed in the USA to measure patient health literacy in clinical settings. We adapted the NVS for use in Canada, in English and French, and created a computerized version. Our objective was to evaluate the reliability of the Canadian NVS as a self-administered computerized tool.

DESIGN

We used a randomized crossover design with a washout period of 3-4 weeks to compare health literacy scores obtained using the computerized version with scores obtained using the standard interviewer-administered NVS. ANOVA models and McNemar's tests assessed differences in outcomes assessed with each version of the NVS and order effects of the testing.

SETTING

Participants were recruited from multicultural catchment areas in Ontario and Nova Scotia.

SUBJECTS

English- and French-speaking adults aged 18 years or older.

RESULTS

A total of 180 (81 %) of the 222 adults (112 English/110 French) initially recruited completed both the interviewer-NVS and computer-NVS. Scores for those who completed both assessments ranged from 0 to 6 with a mean of 3·63 (sd 2·11) for the computerized NVS and 3·41 (sd 2·21) for the interview-administered NVS. Few (n 18; seven English, eleven French) participants' health literacy assessments differed between the two versions.

CONCLUSIONS

Overall, the computerized Canadian NVS performed as well as the interviewer-administered version for assessing health literacy levels of English- and French-speaking participants. This Canadian adaptation of the NVS provides Canadian researchers and public health practitioners with an easily administered health literacy assessment tool that can be used to address the needs of Canadians across health literacy levels and ultimately improve health outcomes.

The Relationship Between Health Literacy and Health Conceptualizations:An Exploratory Study of Elementary School-Aged Children

Analyzing children's conceptualizations of health and body and health literacy will significantly add understanding to how problematic health attitudes and behaviors may take root (Driessnack, Chung, Perkhounkova, & Hein, 2014). The knowledge gained from such an assessment can be applied towards communication contexts that aim to promote children's health literacy and their well-being. With increased health literacy, children can actively participate in decision-making regarding their own health and can understand why healthy behaviors are important to adult health (Borzekowski, 2009). The purpose of this exploratory study was to examine the understudied intersection between health literacy and health conceptualizations in children in order to elaborate on health literacy theory. Specifically, the findings contribute to health communication between children and their caregivers, and between children and health care providers. Qualitative, in depth interviews were conducted with elementary school children. The significance of the study is its contribution to health communication for children, where interventions can consider health literacy types and levels before addressing children's health outcomes. Findings show how we can understand children's conceptualizations and can address health literacy skills inside and out of the classroom in ways that resonate with children.

Generic health literacy measurement instruments for children and adolescents: a systematic review of the literature

BACKGROUND

Health literacy is an important health promotion concern and recently children and adolescents have been the focus of increased academic attention. To assess the health literacy of this population, researchers have been focussing on developing instruments to measure their health literacy. Compared to the wider availability of instruments for adults, only a few tools are known for younger age groups. The objective of this study is to systematically review the field of generic child and adolescent health literacy measurement instruments that are currently available.

METHOD

A systematic literature search was undertaken in five databases (PubMed, CINAHL, PsycNET, ERIC, and FIS) on articles published between January 1990 and July 2015, addressing children and adolescents ≤18 years old. Eligible articles were analysed, data was extracted, and synthesised according to review objectives.

RESULTS

Fifteen generic health literacy measurement instruments for children and adolescents were identified. All, except two, are self-administered instruments. Seven are objective measures (performance-based tests), seven are subjective measures (self-reporting), and one uses a mixed-method measurement. Most instruments applied a broad and multidimensional understanding of health literacy. The instruments were developed in eight different countries, with most tools originating in the United States (n = 6). Among the instruments, 31 different components related to health literacy were identified. Accordingly, the studies exhibit a variety of implicit or explicit conceptual and operational definitions, and most instruments have been used in schools and other educational contexts. While the youngest age group studied was 7-year-old children within a parent-child study, there is only one instrument specifically designed for primary school children and none for early years.

CONCLUSIONS

Despite the reported paucity of health literacy research involving children and adolescents, an unexpected number of health literacy measurement studies in children's populations was found. Most instruments tend to measure their own specific understanding of health literacy and not all provide sufficient conceptual information. To advance health literacy instruments, a much more standardised approach is necessary including improved reporting on the development and validation processes. Further research is required to improve health literacy instruments for children and adolescents and to provide knowledge to inform effective interventions.

Parents' Underestimations of Child Weight: Implications for Obesity Prevention

PURPOSE

Obesity prevention efforts may be ineffective if parents lack awareness of their children's overweight status. This study examined the factors that predicted parents' underestimation of child weight status.

DESIGN AND METHODS

Using a cross sectional design, researchers recruited children and parents in a local children's museum. Parents completed a demographic questionnaire, the Newest Vital Sign, and the Child Body Image Scale. Children's height and weight were measured to calculate child BMI. Random effects modeling examined the association between predictor variables (parent race/ethnicity, income, education, and health literacy, and child BMI percentile, gender, and age) and the dependent variable, parent underestimation of child weight status.

