Adolescents' Health Literacy and Decision-making: A Qualitative Study

Fleary, Sasha A.; Joseph, Patrece

doi:10.5993/ajhb.44.4.3

Cited by 40 publications

(22 citation statements)

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“…Recent studies suggest that national and local efforts that incorporate key cultural characteristics such as language and context are particularly effective with young people, and potentially effective in reducing high risk sexual behaviors and increasing HIV testing [ 52 , 53 , 54 ]. Additionally, beyond basic health literacy, strengthening individuals interactive health literacy may reduce disparities, promote greater health equity and help to achieve EHE by strengthening individuals’ ability to discuss safer sex negotiation with their peers and sexual partners as well as strengthen their interactions with healthcare providers [ 55 , 56 ]. Finally, to achieve the goals of EHE, in addition to strengthening peer education (i.e., amongst peers and/or sexual partners), greater attentiveness to the dissemination of information regarding sexual health should be integrated into secondary and post-secondary educational contexts as well, as extant studies demonstrate their effectiveness in educational settings [ 57 , 58 ].…”

Section: Discussionmentioning

confidence: 99%

Ending the Epidemic: Assessing Sexual Health Communication, Personal Agency, and HIV Stigma among Black and Latino Youth in the U.S

Keene

Boyd

2021

IJERPH

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Sexual health communication warrants greater attention as it may help to reduce the rates of HIV incidence among youth. A growing body of literature suggests that conversations about sexual health among Black and Latino youth may serve as a potential strategy for HIV prevention. The current study investigates whether sexual health communication—in particular, conversations about sexual health and HIV—influences Black and Latino youth’s personal agency regarding their role in achieving an HIV-free generation. For this secondary data analysis, we used the National Survey of Teens and Young Adults on attitudes towards HIV/AIDS (n = 701). Participants included youth between the ages 15 and 24, and the average was 20 years. We used a multiple regression analysis to examine whether sexual health communication contributed to youth knowledge and awareness of (1) the national plan for EHE, and (2) their role in ending the epidemic”. (1) knowledge and awareness of the national plan for EHE, and (2) role in ending the epidemic. The final multiple regression model was statistically significant [R2 = 0.16 F (12, 701) = 001, p < 0.001] for both outcomes. Study results found that sexual health communication was positively related to Black and Latino youth’s awareness of efforts to end the HIV epidemic (EHE) and their belief that they could play a role in achieving EHE. In addition, HIV stigma influenced personal agency and whether youth were aware of efforts to achieve EHE. Our results demonstrated that openly communicating about sexual health and HIV may contribute to a sense of personal agency among Black and Latino youth. In addition, understanding whether sexual health communication contributes to a sense of personal agency among youth may inform HIV prevention efforts to achieve the goals set forth by the national EHE plan for the U.S.

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Section: Discussionmentioning

confidence: 99%

Ending the Epidemic: Assessing Sexual Health Communication, Personal Agency, and HIV Stigma among Black and Latino Youth in the U.S

Keene

Boyd

2021

IJERPH

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“…Item separation reliability (0.97) was acceptable. Wright sample-independent reliability statistic was 0.94 with the scores differentiating four levels of performances: Emerging (0-10), Expanding (11)(12)(13)(14)(15)(16)(17)(18)(19), Lower Bridging (20)(21)(22)(23)(24)(25)(26)(27), and Upper Bridging (28)(29)(30). The KR-20 alpha was 0.91.…”

Section: Aahl Compositementioning

confidence: 97%

“…Six focus groups (~8 students/group) were conducted with 9 th -12 th grade high school students (Mean age=16.49, Standard deviation [SD]=1.35, 86.5% girls, 35% non-Hispanic Black, 35% Hispanic/Latinx, 92% free/reduced lunch eligible) to better understand adolescents' de nition and operationalization of HL (full results reported elsewhere (14)). Participants also provided qualitative responses to scenarios related to IHL and CHL.…”

Section: Item Bank Developmentmentioning

confidence: 99%

“…In their qualitative research, Fleary and Joseph (14,15) found that the HL skills adolescents use in their health decision-making encompass Sørenson and colleague's (8) HL de nition and Nutbeam's (9) FHL, IHL, and CHL paradigm. For example, adolescents described being able to ask questions at their doctor's appointments (IHL) and critically analyze health information provided to them (CHL) as examples of good health decision-making skills.…”

Section: Introductionmentioning

confidence: 99%

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Development and Validation of Assessments of Adolescent Health Literacy: A Rasch Measurement Model Approach

