Emphasizing the child in child health literacy research

Subjective health literacy skills among Greek secondary school students: results from a national-wide survey

Health literacy is a significant element of education and is inextricably linked to children's and adolescents' growth and prosperity. It is critical to monitor students' health literacy on a nationwide scale and identify the factors that influence it in order to create policies that advance it. The purpose of this study was to determine the health literacy level of Greek secondary school students and to correlate it with possible determinants such as personal and family characteristics, social support and personal and/or family illness experiences. A representative sample of 2749 seventh-, ninth-, and tenth-grade students was involved. Results showed that a higher motivation to learn about health topics and having positive social interactions and support were strongly associated with a higher level of health literacy. Gender, high academic achievement, absence of learning disabilities, gender, preference for biology and informatics and primary source of health information were also found to influence the skills' level. In order to enhance health literacy, the Greek educational system should take measures to include health literacy skills development goals in their curricula.

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.

Healthcare access for children in a low-income area in Cape Town: A mixed-methods case study

BACKGROUND

 In Cape Town, the under-5 mortality rate has plateaued to 20 per 1000 live births, with 60% of child deaths occurring out of hospital. The southern subdistrict has the largest paediatric population in Metro West and accounts for 31% of deaths. This study aimed to uncover the access barriers and facilitators underlying this high burden of out-of-hospital deaths.

METHODS

 An exploratory mixed-methods case study design employed three data collection strategies: a quantitative survey with randomly sampled community members, semi-structured interviews with purposively sampled caregivers whose children presented critically ill or deceased (January 2017 - December 2020) and a nominal group technique (NGT) to build solution-oriented consensus among purposively sampled health workers, representing different levels of care in the local health system.

RESULTS

 A total of 62 community members were surveyed, 11 semi-structured caregiver interviews were conducted, and 11 health workers participated in the NGT. Community members (74%) experienced barriers in accessing care. Knowledge of basic home care for common conditions was limited. Thematic analysis of interviews showed affordability, acceptability, and access, household and facility factor barriers. The NGT suggested improvement in community-based services, transport access and lengthening service hours would facilitate access.

CONCLUSION

 While multiple barriers to accessing care were identified, facilitators addressing these barriers were explored. Healthcare planners should examine the barriers within their geographic areas of responsibility to reduce child deaths.Contribution: This study uncovers community perspectives on childhood out-of-hospital deaths and makes consensus-based recommendations for improvement.

Are exposure to health information and media health literacy associated with fruit and vegetable consumption?

BACKGROUND

Health information promotes a healthy lifestyle; however, media health literacy (MHL) is essential to personal intake, especially fruit and vegetables (F&V). This study aimed to determine how exposure to health information and MHL affect F&V consumption among Thai youth aged 10-14 years. Health behavior at this age can be an important determinant of consumption habits when transitioning into adulthood.

METHODS

A stratified two-stage sample survey was conducted to recruit 1,871 youth across regions to be nationally representative. Qualtrics offline survey application was used for data collection face-to-face with all respondents. Multiple linear regression was used to analyze the explanatory variables on fruit consumption and vegetable consumption.

RESULTS

This study found that almost 70% of Thai youth were exposed to health-related content via the Internet, and had low analytical skills to process that information. Grade Point Average (GPA), exposure to health information, various media types, frequency of exposure to health information, and MHL influenced the frequency of F&V intake. Health status related to fruit intake, age, place of residence, amount of pocket money, and body mass index (BMI) were associated with F&V consumption.

CONCLUSION

Exposure to health information and MHL are associated with F&V intake. Therefore, exposure to health information and MHL should be addressed for policy formulation in Thai schools and the health system.

Playful educational interventions in children and adolescents' health literacy: a systematic review

There is a need to investigate methods to increase children's health knowledge. Therefore, the aim of this study was to systematically evaluate the literature on playful educational interventions in health literacy aimed at children aged 6-12 years. For this purpose, the Cochrane Library, EMBASE, LILACS, PubMed, Scopus, Web of Science and grey literature were searched for relevant studies. Randomized, quasi-randomized or non-randomized clinical trials, in which the primary outcome was health literacy in children, were included. Due to the heterogeneity of the studies, the data were qualitatively evaluated. Eleven studies were included in this analysis. Most of the studies were randomized (n = 10). Among the health issues addressed in these studies, obesity prevention was the most studied (n = 5). All participants had low methodological quality, and the most commonly used interventions were games, dramas and theatre plays. Although most studies have pointed to an increase in health knowledge after interventions, it was not possible to determine whether such knowledge was retained over time, whether it effectively changed health behaviours, or if it led to the effective adoption of a healthier lifestyle. Health literacy through playful methods is potentially effective in increasing health knowledge and changing health behaviours. However, literature on its impact on the adoption of healthy lifestyles is inconclusive. Future research with fewer limitations and better methodological designs may help selecting the best intervention strategy to promote health literacy.

HealthLit4Kids: teacher experiences of health literacy professional development in an Australian primary school setting

Health literacy (HL) is a critical asset for 21st century learners to possess given its positive impact on health outcomes and educational attainment. Concerningly, HL is an area that primary school teachers report having a lack of understanding, confidence, and ability to teach. The HealthLit4Kids initiative aimed to address this issue through a series of teacher professional development (PD) workshops. To evaluate how teachers experienced the PD, teacher evaluations collected at the completion of each of the workshops were analysed using a mixed methods approach. According to the teachers, the PD had improved their understanding of HL, including how to implement it into their practice. The study also found that the teachers perceived that collaborative practice was a key strength of the programme, and that at the end of the PD, teachers described valuing HL more in their practice. Teachers reported time as a major barrier to them implementing the professional learning and suggested further resources could help to mitigate this barrier. Additional research is required to help substantiate the claims made in this research. This study also highlights the critical need for additional HL resources for primary school teachers.