RESULTS

Participants included 160 parents (213 children aged 7-12years) representing a racially and ethnically diverse sample who were affluent, educated, and with 36.6% of parents assessed with limited health literacy. Although 45.1% of children were overweight/obese, only 7.5% of parents chose this weight status; 80% of parents underestimated the weight of their normal weight children, 96% underestimated their overweight children, and 72% underestimated their obese children. Parents were more likely to underestimate weight of older children and those under 81st percentile of BMI. No other predictors were significant.

CONCLUSIONS

Parent underestimation of child weight status appears to be a widespread phenomenon in this sample, regardless of race, ethnicity, income, education, and health literacy.

PRACTICE IMPLICATIONS

The consistent underestimation of child weight suggests that parents' misperception of weight status represents a critical pathway for intervention. Methods to improve parents' perception of child weight need be developed and tested.

Assessment of health literacy with the Newest Vital Sign and its correlation with body mass index in female adolescent students

Background One of the significant outcomes of health education is health literacy (HL), which should be expanded to improve health promotion. Objective The aim of this study was to assess HL and its relationship with Body Mass Index (BMI) in female adolescent students. Subjects This study was conducted on 235 female students (aged 13-15 years) which were selected with cluster sampling. Methods For assessing HL, the Newest Vital Sign (NVS) was used and BMI Z-score was evaluated following the World Health Organization (WHO) guidelines. Data were analyzed using SPSS version 16. Results Based on this study's results, 11.5%, 37% and 51.5% of adolescents had adequate HL, limited HL and inadequate HL, respectively. There was a negative correlation between adolescents HL and BMI, rs = -0.233 (p < 0.001). Conclusion Most of adolescents had limited HL and students with higher BMI had a worse HL score. As a matter of fact, as adequate HL has a significant role for promoting health in the society policy makers must design educational programs for adolescents especially in non-medical settings such as schools where adolescents spend most of their time.

Health Literacy in Adolescents With Sickle Cell Disease

PURPOSE

To evaluate health literacy in a cohort of 75 adolescents with sickle cell disease (SCD).

DESIGN AND METHODS

This cross-sectional, descriptive correlational study included assessment of demographic measures and appraisal of data resulting from completion of the REALM-Teen and Newest Vital Sign (NVS) instruments by 75 Black, non-Hispanic adolescents with SCD. Convenience sampling was utilized. Inclusion criteria were a diagnosis of one of the four primary genotypes of SCD and age 10-19years.

RESULTS

Thirty-seven males and 38 females were recruited for the study. Their mean age was 14.7years (SD=2.2; range 8.1). Their grade level ranged from 4 to 12 (mean 8.7; SD=2.2). Scores on the REALM-Teen ranged from 12 to 66 (mean 53.7; SD=12.8). Scores on the NVS ranged from 0 to 6 (mean 2.37; SD=1.33). These health literacy scores were lower using both the REALM-Teen and the NVS instruments when compared to scores in all healthy adolescents and adults. Current grade level and health literacy scores showed a moderately high positive correlation (r=0.52, p<0.01). Health literacy scores were also significantly positively correlated with age (r=0.49, p<0.01) and income (r=0.37, p<0.01).

CONCLUSIONS

Health literacy in adolescents with SCD is suboptimal. Future research should include identifying facilitators and barriers to health literacy levels in a larger cohort of adolescents with SCD.

PRACTICE IMPLICATIONS

Health literacy is a potential facilitator of successful health outcomes for all adolescents. This study lays a solid foundation for future adolescent health literacy initiatives.

Does the use of the Informed Healthcare Choices (IHC) primary school resources improve the ability of grade-5 children in Uganda to assess the trustworthiness of claims about the effects of treatments: protocol for a cluster-randomised trial

BACKGROUND

The ability to appraise claims about the benefits and harms of treatments is crucial for informed health care decision-making. This research aims to enable children in East African primary schools (the clusters) to acquire and retain skills that can help them make informed health care choices by improving their ability to obtain, process and understand health information. The trial will evaluate (at the individual participant level) whether specially designed learning resources can teach children some of the key concepts relevant to appraising claims about the benefits and harms of health care interventions (treatments).

METHODS

This is a two-arm, cluster-randomised trial with stratified random allocation. We will recruit 120 primary schools (the clusters) between April and May 2016 in the central region of Uganda. We will stratify participating schools by geographical setting (rural, semi-urban, or urban) and ownership (public or private). The Informed Healthcare Choices (IHC) primary school resources consist of a textbook and a teachers' guide. Each of the students in the intervention arm will receive a textbook and attend nine lessons delivered by their teachers during a school term, with each lesson lasting 80 min. The lessons cover 12 key concepts that are relevant to assessing claims about treatments and making informed health care choices. The second arm will carry on with the current primary school curriculum. We have designed the Claim Evaluation Tools to measure people's ability to apply key concepts related to assessing claims about the effects of treatments and making informed health care choices. The Claim Evaluation Tools use multiple choice questions addressing each of the 12 concepts covered by the IHC school resources. Using the Claim Evaluation Tools we will measure two primary outcomes: (1) the proportion of children who 'pass', based on an absolute standard and (2) their average scores.

