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

Understanding Critical Health Literacy Among Adolescents: Psychometric Properties of the CHLA Questionnaire in Lower Secondary Schools in Norway

BACKGROUND

Schools are important arenas for the promotion of critical health literacy (CHL) among adolescents. Key domains of CHL are information appraisal, understanding social determinants of health, and abilities to act on determinants of health. In this paper, we examine the psychometric properties of the Critical Health Literacy for Adolescents Questionnaire (CHLA-Q).

METHODS

A cross-sectional survey study was performed at 5 schools in Norway. Respondents included 522 pupils aged 13-15 years old. Confirmatory factor analysis (CFA) was conducted to examine the structural validity. Internal reliability was assessed using ordinal Cronbach's alpha.

RESULTS

The estimated model had acceptable closeness of fit. Five of 6 scales displayed adequate internal reliability.

CONCLUSION

The results indicate acceptable fit of the CHLA-Q framework and that 5 of the 6 scales are applicable to inform future research and interventions. More research is needed on measurement of the second domain of CHL.

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.

Measuring Health Literacy in Childhood and Adolescence with the Scale Health Literacy in School-Aged Children – German Version

Abstract. Health literacy can help explain health inequalities in childhood and adolescence. However, suitable instruments for assessing health literacy in this age group are rare, especially in the German-speaking countries. One economical measure is the 10-item Health Literacy in School-Aged Children (HLSAC) scale, developed and reviewed as part of the WHO Child and Adolescent Health Study (HBSC, Health Behavior in School-Aged Children). In the present study, we tested dimensionality, measurement invariance, and associations with health-related measures of the German version of the scale (HLSAC–German), using data from the 2018 national German HBSC study ( N = 4,347 students aged 11, 13, and 15 years). We also tested HLSAC–German with 11-year-olds, representing an expansion of the original scale. Exploratory and confirmatory factor analyses consistently demonstrated the unidimensionality of the scale (α = .88). Complete scalar measurement invariance was found for sex and partial scalar measurement invariance for age groups and school type, allowing for the comparison of means. Associations with indicators of health and health behavior further demonstrate the construct validity of the scale. The analyses show that the scale is suitable for the economic measurement of a general factor of health literacy in 11- as well as in 13- and 15-year-olds.

Exploring pandemic-related health literacy among adolescents in Germany: a focus group study

Background

Health literacy enables people to cope efficiently with health threats, such as the COVID-19 pandemic. However, little is known about health literacy among adolescents in general and especially in the context of pandemics. This study aimed to explore pandemic-related health literacy among adolescents by addressing cognitive, behavioral, conative, and affective components of the multidimensional health literacy construct.

Methods

Four online focus groups with 24 adolescents aged 13-17 years from four German federal states were conducted during the COVID-19 pandemic in May and June 2021. Data were analyzed using qualitative content analysis.

Results

Regarding the cognitive and behavioral components of pandemic-related health literacy, adolescents reported to use a broad range of traditional and digital media and personal information sources. The adolescents considered pandemic-related information to be good and easy to understand, when the information is presented in a concise and structured manner. The participants stated difficulties in finding, understanding, and evaluating pandemic-related information regarding particular protective measures. The adolescents described themselves to be critical when evaluating pandemic-related information and reported a high level of adherence to protective measures. Regarding the conative and affective components of health literacy, the adolescents explained that their wish to protect their loved ones from getting infected was the predominant motive for adherence to protective measures. They were convinced that people of their age play a role in pandemic containment. The adolescents reported sometimes making exceptions from adhering to protective measures to cope with negative feelings they experienced during the pandemic.

Conclusions

This study provides insights on how measures to improve pandemic-related health literacy among adolescents may be tailored to their needs. Prompt, concise, structured, and comprehensible preparation and communication of pandemic-related information in addition to educational efforts to strengthen health-related cognitive skills and critical health literacy may be supportive to reduce barriers in finding, understanding, and evaluating pandemic-related content.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00937-9.

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.

Wissen schafft Gesundheit: Das Programm „Fit in Gesundheitsfragen“ zur Stärkung der Gesundheitskompetenz von Schülerinnen und Schülern

In Deutschland weist mehr als die Hälfte der Bevölkerung eine geringe Gesundheitskompetenz auf. Diese Menschen haben Schwierigkeiten, gesundheitsrelevante Informationen zu finden, einzuordnen und anzuwenden. Unter ihnen sind auch viele junge Menschen, was den Stellenwert früher Interventionen zur Förderung der Gesundheitskompetenz verdeutlicht.