Health Literacy Among Young People in Africa: Evidence Synthesis

Background

Health literacy has critical health implications. Health literacy in young people is a pressing matter as it determines their current and future health. Although health literacy research is increasing, there are limited health literacy studies from Africa. The aim of this study was to provide a coherent summary and synthesis of the available health literacy studies among young people in Africa.

Methods

A systematic scoping review was chosen to attain the aim of this study. PubMed, CINAHL, AJOL, JBI EBP, EBSCO, and Google Scholar were searched for evidence. Based on JBI's methodology for reviews, a three-step search strategy was employed. The search was conducted up to April 20, 2022. The PRISMA flow diagram guideline was used to ensure a transparent reporting of the review process.

Results

The search for evidence identified 386 records, of which 53 were selected and their full texts were assessed for eligibility. Nine studies matched the eligibility criteria. The main findings of the eligible studies are: health literacy levels, association between health literacy and health outcomes, and predictors of health literacy among young people. Low health literacy was common among young people, and there was a significant association between low health literacy and negative health outcomes among this group. Health literacy among young people was impacted by a wide range of socio-demographic factors.

Conclusion

Health literacy studies among young people in Africa were rare. Although the reviewed studies shed some light on health literacy levels, the association between health literacy and health outcomes, and the predictors of health literacy among young people, they may not give an accurate picture of health literacy among young people, for several reasons. Both primary and secondary health literacy studies are needed to fully understand the issue, and to develop and guide policies and interventions in Africa.

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.

The imperative to develop health literacy: An ethical evaluation of HealthLit4Kids

An imperative exists to promote health literacy (HL) development in today's young people. Included in curricula worldwide, health literacy has been recognised as a social determinant in its own right, which has the potential to redress inequity and positively impact health and educational outcomes. While it has been shown that schools provide an ideal setting to support HL development, available evidence suggests that health may be undertaught in primary schools, and further resources are required to support educators' inclusion of HL in their lessons. The aims of this paper were to (1) highlight the ethical imperative to promote HL through schools and (2) provide an ethical evaluation of an existing HL intervention. Spike's (2018) four principles for public health ethics were employed as a framework for evaluating a program's ethical status and suitability in the school setting. In this paper, one program, HealthLit4Kids, is evaluated according to Spike's framework, and shown to be an ethically acceptable approach to foster HL in young people. These results model how other HL programs may be evaluated and offer critical insights concerning how HL could be promoted in an ethically acceptable manner in the classroom.

Promoting food literacy in primary school classrooms through the HealthLit4Kids Program in Australia

Food literacy (FL) refers to the knowledge, skills, and behaviours associated with healthy eating. Schools are recognised as an important setting for FL promotion during childhood. HealthLit4Kids is an Australian primary school intervention that engages students, families, and educators to promote health literacy. This study aimed to assess the promotion of FL, a subtype of health literacy, in primary school classrooms across five schools. Teachers planned and implemented classroom activities over a 12-month period. Researchers examined lesson plans created by teachers and ‘artefacts’ (e.g. drawings, models) created by students during activities. Most classroom activities considered the nutritional knowledge and interpersonal communication skills associated with healthy eating, whereas fewer activities addressed students’ ability to critically analyse and apply information relating to food. The FL themes considered most frequently in classroom activities were ‘food and health choices’, ‘knowledge’, and ‘skills and behaviour’. Whereas the FL themes considered less frequently were ‘food systems’, ‘emotion’, and ‘culture’. The delivery of classroom activities was supported by the integration of other curriculum areas (e.g. The Arts and English). Future studies are required to understand how school-based interventions can promote the areas of FL that were less frequently addressed in this intervention in the classroom and beyond.

Development and validation of an instrument for the health literacy assessment of secondary school students (HeLiASeSS)

Purpose

The development of health literacy skills is of paramount importance especially for students, as it is associated with their wellbeing and academic success. Assessing students' health literacy is necessary for its advancement. This study comes to fill the need for a valid multidimensional health literacy assessment instrument for secondary school students.

Design/methodology/approach

Initially, the authors defined the conceptual framework within which the items of this instrument were generated. Its final form was obtained through three pilot studies. A test-retest followed and, finally, a nationwide survey was conducted on Greek seventh-, ninth- and tenth-grade students (N = 2,800).

Findings

A 37-item instrument, the Health Literacy Assessment for Secondary School Students (HeLiASeSS), was developed which includes the following nine dimensions/skills of health literacy: “access to”, “understand” and “evaluate” (health information), “functional communication”, “interactive communication” and “critical communication”, “relying on health information”, “self-efficacy regarding health matters” and “intention for active citizenship regarding health matters”. HeLiASeSS proved to have good stability (ICC = 0.943) and high internal consistency reliability (a = 0.903).

Originality/value

HeLiASeSS offers the possibility of a reliable and valid assessment of secondary school students' health literacy skills providing a multidimensional evaluation of this construct and is expected to be useful in interventions aiming at promoting this type of literacy.

