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

Health Literacy Levels of Patients With Juvenile Idiopathic Arthritis and Their Parents

BACKGROUND

The aim of this study was to reveal the relationship between the health literacy (HL) levels of children with juvenile idiopathic arthritis (JIA) and their parents, and the general health status and physical performance of the children.

METHODS

This study included 79 children aged 9-18 years with a diagnosis of JIA and one of their parents. HL levels were evaluated with the Turkish version of the Health Literacy for School-Aged Children and Turkish Health Literacy-32 (THL-32) for children and Adult Health Literacy Scale (AHLS) for their parents. The Childhood Health Assessment Questionnaire (CHAQ), 6-minute walk test (6-MWT), 10-meter walking test (10-MWT) and 10-stair climbing test (10-SCT) was used to evaluate the children. Juvenile Arthritis Biopsychosocial Questionnaire (JAB-Q) was used to assess the children's and parents' psychosocial status and perception of health.

RESULTS

HL levels of patients with JIA were 16.5% low HL, %55.7 moderate HL and 27.8% high HL. According to THL-32 scale score, HL level of parents were as follows: inadequate, 3.8%; problematic, 22.8%; sufficient, 34.2%; and excellent, 39.2%. Children's HL levels increase positively as they get older, and no significant relationship was found with other parameters. The AHLS, CHAQ and JAB-Q scores were better in the group with higher education levels of the parents. No statistically significant association was found between the HL of the children and that of the parents.

CONCLUSION

In our study, it was found that the high education levels of the parents positively affected the quality of life and physical condition of their children and parental HL levels. In addition, it was shown that the HL levels of children with JIA were not statistically related to other parameters.

PATIENT OR PUBLIC CONTRIBUTION

Children diagnosed with JIA and one of their parents actively participated in the study. Feedback from children and families provided important information about obtaining and using HL information before and during the study. The importance of therapy programs and information focusing on the patient and their family, as well as the inter-multidisciplinary approach, in combating a chronic disease at an early age was reinforced by the feedback received from patients and their families.

Predisposing factors of health promotion behaviors and health literacy in adolescents: A cross-sectional design

OBJECTIVE

This study was designed to measure health promotion behaviors, health literacy (HL) levels, and their predisposing factors among adolescents.

DESIGN

A cross-sectional design was used.

SAMPLE

The study was completed by 1046 students aged 11-14 years.

MEASUREMENTS

Data were collected via the HL for School-Aged Children Scale and the Adolescent Health Promotion Scale.

RESULTS

HL was significantly associated with gender, participation in sport activities, and health promotion behaviors. There was no confounding factor for HL. Adolescent health promotion behaviors were significantly associated with academic level, weight perception, participation in sport activities, and HL.

CONCLUSIONS

Nurses could improve communication and decision-making skills related to health behaviors and learn how to obtain health-related knowledge to promote the health of adolescents.

The effect of health literacy on health behaviors in a sample of Turkish adolescents

PURPOSE

Health literacy is a strong factor in the health outcomes and behaviors of adolescents. This study was conducted to examine the health literacy levels of adolescents, their health behaviors, and the effect of health literacy on health behaviors.

DESIGN AND METHODS

This cross-sectional study was conducted with a total of 649 adolescents between the ages of 14 and 18. Data were collected using the Adolescent Lifestyle Profile II (ALP-R2) and the Health Literacy Scale for School-Age Children (HLSAC). A multiple regression analysis was conducted to determine the effects of health literacy on health behaviors and the factors associated with health behaviors.

RESULTS

The mean total ALP-R2 score of the participants was 114.35 ± 17.48, and their mean HLSAC score was 28.95 ± 5.79. Among the participants, 26% had low health literacy, 61.9% had moderate health literacy, and 12% had high health literacy. The regression analysis revealed that the health literacy levels of the participants significantly predicted all dimensions of health behaviors and total health behaviors (p < 0.001). The health literacy levels of the participants, the community where the adolescent lived, their participation in social activities, family relationships, friend relationships, and health perceptions significantly predicted their total health behaviors (R2 = 0.347; p < 0.001).

CONCLUSIONS

The health literacy levels and health behaviors of adolescents were found to be moderate, and their health behaviors increased as their levels of health literacy increased. The results showed that the health literacy and health behaviors of adolescents need to be improved.

IMPLICATIONS FOR PRACTICE

Nurses should provide training to increase the healthy lifestyle behaviors and health literacy of adolescents.

