BackgroundChildren and young people constitute a core target group for health literacy research and practice: during childhood and youth, fundamental cognitive, physical and emotional development processes take place and health-related behaviours and skills develop. However, there is limited knowledge and academic consensus regarding the abilities and knowledge a child or young person should possess for making sound health decisions. The research presented in this review addresses this gap by providing an overview and synthesis of current understandings of health literacy in childhood and youth. Furthermore, the authors aim to understand to what extent available models capture the unique needs and characteristics of children and young people.MethodSix databases were systematically searched with relevant search terms in English and German. Of the n = 1492 publications identified, N = 1021 entered the abstract screening and N = 340 full-texts were screened for eligibility. A total of 30 articles, which defined or conceptualized generic health literacy for a target population of 18 years or younger, were selected for a four-step inductive content analysis.ResultsThe systematic review of the literature identified 12 definitions and 21 models that have been specifically developed for children and young people. In the literature, health literacy in children and young people is described as comprising variable sets of key dimensions, each appearing as a cluster of related abilities, skills, commitments, and knowledge that enable a person to approach health information competently and effectively and to derive at health-promoting decisions and actions.DiscussionIdentified definitions and models are very heterogeneous, depicting health literacy as multidimensional, complex construct. Moreover, health literacy is conceptualized as an action competence, with a strong focus on personal attributes, while also recognising its interrelatedness with social and contextual determinants. Life phase specificities are mainly considered from a cognitive and developmental perspective, leaving children’s and young people’s specific needs, vulnerabilities, and social structures poorly incorporated within most models. While a critical number of definitions and models were identified for youth or secondary school students, similar findings are lacking for children under the age of ten or within a primary school context.

BackgroundHealth literacy is an important health promotion concern and recently children and adolescents have been the focus of increased academic attention. To assess the health literacy of this population, researchers have been focussing on developing instruments to measure their health literacy. Compared to the wider availability of instruments for adults, only a few tools are known for younger age groups. The objective of this study is to systematically review the field of generic child and adolescent health literacy measurement instruments that are currently available.MethodA systematic literature search was undertaken in five databases (PubMed, CINAHL, PsycNET, ERIC, and FIS) on articles published between January 1990 and July 2015, addressing children and adolescents ≤18 years old. Eligible articles were analysed, data was extracted, and synthesised according to review objectives.ResultsFifteen generic health literacy measurement instruments for children and adolescents were identified. All, except two, are self-administered instruments. Seven are objective measures (performance-based tests), seven are subjective measures (self-reporting), and one uses a mixed-method measurement. Most instruments applied a broad and multidimensional understanding of health literacy. The instruments were developed in eight different countries, with most tools originating in the United States (n = 6). Among the instruments, 31 different components related to health literacy were identified. Accordingly, the studies exhibit a variety of implicit or explicit conceptual and operational definitions, and most instruments have been used in schools and other educational contexts. While the youngest age group studied was 7-year-old children within a parent-child study, there is only one instrument specifically designed for primary school children and none for early years.ConclusionsDespite the reported paucity of health literacy research involving children and adolescents, an unexpected number of health literacy measurement studies in children’s populations was found. Most instruments tend to measure their own specific understanding of health literacy and not all provide sufficient conceptual information. To advance health literacy instruments, a much more standardised approach is necessary including improved reporting on the development and validation processes. Further research is required to improve health literacy instruments for children and adolescents and to provide knowledge to inform effective interventions.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5054-0) contains supplementary material, which is available to authorized users.