Living with food allergy: What this means for children

Health-related knowledge, skills and attitudes that translate to behaviours are important foundations for healthy living. However, deficiencies in any one of these factors have the potential to impact quality of life. This study investigates how Australian children perceive and manage their food allergy as they transition through childhood onto adolescence. To measure this, children aged 12 years and under completed an online survey [under 8 years and 8-12 years] on knowledge, skills and attitudes. Although recruitment involved advertisements to over 700 Australian pre-schools, 44 allergy specialists and multiple representations to the patient support group, Allergy & Anaphylaxis Australia, completion relied on parental notification and/or guidance. Of the 139 participants recruited, 114 commenced the survey with 65 participants under 8 years (58%) and 49 between 8 and 12 years. Results showed participants recognised different ways to keep safe with children under 8 years (N = 65) 100% cognisant of the need to check with 'Mum/Dad' or teachers if they could safely eat food as well as the importance of not swapping lunches, while there was a slight change in compliance for those aged 8-12 years as three (6.1%, n = 3/49) children did not see the necessity of asking an adult/teacher if a food item was safe to eat. Older children were also less likely to tell friends about their food allergy even if they thought they were having an allergic reaction, despite children under 8 years more likely to feel different to friends (38%, n = 24/64) compared to those aged 8-12 years (31%, n = 14/45). Although both groups disliked parents' fussing, for children under 8 years, there was a strong association between this and 'feeling different to friends'. Results from this study highlight the importance of normalising food allergy at home and in the community, so children are confident in telling others about their food allergy.

Health Care Transition in Adolescents and Young Adults With Chronic Kidney Disease: Focus on the Individual and Family Support Systems

Health care transition (HCT) from pediatric to adult-focused services is a longitudinal process driven by the collaboration and interactions of adolescent/young adult patients, their families, providers, health care agencies, and environment. Health care providers in both pediatric and adult-focused settings must collaborate, as patients' health self-management skills are acquired in the mid-20s, after they have transferred to adult-focused care. Our manuscript discusses the individual and family support systems as they relate to adolescents and young adults with chronic or end-stage kidney disease. In the individual domain, we discuss demographic/socioeconomic characteristics, disease complexity/course, cognitive capabilities, and self-management/self-advocacy. In the family domain, we discuss family composition/culture factors, family function, parenting style, and family unit factors. We provide a section dedicated to patients with cognitive and developmental disability. Furthermore, we discuss barriers for HCT preparation and offer solutions as well as activities for HCT preparation.

Sociocultural, health knowledge, and health literacy among children ages 9-10 years in Thailand

BACKGROUND

Health literacy (HL) enables a person to make good decisions regarding health care, disease prevention, and health promotion to maintain and improve health. In Thailand, most existing studies focus on adults' HL rather than children. This research aimed to determine the influence of sociocultural and health knowledge on HL among children ages 9-10 years in Thailand.

MATERIALS AND METHODS

A cross-sectional study was conducted among 1650 children aged 9-10 years. The respondents were recruited using multistage random sampling from 39 primary schools of 13 provinces in all four regions of Thailand. A self-administered structured questionnaire was used to collect the required data. The multilevel analysis was used to determine the association between sociocultural, health knowledge, and HL while controlling the effects of covariates. The result was presented as adjusted odd ratios and its 95% confidence interval (CI).

RESULTS

Of the total 1650 respondents, 86.24% (95% CI: 84.49%-87.82%) had adequate and excellent levels of HL. The multivariable analysis indicated factors that were significantly associated with adequate and excellent levels HL including adequacy of per diem (adjusted odds ratio [adj. OR] = 6.78; 95% CI: 3.54-12.97) and had good relationship with teachers (adj. OR = 2.19; 95% CI: 1.55-3.09). Sources of health education which were received health education from parents (adj. OR = 3.51; 95% CI: 2.39-5.14), from teachers (adj. OR = 2.03; 95% CI: 1.43-2.89), and from the Internet (adj. OR = 1.83; 95% CI: 1.12-2.99) were also significantly associated with HL. Another significant factor was had good level of health knowledge (adj. OR = 1.86; 95% CI: 1.30-2.66) when control clustering effect of region, provinces, school, and classroom size.

CONCLUSIONS

More than 85% of children ages 9-10 years in Thailand had adequate and excellence levels of HL. Sociocultural and health knowledge had influence on children HL.

How children in Sweden accessed and perceived information during the first phase of the Covid-19 pandemic

AIM

To describe how children in Sweden accessed and perceived information about SARS-CoV2 and Covid-19 during the first phase of the outbreak.

METHODS

This study is a substudy of an international cross-sectional online mixed methods survey examining elements of children's health literacy in relation to Covid-19. The survey included multiple-choice questions, open-ended questions and drawings and collected information from 50 Swedish children (7-12 years). Data were analysed concurrently on a descriptive level using statistics and content analysis. Quantitative and qualitative data, including the drawings, were considered equally important and resulted in six categories, illuminating how children accessed and perceived information about the pandemic.

RESULTS

The survey showed that children accessed information mainly from school but also from TV. They preferred information from reliable sources. Children reported the information they accessed as easy to understand and it prompted them to ask new questions. They reported they knew a lot about the pandemic, for example, the potential danger to themselves and others and how to act to protect themselves and others. They perceived the pandemic as an intrusion on their lives.

CONCLUSIONS

This study indicates that Swedish children between 7 and 12 years old were well informed about SARS-CoV2 and Covid-19 during the first phase of the pandemic. School was shown to be an important source of information. The children could explain how to act to protect themselves and others from becoming infected by the virus.

Development and validation of the reproductive health literacy questionnaire for Chinese unmarried youth

OBJECTIVES

This study aimed to develop and validate the reproductive health literacy questionnaire for Chinese unmarried youth aged 15-24.

METHODS

We conducted a validity and reliability study of the questionnaire through a cross-sectional survey and test-retest analysis in four districts in Shanghai between April and June 2017. A total of 1587 participants completed a self-administered questionnaire anonymously on-site and the trained investigators conducted quality check afterwards. Sixty participants among them completed the test-retest assessment with 2 weeks interval. The reliability was determined by internal consistency, spilt-half reliability and test-retest reliability. The construct validity was assessed by confirmatory factor analysis.

