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

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

Background: In 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. Methods: The 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. Results: Adolescent 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. Conclusions: The 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.Peer Reviewe

Additional file 3: of 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

Table S3. Results of cognitive interviews in the MOHLAA study in Germany (12/2015–03/2016) and derived implications per individual item. (DOCX 29 kb

Additional file 1: of 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

Table S1. German version of the European Health Literacy Survey Questionnaire tested in the MOHLAA study in Germany (12/2015–03/2016). (DOCX 53 kb

Additional file 2: of 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

Table S2. Characteristics of the participants of cognitive interviews in the MOHLAA study in Germany (12/2015–03/2016). (DOCX 45 kb

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