The effect of health literacy-grounded web-based education on nutrition and exercise behaviours in adolescents: A randomized controlled trial

AIM

The research was conducted to measure the effect of health literacy-grounded web-based education program on health literacy, nutrition and exercise behaviours in adolescents.

BACKGROUND

The increasing prevalence of obesity in adolescents is explained by a sedentary lifestyle and unhealthy diet. Health literacy is essential for adolescents to maintain their healthy behaviours.

METHODS

The research was conducted as a parallel group randomized controlled trial. The study was completed by 114 adolescents (experimental = 42, control = 72). The Personal Information Form, the Health Literacy Scale for School-Age Children and the Nutrition and Exercise Subscales were used to collect data. A web-based education program was implemented. Two-way mixed design ANOVA with Bonferroni test was used to examine the group, time and group * time interaction of the measurements.

RESULTS

There was no statistically significant difference between the experimental and control groups regarding health literacy level, nutrition and exercise behaviours pre-test mean scores (p > 0.05). In the post-test, the mean scores of health literacy and nutrition behaviours in the experimental group were higher than the control group (p < 0.001). However, there was no significant difference in exercise behaviours (p > 0.05). The power and effect size in mean scores changes for health literacy (99.8%, η2 = 0.039) and nutrition (99.8%, η2 = 0.039) were moderate.

CONCLUSION

The study concluded that health literacy-grounded web-based education program increased the health literacy levels of adolescents and improved their nutritional behaviours; however, there was no sufficient change in exercise behaviours.

Evaluation of cross-cultural adaptation and validation of the Persian version of the health literacy for school-aged children scale: Methodological study

Background and Aims

Health literacy (HL) is an essential determinant of health in children. Inadequate HL causes problems for individuals and society, such as more hospitalizations, medication errors, poor health, and higher mortality and health care costs. A valid and reliable scale is needed to measure this population's HL. This study evaluated the cross-cultural adaptation and validation of the Persian version of the HL for School-Aged Children (HLSAC) Scale.

Methods

In this methodological research, the HL scale of school-aged children was translated from English to Persian using the Backward-Forward translation protocol. The content validity, face validity, construct validity (Exploratory Factor Analysis [EFA] and Confirmatory factor analysis [CFA]), plus reliability, were evaluated by Internal consistency and stability methods. Two hundred forty samples from south of Tehran were selected by multi-stage sampling method to assess the construct validity. Data analysis was performed using SPSS v24 and Jamovi v2.2.

Results

A qualitative evaluation of face and content validity showed that experts and the target group approved all items on the scale. The results of EFA indicated the existence of one factor, explaining 47.17% of the total variance of the scale. The CFA results showed that the one-factor model of the Persian version of the HL scale for children is almost acceptable. (χ 2/df = 2.94, Root Mean Square Error of Approximation = 0.09, Normed-Fit Index = 0.89, Tucker-Lewis Index = 0.89, Comparative Fit Index = 0.92). Cronbach's alpha coefficient for the whole scale was 0.80, and the Intraclass Correlation Coefficient value for the whole scale was calculated as 0.78 using the single-rating, absolute-agreement, 2-way mixed-effects method.

Conclusion

The study validates the HLSAC Scale, affirming its suitability for assessing HL in Persian-speaking child populations.

The Brief Health Literacy Scale for Adults: Adaptation and Validation of the Health Literacy for School-Aged Children Questionnaire

The Health Literacy for School-Aged Children (HLSAC) is a brief, generic instrument measuring health literacy among school-aged children. Given its brevity and broad conceptualization of health literacy, the HLSAC is a potentially valuable measuring instrument among adults as well. This validation study aimed to adapt the HLSAC questionnaire to an adult population through assessment of content validity and subsequently determine the structural validity of the adapted instrument, the Brief Health Literacy scale for Adults (B-HLA). The content validity of the HLSAC was assessed through interviews with respondents and experts, and the structural validity of the adapted instrument (B-HLA) was evaluated using Rasch analysis. The content validity assessment (n = 25) gave rise to adjustments in the wording of five items. The B-HLA demonstrated an overall misfit to the Rasch model (n = 290). Items 6 and 8 had the poorest individual fits. We found no signs of local dependency or differential item functioning concerning sex, age, education, and native language. The B-HLA demonstrated unidimensionality and ability to discriminate across health literacy levels (PSI = 0.80). Discarding items 6 or 8 resulted in an overall model fit and individual fit of all items. In conclusion, the B-HLA appears to be a valid and reliable instrument for assessing health literacy among adults.