RESULTS

The 58-question reproductive health literacy questionnaire for Chinese unmarried youth demonstrated high internal consistency (Cronbach's α = 0.919), spilt-half reliability (Guttman splitting coefficient = 0.846) and test-retest reliability (correlation coefficient = 0.720). The confirmatory factor analysis showed that the construct of the questionnaire fitted well with the hypothetical model. The reproductive health literacy scores in unmarried girls aged 15-24 were higher than boys (P < 0.05) and college students who lived in rural areas when they were middle and high school obtained lower score than those living in cities and suburbs (P < 0.01).

CONCLUSION

The reproductive health literacy questionnaire for Chinese unmarried youth demonstrated good reliability and validity, which could potentially be used as an effective evaluation instrument to assess reproductive health literacy among Chinese young people.

Effects of Parental Involvement in a Preschool-Based Eye Health Intervention Regarding Children's Screen Use in China

In this digital era, young children spend a considerable amount of time looking at telephone, tablet, computer and television screens. However, preventative eye health behavior education could help avoid and relieve asthenopia. The effects of parental influence on their children's eye health behavior through the preschool eye health education intervention program were examined. The Health Belief Model was used to develop parental involvement strategy and eye health curriculum. The study was conducted in a large public preschool with five branches in Beijing, China. A total of 248 parent-child pairs participated in the baseline and follow-up surveys, of which 129 were in the intervention group and 119 were in the comparison group. The generalized estimating equation analysis results indicated that parental involvement in preschool-based eye health intervention on screen uses had positive influence on parents' eye health knowledge, cues to action, and parenting efficacy. The intervention program also had positive effects on the increasing level of children's eye health knowledge, beliefs, cues to action, self-efficacy, and behaviors. The results supported the implementation of a preschool-based eye health intervention program with parental involvement, which could potentially enhance children's and parents' eye health beliefs and practices.

Elucidating the child's perspective in health promotion: children's experiences of child-centred health dialogue in Sweden

Promoting young children’s health through health promotion activities is an investment for the future. In the Child Health Services in the south of Sweden a structured Child-Centred Health Dialogue (CCHD) directed to all 4-year-old children was developed using illustrations based on the most important health messages associated with the promotion of healthy lifestyle in preschool children. The aim of this study was to explore the experiences of children participating in CCHD using 21 non-participant observations during their 4-year health visit and additionally 16 individual interviews 0–7 days after their visit, conducted in the child’s home in the presence of a caregiver. Children participated as social actors when guided to express their views based upon their own understanding was the overall main category generated from the qualitative content analysis. The children showed that they liked to participate actively but could influence their choice to participate. They expressed their views based on their daily life and wanted to understand the meaning of the information with which they interacted. The study revealed that 4-year-old children given the opportunity to speak for themselves—elucidating the child’s perspective—interpreted the health messages in a different way than the intended meaning of the illustrations developed by adults. These findings are important for the improvement of CCHD and underline the utmost importance of including children in research on health promotion. This study supports the view that 4-year-old children can take an active role in their health and are capable of making health information meaningful.

Children's understanding of epilepsy: A qualitative study

PURPOSE

To use a qualitative research approach to determine children's understandings of epilepsy and their epilepsy treatment.

METHODS

Children aged 7-16 years with physician-confirmed active epilepsy (i.e., having had an epileptic seizure in the past year and or currently taking antiepileptic drugs (AEDs), and not known to have an intellectual disability, were invited to participate. Children had semi-structured interviews separately on two occasions. Between the first and second interviews, an observation of a routine epilepsy clinic appointment of individual children was conducted, and was then discussed during the second interview. Participatory research tools were used in both child interviews to facilitate discussions. Interviews were audio recorded and transcribed, pseudonymized and entered into NVivo (version 12, QSR International). Data were analyzed using a thematic approach.

RESULTS

Twenty-three children of mean age 10.1 years (range 8-14), mean duration of epilepsy of 4.6 years (range 2-10) were enrolled. Twelve were 12 female; 7 had focal, 14 had generalized, and 2 had combined epilepsy; 20 were on monotherapy; and 16 had tried previous AEDs. All had an initial (first) interview; 20 were observed during a clinic appointment and had a second interview. Five broad themes emerged: understanding of epilepsy; understanding of seizures; understanding of medication; understanding of children's role in clinical appointments; influences on children's understanding. Children spoke about what epilepsy meant by describing the physical sensations of having a seizure or through the act of taking medication. Children described the role they had, or felt they should have, but reported challenges in being meaningfully involved in clinical appointments. While healthcare professionals were initial information nodes, epilepsy information from parents appeared to be more significant for children.

CONCLUSIONS

The perspectives of children with epilepsy are valuable for clinicians to understand; assumptions should not be made that children's views can be accessed via parents. Clinicians need to be constantly aware of children's views and ways of understanding and communicating about their epilepsy. To support this, the research - drawing on children's words, meanings, and stories - was used to inform an easily accessible, gender-neutral, animation about epilepsy that provides information about the condition, seizures, and medication (https://youtu.be/MO7xXL2ZXP8).

Child-Centred Health Dialogue for primary prevention of obesity in Child Health Services - a feasibility study

Aims: The aim of this study was to test a Child-Centred Health Dialogue model for primary prevention of obesity for 4-year-old children in Child Health Services, for its feasibility and the responsiveness of its outcomes. Methods: A feasibility study was set up with a non-randomised quasi-experimental cluster design comparing usual care with a structured multicomponent Child-Centred Health Dialogue consisting of two parts: (1) a universal part directed to all children and (2) a targeted part for families where the child is identified with overweight. Results: In total, 203 children participated in Child-Centred Health Dialogue while 582 children received usual care. Nurses trained in the model were able to execute both the universal health dialogue and the targeted part of the intervention. Tutorship enabled the nurses to reflect on and discuss their experiences, which strengthened their confidence and security. One year after the intervention fewer normal-weight 4-year-olds in the intervention group had developed overweight at the age of five compared with the control group, and none had developed obesity. The difference in overweight prevalence at follow-up did not reach statistical significance. Conclusions: This study demonstrates that a child-centred, multicomponent, interactive intervention for the promotion of healthy lifestyles and primary prevention of obesity for all 4-year-old children participating in Child Health Services is feasible on a small scale. As almost all caregivers make use of Child Health Services in Sweden, the findings should be confirmed in a randomised controlled trial before the intervention can be implemented on a larger scale.