Das Programm „Fit in Gesundheitsfragen“ der Gesundheitsinformationsdienste vom Forschungszentrum Helmholtz Munich und dem Deutschen Krebsforschungszentrum hat zum Ziel, einen Beitrag zur Förderung verschiedener Dimensionen von Gesundheitskompetenz bei Kindern und Jugendlichen zu leisten. Dazu werden innovative Fortbildungsformate für Lehrkräfte und Unterrichtsmaterialien für Lernende der Sekundarstufen I und II konzipiert und begleitend evaluiert. Am Modell der Volkskrankheiten Krebs und Diabetes mellitus wird Wissen zu deren Entstehung, Prävention, Behandlung und Erforschung vermittelt. Darüber hinaus werden Wissen über das Gesundheitssystem und Materialien zur Förderung der Gesundheitskompetenz bereitgestellt. Die Evaluation erhebt Indikatoren zu Reichweite und Akzeptanz der Maßnahmen.

Seit 2018 wurden 46 Unterrichtsmaterialien und 3 Informationsschriften mit Hintergrundwissen für Lehrende veröffentlicht. Ferner wurden 50 Lehrerfortbildungen durchgeführt, an denen bis Ende 2021 rund 1600 Lehrkräfte und Multiplikatoren in Präsenz oder online teilnahmen. Sie erteilten den jeweiligen Veranstaltungen zu über 90 % sehr gute und gute Noten. Rund 80 % der Teilnehmenden gaben an, die vermittelten Themen in ihrem Unterricht aufgreifen zu wollen. Ein weiterer Ausbau des Angebots ist vorgesehen. Die Testung ausgewählter Materialien im Hinblick auf die Förderung der Gesundheitskompetenz in einer Stichprobe von Lernenden ist in Planung.

Developing Indicators to Measure Critical Health Literacy in the Context of Norwegian Lower Secondary Schools

A critical health literacy (CHL) approach is recommended for promoting health in the school context. This construct is complex and includes three interconnected domains: (A) appraisal of critical information, (B) awareness of the social determinants of health (SDH), and (C) collective action to promote health and well-being. In recent literature reviews, no measurement instrument that covers all three domains of CHL in the school-context was found. Our aim was to develop self-reported measurement scales for each domain of CHL. The development process reported in this study was conducted in two stages. In the first stage, an initial item pool was generated based on literature reviews and focus group interviews (N = 15) with adolescents (steps 1–2). In the next steps, items were adjusted and removed based on the feedback from an expert panel and from representatives from the target group (steps 3–5). In stage two, we aimed to reduce the number of items and develop scales for each domain. We then piloted the current draft, which consists of 28 items (N = 114). A sub-sample (N = 10) of the participants were interviewed after they completed the survey to examine the instrument’s face validity. Cronbach’s α was used to assess the internal reliability of the scales; the reliability was promising for scales A (α = 0.83) and C (α = 0.85) but was below the recommended value for scale B (α = 0.61). The model fit indices were promising (TLI_scaleA = 0.97, RSMEA_scaleA = 0.055, TLI_scaleB = 1.05, RMSEA_scaleB = 0.00, TLI_scaleC = 0.95, RMSEA_scaleC = 0.074). The piloted version of scales A and C were positively correlated with subjective health literacy, health-related quality of life, and subjective health; however, we found no such correlations for scale B. The post-survey group interviews led to some adjustments in scales A and B. The revised version of CHLA-Q must be tested using a larger sample; this will enable more robust statistical testing of the properties of the items and the scale.

Promoting Navigation Health Literacy at the Intersection of Schools and Communities. Development of the Game-Based Intervention Nebolus

Emerging empirical evidence indicates a limited health literacy for a substantial proportion of children and adolescents. Although it is generally agreed upon promoting health literacy as early as possible in the lifespan, there is a lack of interventions addressing children and adolescents and their primary living environments. This article describes the development of Nebolus, a game-based intervention aiming to promote navigation health literacy at the intersection of schools and communities. Its intervention foundation lies in a socio-ecological understanding of health as well as in the Entertainment Education approach. Following an extensive literature search on health-related location-based games, a co-creation process was initiated that involved adolescents, community stakeholders, and design/IT professionals in all phases of the intervention development. The final Nebolus intervention includes three core activities: (1) a Nebolus rally app for adolescents aged 12 to 16 years, (2) an online planning tool allowing local health service providers/professionals to set up own Nebolus rallies, and (3) accompanying teaching material on health literacy in the school setting to be used before and after the Nebolus rallies. This article provides an overview of the intervention layout and discusses strengths and challenges of its development and implementation.

