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.

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.

(1) Background: There is a need for studies on population-level health literacy (HL) to identify the current state of HL within and between countries. We report comparative findings from 10 European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia) on adolescents’ HL and its associations with gender, family affluence (FAS), and self-rated health (SRH). (2) Methods: Representative data (N = 14,590; age 15) were drawn from the HBSC (Health Behavior in School-Aged Children) study. The associations between HL, gender, FAS, and SRH were examined via path models. (3) Results: The countries exhibited differences in HL means and in the range of scores within countries. Positive associations were found between FAS and HL, and between HL and SRH in each country. Gender was associated with differences in HL in only three countries. HL acted as a mediator between gender and SRH in four countries, and between FAS and SRH in each country. (4) Conclusions: The findings confirm that there are differences in HL levels within and between European countries, and that HL does contribute to differences in SRH. HL should be taken into account when devising evidence-informed policies and interventions to promote the health of adolescents.

The sports club setting may work towards equalizing health literacy differences related to school achievement. However, the clubs should ensure that access is available to as many adolescents as possible; by this means they may spread beneficial influences, supporting the development of health literacy among broader population groups.