How Do Disadvantaged Children Perceive, Understand and Experience Household Food Insecurity?

Food insecurity is associated with reduced physical, social, and psychological functioning in children. There has been sparse research into child food insecurity that incorporates children's own perspectives, as adults are often interviewed as child proxies. While a nuanced, child-centred understanding of food insecurity is needed to inform effective policy and program responses, little is known about Australian children's firsthand understanding or experience of household food insecurity. This study aimed to fill this gap by inviting preadolescent children's perspectives. Eleven participants aged 10-13 years (seven girls and four boys) took part in the study and were recruited from an Australian charity school holiday camp that targets severely disadvantaged youth. Children took part in individual semi-structured interviews that incorporated drawings and emoji scales. Qualitative interviews were audio recorded, transcribed, and analysed using thematic techniques. Four themes emerged from the data analysis, children had: (i) financial understanding; (ii) awareness of food insecurity and coping mechanisms; (iii) sharing, empathy, and compassion for food insecure families; and (iv) described the nature of 'food' preparation. This study provides a child-centric analysis, demonstrating how children's agency is enacted and constrained in food insecure contexts. This child-derived understanding of food insecurity provides a critical basis from which to build effective approaches to assess and respond to this significant social issue.

Exploring the mechanism through which a child-friendly storybook addresses barriers to child-participation during HIV care in primary healthcare settings in KwaZulu-Natal, South Africa

Background

Healthcare workers (HCWs) in South Africa widely use job-aids as practical tools to enhance the provision of HIV services, thereby improving patient-provider interactions during the care process. Job-aids are visual support materials that provide appropriate information using graphics and words in a simple and yet effective manner. We explored the mechanism through the KidzAlive Talk tool storybook (Talk tool), a child-centred job-aid for HCWs that facilitates child-participation during HIV consultations in primary healthcare (PHC) clinics implementing the KidzAlive model.

Methods

The study was conducted in PHC clinics across four districts; namely: uMkhanyakude, Zululand, uMgungundlovu, and eThekwini in KwaZulu-Natal (KZN), South Africa. We conducted in-depth interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained and mentored HCWs (n = 20). Data were collected in both English and isiZulu languages through user-specific, structured in-depth interviews. All the interviews were audio-recorded (with participants’ assent and consent, respectively). Data were transcribed verbatim, prior to translating the isiZulu transcripts to English. Translations were done by a member of the research team competent in both languages. Electronic data were imported to NVivo 10 for analysis and subsequently analysed using a thematic analysis method followed by a constant comparative and modified grounded theory analysis method.

Results

The findings identified the following barriers to child-participation: Primary caregiver limiting the child’s involvement due to fear of traumatising them; HCWs’ limited knowledge and skills to deliver child-centred HIV care; childhood developmental stage-related limitations and healthcare institutional paternalism. The Talk tool addresses the above barriers by using simple language and terminology to cater for children at various stages of development; alleviating HCWs’ and PCGs’ fear of possible psychological harm to the child; using storytelling and colourful cartoon illustrations for child edutainment; Being versatile by allowing for multiple utility and tackling institutional paternalism that limit child-involvement in the process of care.

Conclusions

This study provided evidence on how the Talk tool storybook addresses barriers to child-participation in the HIV care process. The evidence generated from this study is compelling enough to recommend the scale-up of this innovation in low-resource settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10483-8.

Assessing parents, youth athletes and coaches subjective health literacy: A cross-sectional study

OBJECTIVES

The aim was to describe levels of subjective Health Literacy (HL), and to examine possible differences in prevalence proportions between sexes, age groups and level of educations among youth athletes and their mentors (coaches, parents/caregivers) in Swedish Athletics.

DESIGN

Cross-sectional.

METHODS

Data on subjective HL were collected using the Swedish Communicative and Critical Health Literacy (S-CCHL) instrument for mentors and for youth the School-Aged Children (HLSAC) instrument. Questions assessing mentors' literacy on sports injury and return to play were also included.

RESULTS

The surveys were completed by 159 (91%) mentors and 143 youth athletes (87%). The level of S-CCHL was sufficient in 53% of the mentors. Of youth athletes, 28% reported a high level of HL and the item with least perceived high HL (21%) was critical thinking. Ninety-four percent of the mentors believed that it is quite possible to prevent injuries in athletics and 53% perceived having a very good knowledge about how to prevent injuries. Forty-six percent of the mentors perceived having a very good knowledge of return to sport criteria.

CONCLUSIONS

The level of health literacy was low with about half of the mentors and one out of three youth athletes having adequate HL levels. Only half of the mentors stated having a good knowledge of various injury prevention strategies. To reduce health consequences in youth sport and enable talent development more work is needed to understand the facilitators and barriers for the uptake of various health promotion and injury prevention strategies.

Health Literacy: An Interactive Outcome Among Secondary Students in Beijing

BACKGROUND

Health literacy enables a person to make good decisions regarding health care, disease prevention, and health promotion to maintain and improve health. Although health literacy research in China has gained increasing attention in recent years, most existing studies focus on adults rather than adolescents. In addition, little theory-driven empirical research has been conducted to fully understand the relationship among health literacy, its influencing factors, and health outcomes scored on a skills-based health literacy instrument.

OBJECTIVE

This study applied Manganello's framework to investigate how health literacy was related to its antecedents and health status in secondary students in Beijing, China.