[Evidence-based primary prevention and health promotion: methods and procedures in 5 research consortia]

Von 2014 bis 2022 erforschen die 5 deutschen Forschungsverbünde AEQUIPA, CAPITAL4HEALTH, HLCA, PartKommPlus und SMARTACT Themen der Primärprävention und Gesundheitsförderung mit dem Ziel, die Evidenzgrundlagen in diesen Bereichen weiterzuentwickeln. In diesem Beitrag wird die Arbeit der 5 Forschungsverbünde für Primärprävention und Gesundheitsförderung unter dem Aspekt der Evidenzbasierung aus der internen Perspektive vorgestellt, analysiert und diskutiert. Als orientierender Rahmen dient ein Modell der evidenzbasierten Public Health.

Die 5 Forschungsverbünde nutzen für die Evidenzgenerierung vielfältige Zugangswege bzgl. der Beteiligung nichtakademischer, zivilgesellschaftlicher Akteur*innen und Nutzer*innen. Es finden sich vielfältige Studiendesigns, die von randomisiert kontrollierten Studien und systematischen Reviews zu diversen qualitativen Designs reichen. Die Nutzung von Modellen und Theorien unterstützt die Evidenzbasierung. Über die Evidenzentwicklung hinaus legen alle Verbünde einen Schwerpunkt auf die zumindest exemplarische Implementierung des neuen Wissens.

Durch die Methodenvielfalt kann eine breit gefächerte Evidenzbasierung unter Berücksichtigung verbundspezifischer Aspekte realisiert werden. Grenzen für eine weitere systematische Stärkung der Evidenzbasierung liegen in strukturellen Rahmenbedingungen. Insbesondere die Einbindung von nichtakademischen, zivilgesellschaftlichen Akteur*innen und Nutzer*innen für die Arbeit mit schwer erreichbaren Zielgruppen kann oft nicht ausfinanziert bzw. zeitlich berücksichtigt werden. Die COVID-19-Pandemie verdeutlicht die Wichtigkeit eines flexiblen Methodenspektrums, in dem ein sinnvolles Zusammenspiel von digitalen und analogen Methoden anzustreben ist.

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.

Dimensionen der Gesundheitskompetenz von Viertklässler*innen

Hintergrund

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

Ziel der Arbeit (Fragestellung)

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

Material und Methoden

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

Ergebnisse

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

Schlussfolgerung

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

Subjective Generic Health Literacy and Its Associated Factors among Adolescents: Results of a Population-Based Online Survey in Germany

Profound data on adolescent health literacy are needed as a requirement for the development of health literacy promoting interventions. This paper aims to study the level of generic health literacy among adolescents and to explore associations between health literacy and socio-demographic (age, sex, family affluence, migration background), social (social support by family and friends) and personal (self-efficacy) factors. We conducted a representative cross-sectional online survey. Four health literacy dimensions were captured among 14–17 years old adolescents living in Germany (n = 1235) with the “Measurement of Health Literacy Among Adolescents-Questionnaire” (MOHLAA-Q). Descriptive, bivariate and multiple logistic regression analyses were used to analyse the data (n = 1202). We found poor health literacy levels—to varying degrees—in all examined health literacy dimensions: dealing with health-related information (8.41% with many difficulties), health-related communication skills (28.13% with low skills), attitudes toward one’s own health and health information (8.81% with passive attitudes) and health-related knowledge (22.73% with low levels). We identified significant associations between poor health literacy levels and all factors studied except for age. Our results indicate a need for the implementation of evidence-based health literacy-related promoting interventions, preferentially in education and training institutions.

Interdisciplinary Perspectives on Health Literacy Research Around the World: More Important Than Ever in a Time of COVID-19

As we write our editorial for a health literacy special issue in the midst of the international COVID-19 crisis, we take this opportunity to highlight the importance of individual, community, and population health literacy. We are not only in a "pandemic" but also an "infodemic". Health literacy is more important than ever in the face of these global health threats, which have impacted outcomes across the levels of the socio-ecological model (SEM), including individual health behaviors, family relationships, organizational behavior, state policy-making, national mortality statistics, and the international economy in the span of weeks. Our special issue sought to pull together interdisciplinary threads guided by two principles. The first was defining health literacy as essential skills and situational resources needed for people to find, understand, evaluate, communicate, and use information and services in a variety of forms across various settings throughout their life course to promote health and wellbeing. The second was the idea that enhancing health literacy in populations and systems is critical to achieving health equity. In this time of public health need across traditional borders, the inter-sectoral and international perspectives of special issue articles are more urgent than ever. A greater understanding, appreciation, and application of health literacy can support policy action on multiple levels to address major public health challenges. Health literacy should be built deliberately as a population-level resource and community asset. We have summarized the set of articles in this special issue across the levels of the SEM, hoping their thoughtful considerations and interesting findings will help to support global health and wellness and inspire future research, policy, and practice in this global public health emergency and beyond.