The generic and pandemic-related health literacy among adolescents in Germany

Hintergrund: Gesundheitskompetenz als eine Gesundheitsdeterminante ist für die Gesundheitsförderung sowie die Prävention nicht-übertragbarer und übertragbarer Erkrankungen und demnach auch für die Pandemieeindämmung bedeutsam. Bisher liegen für Deutschland keine repräsentativen Daten zur generischen Gesundheitskompetenz sowie keine Erkenntnisse zur pandemiebezogenen Gesundheitskompetenz von Jugendlichen als Voraussetzung für die Entwicklung von Förder- und Interventionsstrategien vor. Vor diesem Hintergrund verfolgte diese Forschungsarbeit das Ziel, die Evidenzlage hinsichtlich der generischen und pandemiebezogenen Gesundheitskompetenz Jugendlicher in Deutschland zu verbessern. Methoden: Die generische Gesundheitskompetenz 14- bis 17-Jähriger wurde anhand der behavioralen und kognitiven, behavioral-kommunikativen, affektiven und konativen und der kognitiven Dimensionen der Gesundheitskompetenz in einer repräsentativen populationsbezogenen Online-Befragung untersucht. Es erfolgten Analysen 1) zur Verteilung der Gesundheitskompetenz, 2) zu Assoziationen zwischen Gesundheitskompetenz und soziodemografischen, sozialen und personalen Faktoren und 3) zu Assoziationen zwischen Gesundheitskompetenz und Gesundheitsverhalten. Die pandemiebezogene Gesundheitskompetenz mit Fokus auf die behavioralen und kognitiven sowie affektiven und konativen Dimensionen wurde mittels vier Online-Fokusgruppen während der COVID-19-Pandemie exploriert. Ergebnisse: Der Anteil Jugendlicher mit niedrigen Leveln der Gesundheitskompetenz war in den untersuchten Dimensionen unterschiedlich ausgeprägt: behavioral und kognitiv: 8,4 %; behavioral-kommunikativ: 28,1 %; affektiv und konativ: 8,8 %; kognitiv: 22,7 %. Mit Ausnahme des Alters waren alle untersuchten soziodemografischen (Geschlecht, familiärer Wohlstand, Migrationshintergrund), sozialen (soziale Unterstützung durch Familie und Freunde) und personalen (Selbstwirksamkeit) Faktoren mit niedrigen Leveln der Gesundheitskompetenz in den untersuchten Dimensionen assoziiert. Die Dimensionen der Gesundheitskompetenz waren in unterschiedlichem Maße mit Gesundheitsverhalten assoziiert: niedrige Level der Gesundheitskompetenz in der behavioral-kommunikativen sowie in der affektiven und konativen Dimension begünstigten die Chance für riskantes Gesundheitsverhalten (kein täglicher Obst- und Gemüsekonsum, keinen Sport treibend, aktuell rauchend). Die Exploration ermöglichte ein besseres Verständnis der pandemiebezogenen Gesundheitskompetenz. Diskussion: Durch die Identifizierung von Gruppen mit niedriger generischer Gesundheitskompetenz und durch die Feststellung von Assoziationen zwischen Gesundheitskompetenz und Gesundheitsverhalten ermittelte die Arbeit konkrete Bedarfe und Ansatzmöglichkeiten für gesundheitsfördernde und präventive Interventionsstrategien. Einblicke in die pandemiebezogene Gesundheitskompetenz erlauben eine erste Einschätzung dahingehend, dass deren Förderung einen Beitrag zur Eindämmung von Pandemien leisten könnte.Background: Health literacy as a health determinant is important for health promotion as well as the prevention of non-communicable and communicable diseases and thus also for pandemic containment. To date, there are no representative data on generic health literacy in Germany, nor findings on the pandemic-related health literacy of adolescents as a precondition for the development of promotion and intervention strategies. Following this, this research work aimed to improve the evidence regarding generic and pandemic-related health literacy among adolescents in Germany. Methods: Generic health literacy of 14- to 17-year-olds was assessed using the behavioral and cognitive, behavioral-communicative, affective and conative, and cognitive dimensions of health literacy in a representative population-based online survey. Analyses were conducted on 1) the distribution of health literacy, 2) associations between health literacy and sociodemographic, social, and personal factors, and 3) associations between health literacy and health behaviors. Pandemic-related health literacy, focusing on behavioral and cognitive as well as affective and conative dimensions, was explored through four online focus groups during the COVID-19 pandemic. Results: The proportion of adolescents with low health literacy levels varied across the dimensions studied: behavioral and cognitive: 8.4 %; behavioral-communicative: 28.1 %; affective and conative: 8.8 %; cognitive: 22.7 %. With the exception of age, all socio-demographic (gender, family affluence, migration background), social (social support from family and friends) and personal (self-efficacy) factors studied were associated with low levels of health literacy in the dimensions studied. The dimensions of health literacy were associated with health behaviors to different degrees: low levels of health literacy in the behavioral-communicative and in the affective and conative dimensions increased the chance for risky health behaviors (not eating fruit and vegetables daily, not exercising, currently smoking). Exploration provided a better understanding of pandemic-related health literacy. Discussion: By identifying groups with low generic health literacy and establishing as-sociations between health literacy and health behaviors, the work identified specific needs and approaches for health promotion and preventive intervention strategies. Insights into pandemic-related health literacy allow a first evaluation that its promotion could contribute to the containment of pandemics

