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

Ability to Maintain and Improve Health and Socio-Demographic Correlates among Children in Albania

Objective

Our aim was to assess the level and socio-demographic correlates of the ability to maintain health among children in Albania, a post-communist country in the Western Balkans.

Methods

A cross-sectional study was conducted in Albania in September 2022. The study population consisted of a nationwide representative sample of 7,831 schoolchildren (≈54% girls) aged 12-15 years. A structured self-administered and anonymous questionnaire inquired about the children's attitudes toward health promotion (ability to maintain and improve health) and a range of key dimensions on knowledge and practices regarding healthcare services. Socio-demographic data were also collected. Binary logistic regression was used to assess the socio-demographic correlates of children's ability to maintain health.

Results

Overall, about 71% of schoolchildren exhibited the best attitudes toward health promotion (ability to maintain and improve health). In the multivariable adjusted logistic regression models, poorer attitudes toward health promotion (ability to maintain and improve health) were significantly related to older age (OR=1.2, 95% CI=1.0-1.3), middle/low maternal education (OR=1.2, 95%CI=1.1-1.3), poor/very poor economic situation (OR=1.5, 95%CI=1.2-1.8), lack of appropriate knowledge about rights to healthcare (OR=1.3, 95% CI=1.1-1.5), lack of knowledge about obtaining healthcare services (OR=1.7, 95%CI=1.4-2.2), and lack of consultations/visits with health professionals excluding vaccinations (OR=1.2, 95%CI=1.1-1.4).

Conclusions

Almost 1/3rd of Albanian schoolchildren included in this study did not exhibit the best attitudes toward health promotion (ability to maintain and improve health). The best attitudes were related to a higher socioeconomic level and adequate knowledge and practices regarding healthcare services. There is thus a need to increase health literacy levels among children in order to ultimately induce sustainable healthy behavioural/lifestyle practices.

Acquisition, application, and distribution of health literacy from culturally sensitive type 2 diabetes education among Arabic-Speaking migrants in Denmark: A longitudinal qualitative analysis

BACKGROUND

Effective self-management of type 2 diabetes requires adequate health literacy (HL) and a supportive network. Diabetes self-management education and support programmes play a crucial role in improving these factors. However, limited research exists on how such programmes can support health literacy among migrants and facilitate the dissemination of knowledge within their social networks.

AIM

This study aimed to investigate the perspectives of Arabic-speaking informants with a migrant background in relation to how their type 2 diabetes-related health literacy was acquired, applied and distributed within social networks through participation in a culturally sensitive diabetes self-management education and support (DSMES) programme.

METHODS

Semi-structured interviews were conducted with 12 informants during the programme and three to 7 months later, from September 2019 to May 2020. Abductive analysis was applied using HL and distributed health literacy (DHL) theory as frameworks.

RESULTS

The analysis generated three themes: (1) sources of health information and the development of health literacy; (2) changes towards active self-management; and (3) distributed health literacy. Prior to programme participation, informants faced challenges in navigating conflicting information from family, friends and social media. After participating in the programme, they reported improvements in HL, particularly in knowledge acquisition. Many became more actively engaged in decision-making and exhibited improved health behaviours, such as dietary choices. Nonetheless, some informants continued to struggle with choosing appropriate prevention and treatment strategies. Notably, certain informants acted as HL mediators, sharing their newly acquired knowledge within their social networks in Denmark and abroad.

CONCLUSION

Culturally sensitive diabetes self-management education programmes have the potential to enhance HL among migrants, leading to the distribution of relevant diabetes knowledge within their social networks. Future studies should explore how members of migrants' social networks perceive their supportive role in type 2 diabetes management. Programmes can benefit from emphasising critical HL and exploring how participant-informants effectively communicate diabetes-related knowledge within their networks to address misinformation and conflicting information.

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.

Factors related to health literacy among Brazilian adolescents: cross-sectional study

OBJECTIVE

To analyze the relationship between sociodemographic and clinical factors with health literacy in Brazilian adolescents.

METHOD

This is a cross-sectional study with 526 adolescents aged 14 to 19. Data were collected virtually between July and September 2021 using a sociodemographic characterization questionnaire, clinical profile and the Health Literacy Assessment Tool - Portuguese version. The variables were evaluated by multiple linear regression with normal response, with significance p < 0.05.

RESULTS

The average age was 16.9 years (±1.6), the average health literacy score was 25.3 (±5.4). Female gender (p = 0.014), university educational level (p = 0.002) and use of medication (p = 0.020) were related to higher levels of health literacy. Adolescents with chronic illnesses had a higher total literacy score, on average 1.51 points, compared to those without chronic illnesses.

CONCLUSION

Male adolescents and those with less education performed worse in health literacy and, therefore, deserve special attention in health promotion actions.

