Development and Validation of the Adolescent Media Health Literacy Scales: Rasch Measurement Model Approach

Abstract

Background High media use has been implicated in negative social and health outcomes among adolescents. Therefore, it is critical that adolescents develop skills to healthily engage with media content. Media health literacy (MHL), skills for assessing and responding to health-related media content, and potentially targetable moderators for the relationship between media use and health-related outcomes are understudied in adolescents. The lack of MHL assessment tools may have contributed to this research gap. Objective This study aimed to develop and validate test-based scales of adolescents’ MHL. Methods The items developed were vetted iteratively via community reviews and cognitive interviews to establish content and face validity. Adolescents (N=355) completed a questionnaire that included the revised MHL items. The scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) were validated using Rasch measurement models. Convergent validity was assessed by correlating the summed scores of the three scales with existing functional and internet-related health literacy measures. Criterion validity was assessed by modeling logistic regressions for predicting health literacy–related behaviors from each scale after controlling for demographics. Effect sizes were estimated, and a short form was also validated. Results The final MHL scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) fit their Rasch models. The 9-item Recognition/Identification and 9-item Influence/Critical Analysis scales had good convergent validity with functional and internet-related health literacy measures and were positively related to reading instructions before taking medicines and questioning the truthfulness of health information found online. The 12-item MHL Scales-Short Form also had good convergent and criterion validity. However, convergent and criterion validity were not established for the 3-item Action/Reaction Scale. Conclusions The Recognition/Identification and Influence/Critical Analysis scales and the MHL Scales-Short Form may be used to determine the impact of MHL on media use and health outcome relationships and ultimately inform the development of interventions and policies to affect these relationships in multiple settings.

Validation of the Assessments of Adult Health Literacy: A Rasch Measurement Model Approach

“…The models were re-estimated and fit statistics were reviewed after each item removal. As proposed by Linacre ( 28 ) and done in other studies ( 29 , 30 ), person misfit considerations included removing one round of the most misfitting responses, re-estimating the model, and comparing the fit statistics of the modified and original responses. If the modified responses improved model fit, then the modified dataset was retained and final analyses were conducted on this dataset.…”

“…Below Basic (scores 0-7), Basic (scores 8-15), Intermediate (scores 16-23), Pro cient (scores 24-29), and Advanced (scores [30][31][32]. The score range was larger than the number of items due to items with polytomous response options.…”

Measuring HL in adolescent students: a preliminary report on the development of a task- and skills-based assessment instrument for use in educational settings

“…1. Self-report on general HL skills 2. self-report on media literacy skills and motivation 3. understand medical language 4. find information on a health website 5. understand a doctor's interview 6. understand symbols related to healthcare, the healthcare system 7. appraise online health information for reliability 8. correctly complete the nutrition triangle 9. name medical professions and identify the purpose for consultation (knowledge of the healthcare system) 10. interpret a patient package insert (apply the information) 11. answer questions about a nutrition label (apply the information) 12. interpret a health graph 13. interpret a table on recommended daily amounts of vitamins (apply the information) 14. a calculation task on health figures (apply the information)…”

“…In 2006, Baker [10] distinguished between health-related print literacy and health-related oral literacy, which were both fed by health-related reading fluency, health-related vocabulary, and familiarity with health concepts. Fleary [11], more recently, has emphasized the critical engagement with health-related (digital) media content as a subskill of HL. Indeed, in some (leading) countries, HL as a concept is now starting to move away from a small focus on literacy for the management of one's disease in healthcare settings to a much broader conceptualization, including generic skills and competences to deal with any health-related information in critical ways to the benefit of disease prevention and health promotion.…”

“…The HL measurement instruments used in research may not reflect the tasks set to students for educational purposes. Also, tools that have been developed for education within one particular cultural context (e.g., [11]) may not be culturally appropriate for another context.…”