Investigating associated factors of primary and specialist health care utilization among people with selected nationalities: results of a multilingual survey in two German federal states

Background Approximately every fourth person in Germany has a migration background. Health research on the use of primary and specialist health care in this group is still scarce. Few studies have suggested a difference in the use of primary and specialist health care among people with a migration background. Potential resources and barriers to health care access should be investigated as they are critical to health equity. This study investigates associated sociodemographic, migration-sensitive, and health-related factors of primary and specialist health care utilization among people with a migration background as defined by nationality. Methods Analyses are based on data from a feasibility study of the project “Improving Health Monitoring in Migrant Populations” (IMIRA), conducted by the Robert Koch Institute. The sample (n = 1055) included persons with Croatian, Polish, Romanian, Syrian, and Turkish nationalities living in the federal states of Berlin and Brandenburg, Germany. Descriptive and bivariate analyses as well as multiple binary logistic regression analyses were carried out to assess sociodemographic (sex, age, socioeconomic position), health-related (self-rated health), and migration-sensitive factors (duration of residence in Germany, residence status, German language proficiency) associated with the use of primary and specialist health care services in the past 12 months. Results Of the total study population, 79.62% visited a general practitioner and 59.53% a specialized physician in the past 12 months. Participants who were female sex, aged 65 and older, and with moderate/poor/very poor self-rated health had higher odds of visiting a general practitioner and a specialized physician, with the strongest impact from self-rated health. After controlling for sociodemographic and health-related factors, duration of residence in Germany and residence status were associated with primary but not with specialist health care utilization. Conclusions Our results suggest that migration-sensitive characteristics, such as duration of residence, should be considered in a differentiated manner in health services research to gain detailed insights into health care utilization and its potential barriers among the heterogenous group of people with a migration background. Further research needs to be done to evaluate how to get people into contact with a general practitioner.Peer Reviewe

Exploring pandemic-related health literacy among adolescents in Germany: a focus group study

Background Health literacy enables people to cope efficiently with health threats, such as the COVID-19 pandemic. However, little is known about health literacy among adolescents in general and especially in the context of pandemics. This study aimed to explore pandemic-related health literacy among adolescents by addressing cognitive, behavioral, conative, and affective components of the multidimensional health literacy construct. Methods Four online focus groups with 24 adolescents aged 13-17 years from four German federal states were conducted during the COVID-19 pandemic in May and June 2021. Data were analyzed using qualitative content analysis. Results Regarding the cognitive and behavioral components of pandemic-related health literacy, adolescents reported to use a broad range of traditional and digital media and personal information sources. The adolescents considered pandemic-related information to be good and easy to understand, when the information is presented in a concise and structured manner. The participants stated difficulties in finding, understanding, and evaluating pandemic-related information regarding particular protective measures. The adolescents described themselves to be critical when evaluating pandemic-related information and reported a high level of adherence to protective measures. Regarding the conative and affective components of health literacy, the adolescents explained that their wish to protect their loved ones from getting infected was the predominant motive for adherence to protective measures. They were convinced that people of their age play a role in pandemic containment. The adolescents reported sometimes making exceptions from adhering to protective measures to cope with negative feelings they experienced during the pandemic. Conclusions This study provides insights on how measures to improve pandemic-related health literacy among adolescents may be tailored to their needs. Prompt, concise, structured, and comprehensible preparation and communication of pandemic-related information in addition to educational efforts to strengthen health-related cognitive skills and critical health literacy may be supportive to reduce barriers in finding, understanding, and evaluating pandemic-related content.Peer Reviewe

