COVID-19: health literacy is an underestimated problemRapid development of coronavirus disease 2019 (COVID-19) into a pandemic has called for people to acquire and apply health information, and adapt their behaviour at a fast pace. 1 Health communication intended to educate people about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and how to avoid getting or spreading the infection has become widely available. Most valuable information is created in an easyto-understand manner that offers simple and practical solutions, such as washing hands, maintaining physical distance 2 , and where to find information about the latest recommendations, and advice. Unfortunately, there is also complex, contradictory, and false information. 1 Similarly, individuals are considered able to acquire, understand, and use this information in a sound and ethical mannerie, to be health literate.However, the COVID-19 infodemic 1 has highlighted that poor health literacy among a population is an underestimated public health problem globally. For instance, in Europe, nearly half of adults reported having problems with health literacy and not having relevant competencies to take care of their health and that of others. 3 Health literacy is already seen as a crucial tool for the prevention of non-communicable diseases with investments in education and communication sought to be sustainable, long-term measures starting early in the life course. 4 However, when COVID-19 emerged rapidly, two aspects became striking. First, globally, health literacy is as important for the prevention of communicable diseases as it is for non-communicable diseases. Second, along with system preparedness, individual preparedness is key for solving complex real-life problems. In this pandemic, it is difficult, yet possible, to take the time to enhance health literacy because immediate action is required by governments and citizens.For countries to secure health-care services for the most susceptible individuals, many people have adopted policies that restrict physical contact by banning events, sizing limits for group gatherings, and even issuing stayat-home orders. Governments and health authorities are pleading for individual responsibility in avoiding all unnecessary risks for infection with or spread of SARS-CoV-2. During these times, the discussion around human rights and personal freedom, democracy, social

PurposeTo define health literacy as a learning outcome in schools, and to describe the learning conditions that are relevant for targeting health literacy. Design/methodology/approachThis paper draws on theoretical and empirical educational literature, and also the experiences of the authors. FindingsHealth literacy is defined as consisting of five core components: (1) theoretical knowledge, (2) practical knowledge, (3) critical thinking, (4) self-awareness, and (5) citizenship. The first three components are rather similar to the commonly-accepted health literacy concept, but the definition given in this paper expands the concept via two additional -but essential -components. It is emphasized that when one is aiming to develop students' internal capacity to construct their own meanings regarding health topics, these two additional components are called for. We argue that one of the main aims of health teaching in schools should be to foster students' ability to define their own beliefs, identity and social relations. Moreover, if we wish students to become responsible citizens, acting in an ethically responsible way, competencies such as ethical reflection skills should be developed in schools. We also highlight the fact that the development of certain health literacy components calls for particular kinds of learning conditions. Originality/value2 The paper identifies the core components of health literacy as a learning outcome and gives practical examples of means to achieve a particular target.

Aims: The present paper focuses on the measurement of health literacy (HL), which is an important determinant of health and health behaviours. HL starts to develop in childhood and adolescence; hence there is a need for instruments to monitor HL among younger age groups. These instruments are still rare. The aim of the project reported here was therefore to develop a brief, multidimensional, theorybased instrument to measure subjective HL among school-aged children. Methods: The development of the instrument covered four phases: item generation based on a conceptual framework, a pilot study (n=405), test-retest (n=117), and construction of the instrument (n=3853). All the samples were taken from Finnish 7 th and 9 th graders. Results: Initially, 65 items were generated, of which 32 items were selected for the pilot study. After item reduction, the instrument contained 16 items. The test-retest phase produced estimates of stability. In the final phase a 10-item instrument was constructed, referred to as Health Literacy for School-aged Children (HLSAC). The instrument exhibited a high Cronbach alpha (.93), and included two items from each of five predetermined theoretical components (theoretical knowledge, practical knowledge, critical thinking, self-awareness, citizenship). Conclusions: The iterative and validity driven development process made it possible to construct a brief multidimensional HLSAC instrument. Such instruments are suitable for large-scale studies, and for use with children and adolescents. Validation will require further testing for use in other countries.

PurposeA systematic review of literature was conducted to compile, analyse and describe the methodology and measurement of childhood/adolescent health literacy.Design/methodology/approachSix online databases (ERIC, PubMed, CINAHL, Biomed Central, Web of Science and Sports Discuss) were systematically searched to identify English language, peer‐reviewed articles, published between 1980 and April 2011, which reported on the measurement of health literacy in a population under the age of 18. The search identified 16 articles to be included in the final review, from which, data were systematically extracted in order to answer four review questions concerning several aspects of the method and effectiveness of the completed studies.FindingsThe majority (n=13) of the studies described the use of newly developed measurement tools and enquiry methods. The majority (n=14) assessed health literacy via task performance as opposed to examining self‐reported health literacy. Thirteen health topics and nine distinct components of health literacy were identified as being scrutinised by the 16 articles. Examination of the intended measurement aims of each study, in comparison with the actual measurement methods revealed that six studies fully succeeded in examining what they intended to measure. It is concluded that even though research in this field is escalating, clear definitions and measurement methods of childhood health literacy must be developed in order to effectively expand the field further and comprehensively assess childhood health literacy.Originality/valueThis review is to our knowledge the first to collate and examine studies concentrating solely on the measurement of health literacy in a child and/or adolescent population.

If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. Subjective health literacy among school-aged children Abstract Purpose The aim of this study was to explore Finnish adolescents' subjective health literacy (HL) in association to school achievement, learning difficulties, educational aspirations, and family affluence. Design/methodology/approach Nationally representative data were collected in Finland as part of the international Health Behaviour in School-aged Children (HBSC) study. The respondents consisted in total of 3,833 adolescents (7th and 9th graders) from 359 schools. The Health Literacy for School-aged Children (HLSAC) instrument was applied to measure adolescents' subjective HL, while the Family Affluence Scale (FAS) was used to measure adolescents' socioeconomic status. Information was gathered on school achievement, learning difficulties, and educational aspirations. Findings Approximately one third of the adolescents manifested a high level of HL, around 60% had a moderate level of HL, and about one tenth had low HL. The HL level was lower for boys than for girls, and lower for 7th graders than for 9th graders. In the total sample the strongest explanatory variables for HL were school achievement in the first language, and educational aspirations. Originality/value This study provides the first Finnish nationally representative examination of adolescents' subjective HL levels, and how these vary across age and gender groups. In drawing conclusions and presenting suggestions for HL interventions, it is important to verify the nature of the HL examined in any given study, and how it was researched.