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

Domanska OM, Firnges C, Bollweg TM, Sørensen K, Holmberg C, Jordan S. 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. Archives of Public Health. 2018;76(1): 46

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

Domanska OM, Bollweg TM, Loer A-K, Holmberg C, Schenk L, Jordan S. Development and Psychometric Properties of a Questionnaire Assessing Self-Reported Generic Health Literacy in Adolescence. International Journal of Environmental Research and Public Health. 2020;17(8): 2860.Health literacy is a promising approach to promoting health and preventing disease among children and adolescents. Promoting health literacy in early stages of life could contribute to reducing health inequalities. However, it is difficult to identify concrete needs for action as there are few age-adjusted measures to assess generic health literacy in young people. Our aim was to develop a multidimensional measure of health literacy in German to assess generic health literacy among 14- to 17-year-old adolescents, namely, the “Measurement of Health Literacy Among Adolescents Questionnaire” (MOHLAA-Q). The development process included two stages. Stage 1 comprised the development and validation using a literature review, two rounds of cognitive interviews, two focus groups and two rounds of expert assessments by health literacy experts. Stage 2 included a standard pretest (n = 625) of the questionnaire draft to examine the psychometric properties, reliability and different validity aspects. The MOHLAA-Q consists of 29 items in four scales: (A) “Dealing with health-related information (HLS-EU-Q12-adolescents-DE)”; (B) “Communication and interaction skills”, (C) “Attitudes toward one’s own health and health information”, and (D) “Health-related knowledge”. The confirmatory factor analysis indicated a multidimensional structure of the MOHLAA-Q. The internal consistency coefficients (Cronbach’s α) of the scales varied from 0.54 to 0.77. The development of the MOHLAA-Q constitutes a significant step towards the comprehensive measurement of adolescents’ health literacy. However, further research is necessary to re-examine its structural validity and to improve the internal consistency of two scales

Measuring health literacy of children and adolescents. Development and validiation of the age-specific survey instruments