Motivational readiness for physical activity and health literacy: results of a cross-sectional survey of the adult population in Germany

Background: Health literacy, defined as the knowledge, motivation, and competences to use health information to improve health and well-being, is associated with regular physical activity. However, there is limited evidence on whether health literacy is also related to the motivational readiness for physical activity in a general population. The aim of this study was to investigate whether motivational readiness for leisure-time physical activity is associated with health literacy. Methods: Analyses were based on data of 21,895 adults from the cross-sectional German Health Update and European Health Interview Survey 2014/2015 (GEDA 2014/2015-EHIS). Motivational readiness for leisure-time physical activity was assessed with stages of change for physical activity with a set of validated items. It was then classified, according to an established algorithm, into five stages: precontemplation, contemplation, preparation, action, and maintenance. Health literacy was measured with the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and categorised as low, medium, and high. For bivariate and multinomial logistic regression analyses, the stages were categorised in three phases as: (1) no intention (precontemplation), (2) planning (contemplation or preparation), and (3) in activity (action or maintenance). The models were adjusted for sex, age, education, health consciousness, self-efficacy, and self-perceived general health status. Results: High compared to low health literacy was associated with a 1.65-times (95% CI = 1.39-1.96) greater probability of being in activity than planning. High compared to low health literacy was associated with a reduced risk of having no intention to change physical activity behaviour (relative risk ratio, RRR = 0.84, 95% CI = 0.75-0.95). The associations persisted after adjusting for covariates. Conclusion: High health literacy was positively associated with more advanced phases of motivational readiness for leisure-time physical activity. Therefore, taking health literacy into account in interventions to promote motivational readiness for leisure-time physical activity could be a useful approach

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

Transmission of SARS-CoV-2 among children and staff in German daycare centres

In daycare centres, the close contact of children with other children and employees favours the transmission of infections. The majority of children <6 years attend daycare programmes in Germany, but the role of daycare centres in the SARS-CoV-2 pandemic is unclear. We investigated the transmission risk in daycare centres and the spread of SARS-CoV-2 to associated households. 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case were enrolled in the study (10/2020–06/2021). Close contact persons within daycare and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, symptom diary). Households were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centres was 9.6%. The SAR tended to be higher when the Alpha variant was detected (15.9% vs. 5.1% with evidence of wild type). The household SAR was 53.3%. Exposed daycare children were less likely to get infected with SARS-CoV-2 than employees (7.7% vs. 15.5%). Containment measures in daycare programmes are critical to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households.Peer Reviewe

SARS-CoV-2 Transmissibility Within Day Care Centers—Study Protocol of a Prospective Analysis of Outbreaks in Germany

Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults. Methods and Analysis: COALA (“Corona outbreak-related examinations in day care centers”) is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance. Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.Peer Reviewe

Subjective Generic Health Literacy and Its Associated Factors among Adolescents: Results of a Population-Based Online Survey in Germany

