Do adolescents understand the items of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) – German version? Findings from cognitive interviews of the project “Measurement of Health Literacy Among Adolescents” (MOHLAA) in Germany

Abstract

BackgroundIn Germany, there are no measurement tools to assess the general health literacy of adolescents. The aim of the study “Measurement of Health Literacy Among Adolescents” (MOHLAA) is to develop such a tool for use among adolescents aged 14–17. The German version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47-GER) served as a blueprint for the development of the tool. The present study examined the extent to which the HLS-EU-Q47-GER can be applied to the measurement of general health literacy in adolescents.MethodsThe applicability of the HLS-EU-Q47-GER for adolescents was tested qualitatively using cognitive interviewing (CI). Purposive sampling was used to achieve an equal distribution of participants regarding age groups, educational backgrounds and gender. CI was standardized on the basis of an interview guide. Verbal probing and the retrospective think-aloud technique were applied. The interviews were audio-recorded, transcribed and analyzed using the criteria of theory-based analysis, which were derived from the model of cognitive processes. The analysis focused on identifying terms and questions that were difficult to understand and on scrutinizing the extent to which the content of the items is appropriate for assessing adolescents’ health literacy.ResultsAdolescent respondents were unfamiliar with some terms of the HLS-EU-Q47-GER or provided heterogeneous interpretations of the terms. They had limited or no experience regarding some health-related tasks in health care and disease prevention that are addressed by HLS-EU-Q-items. A few items seemed to be too “difficult” to answer due to a high abstraction level or because they lacked any reference to the everyday lives of youth. Despite comprehension problems with some of the HLS-EU items, the respondents assessed the covered health-related tasks as “very easy” or “fairly easy”. CI stressed the importance of interpersonal agents, especially parents, in helping adolescents understand and judge the reliability of health information.ConclusionsThe results of CI indicated that the applicability of the HLS-EU-Q47-GER to the measurement of general health literacy among adolescents aged 14–17 is limited. In order to prevent biased data, some items of the questionnaire should be adjusted to adolescents’ state of development and experiences with health care and disease prevention.Electronic supplementary materialThe online version of this article (10.1186/s13690-018-0276-2) contains supplementary material, which is available to authorized users.

Development and Psychometric Properties of a Questionnaire Assessing Self-Reported Generic Health Literacy in Adolescence

“…Stage 1 comprised a literature review (LR) (step 1), two rounds of cognitive interviews (CIs) (step 2 and 6) and focus groups (FGs) (step 3), both with adolescents aged 14-17, the creation of the item pool (step 4) and two rounds of expert assessments (EAs) by health literacy experts (step 5 and 7). Here, we only describe the most important steps, a detailed description of the methods and results of the first-round CIs and the FGs can be found elsewhere [32,33].…”

“…The main results of the development process were also discussed with the HLCA Scientific Advisory Board, which includes international health literacy experts. To test the 1st draft of the MOHLAA-Q, we once again conducted CIs (step 6) following the same procedure as in the 1st round of CIs [32] apart from the sampling and recruitment procedure. Subsequently, in step 7, five experts from the HLCA consortium scored the clarity of the wording of each item of the preliminary 2nd draft and the item relevance regarding the generic health literacy construct.…”

“…As a second result of the LR, we identified six tools that have been applied in studies with adolescents [64,[68][69][70][71][72]. Hence, we decided to use the HLS-EU-Q47-GER as a blueprint for the following reasons: the tool was available in the German language; its short version had already been tested in a quantitative study with 15-year-olds in Austria [64]; and the instrument considers health literacy not only relating to health care but also to disease prevention and health promotion [32].…”

“…Surprisingly, the respondents evaluated the health-related tasks as being "very easy" or "fairly easy". Additionally, the findings stressed the importance of interpersonal agents, especially parents, in helping adolescents understand and judge the reliability of health information [32]. For the 1st draft of the MOHLAA tool, we adapted 16 items based on the HLS-EU-Q47-GER.…”

Health literacy and health outcomes in China’s floating population: mediating effects of health services

“…The European Health Literacy Survey Questionnaire was used to investigate health literacy in the floating population. This questionnaire is multidimensional and has been used to measure health literacy in European populations [27]. The questionnaire is available in three versions.…”