Sexual and reproductive health literacy among young people in Sub-Saharan Africa: evidence synthesis and implications

BACKGROUND

Sexual and reproductive health literacy is a key to attaining and maintaining sexual and reproductive health, especially among young people in low-income countries, such as sub-Saharan Africa. While the importance of sexual and reproductive health literacy is gaining wider recognition, studies on the topic have been mainly concentrated in high-income (developed) countries.

OBJECTIVE

The aim of this study was to provide a coherent summary and synthesis of the available evidence on sexual and reproductive health literacy among young people in sub-Saharan Africa, with implications for policy, interventions, and research.

METHODS

The review was conducted using the Joanna Briggs Institute's methodology for reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline to enhance the clarity and transparency of the reporting process. PubMed, CINAHL, AJOL, AIM, and Google Scholar were searched for evidence from 18 March to 20 May 2022.

RESULTS

The search provided 2,682 articles in total, of which only 24 met the eligibility criteria and were included in this review. The findings revealed persistent sexual and reproductive health information/knowledge gaps, poor sexual and reproductive health-related knowledge and practices, lack of exercising sexual and reproductive health knowledge, and multiple determinants of sexual and reproductive health literacy among young people, ranging from personal to larger structural conditions.

CONCLUSION

The review found that sexual and reproductive health literacy among young people in sub-Saharan Africa is concerning and has not been fully researched. A deeper understanding of the issue is essential for designing and implementing effective interventions to improve sexual and reproductive health literacy and health outcomes among young people.

Health Literacy in Ethiopia: Evidence Synthesis and Implications

Background

Health literacy plays a pivotal role in healthcare utilization and health-related lifestyle choices. This makes health literacy a pressing concern, particularly in low-income countries like Ethiopia, where there are intricate health challenges. Despite its significance, there is a dearth of studies on the issue in Ethiopia. This study aimed to provide a comprehensive synthesis of the available evidence on health literacy in Ethiopia, and to discuss the implications for healthcare practice, health promotion, and research endeavors.

Methods

A systematic scoping review was conducted to achieve the purpose of this study. A comprehensive search of databases such as PubMed, CINAHL, AJOL, and PLOS Global Public Health was conducted for eligible evidence. Searches were conducted from May 12 to September 9, 2022. The PRISMA flow diagram guideline was utilized to ensure transparent reporting of the reviews process. The data extraction tool used was based on the JBI methodology guidance for reviews.

Results

The search in total yielded 543 records. However, only 16 studies met the eligibility criteria after a thorough screening process. All eligible studies were conducted in health facilities and schools with limited scopes. The main findings of the eligible studies focused on health literacy levels, health information sources, and health literacy determinants among the studies participants. Many of the studies reported low health literacy levels and multiple predicting factors ranging from personal to socioeconomic conditions among the respondents.

Conclusion

This review has provided critical insights into the state of health literacy in Ethiopia. There is a need for comprehensive research and the development of context-appropriate health literacy measurements tailored to the Ethiopian context, as well as evidence-based health literacy interventions. Prioritizing health literacy as a key research and intervention area is essential for improving the health of individuals and populations and achieving health-related Sustainable Development Goals in Ethiopia.

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

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

How Adolescents and Parents See Their Moral Responsibilities With Regard to Adolescents Using Alcohol-A Deductive Secondary Analysis

BACKGROUND

This study described how adolescents and the parents saw their moral responsibilities with regard to adolescents using alcohol.

METHODS

This was a deductive secondary analysis, based on Hart's taxonomy of moral responsibility. The primary studies were based on 19 group interviews with 87 adolescents aged 14-16 and 17 interviews with 20 parents. Voluntary participants were recruited by purposive sampling from two public schools in Finland.

RESULTS

Role responsibilities comprised of adolescents taking care of themselves and parents providing authority figures and helping adolescents to make rational decisions about alcohol. Capacity responsibilities referred to adolescents' abilities to make independent decisions on using alcohol and their developing abilities to control their actions. Parents required abilities to get involved in and show an interest in their children's everyday lives. Causal responsibilities focused on ensuring that adolescents did not cause harm when they used alcohol, and parents had to acknowledge and react to the consequences. Liability responsibilities were about the law on alcohol use and responsibilities for any legal consequences. The role schools could play was important.

CONCLUSIONS

Adolescents and parents had wide-ranging responsibilities related to the adolescents' using alcohol and school nurses could play an important role in healthy decisions.

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.

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.