Fleary¹,

Freund²,

Nigg³

2021

Preprint

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BackgroundHealth literacy (HL) is implicated in improved health decision-making and health promotion, and reduced racial, ethnic, and socioeconomic health disparities. Three major areas of HL include functional, interactive, and critical HL. HL skills develop throughout the lifespan as individuals’ psychosocial and cognitive capacities develop and as they accumulate experiences with navigating health systems. Though adolescence is marked by increased involvement in health decision-making, most HL studies and measures of HL have focused on adults. Both the adult and adolescent HL literature are also limited by the paucity of validated test-based measures for assessing HL. The existing test-based validated HL measures for adolescents were originally designed for adults. However, adolescents are at an earlier phase of developing their HL skills (e.g., fewer experiences navigating the health system) compared to adults and measures originally designed for adults may assume prior knowledge that adolescents may lack therein underestimating adolescents’ HL. This study developed and validated test-based assessments of adolescents’ functional, interactive, and critical HL.MethodsItems were generated in an iterative process: focus groups with adolescents to inform item content, cognitive interviews with adolescents and expert consultation established content and face validity of the initial items, items were revised or removed where indicated. High school students (n=355) completed a measurement battery including the revised HL items. The items were evaluated and validated using Rasch measurement models. ResultsThe final 6-item functional, 10-item interactive, and 7-item critical HL assessments and their composite (23 items) fit their respective Rasch models. Item-level invariance was established for gender (male vs. female), age (12-15-year-olds vs. 16-18-year-olds), and ethnicity in all assessments. The assessments had good convergent validity with an established measure of functional HL and scores on the assessments were positively related to reading instructions before taking medicine and questioning the truthfulness of information found online. ConclusionsThese assessments are the first test-based measures of adolescents’ interactive and critical HL, the first test-based measure of functional HL designed for adolescents, and first composite test-based assessment of all three major areas of HL. These assessments should be used to inform strategies for improving adolescents’ HL, decision-making, and behaviors.

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“…However, in their review of the literature, Fleary and colleagues [ 11 ] found that most studies exploring the relationship between adolescents’ HL and health behaviors predominantly assessed FHL. In their qualitative research, Fleary and Joseph [ 14 , 15 ] found that the HL skills adolescents use in their health decision-making encompass Sørenson and colleague’s [ 8 ] HL definition and Nutbeam’s [ 9 ] FHL, IHL, and CHL paradigm. For example, adolescents described being able to ask questions at their doctor’s appointments (IHL) and critically analyze health information provided to them (CHL) as examples of good health decision-making skills.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of assessments of adolescent health literacy: a Rasch measurement model approach

2022

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Background Health literacy (HL) is implicated in improved health decision-making and health promotion, and reduced racial, ethnic, and socioeconomic health disparities. Three major areas of HL include functional, interactive, and critical HL. HL skills develop throughout the lifespan as individuals’ psychosocial and cognitive capacities develop and as they accumulate experiences with navigating health systems. Though adolescence is marked by increased involvement in health decision-making, most HL studies and measures of HL have focused on adults. Both the adult and adolescent HL literature are also limited by the paucity of validated test-based measures for assessing HL. The existing test-based validated HL measures for adolescents were originally designed for adults. However, adolescents are at an earlier phase of developing their HL skills (e.g., fewer experiences navigating the health system) compared to adults and measures originally designed for adults may assume prior knowledge that adolescents may lack therein underestimating adolescents’ HL. This study developed and validated test-based assessments of adolescents’ functional, interactive, and critical HL. Methods Items were generated in an iterative process: focus groups with adolescents informed item content, cognitive interviews with adolescents and expert consultation established content and face validity of the initial items, and items were revised or removed where indicated. High school students (n = 355) completed a measurement battery including the revised HL items. The items were evaluated and validated using Rasch measurement models. Results The final 6-item functional, 10-item interactive, and 7-item critical HL assessments and their composite (23 items) fit their respective Rasch models. Item-level invariance was established for gender (male vs. female), age (12–15-year-olds vs. 16–18-year-olds), and ethnicity in all assessments. The assessments had good convergent validity with an established measure of functional HL and scores on the assessments were positively related to reading instructions before taking medicine and questioning the truthfulness of health information found online. Conclusions These assessments are the first test-based measures of adolescents’ interactive and critical HL, the first test-based measure of functional HL designed for adolescents, and the first composite test-based assessment of all three major areas of HL. These assessments should be used to inform strategies for improving adolescents’ HL, decision-making, and behaviors.

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Adolescents' Health Literacy and Decision-making: A Qualitative Study

Cited by 40 publications

References 0 publications

Ending the Epidemic: Assessing Sexual Health Communication, Personal Agency, and HIV Stigma among Black and Latino Youth in the U.S

Ending the Epidemic: Assessing Sexual Health Communication, Personal Agency, and HIV Stigma among Black and Latino Youth in the U.S

Development and Validation of Assessments of Adolescent Health Literacy: A Rasch Measurement Model Approach

Development and validation of assessments of adolescent health literacy: a Rasch measurement model approach

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