ZusammenfassungDas Konzept der digitalen Gesundheitskompetenz ist das Ergebnis der zunehmenden gesellschaftlichen Durchdringung von digitalen Medien und deren Nutzung im Alltag. Infolge der hohen Zugänglichkeit und Allgegenwärtigkeit von Gesundheitsinformationen steigt die Notwendigkeit nicht nur des Suchens und Findens, sondern insbesondere der Einschätzung ihrer Verlässlichkeit und der darauf bezogenen Selektion und Anwendung für eigene Gesundheitsbelange. Gerade im Kontext der Digitalisierung ist zudem zu berücksichtigen, dass die Nutzenden nicht nur passiv rezipieren, sondern aktiv am Kommunikationsgeschehen durch Interaktion mit bestehenden Inhalten oder durch eigene Informationsbeiträge teilhaben.Der vorliegende Beitrag gibt eine Übersicht über den aktuellen Forschungsstand zur digitalen Gesundheitskompetenz, wobei der Fokus vor allem auf dem Kindes- und Jugendalter liegt. Neben seiner terminologisch-konzeptionellen Verortung und der notwendigen Verschränkung mit dem Ansatz der Medienkompetenzen wird das Verhältnis von digitaler Gesundheitskompetenz und sozialer sowie gesundheitlicher Ungleichheit betrachtet. Als ungleichheitsgenerierend wird dabei weniger der unterschiedliche Zugang zu digitalen Medien angesehen, sondern vor allem die Unterschiede in den zum Umgang notwendigen Kompetenzen. Nach einer Übersicht über die wenigen bisher verfügbaren Instrumente zur Erfassung der digitalen Gesundheitskompetenz werden am Beispiel des Settings Schule erste Überlegungen zu ihrer individuellen und strukturellen Stärkung angestellt.

Introduction To measure Health literacy (HL) as proposed in the context of the European Health Literacy Survey/questionnaire (HLS-EU-Q), the Health Literacy for Children and Adolescents (HLCA) Consortium (GE) adapted it for children. A trans-cultural adaptation and validation to Portuguese (HLS-EU-PTc), will supply policy makers, experts and health professionals with information that can promote healthier communities while fighting health disparities. Methods After permission was granted from the HLCA Consortium the TRAPD model was used (eg parallel translation, focus groups, two back translations). An assessment and pretesting of HLS-EU-PTc was done with 16 children for cognitive testing. A qualitative explanatory (n = 16) and quantitative, cross-sectional study (n = 82), age mean 13, SD 0.96, from Portugal (mainland) was implemented for proceed with the validation process. A variety of measures were obtained like internal consistency and mean scores. Results Preliminary results for evaluation of the psychometric properties of the HLS-EU-PTc show satisfactory internal consistency (Cronbach’s alpha coefficient 0.87). In a scale from 1 (very difficult) to 4 (very easy) for indicators of the HLS-EU-PTc, we have a mean of 3.25 and a SD of .478. Conclusions This is the first study to examine the feasibility of a Portuguese version (HLS-EU-PTc) of the HLS-EU-Q adapted for children and it indicates high internal consistency and level of self-reported HL. The usefulness of the HLS-EU-PTc instrument can be further discussed while planning public health policy strategies from the HL standpoint. The validated HLS-EU-PTc version of the HLS-EU-Qc survey, with the user’s manual can be accessed at www.literacia-saude.info.

(1) Background: Health literacy is considered a personal asset, important for meeting health-related challenges of the 21st century. Measures for assisting students’ health literacy development and improving health outcomes can be implemented in the school setting. First, this is achieved by providing students with learning opportunities to foster their personal health literacy, thus supporting behavior change. Second, it is achieved by measures at the organizational level promoting social change within the proximal and distal environment and supporting the school in becoming more health-literate. The latter approach is rooted in the concept of organizational health literacy, which comprises a settings-based approach aiming at changing organizational conditions to enhance health literacy of relevant stakeholders. The HeLit-Schools project aims to develop the concept of health-literate schools, describing aspects that need to be addressed for a school to become a health-literate organization. (2) Method: The concept development builds on existing concepts of organizational health literacy and its adaptation to the school setting. (3) Results: The adaptation results in the HeLit-Schools concept describing a health-literate school with eight standards. Each standard depicts an area within the school organization that can be developed for fostering health literacy of school-related persons. (4) Conclusions: The HeLit-Schools concept offers an approach to organizational development for sustainably strengthening health literacy.