A teacher professional development programme to enhance students’ critical health literacy through school-based health and physical education programmes

Health literacy is a critical asset for adolescents to develop given its positive impact on health outcomes. The few studies that have targeted teacher knowledge and attitudes show that teachers themselves find it difficult to: navigate the multi-modal nature of health information; critically evaluate the different modes and texts; and apply health-related information in a variety of contexts. This research study aimed to address this issue through developing and implementing a teacher professional development (PD) programme for three Australian secondary schools and nine Health and Physical Education (HPE) teachers to improve health literacy, particularly critical health literacy, content and pedagogies embedded in current HPE programmes. Fifteen HPE programmes were analysed using Nutbeam’s health literacy hierarchy and the Australian Curriculum: HPE outcomes and content, with this analysis informing a personalized PD programme. To evaluate how teachers experienced the personalized PD programme, interviews conducted at the completion of the PD programme were analysed using Braun and Clarke’s thematic approach. According to the teachers, the PD had improved their knowledge and understanding of the three levels of HL, including how to implement it into their practice. The personalized nature was a key strength of the PD programme as it allowed for changes to be made in a time-efficient manner, a known challenge for teachers. Teachers recommended the provision of additional resources that foster students’ critical health literacy levels and an additional session to ensure sustainable changes in planning and teaching practices.

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.

Public Libraries as Supportive Environments for Children's Development of Critical Health Literacy

Critical health literacy enables individuals to use cognitive and social resources for informed action on the wider determinants of health. Promoting critical health literacy early in the life-course may contribute to improved health outcomes in the long term, but children's opportunities to develop critical health literacy are limited and tend to be school-based. This study applies a settings-based approach to analyse the potential of public libraries in England to be supportive environments for children's development of critical health literacy. The study adopted institutional ethnography as a framework to explore the public library as an everyday setting for children. A children's advisory group informed the study design. Thirteen children and 19 public library staff and community stakeholders were interviewed. The study results indicated that the public library was not seen by children, staff, or community stakeholders as a setting for health. Its policies and structure purport to develop health literacy, but the political nature of critical health literacy was seen as outside its remit. A supersetting approach in which children's everyday settings work together is proposed and a conceptual model of the public library role is presented.

The Development and Evaluation of an e-Learning Course That Promotes Digital Health Literacy in School-age Children: Pre-Post Measurement Study

Background

Experts agree that the promotion of (digital) health literacy should be an integral part of the school curriculum. However, promoting (digital) health literacy within the German school system is difficult because (digital) health education is not a mandatory school subject in all the German states. Therefore, experts suggest that (digital) health literacy could be addressed as part of the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz).

Objective

The goal of this study was to evaluate a newly developed e-learning course that was designed to improve (digital) health literacy in school-age children and concurrently to teach skills specified in the mandatory framework for digital education and digital literacy in schools. It was hypothesized that participants’ health literacy and digital health literacy levels would be higher after completing the e-learning course than they were before doing the course. Furthermore, it was hypothesized that after completing the e-learning course, participants’ subjective and objective knowledge in the domain of (digital) health literacy would be higher than it was before doing the course.

Methods

The pre-post measurement study was conducted online. After participants (N=323) gave their informed consent to participate in the study, they provided demographic information and answered all measures (premeasurement). Following this, participants had 7 days to complete the e-learning course. After finishing the e-learning course, participants answered all the measures again (postmeasurement).

Results

To test the hypotheses, Bayesian paired samples t tests (1-sided) were conducted. After completing the e-learning course, participants showed higher health literacy levels. Specifically, they showed higher competency levels in the domains of theoretical knowledge (Bayes factor [BF]_–0=676,000; δ=–0.316), practical knowledge (BF_–0=92,300; δ=–0.294), critical thinking (BF_–0=7.42e+13; δ=–0.482), self-awareness (BF_–0=11,500,000; δ=–0.345), and citizenship (BF_–0=266,000; δ=–0.306). Furthermore, participants achieved higher digital health literacy levels. Specifically, they achieved higher competency levels in the domains of information searching (BF_–0=2.339; δ=–0.135), evaluating reliability (BF_–0=2.03e+11; δ=–0.434), and determining relevance (BF_–0=316,000; δ=–0.308). Moreover, participants demonstrated higher subjective (BF_–0=3.58e+82; δ=–1.515) and objective knowledge (BF_–0=3.82e+97; δ=–1.758) in the domain of (digital) health literacy.

Conclusions

The newly designed e-learning course provides an easy way for schools and teachers from all German states to integrate (digital) health literacy education into their school curriculums and lessons. The evaluated course is especially attractive because it was designed to improve (digital) health literacy and at the same time to teach skills specified in the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz).