The effect of structured health promotion education given to adolescents on health literacy and health-promoting behaviors

PURPOSE

This study was conducted to determine the effect of structured health promotion education given to adolescents on health literacy and health promotion level.

DESIGN AND METHODS

The research was designed according to the pretest-posttest control group model and conducted using the quasi-experimental method. The population of the study consisted of students studying in the 6th, 7th, and 8th grades of a secondary school. A total of 191 students were assigned to the intervention group and the control group. The data were collected using the Sociodemographic Characteristics Form, the Adolescent Health Promotion Scale, and the School Age Health Literacy Scale. Structured Health Promotion Education consisting of six modules was given to the intervention group. The control group did not receive any intervention.

RESULTS

Of the students, 33.9% were in the 8th grade, 76.6% were born in Turkey, 31.6% had a father and mother who were secondary school graduates, 72.5% were from moderate-income families, and 83% had no chronic health problems. The groups' health literacy and adolescent health-promoting behaviors pretest mean scores before the intervention were homogeneous (p > 0.05). There was a significant difference between the groups' health literacy and adolescent health-promoting behaviors posttest mean scores after the intervention (p < 0.05).

CONCLUSIONS

While structured health promotion education was found to increase health literacy and health-promoting behaviors, nutrition, stress management, life satisfaction, and health responsibility behaviors in adolescents, it did not affect social support and exercise behaviors.

IMPLICATIONS FOR PRACTICE

Nurses should provide training to increase students' health literacy and health-promoting behaviors.

The development and cross-national validation of the short health literacy for school-aged children (HLSAC-5) instrument

Health literacy is an asset for and indicator of adolescents' health and wellbeing, and should therefore be monitored and addressed across countries. This study aimed to develop and validate a shorter version of the original 10-item health literacy for school-aged children instrument in a cross-national context, using data from the health behaviour in school-aged children 2017/18 survey. The data were obtained from 25 425 adolescents (aged 13 and 15 years) from seven European countries. Determination was made of the best item combination to form a shorter version of the health literacy instrument. Thereafter, the structural validity, reliability, measurement invariance, and criterion validity of the new 5-item instrument were examined. Confirmatory factor analysis showed a good model fit to the data across countries and in the total sample, confirming the structural validity (CFI = 0.995, TLI = 0.989, SRMR = 0.011, RMSEA = 0.031). The internal consistency of the instrument was at a good level across countries (α = 0.87-0.98), indicating that the instrument provided reliable scores. Configural and metric invariance was established across genders, ages, and countries. Scalar invariance was achieved for age and gender groups, but not between countries. This indicated that the factor structure of the scale was similar, but that there were differences between the countries in health literacy levels. Regarding criterion validity, structural equation modelling showed a positive association between health literacy and self-rated health in all the participating countries. The new instrument was found to be valid and reliable for the purposes of measuring health literacy among adolescents in a cross-national context.

Health literacy among adolescents and young adults in the Eastern Mediterranean region: a scoping review

OBJECTIVES

For adolescents and young adults, most health literacy research has been conducted in Western countries, but few studies have been conducted in the Eastern Mediterranean region (EMR). This review aimed to explore the existing health literacy research in the EMR in addition to the levels of health literacy and its associated factors among adolescents and young adults.

METHODS

The search, conducted using the PubMed/MEDLINE, EBSCOhost/CINAHL plus, Web of Science and J-STAGE databases, was initially performed on 16 June 2022 and later updated on 1 October 2022. Studies that targeted 10-25 years old persons, conducted in any of the EMR countries and that used the health literacy concept and/or described its levels or predictors were included in the review. Content analysis was used for data extraction and analysis. Data related to the study methods, participants, outcome variables and health literacy were extracted.

RESULTS

The review included 82 studies, most of which were conducted in Iran and Turkey and adopted a cross-sectional design. Half of the studies showed that more than half of adolescents and young adults had low or moderate health literacy. Nine studies applied university-based or school-based health education interventions to improve health literacy, which was also predicted by demographic and socioeconomic factors and internet usage. Little attention was paid to assessing the health literacy of vulnerable people, such as refugees and those with a disability and exposed to violence. Finally, various health literacy topics were investigated, including nutrition, non-communicable diseases, media and depression.

CONCLUSION

Health literacy levels were low-to-moderate in adolescents and young adults in the EMR. To promote health literacy, it is recommended to use school-based health education and attempt to reach adolescents and young adults through social media platforms. More attention should be paid to refugees, people with disabilities and those exposed to violence.