METHODS

A cross-sectional study was conducted with 650 students in Years 7 to 9 (age 11-17 years) from four secondary schools. Students completed a self-administered questionnaire based on Manganello's health literacy framework, which measured key upstream determinants, including health literacy and self-report health status. Health literacy was measured on an 8-item skills-based instrument that assesses a person's ability to find, understand, appraise, and communicate health information in everyday life (scores range from 0-37). Descriptive statistics and path analysis were conducted to investigate the mediating role of health literacy in predicting health status.

KEY RESULTS

Overall, the average scores of students' health literacy was 26.37 (±5.89). Manganello's framework was supported by the data collected (χ2/df = 2.049, p = .001, comparative fix index = 0.966, root mean square error of approximation = 0.041). Personal self-efficacy (r = 0.11, p = .007), social support (r = 0.18, p < .001), and school environment (r = 0.27, p < .001) predicted health literacy, which in turn predicted students' health status (r = 0.12, p = .005).

CONCLUSIONS

Adolescent health literacy is not only a person's capability to protect health, but also an interactive outcome with the broader environment. Promoting health literacy could be a useful strategy to improve health status for adolescents; however, a holistic approach is needed to increase students' self-efficacy, promote social support, and create positive school environments to achieve optimal health literacy and health outcomes. [HLRP: Health Literacy Research and Practice. 2021;5(1):e1-e14.] PLAIN LANGUAGE SUMMARY: We investigated how health literacy was related to its influencing factors and health status among secondary students in Years 7 to 9 in Beijing, China. Students with low self-efficacy, low social support, and low perceptions of positive school environment were more likely to have low health literacy, which in turn predicted poor health status.

Chinese Students' Health Literacy Level and Its Associated Factors: A Meta-Analysis

Health Literacy (HL) is an important determinant of health. Many scholars have conducted a large number of studies on the level of Chinese students’ HL and its associated factors. However, previous studies on HL level and the factors that influence it have been contradictory. Therefore, this systematic review and meta-analysis was conducted to estimate the level of Chinese students’ HL and its three dimensions (knowledge, behavior and skills) and to identify factors associated with HL in Chinese students. Two investigators independently searched literature, selected research and extracted data through comprehensively searching of four international electronic databases and three Chinese electronic database to identify all relevant observational studies on affecting factors for HL in Chinese students published in English and Chinese from database January, 2010 to September, 2020. In total, 61 articles were extracted in the study. The results showed that the level rates of HL and its three dimensions were 26%, 35%, 26%, 51%, respectively. For Chinese students, the significant factors were urban residents, senior class students, well performance at school, the Han nationality, focus on health knowledge, less exposure to video games, highly educated parents, income of one-child families, receiving health education, having medical background. This study provides some inspirations for improving the level of Chinese students’ HL and their health. First, the findings may help Chinese policy makers understand the overall HL of Chinese students and their levels across three dimensions (knowledge, behavior and skills). Second, protective factors for Chinese students’ HL were found in this research, which will help to improve the level of Chinese students’ HL, stimulate students’ awareness of prevention, and lay the foundation for a healthy China.

Post-training and mentorship experiences of KidzAlive-trained healthcare workers at primary healthcare facilities in KwaZulu-Natal, South Africa

Background

KidzAlive, a multicomponent, child-centred capacity building model was adopted by South Africa’s National Department of Health to address the challenges of quality of care among HIV+ children. This model involves training and mentoring healthcare workers (HCWs) on a child-centred care approach of communicating with children and their primary caregivers (PCGs). This study explored HCWs’ post-training experiences after a 6-months implementation period.

Aim

To evaluate the KidzAlive model as a healthcare approach that seeks to improve the quality of HIV care among children.

Setting

The study was conducted in 20 PHC rural and urban facilities across four districts in KwaZulu-Natal.

Methods

Interviews were conducted by trained interviewers who followed a structured interview guide. These were audio-recorded, transcribed, and imported into NVivo 10 software for thematic analysis. Thematic analysis was used to develop a coding framework from the participant’s responses.

Results

Five themes, namely: (1) increased healthcare worker knowledge, skills and confidence to provide child-friendly HIV services to children; (2) increased involvement of HIV + children in own healthcare journey; (3) the involvement of primary caregivers in children’s healthcare journey; (4) improved health outcomes for HIV + children; and e) transformation of the PHC environment towards being more child-friendly.

Conclusion

The findings present preliminary evidence of successful KidzAlive trained HCWs’ buy-in of KidzAlive intervention. KidzAlive has been well integrated into current service delivery processes in PHC facilities. However, more rigorous research is warranted to fully understand the impact of this intervention on children and their primary caregivers.

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.

Child and Youth Health Literacy: A Conceptual Analysis and Proposed Target-Group-Centred Definition

(1) Background: This article adopts an interdisciplinary perspective to analyse, examine, and reflect upon prominent health literacy (HL) understandings in childhood and youth. (2) Method: The conceptual analysis combined Rodgers’ and Jabareen’s approaches to conceptual analysis in eight phases. (3) Results: First, we present exploratory entry points for developing a child-specific HL understanding based on the six dimensions of a ‘health-literacy 6D model’. Second, we describe and reflect upon five meta-level dimensions covering the HL definitions and models for children and youth found in the conceptual analysis. Third, we integrate our findings into a target-group-centred HL definition for children and youth. (4) Discussion/Conclusion: This article raises awareness for the heterogeneity of the current conceptual HL debate. It offers a multidisciplinary approach for advancing the existing understanding of HL. Four recommendations for future actions are deduced from the following four principles, which are inherent to the proposed target-group-centred HL definition: (a) to characterize HL from an asset-based perspective, (b) to consider HL as socially embedded and distributed, (c) to recognize that HL develops both in phases and in flexible ways, and (d) to consider the multimodal nature of health-related information. Further research is necessary to test the feasibility and applicability of the proposed definition and conceptual understanding in both research and practice.

