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

Abstract

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.

Development of a Proposal for a Program to Promote Positive Mental Health Literacy among Adolescents: A Focus Group Study

“…In relation to the category ‘ assessment ’, participants advocated for evaluation before and after program implementation and also during the follow-up [ 9 , 37 , 38 ], where adolescents should be given instruments to evaluate PMeHL, either through instruments that already exist and are properly validated and adapted or through an instrument that the research team constructs specifically for program evaluation. In addition, they recommend that during each session, the adolescents should be evaluated by the program facilitators through the application of observation grids that the research team needs to create in order to obtain information not only about the adolescents’ progress, but also suggestions for improvement of the program in progress, as recommended by Richards & Halberg [ 37 ] and by Morgado et al [ 9 , 30 ].…”

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

“…The HLSAC thus measures the respondents' currently experienced abilities in relation to the five components and does not refer to any age-specific health challenges or use age-specific cut-offs. The HLSAC was originally developed to inform the integration of health literacy in school curricula and has been validated among children and adolescents in several countries, including Denmark [27][28][29][30][31][32]. However, given its brevity and broad conceptualization of health literacy [26], the HLSAC may be a valuable health literacy measuring instrument among adults as well.…”