[DNVF Memorandum Health Literacy (Part 2) - Operationalisation and Measuring of Health Literacy from a Health Services Research Perspective]

Das vorliegende „DNVF Memorandum Gesundheitskompetenz (Teil 2) – Operationalisierung und Messung von Gesundheitskompetenz aus Sicht der Versorgungsforschung“ des Deutschen Netzwerks Versorgungsforschung e.V. (DNVF) stellt die Fortführung des Memorandums „DNVF Memorandum Gesundheitskompetenz (Teil 1) – Hintergrund, Gegenstand und Fragestellungen in der Versorgungsforschung“ dar. Neben den allgemeinen Anforderungen an die Messung der Gesundheitskompetenz, beschäftigt sich dieses Memorandum auch mit den speziellen Anforderungen, wie die Abgrenzung zu verwandten Konstrukten, den Unterschieden zwischen performanzbasierten und Selbsteinschätzungsverfahren, den Unterschieden zwischen generischen und spezifischen Instrumenten, dem Einsatz von Screeninginstrumenten sowie der Messung der Gesundheitskompetenz bei speziellen Personengruppen. Weiterhin werden Besonderheiten bei der Messung der digitalen Gesundheitskompetenz, Potenziale qualitativer und partizipativer Forschungszugänge sowie forschungsethische Gesichtspunkte bei der Messung der Gesundheitskompetenz erarbeitet. Ein besonderer Wert wird auf den Praxisbezug gelegt, der am Ende der jeweiligen Abschnitte mit einem Fazit für die Versorgungsforschung aufgegriffen wird. Abschließend wird einen Blick auf Herausforderungen und Forschungsdesiderate im Zusammenhang mit der Messung von Gesundheitskompetenz im Rahmen der Versorgungsforschung geworfen.

Health Literacy in Portugal: Results of the Health Literacy Population Survey Project 2019-2021

Health literacy entails the knowledge, motivation, and competencies to access, understand, appraise, and apply health information in order to make judgments and decisions in everyday life concerning health care, disease prevention, and health promotion to maintain or improve quality of life throughout the life course. It has become an essential concept in public health. It is considered a modifiable determinant of health decisions, health behaviors, health, and healthcare outcomes. Prior studies suggest highly variable levels of health literacy across European countries. Assessing and monitoring health literacy is critical to support interventions and policies to improve health literacy. This study aimed to describe the process of adaptation to Portugal of the short-form version of the Health Literacy Survey (HLS₁₉-Q12) from the Health Literacy Population Survey Project 2019–2021, also establishing the health literacy levels in the Portuguese population. The sample comprised 1247 valid cases. The survey consisted of a brief questionnaire on the determinants of health literacy, plus the HLS₁₉-Q12 questionnaire and the specific health literacies packages on digital health literacy, navigational health literacy, and vaccination health literacy. The results suggest that 7 out of 10 people in Portugal (mainland) have high health literacy levels and support the results of other studies concerning the main socioeconomic determinants of general health literacy. Furthermore, the results suggest that “navigation in the health system” tasks are the most challenging tasks regarding specific health literacies. The overall data suggest the HLS₁₉-Q12 as a feasible measure to assess health literacy in the Portuguese population. Thus, it can be used in Portugal to assess the population’s needs and monitor and evaluate policies and initiatives to promote health literacy by addressing its societal, environmental, personal, and situational modifiable determinant factors.

Seeking a deeper understanding of 'distributed health literacy': A systematic review

BACKGROUND

Previous research suggests that it would be useful to view health literacy as a set of 'distributed competencies', which can be found dispersed through the individual's social network, rather than an exclusively individual attribute. However, to date there is no focused exploration of how distributed health literacy has been defined, conceptualized or assessed in the peer-reviewed literature.

AIMS

This systematic review aimed to explore: (1) definitions and conceptual models of distributed health literacy that are available from the peer-reviewed literature; and (2) how distributed health literacy has been measured in empirical research.

METHODS

We searched MEDLINE, Embase, CINAHL, PsycInfo, Scopus, ERIC and Web of Science using truncated versions of the keywords 'literacy' and 'distributed' (within five words' distance). We collated the definitions and conceptual models of distributed health literacy, and report on how health literacy has been measured in empirical research studies. Findings related to distributed health literacy from included manuscripts were synthesized using thematic synthesis.

RESULTS

Of the 642 studies screened, 10 were included in this systematic review. The majority were empirical manuscripts reporting on qualitative research in one of five countries, with two reviews, one conceptual analysis and one quantitative study. Edwards' definition of distributed health literacy, which emphasizes the health literacy abilities, skills and practices of others that contribute to an individual's level of health literacy was widely applied in a variety of clinical and geographical settings. However, we did not identify any quantitative instruments which directly measured distributed health literacy. There was significant variability in questions used to explore the concept qualitatively, and discrepancies across studies in regard to (a) what constitutes distributed health literacy and what does not (e.g., general social support), and (b) the relationship between distributed health literacy and other constructs (e.g., public health literacy).

CONCLUSION

Although there is a widely applied definition of distributed health literacy, our review revealed that the research space would benefit from the development of the concept, both theoretically for example via conceptual distinctions between distributed health literacy and other types of social support, and empirically for example through the development of a quantitative measurement instrument.