DISCUSSION

As far as we are aware this is the first randomised trial to assess whether key concepts needed to judge claims about the effects of treatment can be taught to primary school children. Whatever the results, they will be relevant to learning how to promote critical thinking about treatment claims. Trial status: the recruitment of study participants was ongoing at the time of manuscript submission.

TRIAL REGISTRATION

Pan African Clinical Trial Registry, trial identifier: PACTR201606001679337 . Registered on 13 June 2016.

Emphasizing the child in child health literacy research

Child health literacy is a 'hot topic' of late, as researchers and practitioners work to attain an equitable and healthy future. Health literacy emphasizes the wide range of skills that people need to access, understand, evaluate and use health information to promote good health. In light of the recognition that health literacy is an important determinant of health for adults, addressing child health literacy early on is essential to maximize future health outcomes. Meeting children's specific needs arguably includes the delivery of information that can be easily accessed and understood by younger age groups. While much academic discourse pertains to the importance of building parental health literacy, there is less literature that explicitly focuses on child-centred health literacy. On the premise that health literacy is an asset, this paper provides an argument for investing in children's health literacy by working with children to encourage meaningful contributions in research and practice.

A cognitive approach for design of a multimedia informed consent video and website in pediatric research

OBJECTIVE

Poor participant comprehension of research procedures following the conventional face-to-face consent process for biomedical research is common. We describe the development of a multimedia informed consent video and website that incorporates cognitive strategies to enhance comprehension of study related material directed to parents and adolescents.

MATERIALS AND METHODS

A multidisciplinary team was assembled for development of the video and website that included human subjects professionals; psychologist researchers; institutional video and web developers; bioinformaticians and programmers; and parent and adolescent stakeholders. Five learning strategies that included Sensory-Modality view, Coherence, Signaling, Redundancy, and Personalization were integrated into a 15-min video and website material that describes a clinical research trial.

RESULTS

A diverse team collaborated extensively over 15months to design and build a multimedia platform for obtaining parental permission and adolescent assent for participant in as asthma clinical trial. Examples of the learning principles included, having a narrator describe what was being viewed on the video (sensory-modality); eliminating unnecessary text and graphics (coherence); having the initial portion of the video explain the sections of the video to be viewed (signaling); avoiding simultaneous presentation of text and graphics (redundancy); and having a consistent narrator throughout the video (personalization).

DISCUSSION

Existing conventional and multimedia processes for obtaining research informed consent have not actively incorporated basic principles of human cognition and learning in the design and implementation of these processes. The present paper illustrates how this can be achieved, setting the stage for rigorous evaluation of potential benefits such as improved comprehension, satisfaction with the consent process, and completion of research objectives.

CONCLUSION

New consent strategies that have an integrated cognitive approach need to be developed and tested in controlled trials.

Health and Nutrition Literacy and Adherence to Treatment in Children, Adolescents, and Young Adults With Chronic Kidney Disease and Hypertension, North Carolina, 2015

Introduction

Adherence to treatment and dietary restrictions is important for health outcomes of patients with chronic/end-stage kidney disease and hypertension. The relationship of adherence with nutritional and health literacy in children, adolescents, and young adults is not well understood. The current study examined the relationship of health literacy, nutrition knowledge, nutrition knowledge–behavior concordance, and medication adherence in a sample of children and young people with chronic/end-stage kidney disease and hypertension.

Methods

We enrolled 74 patients (aged 7–29 y) with a diagnosis of chronic/end-stage kidney disease and hypertension from the University of North Carolina Kidney Center. Participants completed instruments of nutrition literacy (Disease-Specific Nutrition Knowledge Test), health literacy (Newest Vital Sign), nutrition behavior (Nutrition Knowledge–Behavior Concordance Scale), and medication adherence (Morisky Medication Adherence Scale). Linear and binary logistic regressions were used to test the associations.

Results

In univariate comparisons, nutrition knowledge was significantly higher in people with adequate health literacy. Medication adherence was related to nutrition knowledge and nutrition knowledge–behavior concordance. Multivariate regression models demonstrated that knowledge of disease-specific nutrition restrictions did not significantly predict nutrition knowledge–behavior concordance scores. In logistic regression, knowledge of nutrition restrictions did not significantly predict medication adherence. Lastly, health literacy and nutrition knowledge–behavior concordance were significant predictors of medication adherence.

Conclusion

Nutrition knowledge and health literacy skills are positively associated. Nutrition knowledge, health literacy, and nutrition knowledge–behavior concordance are positively related to medication adherence. Future research should focus on additional factors that may predict disease-specific nutrition behavior (adherence to dietary restrictions) in children and young people with chronic conditions.