Initial development of the Health Literacy and Resiliency Scale: Youth version

Using co-design to develop the Adolescent Health Literacy Questionnaire for adolescents in Ireland

Health literacy measurement studies are important for the success of health promotion efforts targeting adolescents. However, the majority of health literacy measurement tools were originally developed for adult populations and may not be reflective of health literacy in the context of adolescence. The present study sought to co-design a health literacy questionnaire and vignettes for adolescents in Ireland aged 12-18 years. This article describes the qualitative phase of the study. In 2019-2021, eight adolescents from the Irish Heart Foundation's Youth Advisory Panel participated in two concept mapping workshops during which they defined healthy living. Results of the thematic analysis indicated that adolescents defined 'healthy living' as a life that was balanced, prioritizing mental health and sleep. According to their definition, healthy living was comprised of six main constructs, namely, knowledge; sources of quality health information; facilitators and barriers; influence of others; self-efficacy, self-management and resilience; and citizenship and communication. These constructs were used to develop vignettes and items for the Adolescent Health Literacy Questionnaire (AHLQ). These were tested on a sample of 80 adolescents to check whether the respondents understood the items and vignettes as intended. Results of the nine cognitive interviews indicated that the adolescents understood the content of the 10 vignettes and 41 items. While the vignettes and AHLQ were developed with Irish adolescents, the approaches taken can be generalized to adolescents living in other countries. This will allow for the development of tailored and relevant solutions for health literacy development and health promotion for this sub-population.

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021

BACKGROUND

It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages.

METHODS

The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021.

RESULTS

The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties.

CONCLUSION

This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.

Perceptions of School Life and Academic Success of Adolescents With Asthma

Adolescents spend approximately one-third of their day at school. With the growing prevalence of adolescent asthma, 1 in every 10 adolescents copes with asthma throughout the day, including in the school environment. Yet, little is known about the school experiences of adolescent students with asthma. Guided by the social-ecological model, this study aimed to explore the links between asthma and school experiences in middle and high school as perceived by students with asthma. In-depth interviews were conducted with 20 adolescents with asthma aged 12 to 17 who attended middle or high school around the mid-west area of Florida. Students shared insights on their school experiences and academic performance. Data were analyzed and interpreted using thematic analysis. Four overarching and intertwined themes shaped the school experiences of students with asthma: 1. Asthma control and management; 2. Social support; 3. Asthma knowledge and awareness; and 4. Accommodation of health and academic needs. Study findings suggest addressing the school disparities of adolescent students with asthma through a comprehensive, multi-level approach. Schools should create asthma education opportunities, improve the school system and environmental accommodations, enhance asthma control, and increase continuous social support by peers and school personnel.

Content validity of the Japanese version of the health literacy and resiliency scale for youth with chronic illness

Health literacy, which is the ability to find, understand, and use information as well as services to make informed health-related decisions and actions, is essential for ensuring that youths with chronic diseases adapt to and live with their illnesses. However, in Japan, an appropriate approach for measuring health literacy levels among children is yet to be developed. The Health Literacy and Resiliency Scale for Youth (HLRS-Y) was developed by Kathy Bradley-Klug and her colleagues to assess health literacy, resiliency, and self-advocacy/support among youths aged between 13 and 21 years with chronic illnesses in the United States of America (United States). In this study, we aimed to develop a Japanese version of the HLRS-Y and evaluate its content validity. After receiving approvals from the original authors, four nurse researchers with expertise in pediatric nursing translated the scale into Japanese (forward translation). Afterwards, the appropriateness of each expression was examined by a pediatrician. Next, an English native speaker translated the expressions into English (back-translation). We reported the back-translated version of the scale to the original authors to confirm its accuracy. The scale's content validity index (CVI) was evaluated by health professionals working in the fields of pediatric, transitional, and adult health care. The participants rated the items using a four-point scale. Each item was evaluated for a minimum item-level content validity index (I-CVI) value of 0.78. The scale's total and subscale validities were evaluated using a minimum scale-level content validity index based on an average (S-CVI/Ave) value of 0.90. Eleven participants responded to an online survey for evaluating content validity. Of the 36 items, 34 met the I-CVI criteria. Two items did not exceed the criteria's value, but they approximated it. The values of the S-CVI/Ave were 0.96, thereby satisfying the criteria's requirements. Based on the results, it was confirmed that the Japanese version of the HLRS-Y had good content validity. Future studies should examine the factor validity, known group validity, and reliability of this scale.

Health Knowledge and Adherence as Predictors of Viral Burden and CD4+ T-Cell Count in Youth and Young Adults Living With HIV

Health literacy influences HIV treatment for youth and, thus, is a research priority. We explored health knowledge and self-reported adherence, as indicators of health literacy, among youth living with HIV (YLWH) and the association between health literacy and health outcomes. A total of 102 YLWH ages 13-25 years participated in the study. Participants completed the Brief Estimate of Health Knowledge and Action-HIV Version; CD4 T-cell counts and viral loads were extracted from participant medical records. Participants had a moderate amount of HIV knowledge, and most reported taking their medications under most conditions. Decreasing action scores were statistically associated with an increased likelihood of having a detectable viral load. Health literacy is an important factor that should be addressed by practitioners working with YLWH. More research is needed to determine the best way to measure and improve health literacy.