Validation of the brief instrument "Health Literacy for School-Aged Children" (HLSAC) among Norwegian adolescents

Health literacy (HL) has been identified as an important and modifiable determinant of health. To succeed in promoting HL, it is crucial to evaluate interventions addressing HL using validated instruments. However, HL measurement is an under-researched area among adolescents. The Health Literacy for School-Aged Children (HLSAC) scale is developed in Finland to measure the subjective HL levels of school-aged children. The HLSAC has been used and validated across Europe. No validated instrument for measuring HL among Norwegian adolescents has been identified. Therefore, the aim of this study was to assess the psychometric properties of the HLSAC among Norwegian adolescents in upper secondary schools. Cross-sectional data were collected in 2017 from 1 054 adolescents with a response rate of 93.5%. The participants were students aged 16-21 (mean = 17.3) years from four upper secondary schools in an urban area in Mid-Norway. Confirmatory factor analysis (CFA) was utilized to investigate the underlying dimensionality of the data together with composite reliability based on Raykov's reliability coefficient and certain aspects of construct validity. The original ten-item one-dimensional version of the HLSAC revealed a poor fit. A one-dimensional version including six of the original ten items presented the best fit to our data, demonstrating good reliability and construct validity. This validation study suggests a one-dimensional solution of the HLSAC scale including six of the original ten items, i.e., the HLSAC-6 as a statistical valid and reliable measure for HL among adolescents in upper secondary schools. However, the modifications of the instrument indicate the need for further investigation of the HLSAC in this age group, i.e. by conducting cognitive interviews and focus-group discussions on the concept of HL among adolescents. Testing the wording of the HLSAC prior to additional psychometric evaluations of both the original HLSAC and the suggested HLSAC-6 is recommended. Finally, developing more age-appropriate items for the measurement of HL in this age-group is suggested.

Adolescents' Nutrition: The Role of Health Literacy, Family and Socio-Demographic Variables

Adolescent obesity rates are increasing on an epidemic level and food intake is one of the most important causes of this condition. From an ecological perspective, food intake is, in turn, influenced by many factors that need to be considered. This study aims to evaluate the associations between socio-demographic factors (gender, family origin, socio-economic status, parent's education level), which consist of social stratifiers, health literacy and family context, as independent variables, and food intake (consumption of fruits, vegetables, soft drinks and sweets and breakfast frequency) and outcomes (Body Mass Index category), as dependent variables. Data were retrieved from 2145 students (13 and 15 years old) from the Lombardy region (Italy) who participated in the 2018 edition of Health Behaviour in School-Aged Children (HBSC). Six multiple binary logistic regression models were used in this study. Fruit, vegetable and soft drinks consumption models were related to all three-factor levels. Breakfast consumption frequency was associated with socio-demographic variables. BMI category was associated with socio-demographic and family variables. The results confirmed the existence of social inequalities, the importance of health literacy in predicting healthy behaviours and the relevance of the family context. The study confirms the importance of the ecological approach to understanding food intake and overweight/obesity status in adolescents.

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.

Association between health literacy and leisure time physical activity among Lithuanian adolescents

Recently, discussion of the potential of health literacy (HL) for health promotion has increased; however, clear evidence illuminating the relationship between adolescents' HL and their physical activity (PA) remains scarce. This study aimed to assess the association between adolescents' HL and leisure time PA. A representative cross-sectional study was conducted with 2,369 Lithuanian adolescents aged 13-16 years. A self-reported questionnaire gathered information regarding HL, leisure time PA, and other confounders (gender, age, family affluence and parents' exercise). Descriptive statistics and the probabilities of being physically active were estimated using logistic regression. The results revealed that almost 60% of the participants were not sufficiently physically active. Having moderate or high levels of HL was positively associated with leisure time PA. Additionally, being male, belonging to a more affluent family, and having a father who exercise were significant predictors of adolescents' leisure time PA. This study revealed that moderate and high HL positively related to leisure time PA among Lithuanian adolescents. The study results highlighted the importance of encouraging schoolchildren's PA and including HL promotion in a school curriculum.