Australian children's discourses of health, nutrition and fatness

Talking to children about their health-related understandings and experiences can provide valuable information for public health practitioners who seek to improve children's dietary behaviours. To date, however, research on children's food consumption has generally prioritized the views of parents and caregivers, rather than children themselves. This paper reports results from a qualitative study that explored preadolescent children's attitudes and perceptions towards health and nutrition. 38 children aged 11-12 years, across three state government schools, took part in an individual interview or group interview. Interviews were recorded, transcribed verbatim and analysed using thematic analysis techniques. Our results indicate that children inextricably linked the concept of health to diet and physical activity. They pondered the connection between different types of foods and physical implications for the body, emphasising nutrition and physical activity as a resource for preventing the onset of chronic disease and specifically the state of 'fatness'. Children collectively overemphasised the correlation between body size and health, and expressed that people should take responsibility for healthy choices to prevent fatness. In their discussions, they referred to aesthetic elements of the body and negative consequences of obesity. Overall, we argue that children's discourses of health and nutrition are potentially problematic. Results suggest that it is important to reshape these ideas to encourage children to develop more positive relationships with food and physical activity.

Qualitative insight into primary school children’s nutrition literacy

Purpose

Health literacy is a key international public health goal. Conceptualising health literacy as an asset highlights the importance of fostering a health literate youth for the benefit of future generations, yet research has predominantly focused on examining adults’ and older adolescents’ health literacy. This presents a gap for child-centred studies with younger populations. The purpose of this paper is to report the findings from a qualitative study that explored health literacy, in a nutrition context (i.e. nutrition literacy), from primary school children’s perspectives.

Design/methodology/approach

The study examined children’s experiences in accessing, understanding and interacting with nutrition information. In doing so, the research employed a socio-ecological framework to understand facilitators and barriers that can influence children’s nutrition literacy. Preadolescent boys and girls aged 11–12 years were invited to take part in the study. At the time of recruitment, students were attending one of three state government schools in a socioeconomically disadvantaged region of metropolitan South Australia. A series of focus groups and individual semi-structured interviews were conducted with 38 participants. Interview data were audio-recorded, transcribed verbatim and analysed using thematic techniques.

Findings

Children demonstrated that they accessed and interacted with a variety of sources of nutrition information. Nutrition understandings were derived from the home, school and media environments. Parents and teachers were cited as key influences on children’s interactions with nutrition information and children particularly emphasised the trust placed in their teachers as health “experts.” While the home and school environments emerged as potential settings to develop children’s nutrition literacy skills, the children’s narratives also alluded to potential barriers surrounding nutrition literacy.

Originality/value

This study provides further insight into children’s nutrition literacy. While functional nutrition literacy remains a fundamental starting point, children are interested in opportunities to develop more interactive skills, such as those related to cooking. Opportunities also exist to foster more critical competencies. This research thereby highlights the importance of more integrated strategies to promote nutrition literacy among this population group across multiple settings.

Promoting health literacy: sixth graders working in partnership with the local pharmacy

Purpose

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. The purpose of this paper is to focus on sixth graders’ (N=21, aged 13–14) health literacy, particularly in relation to the rational use of medicines and the role of pharmacies.

Design/methodology/approach

The socio-scientific issues (SSI) approach by way of the three-stage model, the stages being scenario, inquiry and decision making, was adopted in this intervention study. The study was a qualitative case study and data consisted of cartoons, audio recordings of group discussions and group interviews. Qualitative data were analyzed using content analysis.

Findings

At the beginning of the intervention, pupils possessed detailed information about the rational use of medicines; however, they did not refer to the role of pharmacy as a source of medicine information which they did after the intervention. They were also more aware particularly how to store and dispose of unnecessary medicines. Their theoretical and practical knowledge related to pharmacy careers and production of medicines was enhanced.

Practical implications

The SSI approach by way of the three-stage model provides an excellent opportunity to schools for local co-operation with the community and familiarization with the careers. Moreover, it offers the possibility to enhance pupils’ health literacy.

Originality/value

The SSI approach is so far less implemented in the context of medicine education and to improve health literacy.

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.

Measuring functional, interactive and critical health literacy of Chinese secondary school students: reliable, valid and feasible?

Health literacy is an increasingly important topic in the global context. In mainland China, health literacy measures mainly focus on health knowledge and practices or on the functional domain for adolescents. However, little is known about interactive and critical domains. This study aimed to adopt a skills-based and three-domain (functional, interactive and critical) instrument to measure health literacy in Chinese adolescents and to examine the status and determinants of each domain. Using a systematic review, the eight-item Health Literacy Assessment Tool (HLAT-8) was selected and translated from English to Chinese (c-HLAT-8). Following the translation process, a cross-sectional study was conducted in four secondary schools in Beijing, China. A total of 650 students in Years 7-9 were recruited to complete a self-administered questionnaire that assessed socio-demographics, self-efficacy, social support, school environment, community environment and health literacy. Results showed that the c-HLAT-8 had satisfactory reliability (Cronbach's α = 0.79; intra-class correlation coefficient = 0.72) and strong validity (translation validity index (TVI) ≥0.95; χ²/ df = 3.388, p < 0.001; comparative fit index = 0.975, Tucker and Lewis's index of fit = 0.945, normed fit index = 0.965, root mean error of approximation = 0.061; scores on the c-HLAT-8 were moderately correlated with the Health Literacy Study-Taiwan, but weakly with the Newest Vital Sign). Chinese students had an average score of 26.37 (±5.89) for the c-HLAT-8. When the determinants of each domain of health literacy were examined, social support was the strongest predictor of interactive and critical health literacy. On the contrary, self-efficacy and school environment played more dominant roles in predicting functional health literacy. The c-HLAT-8 was demonstrated to be a reliable, valid and feasible instrument for measuring functional, interactive and critical health literacy among Chinese students. The current findings indicate that increasing self-efficacy, social support and creating supportive environments are important for promoting health literacy in secondary school settings in China.