PATIENT OR PUBLIC CONTRIBUTION

This paper is a systematic review and did not involve patients or the public.

Videoconference Fatigue: A Conceptual Analysis

Videoconferencing (VC) is a type of online meeting that allows two or more participants from different locations to engage in live multi-directional audio-visual communication and collaboration (e.g., via screen sharing). The COVID-19 pandemic has induced a boom in both private and professional videoconferencing in the early 2020s that elicited controversial public and academic debates about its pros and cons. One main concern has been the phenomenon of videoconference fatigue. The aim of this conceptual review article is to contribute to the conceptual clarification of VC fatigue. We use the popular and succinct label "Zoom fatigue" interchangeably with the more generic label "videoconference fatigue" and define it as the experience of fatigue during and/or after a videoconference, regardless of the specific VC system used. We followed a structured eight-phase process of conceptual analysis that led to a conceptual model of VC fatigue with four key causal dimensions: (1) personal factors, (2) organizational factors, (3) technological factors, and (4) environmental factors. We present this 4D model describing the respective dimensions with their sub-dimensions based on theories, available evidence, and media coverage. The 4D-model is meant to help researchers advance empirical research on videoconference fatigue.

International Understandings of Health Literacy in Childhood and Adolescence—A Qualitative-Explorative Analysis of Global Expert Interviews

(1) Background: With regard to children and adolescents, health literacy should only not be understood as an individual ability, but rather as dependent based on its contextual determinants. The study examines how experts define health literacy in childhood and adolescence and discusses whether they include these factors. (2) Methods: In 48 interviews with experts from 32 countries, specific questions for defining health literacy in childhood and adolescence were analyzed. Data analysis was conducted according to the summary of the qualitative content analysis. Main categories and subcategories were developed exploratively and inductively. (3) Results: No expert had an official definition of health literacy in childhood or adolescence. There were more experts who located health literacy only at the individual level alone than those who located it at both the individual and contextual levels. On the individual level, there was a focus on information processing, knowledge, behavior, and skills. At the contextual level, system responsibility, the ability of others, and relationship between age and development were the main points. (4) Conclusions: To develop an adequate method of dealing with health literacy in the target group, there must be a target group-specific consideration of the dependencies, ages, and developmental stages of that group. While this is considered as consensus in scientific discourse, it has seemingly not yet been adopted in development-related policies internationally.

Programas mediados pela tecnologia para promoção de literacia em saúde mental em adolescentes: revisão sistemática

Resumo A promoção da literacia saúde mental em adolescentes tem recebido particular atenção na saúde pública, dado a adolescência ser vista como um período crítico para prevenção de problemas de saúde mental na idade adulta. Apesar da consistência empírica sobre a eficácia dos programas face a face de literacia da saúde mental para adolescentes, pouco se sabe sobre as características e o efeito de intervenções mediadas pela tecnologia para este objetivo. A presente revisão sistemática teve como finalidade sistematizar conhecimento empírico sobre os efeitos de programas mediados pela tecnologia de promoção da literacia em saúde mental em adolescentes. Procedeu-se a um levantamento sistemático da literatura até dezembro de 2019, tendo sido selecionados quatro estudos empíricos que avaliaram os efeitos deste tipo de programas em diferentes indicadores de saúde mental. Os resultados revelaram que os programas mediados pela tecnologia apresentaram efeitos positivos no aumento da literacia em saúde mental, sendo o sexo e a idade moderadores destas associações. No entanto, o seu efeito na redução do estigma e nos comportamentos de procura de ajuda profissional foi inconsistente. As limitações dos estudos incluídos na revisão são discutidas.

Sexual Interaction in Digital Contexts and Its Implications for Sexual Health: A Conceptual Analysis

Based on its prevalence, there is an urgent need to better understand the mechanisms, opportunities and risks of sexual interaction in digital contexts (SIDC) that are related with sexual arousal. While there is a growing body of literature on SIDC, there is also a lack of conceptual clarity and classification. Therefore, based on a conceptual analysis, we propose to distinguish between sexual interaction (1) through, (2) via, and (3) with digital technologies. (1) Sexual interactions through digital technologies are face-to-face sexual interactions that (a) have been started digitally (e.g., people initiating face-to-face sexual encounters through adult dating apps) or (b) are accompanied by digital technology (e.g., couples augmenting their face-to-face sexual encounters through filming themselves during the act and publishing the amateur pornography online). (2) Sexual interactions via digital technology are technology-mediated interpersonal sexual interactions (e.g., via text chat: cybersex; via smartphone: sexting; via webcam: webcam sex/camming). (3) Sexual interactions with digital technology occur when the technology itself has the role of an interaction partner (e.g., sexual interaction with a sex robot or with a media persona in pornography). The three types of SIDC and their respective subtypes are explained and backed up with empirical studies that are grouped according to two major mediators: consent and commerce. Regarding the causes and consequences of the three types of SIDC we suggest a classification that entails biological, psychological, social, economic, and technological factors. Regarding implications of SIDC we suggest to focus on both opportunities and risks for sexual health. The proposed conceptual framework of SIDC is meant to inform future research.