E-health literacy levels of high school students in Turkey: results of a cross-sectional study

Digital health literacy is defined as the ability to search, find, and understand health information available on electronic resources and to use the information obtained from these resources to address a health problem. This study aimed to identify the digital health literacy levels of high school students and the factors that contribute to its development. This cross-sectional study was conducted with 1250 high school students from 10 high schools. The data were collected using the descriptive characteristics form and e-Health Literacy Scale (eHEALS) for adolescents. The mean age of the students was 15.92 ± 0.95 years and 50.8% of them were girls. The mean score on the eHEALS was 27.52 ± 6.76, which was in the high digital health literacy range (eHEALS ≥ 26). The results indicated the mean digital health literacy scores were high in students who lived in a nuclear family, who understood the importance of good health, who had easy access to the Internet and who had highly educated parents with high income levels. Encouraging the development of digital health literacy through school curricula could offer opportunities for all young people to develop digital health literacy, regardless of socio-economic status or family situation.

Health Literacy Levels among Italian Students: Monitoring and Promotion at School

Health literacy was identified as an important determinant of health, particularly for adolescents. However, more efforts are needed to monitor this construct and provide inputs for policy development. This study aims to: (a) Assess the validity and reliability of the Italian version of the Health Literacy for School-Aged Children (HLSAC-I); (b) Identify the health literacy levels among Italian students and compare them with other countries’ levels; and (c) Identify the associations between health literacy and multiple social determinants (social stratifiers, family, and school connectedness). Data came from the Health Behaviour School-Aged Children survey, carried out in the Lombardy region in northern Italy in 2018. A representative sample of 2,287 13- and 15-year-old Lombardian students was involved. The results support the validity and reliability of the HLSAC-I. A total of 18.7% of the sample reported low levels, and only 6.8% reported high levels. Italian students reported the lowest levels of health literacy compared with other countries. School connectedness and educational approach are the most relevant associated factors. This study confirms a school’s role in reducing inequalities and promoting health. It highlights the importance of monitoring health literacy and implementing health promotion policies at school through a whole-school approach.

Nutrition-Exercise Behaviors, Health Literacy Level, and Related Factors in Adolescents in Turkey

BACKGROUND

Health behaviors of adolescents affect their health and well-being into adulthood. This study was conducted to determine the nutrition-exercise behaviors, health literacy level, and related factors in adolescents.

METHODS

A cross-sectional design was used for this study. Overall, 810 students in grades 6-8 in a Turkish school completed the study. A personal information form, the Nutrition-Exercise Behaviors Scale, and the Health Literacy for School-Aged Children Scale were used for data collection.

RESULTS

According to the mean score of the Health Literacy Scale, 21% of the students had a low level of health literacy, 63.8% had a medium level, and 15.2% had a high level. A positive correlation was found between health literacy level and healthy nutrition-exercise behavior (r = 0.345, p < .001), and a positive correlation between health literacy level and meal pattern (r = 0.230, p < .001). A positive correlation (r = 0.385, p < .001) was found between meal pattern and healthy nutrition-exercise behavior. A moderate positive correlation (r = 0.510, p < .001) was found between unhealthy nutrition-exercise behavior and psychological/addicted eating behavior.

CONCLUSION

The present study revealed that nutrition-exercise behaviors and the health literacy of adolescents were at a moderate level and, there was a relationship between nutrition-exercise behaviors and health literacy levels in adolescents. Interventions should be planned and followed through with parents to help adolescents adopt healthy nutrition and exercise behaviors from an early age and to increase their health literacy level. In this context, it is recommended to implement training and intervention programs for adolescents and their families.

Predicting the Healthy Lifestyle Behaviors of Turkish Adolescents Based on their Health Literacy and Self-Efficacy Levels

PURPOSE

The effects of Turkish adolescents' self-efficacy and health literacy on their health behaviors are examined in this study.

DESIGN AND METHOD

This study employed a descriptive cross-sectional design with a sample population of 440 adolescents between the ages of 13 and 18 years old. The data were collected using a demographic data form and analyzed according to the Self-Efficacy Scale for Children, the Health Literacy Scale, and the Adolescent Lifestyle Profile.

RESULTS

The regression analysis found that the self-efficacy and health literacy levels of adolescents predicted their healthy lifestyle behaviors (F = 141.813, p = 0.000). The self-efficacy and health literacy levels explained 41.9% of the healthy lifestyle behaviors of the subjects, with regression coefficients for self-efficacy and health literacy of 0.545 and 0.185, respectively. Self-efficacy among adolescents significantly predicted all the sub-dimensions of healthy lifestyle behaviors, such as health responsibility, physical activity, nutrition, positive life view, interpersonal relations, stress management, and spiritual health. Similarly, the health literacy levels predicted all the sub-dimensions except for physical activity and stress management.

CONCLUSIONS

In this study, the adolescents' self-efficacy levels and their health literacy levels significantly explained their health behaviors. This finding suggests that increasing the self-efficacy and health literacy levels of adolescents should be increased to develop positive health behaviors among today's youth.