Feasibility of mobile health game "Fume" in supporting tobacco-related health literacy among early adolescents: A three-armed cluster randomized design

OBJECTIVE

New interventions supporting health literacy and a tobacco-free lifestyle in adolescence are needed to narrow the widening gap in existing health inequalities. Health games offer potential and could be utilized for example in school healthcare, but more research is needed to increase the understanding of the effects of game elements in health interventions. The aim of this feasibility study is to determine the short-term effectiveness of the tobacco-related mobile health game Fume and a non-gamified website in comparison with a no-intervention control group, regarding tobacco-related health literacy among 10-13-year-old early adolescents. In addition, we compare the demand for and acceptability of Fume to that of the website.

METHODS

In total, 151 early adolescents participated in this single-blinded, three-armed cluster randomized trial. The participants from three municipalities in southwest Finland were randomly allocated between a group with access to the health game Fume (n = 61), a group with access to the website (n = 47), and a group with no intervention (n = 43). The intervention groups first participated in a 20-min training session with Fume/the website, and then had two weeks to use Fume/the website based on their own interest. Short-term effectiveness was measured by primary (anti-smoking self-efficacy) and secondary (smoking outcome expectations, attitudes towards tobacco use, tobacco-use motives, motivation to decline tobacco use in the future, and knowledge about tobacco) outcomes derived from the theory-based determinants of tobacco-related health literacy and evaluated with self-assessment questionnaires at baseline and post-intervention (after a two-week follow-up). For evaluating the demand, the actual use of Fume/the website was tracked during the two-week period. Regarding acceptability, the raised interest towards Fume/the website and opinions about the interventions were evaluated post-intervention. Differences were tested with the McNemar, Fisher exact, and non-parametric tests.

RESULTS

Statistically significant favorable changes during the study period were found for positive (P = 0.002) and negative (P = 0.02) smoking outcome expectations and attitudes towards cigarette smoking (P = 0.01) within the group using Fume. No statistically significant changes were detected within the website or control groups. Statistically significant differences were not found for the change in outcome variables among the three groups. The number of visits (P < 0.001), number of separate visit days (P < 0.001) and total duration of use (P < 0.001) were larger for the group using Fume than for that using the website. Fume sparked more interest in early adolescents than the website did (P <  0.001). There were no statistically significant differences in opinions about Fume and those regarding the website.

CONCLUSIONS

The intervention with embedded game elements, the health game Fume, was found to be more feasible as a tobacco-related health education intervention than the non-gamified website among early adolescents in light of demand and acceptability (raised interest). Even though no change in anti-smoking self-efficacy was found, the results of this feasibility study demonstrated favorable short-term changes with Fume in some other theory-based determinants of tobacco-related health literacy.

Psychometric testing of the Turkish version of the Health Literacy for School-Aged Children Scale

This study aimed to assess the validity and reliability of the Turkish version of the Health Literacy for School-Aged Children (HLSAC-T) scale. This study was a cross-sectional and methodological design. The sample consisted of 563 sixth and ninth grade students in Izmir, Turkey. Data were collected with the socio-demographic characteristics questionnaire, HLSAC-T, and Turkish version of the Adolescent Lifestyle Profile. Cronbach's α for the scale was .77 and item-total correlations were between .49 and .61 ( p < .001). The model fit indices were determined to be the root mean square error of approximation at .035, the goodness of fit index at .99, and the comparative fit index at .99. The concordance validity and convergent validity were supported and the discriminant validity suggested that the scale successfully discriminated students who cared about healthy lifestyle from the students who did not. The HLSAC-T showed an adequate reliability and validity for determining the subjective health literacy of Turkish school-aged children. The results showed promise that the scale could be translated into other languages.

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.

Suitability of asthma education materials for school-age children: Implications for health literacy

AIMS AND OBJECTIVES

To investigate the suitability of asthma education materials for school-age children with asthma and elucidate how these children used their health-literacy abilities to identify whether the materials can be accepted, comprehended and applied.

BACKGROUND

Effective asthma self-management education is influenced by the suitability of materials and an individual's health literacy.

DESIGN

A mixed-method research design was developed using quantitative and qualitative surveys.

METHODS

The suitability of the materials was assessed on the basis of the Chinese version of the Suitability Assessment of Materials by five experts. In addition, five school-age children (age: 8-12 years) were recruited and interviewed.

RESULTS

In total, 25 pieces of asthma education material for children were collected. On the basis of their type, the materials were categorised as nine brochures, 11 leaflets and five videos. Of the 25 materials, 17 were rated as superior materials, whereas eight were rated as adequate materials. The suitability scores of the video-based materials were significantly higher than those of the brochures and leaflets (p = .006). One print material was considered to have a reading level suitable for fifth-grade or younger children, whereas the remaining materials were considered suitable for sixth-grade or older children. The following six health-literacy domains were identified: recognising asthma through body knowledge, posing reflective questions, identifying self-care difficulties, receiving adult guidance, learning with enjoyment and addressing learning requirements.

CONCLUSIONS

The video-based materials had integrated content and were appealing to children. Cartoon animations, interactive computer games, and skill demonstrations may enhance learning stimulation and motivation and increase learning effects in children.

RELEVANCE TO CLINICAL PRACTICE

The present results may help healthcare providers to understand children's capacities to manage their disease, effectively address children's requirements and function as a key resource for children to strengthen their literacy in asthma management.