Efficient Ways to Combat Doping in a Sports Education Context!? A Systematic Review on Doping Prevention Measures Focusing on Young Age Groups

Youth is characterized by testing and crossing natural boundaries, sometimes with the help of performance-enhancing substances. In this context, doping prevention measures play a crucial role to protect individuals both within and outside the context of elite sport. Based on the PRISMA guidelines, a systematic literature search was conducted in the databases ProQuest (ERIC), Scopus, PSYNDEX/PsychInfo, PubMed, and Web of Science Core Collection to provide an overview of the impact of doping prevention measures, with particular attention to the underlying understanding of learning. As a result of the screening process, 30 of the initial 5,591 articles met the previously defined and recorded eligibility criteria. The analysis led to heterogeneous results regarding content, implementation, target group, or outcome variables considered relevant. Two-thirds of the studies related to the competitive sports context. Nevertheless, there has been a growing interest in studying doping prevention and its effects on non-elite athlete target groups in recent years. In terms of effectiveness, many measures did not achieve long-term changes or did not collect any follow-up data. This contrasts with understanding learning as sustained change and reduces the intended long-term protection of prevention measures, especially for adolescent target groups. Even young age groups from 10 years upwards benefited from doping prevention measures, and almost all doping prevention measures enabled their participants to increase their physical and health literacy. No conclusion can be drawn as to whether doping prevention measures based on constructivist ideas are superior to cognitivist approaches or a combination of both. Nevertheless, programs that actively engage their participants appear superior to lecture-based knowledge transfer. Most of the prevention measures offered a benefit-orientation so that participants can achieve added value, besides trying to initiate health-promoting change through rejection. Because of the lack of sustained changes, a further modification in doping prevention seems necessary. The review results support the value of primary prevention. Doping prevention measures should enable tailored learning and development options in the sense of more meaningful differentiation to individual needs. The implementation in a school context or an online setting is promising and sees doping as a problem for society. The review highlights the importance of accompanying evaluation measures to identify efficient prevention components that promote health and protect young people.

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

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

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 Writing Styles of Web-Based Materials for Children's Health Education Using the Selection of Semantic Features: Machine Learning Approach

BACKGROUND

Medical writing styles can have an impact on the understandability of health educational resources. Amid current web-based health information research, there is a dearth of research-based evidence that demonstrates what constitutes the best practice of the development of web-based health resources on children's health promotion and education.

OBJECTIVE

Using authoritative and highly influential web-based children's health educational resources from the Nemours Foundation, the largest not-for-profit organization promoting children's health and well-being, we aimed to develop machine learning algorithms to discriminate and predict the writing styles of health educational resources on children versus adult health promotion using a variety of health educational resources aimed at the general public.

METHODS

The selection of natural language features as predicator variables of algorithms went through initial automatic feature selection using ridge classifier, support vector machine, extreme gradient boost tree, and recursive feature elimination followed by revision by education experts. We compared algorithms using the automatically selected (n=19) and linguistically enhanced (n=20) feature sets, using the initial feature set (n=115) as the baseline.

RESULTS

Using five-fold cross-validation, compared with the baseline (115 features), the Gaussian Naive Bayes model (20 features) achieved statistically higher mean sensitivity (P=.02; 95% CI -0.016 to 0.1929), mean specificity (P=.02; 95% CI -0.016 to 0.199), mean area under the receiver operating characteristic curve (P=.02; 95% CI -0.007 to 0.140), and mean macro F1 (P=.006; 95% CI 0.016-0.167). The statistically improved performance of the final model (20 features) is in contrast to the statistically insignificant changes between the original feature set (n=115) and the automatically selected features (n=19): mean sensitivity (P=.13; 95% CI -0.1699 to 0.0681), mean specificity (P=.10; 95% CI -0.1389 to 0.4017), mean area under the receiver operating characteristic curve (P=.008; 95% CI 0.0059-0.1126), and mean macro F1 (P=.98; 95% CI -0.0555 to 0.0548). This demonstrates the importance and effectiveness of combining automatic feature selection and expert-based linguistic revision to develop the most effective machine learning algorithms from high-dimensional data sets.

CONCLUSIONS

We developed new evaluation tools for the discrimination and prediction of writing styles of web-based health resources for children's health education and promotion among parents and caregivers of children. User-adaptive automatic assessment of web-based health content holds great promise for distant and remote health education among young readers. Our study leveraged the precision and adaptability of machine learning algorithms and insights from health linguistics to help advance this significant yet understudied area of research.