PRACTICE IMPLICATIONS

Nurses should identify strategies to increase self-efficacy and health literacy among adolescents to protect and improve adolescent health behavior.

Health Literacy and Predictors of Body Weight in Turkish Children

PURPOSE

This study assessed the association between health literacy (both of children and their parents) and body weight in Turkish schoolchildren. This study also aimed to determine the predictors of body weight in children.

DESIGN AND METHODS

This was a descriptive, correlational study that enrolled students and their parents from Turkish secondary schools. Data were collected using the Health Literacy Scale for School-Aged Children, Adult Health Literacy Scale, socio-demographic questionnaires and anthropometric measurements.

RESULTS

The mean child age was 12.76 ± 1.27; 40.2% were male, 41.5% had higher health literacy and 17.2% were obese. Child health literacy did not correlate with body mass index (r = 0.04, p > 0.05), but correlated positively with parent health literacy (r = 0.17, p < 0.05). Parent body mass index was the only explanatory variable in child body mass index.

CONCLUSIONS

Obesity in schoolchildren correlates with parental obesity. The results showed parents should participate in practising strategies that aim to prevent and treat childhood obesity.

PRACTICE IMPLICATIONS

Children's health literacy skills can be improved to develop their health and academic achievements.

Health Literacy and Health Promotion Behaviors of Adolescents in Turkey

PURPOSE

This study was conducted to determine the health literacy and health promotion behaviors of adolescents.

DESIGN AND METHODS

This study used cross sectional and correlational design. The population of the study consisted of 6th, 7th, and 8th grade students from three different secondary schools selected from high, middle, and low income levels. The sample consisted of 2498 students.

RESULTS

The mean score of the health literacy scale of the students was 30.26. The mean score of the adolescent health promotion scale was 143.75. The mean scores of health literacy and adolescent health promotion scores of the students in high income level, sixth grade, and have parents with a baccalaureate or graduate degree were significantly higher (p < 0.005). A moderate positive correlation was found between the school age health literacy scale and the adolescent health promotion scale (p < 0.001).

CONCLUSIONS

Adolescents' health literacy, and their health promotion behaviors were at moderate level. By integrating a basic health knowledge and healthy lifestyle behaviors course into the student curriculum, health literacy of the students could be increased.

PRACTICE IMPLICATIONS

The determination of health literacy and health promotion behaviors in adolescents by nurses in the schools will be a guide for the promotion of enhanced adolescent health.

Psychometric properties of an Arabic-language health literacy assessment scale for adolescents (HAS-A-AR) in Palestine

OBJECTIVES

Health literacy research in Palestine is limited, and a locally validated tool for use among adolescents has been unavailable until now. Therefore, this study aimed to adapt health literacy assessment scale for adolescents (HAS-A) into Arabic language (HAS-A-AR) and Palestinian context and to investigate its psychometric properties.

DESIGN

We conducted a cross-sectional household survey using a stratified random sample and household face-to-face interviews.

SETTING AND PARTICIPANTS

We conducted 1200 interviews with sixth to ninth graders in the Ramallah and al-Bireh district of the West Bank, Palestine in 2017.

METHODS

We translated and adapted HAS-A to be sensitive to the Palestinian context and tested its psychometric properties. We evaluated face and content validity during the back-translation process and checked for construct validity through exploratory factor analysis (EFA). We tested for internal consistency using Cronbach's alpha, MacDonald's omega test and the greatest lower bound (GLB). Furthermore, we calculated the scale's average inter-item correlation.

RESULTS

EFA revealed that HAS-A-AR has a similar structure to the original HAS-A. It extracted three factors (communication, confusion and functional health literacy) whose eigenvalues were >1. Together they explained 57% of the total variance. The proportions of adolescents with high levels of communication, confusion and functional health literacy were 45%, 68% and 80%, respectively. Cronbach's alpha, MacDonald's omega and the GLB values for communication subscale were 0.87, 0.88 and 0.90, and they were 0.78, 0.77 and 0.79 for confusion subscale, while they were 0.77, 0.77 and 0.80, respectively, for functional healthy literacy subscale. The average inter-item correlation for the subscales ranged between 0.36 and 0.59.

CONCLUSION

HAS-A-AR is a valid and reliable health literacy measuring instrument with appropriate psychometric properties. HAS-A-AR is currently available for use among adolescents in Palestine and the surrounding Arab countries with similar characteristics as Palestine, including language, culture and political instability.

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.