Generic health literacy measurement instruments for children and adolescents: a systematic review of the literature

Abstract

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.

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

“…When comparing the MOHLAA-Q with the self-reported instruments developed for adolescents (aged [12][13][14][15][16][17][18][19] in other languages, we found instruments with similar complex structures (at least three-dimensional), e.g., the Health Literacy Measure for Adolescents (HELMA; 44 items), which is divided into eight factors (access, reading, understanding, appraisal, use, communication, self-efficacy, and numeracy) [70]; the Multidimensional Measure of Adolescents Health Literacy (22 items), which has five dimensions (interaction with the health care system, rights and responsibilities, preventive care, information seeking, and patient-provider encounter [71]; and the Health Literacy Assessment Scale for Adolescents (HAS-A; 15 items), which has three dimensions (communication about health information, confusion about health information and understanding health information) [87]. Interestingly, only one instrument, namely, the Health Literacy for School-Aged Children (HLSAC; 10 items), showed acceptable fit of a single-factor model, although the HLSAC was constructed based on five theoretical components (theoretical knowledge, practical knowledge, critical thinking, self-awareness, and citizenship) [71].…”

“…Thus, we integrated a few health-related knowledge questions into the instrument as a performance-based, objective measurement approach. We followed a mixed-method approach combining subjective and objective measurements, as recommended in the literature [19,92]. However, in the quantitative pretest, we found a moderate relationship of scale D with the scale measuring functional health literacy (the NVS) and only a weak relationship between scale D and A.…”

“…In summary, our study highlights different challenges of operationalizing and measuring the broad concept of health literacy in adolescents. Referring to the latest established recommendations for the development and validation of pragmatic health literacy measures [19,57], we successfully drew on the current research in this age group and assessed the content validity of the instrument with health literacy experts. The items aim to capture characteristics of this period of life by asking about health risks and consequences of risky behavior (cf.…”

“…The lack of health literacy data for children and adolescents can be attributed to different causes, one of which is that a clear and commonly accepted definition and conceptual framework of health literacy in these age groups is lacking [17]. In addition, there is a lack of high-quality, valid, and age-adjusted measurements [18][19][20], followed by a lack of studies with children and adolescents [21].…”

The role of functional health literacy in long-term treatment outcomes in psychosocial care for adolescents

“…However, studies on adults show its validity in general to be high, reducing the likelihood of considerable measurement error. Second, the current study documents the relationship between functional health literacy and treatment outcomes, while insight into other aspects of health literacy may be of importance as well, such as communicative/interactive health literacy, defined as the cognitive and social skills necessary to actively communicate in regard to health information, and critical health literacy, defined as the ability to act on health information [11,43]. Third, selection bias may have been introduced through the sampling method.…”