Addressing Health Literacy in Schools in Germany: Concept Analysis of the Mandatory Digital and Media Literacy School Curriculum

It is generally agreed upon that the development of health literacy should be addressed from an early age onwards in order to empower children to develop their full health potential. Schools can be seen as an ideal venue for strengthening health literacy because they reach almost all school-aged children throughout their school years. The development of health literacy at a young age is a catalyst for healthy development throughout across the life span. Evidence shows that health and education are intertwined with favorable effects for health (e.g., health behavior, knowledge) and education outcomes (e.g., academic achievement). However, health literacy is often not sufficiently integrated into the school curriculum despite its importance to health and education. Integrating health literacy into schools is challenging, as both schools and teachers already face numerous educational requirements that may prevent them from addressing health in the classroom because they perceive it as an additional task. This is why taking a sensitive approach is important, adapted to the needs of schools and highlighting the benefits of health literacy. Installing health literacy in schools succeeds more easily if it can be linked to existing curricular requirements. In this context, curriculum and instruction on media literacy, information literacy, and digital literacy are most promising subjects to include health literacy because these concepts share many commonalities with health literacy and often are already part of the school curriculum. The aim of this article is to (1) analyze a mandatory curriculum on media literacy in the state of North-Rhine-Westphalia in Germany, (2) highlight its intersections with health literacy, and (3) show how it can be used to address health literacy. The state media literacy framework is based on the federal standards for “digital education” developed by the German Conference on Education Ministries und Cultural Affairs (KMK). As education policy and practice is decentralized with sixteen federal states in Germany, each of them has got their own media literacy framework, or they are currently developing it. This curriculum analysis may serve as a methodological blueprint for educationalists, teachers, and policy-maker elsewhere in order to include health literacy into existing curricula both health and non-health. It may help to integrate health literacy into schools when combined with existing curricula.

Understanding disadvantaged adolescents' perception of health literacy through a systematic development of peer vignettes

Background

Adolescence represents a crucial phase of life where health behaviours, attitudes and social determinants can have lasting impacts on health quality across the life course. Unhealthy behaviour in young people is generally more common in low socioeconomic groups. Nevertheless, all adolescents should have a fair opportunity to attain their full health potential. Health literacy is positioned as a potential mediating factor to improve health, but research regarding health literacy in adolescents and socially disadvantaged populations is limited. As part of Phase one of the Ophelia (OPtimising HEalth LIterAcy) framework, The purpose of this study was to explore the perceptions of socially disadvantaged Irish adolescents in relation to health literacy and related behaviours, and utilise this data to develop relevant vignettes.

Methods

A convergent mixed method design was used to co-create the vignettes. Questionnaires were completed by 962 adolescents (males n = 553, females n = 409, Mean age = 13.97 ± 0.96 years) from five participating disadvantaged schools in Leinster, Ireland. Focus groups were also conducted in each school (n = 31). Results were synthesised using cluster and thematic analysis, to develop nine vignettes that represented typical male and female subgroups across the schools with varying health literacy profiles. These vignettes were then validated through triangular consensus with students, teachers, and researchers.

Discussion

The co-creation process was a participatory methodology which promoted the engagement and autonomy of the young people involved in the project. The vignettes themselves provide an authentic and tangible description of the health issues and health literacy profiles of adolescents in this context. Application of these vignettes in workshops involving students and teachers, will enable meaningful engagement in the discussion of health literacy and health-related behaviours in Irish young people, and the potential co-designing of strategies to address health literacy in youth.

Conclusion

As guided by the Ophelia framework, the use of authentic, interactive and participatory research methods, such as the co-creation of vignettes, is particularly important in groups that are underserved by traditional research methods. The approach used in this study could be adapted to other contexts to represent and understand stakeholders’ perceptions of health, with a view to explore, and ultimately improve, health literacy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10634-x.

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.

HealthLit4Kids: Supporting schools to be health literacy responsive organisations

ISSUE ADDRESSED

To reduce inequity, services and community organisations must respond to the health literacy needs and strengths of each individual accessing their services. As a social determinant, health literacy is compounded by interactions between the service provider, the individual, and their wider community. Schools provide a critical nexus between the teacher (as service provider), the student (as learner) and their family (carers and wider community) to support the development of children's health literacy.

METHODS

Five Tasmanian primary schools (84 teachers) completed an assessment of their school in relation to the domains of a health literate organisation using the HeLLOTas! (HEalth Literacy Learning Organisations Tasmania) Self-Assessment Checklist, before and after taking part in the HealthLit4Kids program.