Profound data on adolescent health literacy are needed as a requirement for the development of health literacy promoting interventions. This paper aims to study the level of generic health literacy among adolescents and to explore associations between health literacy and socio-demographic (age, sex, family affluence, migration background), social (social support by family and friends) and personal (self-efficacy) factors. We conducted a representative cross-sectional online survey. Four health literacy dimensions were captured among 14&ndash;17 years old adolescents living in Germany (n = 1235) with the &ldquo;Measurement of Health Literacy Among Adolescents-Questionnaire&rdquo; (MOHLAA-Q). Descriptive, bivariate and multiple logistic regression analyses were used to analyse the data (n = 1202). We found poor health literacy levels&mdash;to varying degrees&mdash;in all examined health literacy dimensions: dealing with health-related information (8.41% with many difficulties), health-related communication skills (28.13% with low skills), attitudes toward one&rsquo;s own health and health information (8.81% with passive attitudes) and health-related knowledge (22.73% with low levels). We identified significant associations between poor health literacy levels and all factors studied except for age. Our results indicate a need for the implementation of evidence-based health literacy-related promoting interventions, preferentially in education and training institutions

Subjective Generic Health Literacy and Its Associated Factors among Adolescents: Results of a Population-Based Online Survey in Germany

Profound data on adolescent health literacy are needed as a requirement for the development of health literacy promoting interventions. This paper aims to study the level of generic health literacy among adolescents and to explore associations between health literacy and socio-demographic (age, sex, family affluence, migration background), social (social support by family and friends) and personal (self-efficacy) factors. We conducted a representative cross-sectional online survey. Four health literacy dimensions were captured among 14–17 years old adolescents living in Germany (n = 1235) with the “Measurement of Health Literacy Among Adolescents-Questionnaire” (MOHLAA-Q). Descriptive, bivariate and multiple logistic regression analyses were used to analyse the data (n = 1202). We found poor health literacy levels—to varying degrees—in all examined health literacy dimensions: dealing with health-related information (8.41% with many difficulties), health-related communication skills (28.13% with low skills), attitudes toward one’s own health and health information (8.81% with passive attitudes) and health-related knowledge (22.73% with low levels). We identified significant associations between poor health literacy levels and all factors studied except for age. Our results indicate a need for the implementation of evidence-based health literacy-related promoting interventions, preferentially in education and training institutions.Peer Reviewe

Gesundheitskompetenz und Gesundheitsverhalten im Jugendalter: Ergebnisse einer bundesweiten Online-Befragung Jugendlicher

Hintergrund: Für Deutschland fehlen Informationen zum Zusammenhang zwischen Gesundheitskompetenz und Gesundheitsverhalten Jugendlicher, obwohl in der Stärkung von Gesundheitskompetenz besonders im Jugendalter ein vielversprechender Ansatz zur Förderung des Gesundheitsverhaltens gesehen wird. Ziel der Arbeit: Es wird - unter Berücksichtigung von soziodemografischen Merkmalen und Selbstwirksamkeit - untersucht, ob verschiedene Dimensionen der allgemeinen Gesundheitskompetenz mit dem Gesundheitsverhalten Jugendlicher assoziiert sind. Material und Methoden: Datengrundlage bildet die bundesweite Online-Befragung zur 'Gesundheitskompetenz von Jugendlichen' (GeKoJu) mit 1235 Jugendlichen zwischen 14-17 Jahren in Deutschland. Vier Dimensionen allgemeiner Gesundheitskompetenz wurden mit dem 'Measurement of Health Literacy Among Adolescents Questionnaire' (MOHLAA-Q) durch Selbstangaben erfasst. Gesundheitsverhalten wurde mit Fragen zu Sport, Ernährung, Alkoholkonsum und Rauchen erhoben. Es wurden uni- und bivariate Analysen sowie multiple Regressionsanalysen durchgeführt. Ergebnisse: Jugendliche mit niedrigen Leveln in allen untersuchten Gesundheitskompetenzdimensionen haben eine erhöhte Chance, kein Obst und Gemüse täglich zu konsumieren. Auch die Chance zu rauchen oder keinen Sport zu treiben war höher bei Personen mit geringer ausgeprägten Kommunikations- und Interaktionsfähigkeiten und passiven Einstellungen zur Gesundheit und Gesundheitsinformationen. Riskanter Alkoholkonsum wies keinen Zusammenhang mit Gesundheitskompetenz auf. Schlussfolgerung: Die Ergebnisse legen die Stärkung von aktiven Einstellungen zu Gesundheit und Gesundheitsinformationen und Kommunikations- und Interaktionsfähigkeiten rund um das Thema Gesundheit für die Förderung des Gesundheitsverhaltens Jugendlicher nahe