Hintergrund: Mit dem Begriff Gesundheitskompetenz/Health Literacy werden die Fähigkeiten und Fertigkeiten bezeichnet, Gesundheitsinformationen zu finden, zu verstehen, zu bewerten und diese für gesundheitsbezogene Entscheidungen anzuwenden. Das Konzept der Gesundheitskompetenz wurde bisher vorwiegend bei Erwachsenen erforscht. Bisher liegen für Kinder und Jugendliche kaum geeignete altersgerechte Selbsteinschätzungsinstrumente zur Erfassung generischer Gesundheitskompetenz vor. Zentrale Zielsetzungen der vorliegenden Arbeit sind, zwei Befragungsinstrumente für Grundschulkinder der vierten Klasse (9- bis 10-Jährige) und für Jugendliche (14- bis 17-Jährige) zur Erfassung der selbstberichteten generischen Gesundheitskompetenz zu entwickeln und deren psychometrische Eigenschaften zu evaluieren. Methoden: Als Grundlage für die Entwicklung der beiden Instrumente wurde die deutsche Version des European Health Literacy Survey Questionnaire mit 47 Items (HLS-EU-Q47) verwendet. Die Entwicklungsprozesse beider Instrumente waren mehrstufig und beinhalteten vergleichbare empirische Teilstudien, wie den Einsatz von kognitiven Interviews und eines Standard-Pretests (schriftliche Befragung). Bei der Entwicklung des Befragungsinstrumentes für Jugendliche wurden zusätzlich zwei Fokusgruppen und zwei Runden einer Experten-Bewertung durchgeführt. Die psychometrischen Eigenschaften der getesteten Befragungsinstrumente wurden anhand der Daten aus den schriftlichen Befragungen mit 907 Kindern beziehungsweise 625 Jugendlichen überprüft. Die Analysen umfassten Item-, Reliabilitäts-, Faktoren- und Assoziationsanalysen zur Konstrukt- und Kriterium-Validierung. Ergebnisse: Der Health Literacy Survey Questionnaire for Children (HLS-Child-Q15) und der Measurement of Health Literacy Among Adolescents Questionnaire (MOHLAA-Q) sind bisher die ersten validierten Instrumente in deutscher Sprache zur Erfassung selbstberichteter generischer Gesundheitskompetenz. Die Ergebnisse der qualitativen Teilstudien bestätigten, dass die meisten Kinder und Jugendlichen wenig Erfahrung in den Bereichen Gesundheitsversorgung und Krankheitsprävention haben. Eltern und Personen aus dem direkten Lebenskontext der Zielgruppen spielen daher eine wichtige Rolle bei der Übermittlung, der kritischen Bewertung und der Anwendung von Gesundheitsinformationen. Die kognitiven Kompetenzen für die Bewältigung bestimmter gesundheitsbezogener Aufgaben befinden sich sowohl bei Kindern als auch Jugendlichen noch im Entwicklungsprozess. Die Studienergebnisse deuten darauf hin, dass Kinder und Jugendliche ihre Fertigkeiten und Fähigkeiten bei der Beantwortung von Selbsteinschätzungsinstrumenten eher überschätzen. Diskussion und Implikationen: Bei der Messinstrumentenentwicklung sind kognitive Fähigkeiten, lebensphasenspezifische Wissensstände, Erfahrungen sowie insbesondere altersspezifische Vorstellungen und die Bedeutung von Gesundheitsinformationen für die Zielgruppe zu berücksichtigen. Da Eltern und der soziale Lebenskontext die gesundheitsbezogenen Entscheidungen von Kindern und Jugendlichen stark beeinflussen und mitbestimmen, sollten sie bei der Messung der Gesundheitskompetenz einbezogen werden. Zur Evaluierung der verschiedenen Dimensionen der generischen Gesundheitskompetenz empfiehlt sich in den erforschten Zielgruppen das gleichzeitige Einsetzen von subjektiven und leistungsbasierten Messinstrumenten. Für das Forschungsfeld wäre es erstrebenswert, die Erkenntnisse aus der Messinstrumentenentwicklung auch in der Konzipierung von Gesundheitskompetenz für das Kindes- und Jugendalter stärker zu berücksichtigen.Background: The term health literacy refers to the skills and abilities to find, understand, and assess health information and to apply it when making health-related decisions. The concept of health literacy has been studied so far mainly among adults. To date, there are very few age-appropriate self-assessment instruments to measure generic health literacy among children and adolescents. The main objectives of the work presented here are to develop two survey instruments for primary school children in the fourth grade (9- to 10-year-olds) and for adolescents (14- to 17-year-olds) for the assessment of self-reported generic health literacy and to evaluate their psychometric properties. Methods: The German version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used as the blueprint for the development of both survey instruments. Their development processes were multi-stage and included comparable empirical substudies such as the use of cognitive interviews and a standard pre-test (written survey). In the course of developing the instrument for adolescents, two focus groups and two rounds of expert assessments were also conducted. The psychometric properties of the tested instruments were examined on the basis of data from the written surveys with 907 children and 625 adolescents, respectively. The statistical analyses included item analyses, reliability analyses, factor analyses, and association analyses for testing construct- and criterion-related validity. Results: The Health Literacy Survey Questionnaire for Children (HLS-Child-Q15) and the Measurement of Health Literacy Among Adolescents Questionnaire (MOHLAA-Q) are the first validated German language survey instruments to assess self-reported generic health literacy. The results of the qualitative substudies confirmed that most children and adolescents have little experience with health care and disease prevention. Therefore, parents and other adults from the target groups’ social contexts play a crucial role for the transmission, critical assessment, and application of health information. The cognitive skills needed to manage certain health-related tasks are still being developed in both children and adolescents. The study findings indicate that children and adolescents tend to overestimate their skills and abilities when using the self-assessment questionnaires. Discussion and conclusions: The development of measuring instruments must consider cognitive skills, life-phase-specific knowledge, experience and, in particular, age-specific perceptions and the importance of health information for the target group. Because parents and the social context strongly influence and co-determine children’s and adolescents’ health-related decisions, they should be included in the measurement of health literacy. To evaluate the various dimensions of generic health literacy in the target groups, it is recommended to use both subjective and performance-based measuring instruments. For the research field, it would be desirable that the findings from the development of measuring instruments be more strongly considered in the conception of health literacy for children and adolescents

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

Health literacy is a promising approach to promoting health and preventing disease among children and adolescents. Promoting health literacy in early stages of life could contribute to reducing health inequalities. However, it is difficult to identify concrete needs for action as there are few age-adjusted measures to assess generic health literacy in young people. Our aim was to develop a multidimensional measure of health literacy in German to assess generic health literacy among 14- to 17-year-old adolescents, namely, the “Measurement of Health Literacy Among Adolescents Questionnaire” (MOHLAA-Q). The development process included two stages. Stage 1 comprised the development and validation using a literature review, two rounds of cognitive interviews, two focus groups and two rounds of expert assessments by health literacy experts. Stage 2 included a standard pretest (n = 625) of the questionnaire draft to examine the psychometric properties, reliability and different validity aspects. The MOHLAA-Q consists of 29 items in four scales: (A) “Dealing with health-related information (HLS-EU-Q12-adolescents-DE)”; (B) “Communication and interaction skills”, (C) “Attitudes toward one’s own health and health information”, and (D) “Health-related knowledge”. The confirmatory factor analysis indicated a multidimensional structure of the MOHLAA-Q. The internal consistency coefficients (Cronbach’s α) of the scales varied from 0.54 to 0.77. The development of the MOHLAA-Q constitutes a significant step towards the comprehensive measurement of adolescents’ health literacy. However, further research is necessary to re-examine its structural validity and to improve the internal consistency of two scales

Online Survey for the Assessment of Generic Health Literacy among Adolescents in Germany (GeKoJu): Study Protocol