RESULTS

While the differences between pre- and post-intervention ratings were not large, they moved in a positive direction for all six domains. There was a significant main effect of time, F (1, 4) = 83.9, P < .001, ƞ²  = 0.99, showing that overall ratings increased from before to after the intervention. Teacher-recommended actions across all schools were grouped for insight into their interpretation and application of the tool in the school context.

CONCLUSION

Using the HeLLOTas! Self-Assessment Checklist served a dual purpose. Teachers developed a shared understanding of the characteristics of a health-literate organisation to produce a schoolwide action plan. Simultaneously, we gained valuable insights into the processes required to support the development of organisational health literacy in schools, and we share ten propositions applicable to other schools locally, nationally and internationally. SO WHAT?: To the best of our knowledge, this is the first time that a school's health literacy responsiveness has been measured. Our key propositions will support future efforts by policy makers, researchers and school principals.

A pilot study of adolescent health literacy research in Melbourne: Implementation and reflections

ISSUES ADDRESSED

While adolescent health literacy research has gained momentum, there is little evidence regarding its implementation and data collection in school settings. This study explored the feasibility of collecting health literacy data from Australian secondary schools and piloted three health literacy instruments.

METHODS

A cross-sectional study was designed to recruit four government secondary schools in Melbourne. Active, opt-in consent was obtained from parents and students in Years 7-9, and an online survey was conducted. Three health literacy instruments were used: the 8-item Health Literacy Assessment Tool (HLAT-8), the Newest Vital Sign (NVS), and the 47-item Health Literacy Survey (HLS-47).

RESULTS

A total of 120 students (age 12-15 years) were finally recruited from one school, whereas the other three schools declined due to busy educational commitment or no interest in research. Learnings and reflections on data collection included: a shared perspective of health literacy evaluation between school and researchers; the feasibility of online data collection; and the possibility of obtaining passive, opt-out consent. About one-quarter (23.7%-32.2%) of students were likely to have poor health literacy.

CONCLUSIONS

Although the recruitment was challenging, this pilot study indicates the feasibility of large-scale online health literacy survey in future school-based research. SO WHAT?: Measuring and monitoring adolescent health literacy is essential to achieve the aim of the Australian Curriculum of Health and Physical Education. More implementation research is needed with representative samples to validate health literacy instruments and examine the impact of health literacy on health promotion outcomes in Australian adolescents.

A Comparative Study on Adolescents' Health Literacy in Europe: Findings from the HBSC Study

(1) Background: There is a need for studies on population-level health literacy (HL) to identify the current state of HL within and between countries. We report comparative findings from 10 European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia) on adolescents’ HL and its associations with gender, family affluence (FAS), and self-rated health (SRH). (2) Methods: Representative data (N = 14,590; age 15) were drawn from the HBSC (Health Behavior in School-Aged Children) study. The associations between HL, gender, FAS, and SRH were examined via path models. (3) Results: The countries exhibited differences in HL means and in the range of scores within countries. Positive associations were found between FAS and HL, and between HL and SRH in each country. Gender was associated with differences in HL in only three countries. HL acted as a mediator between gender and SRH in four countries, and between FAS and SRH in each country. (4) Conclusions: The findings confirm that there are differences in HL levels within and between European countries, and that HL does contribute to differences in SRH. HL should be taken into account when devising evidence-informed policies and interventions to promote the health of adolescents.

Adolescent Health Literacy in Beijing and Melbourne: A Cross-Cultural Comparison

While adolescent health literacy has gained momentum, it is under-researched from a cross-cultural perspective. This study aims to compare health literacy among two cultural groups of secondary students in Beijing and Melbourne. A cross-sectional study was conducted with 770 students from five secondary schools in Beijing and Melbourne. A self-administered questionnaire was designed to collect information on health literacy (the eight-item health literacy assessment tool (HLAT-8), the Newest Vital Sign (NVS) and the 47-item Health Literacy Survey (HLS-47)), its antecedents and health outcomes. Overall, students’ health literacy in Melbourne (n = 120) was higher than that in Beijing (n = 650): 28.25 ± 6.00 versus 26.37 ± 5.89 (HLAT-8); and 4.13 ± 1.73 versus 3.65 ± 1.64 (NVS). The proportion of students with low health literacy varied by instruments, representing 23.7–32.2% in Melbourne and 29.0%–45.5% in Beijing. In both cultural groups, students’ self-efficacy, social support, and perceptions of school environment were associated with their health literacy, which in turn predicted their health behaviours, patient-provider communication and health status. Given the nature of our study design and small samples, a cautious conclusion would be that adolescent health literacy is sensitive to the broad cultural context and might be an interactive outcome influenced by an individual’s health skills and the social environment. Particularly, creating a supportive school environment is critical to develop adolescent health literacy that would eventually contribute to better health outcomes.