Quality of health literacy instruments used in children and adolescents: a systematic review

Abstract

ObjectiveImproving health literacy at an early age is crucial to personal health and development. Although health literacy in children and adolescents has gained momentum in the past decade, it remains an under-researched area, particularly health literacy measurement. This study aimed to examine the quality of health literacy instruments used in children and adolescents and to identify the best instrument for field use.DesignSystematic review.SettingA wide range of settings including schools, clinics and communities.ParticipantsChildren and/or adolescents aged 6–24 years.Primary and secondary outcome measuresMeasurement properties (reliability, validity and responsiveness) and other important characteristics (eg, health topics, components or scoring systems) of health literacy instruments.ResultsThere were 29 health literacy instruments identified from the screening process. When measuring health literacy in children and adolescents, researchers mainly focus on the functional domain (basic skills in reading and writing) and consider participant characteristics of developmental change (of cognitive ability), dependency (on parents) and demographic patterns (eg, racial/ethnic backgrounds), less on differential epidemiology (of health and illness). The methodological quality of included studies as assessed via measurement properties varied from poor to excellent. More than half (62.9%) of measurement properties were unknown, due to either poor methodological quality of included studies or a lack of reporting or assessment. The 8-item Health Literacy Assessment Tool (HLAT-8) showed best evidence on construct validity, and the Health Literacy Measure for Adolescents showed best evidence on reliability.ConclusionsMore rigorous and high-quality studies are needed to fill the knowledge gap in measurement properties of health literacy instruments. Although it is challenging to draw a robust conclusion about which instrument is the most reliable and the most valid, this review provides important evidence that supports the use of the HLAT-8 to measure childhood and adolescent health literacy in future school-based research.

Validity and Reliability of the Amharic Version of the HLS-EU-Q47 Survey Questionnaire among Urban School Adolescents and University students in Dire Dawa, Ethiopia

“…In this study, Pearson correlation coefficients between Gen-HL and three sub-dimensions scores showed these coefficients with Gen-HL were found as 0.780, 0.836 and 0.807 with the sub-dimensions HC, DP and HP, respectively and higher correlation coefficient between these sub-dimensions (Table 2). These values were closer to several studies results in European and Asian countries and a study in Brazil showed similar results [15,19,[25][26][27][28][29]. Regarding item-scale convergent validity, most of these items evidently had shown to have very weak correlation (rho) ranging from − 0.022 to 0.450 with variations within these range for general health literacy and for each of these three subscales in both categories of participants ( Table 3).…”

“…Health literacy is a multidimensional and multifaceted construct concept [13] so that there exists variation in indicators and measurement tools [14], [15]. Taking these in account, the European Health Literacy (HLS-EU) project that took place 2009-2012 supported and funded by the European Commission and the national partners in the HSL-EU Consortium aiming to measure health literacy in Europe, establish networks and to promote health literacy in Europe [16][17][18].…”

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

“…Over the last decade, the field of adolescent health literacy has gained momentum globally [1][2][3][4]. As a personal asset, it highlights the empowerment of adolescents and their own rights of citizenship in society [5].…”

“…Given that health literacy is a broad concept with a wide range of assessment tools [3], it is essential to consider it within a specific context for a specific content [22]. In this present study, we defined adolescent health literacy as "an individual's ability to find, understand and use health information and services to promote and maintain good health" [23] and applied it into school settings.…”

Are health literacy and lifestyle of undergraduates related to the educational field? An Italian survey

“…However, although HL in young people has gained increasing attention in the past decade, studies analyzing HL in adolescents and young adults are still limited (26)(27)(28).…”