The promotion of health literacy at a young age can protect, maintain and improve health across the life course. Yet to date, a sound data basis on adolescent health literacy as a requirement for the development of strategies to promote health literacy has not been given. This paper presents a study protocol for the online survey “Health Literacy Among Adolescents” (GeKoJu) that collects the first nation-wide representative data on self-reported generic health among adolescents aged 14–17 years in Germany. The objectives of the survey are (1) to assess the distribution of generic health literacy among adolescents in Germany, (2) to identify socio-demographic and social factors in regard to health literacy and (3) to assess the association of health literacy and health-related outcomes. The cross-sectional survey was conducted from September 2019 through December 2019. A two-stage stratified cluster sampling strategy was applied. Individuals invited to participate in the survey (N = 6608) were randomly selected among German-speaking adolescents aged 14–17 years, with permanent residence in Germany. Generic health literacy is measured with the “Measurement of Health Literacy Among Adolescents-Questionnaire” (MOHLAA-Q). Data collection also covers questions on health behavior, subjective health status, personal and social resources, socio-demographic and social factors and health services use. Results of the GeKoJu survey will provide data for the development of strategies to promote generic health literacy among families, in schools, communities and health care

Differences in risk perception, knowledge and protective behaviour regarding COVID-19 by education level among women and men in Germany. Results from the COVID-19 Snapshot Monitoring (COSMO) study.

The main strategy for combatting SARS-CoV-2 infections in 2020 consisted of behavioural regulations including contact reduction, maintaining distance, hand hygiene, and mask wearing. COVID-19-related risk perception and knowledge may influence protective behaviour, and education could be an important determinant. The current study investigated differences by education level in risk perception, knowledge and protective behaviour regarding COVID-19 in Germany, exploring the development of the pandemic over time. The COVID-19 Snapshot Monitoring study is a repeated cross-sectional online survey conducted during the pandemic in Germany from 3 March 2020 (waves 1-28: 27,957 participants aged 18-74). Differences in risk perception, knowledge and protective behaviour according to education level (high versus low) were analysed using linear and logistic regression. Time trends were accounted for by interaction terms for education level and calendar week. Regarding protective behaviour, interaction terms were tested for all risk perception and knowledge variables with education level. The strongest associations with education level were evident for perceived and factual knowledge regarding COVID-19. Moreover, associations were found between low education level and higher perceived severity, and between low education level and lower perceived probability. Highly educated men were more worried about COVID-19 than those with low levels of education. No educational differences were observed for perceived susceptibility or fear. Higher compliance with hand washing was found in highly educated women, and higher compliance with maintaining distance was found in highly educated men. Regarding maintaining distance, the impact of perceived severity differed between education groups. In men, significant moderation effects of education level on the association between factual knowledge and all three protective behaviours were found. During the pandemic, risk perception and protective behaviour varied greatly over time. Overall, differences by education level were relatively small. For risk communication, reaching all population groups irrespective of education level is critical

Physical activity promotion in daycare centres in Germany: study protocol for a cross-sectional survey within the BeweKi study

Introduction In Germany, a total of 92.2% of children between the age of 3 and school entry age attend daycare centres. Therefore, daycare centres are a suitable setting to promote physical activity among children. Yet, there is a lack of knowledge on the promotion of physical activity in daycare centres with regards to different structures and concepts, culture/policies/practices and the characteristics of directors and pedagogical staff of daycare centres in Germany. The aim of this study is to investigate (a) the status quo, as well as (b) the fostering and hindering conditions (barriers and facilitators) of physical activity promotion in daycare centres in Germany.Methods and analysis The cross-sectional study will collect data from November 2022 to February 2023. For the sample, about 5500 daycare centres will be drawn from an address database available through the German Youth Institute (DJI) and invited to the survey. From each daycare centre a director and a pedagogical staff member will be asked to fill in a standardised self-administered questionnaire. The survey explores characteristics of the daycare centre and the implementation of physical activity promotion, for example, the extent and form of physical activity promotion, the use and size of indoor and outdoor area, structural conditions such as personal and financial resources, personal attitudes towards physical activity promotion, demographic characteristics of pedagogical staff, structural daycare centre’s characteristics such as proportion of children from socioeconomic disadvantaged groups. In addition, micro-geographical data on socioeconomic and infrastructural environment of the daycare centres will be included in the data set.Ethics and dissemination The study has been received and approved by the Commissioner for Data Protection of the Robert Koch Institute and by the Ethics Committee of Alice Salomon Hochschule Berlin, University of Applied Sciences. Results will be disseminated through publications and presentations to scientific community and stakeholders

Health literacy in childhood and youth: a systematic review of definitions and models

Background Children 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. Method Six 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. Results The 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. Discussion Identified 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.CIEC – Research Centre on Child Studies, IE, UMinho (FCT R&D unit 317), Portugal; National Funds through the FCT (Foundation for Science and Technology) and co-financed by European Regional Development Funds (FEDER) through the Competitiveness and Internationalization Operational Program (POCI) through CIEC (Research Centre on Child Studies, of the University of Minho) with the reference POCI-01-0145-FEDER-007562info:eu-repo/semantics/publishedVersio

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes