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Table 2 Health literacy instruments for children and adolescents

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

No. Author, year country language Instrument Type Study aim Sample size, study population, setting Scope of measured components Items, response format Time of administration Reliability Validity, responsiveness and sensitivity
1 Davis et al., 2006 [50]
USA
English
Rapid Estimate of Adult Literacy in Medicine - Teen (REALM-teen)
Adaptation of an existing instrument for adults (REALM)
Objective measurement/performance based assessment Validation of the REALM-teen for adolescents N = 1533
10–19 y.
participants were 50% black, 53% female; 34% were enrolled in middle school and 66% in high school
Secondary school
Mixed setting, schools and healthcare setting
Word recognition; Pronunciation 66 items (not provided)
Health words arranged in increasing order of difficulty
Pronouncing words
Usually 2–3 min, here approx. 3 min Internal consistency
α = .94
Convergent: SORT-R
r = .93
WRAT
r = .83
Receiver operating characteristic (ROC)
analysis: SORT-R
Area under ROC (AUC) = .84
2 Brown et al., 2007 [40]
USA
English
KidsHealth KidsPoll of Health Literacy
New instrument based on National Health Education Standards (NHES)
Subjective measurement/self-report Investigating health literacy and its effects on health behaviour and practice N = 1178
9–13 y.
5th – 8th grade
Secondary school
11 health education centres
Ability to understand, access and apply health information;
Interest in health;
Belief: Ability that health behaviour is affective; Attitude
8 items (provided)
Remote keypads
Close-end questions with a maximum of 5 answer choices
Not available (n.a.) n.a. n.a.
3 Hubbard and Rainey 2007 [41]
USA
English
“Health Literacy Instrument” no name.
New instrument based on Health Education Assessment Project (HEAP)
Objective measurement/performance based assessment (not explicitly stated by the article but indicated in the text) To evaluate the influence of comprehensive textbook-based instruction on students’ acquisition of health-related concepts and skills N = 669 secondary school children and adolescents
n = 333 female; n = 333 male; n = 3 missing
(Treatment group: n = 330; control group: n = 339)
School setting, N = 3 schools (n = 2 middle; n = 1 high school)
Understanding of health concepts about tobacco, physical activity, and nutrition; Ability to access information, interpersonal communication, decision-making, goal setting, and self-management 30 items (not provided)
15 items related to health concepts
15 items related to demonstrate skills
n.a. Reliability coefficient of the concepts scale α = .76 middle school; α = .72 high school; of the skills scale α = .75 middle school; α = .76 high school
HEAP assessment items proved to be reliable
Not provided,
HEAP assessment items proved to be valid
4 Chisolm and Buchanan, 2007 [51]
USA
English
Test of Functional Health Literacy in Adults (TOFHLA) in adolescent population (TOFHLAd), 2 components TOFHLA-R & TOFHLA-N
Adaptation of an existing instrument for adults
Objective measurement/performance based assessment Pilot validation for adolescents N = 50
13–17 y.
n = 26 female; n = 24 male
Healthcare setting
Reading comprehension (TOFHLA-R); Numeracy (TOFHLA-N) 67 items (not provided), 2 components; TOFHLA-R has 50 reading comprehension items, cloze procedure; TOFHLA-N has 17 numeracy items 10–20 min: average of 12.9 min with a range from 8.9 to 17.3 n.a. Concurrent: TOFHLA-R: WRAT3 r = .59 (p < .001)
REALM r = .60
(p < .001)
TOFHLA-N: WRAT3 r = .11 (p = .45)
REALM r = .18 (p = .22)
5 Steckelberg et al., 2009 [48]
Germany
German
Critical Health Competence Test (CHC)
New instrument
Objective measurement/performance based assessment Development and validation of a questionnaire to measure critical health competencies N = 429
15–42 y.
n = 322 (first field test); n = 255 10th and 11th from secondary schools, n = 67 university students n = 107 (second field test); n = 94 secondary schools, n = 13 university students
A. Understanding medical concepts; B. Skills of searching literature (information seeking);
C. Basic statistics (numeracy);
D. Design of experiments and sampling
72 items (not provided);
Scenarios (S) (items): S1 (16), S2 (20), S3 (15), S4 (21).
A, 15 items
B, 22 items
C, 18 items
D, 17 items
Should not exceed 90 min Rasch analysis: Mean person parameter
S1: 395
S2: 497
S3: 635
S4: 473
Construct validity: Cohen’s d = 4.33 [95%
CI 3.51–5.16]
Rasch model WINMIRA
ANOVA = .91
6 Vardavas et al., 2009 [42]
Greece
Greek
Health Literacy Questionnaire for Children
New instrument
Subjective measurement/self-report To locate the topics and to assess the sources of health information of adolescents N = 369, 12–18 y.
46.6% male; 53,4% female; 97, 3% Greek nationality
Secondary school children from urban areas of Athens and Crete
Questions on health education topics; Access and source of health information (seeking); Stated satisfaction n.a. no information on specific items is available n.a. n.a n.a.
7 Schmidt et al., 2010 [43]
Germany
German
GeKoKids Questionnaire
New instrument
Mixed approach To elaborate a set of short scales to measure important health literacy domains in children; and
To analyse their associations among each other
N = 852; aged 9–13 y., Germany
n = 401 female
n = 451 male
n = 29 migration background
Secondary school
Knowledge;
Attitudes;
Communication;
Behaviour;
Self-efficacy
17 items (provided)
Knowledge: 3 items
Communication: 3 items
Attitude: 4 items
Behaviour: 4 items
Self-efficacy: 3 items
n.a. Internal consistencies communication α = .73
attitude α = .57
Rasch analysis:
Knowledge χ2 = 6.45, P = 0.17
Behaviour χ2 = 15.48, P = 0.12
n.a.
8 Wu et al., 2010 [44]
Canada
English
Health literacy instrument for high school students
New instrument
Objective measurement/performance based assessment Development and validation of a health literacy measurement tool for high school students in classrooms N = 275
secondary school children
8th n = 2
9th n = 34
10th n = 202
11th n = 16
12th n = 17
48% male
52% female
69,1% other language than English at home
30,09% language English at home
Understand;
Evaluate
47 items (not provided)
open-ended following health related reading passages
Understand: 30 items
Evaluate: 17 items
n.a. Internal
consistency:
α = .92
Convergent:
Age, r = .17
Male gender,
r = .18
Age came to
Canada,
r = .22
Non-English
speaker,
r = .15
Mother’s edu,
r = .19
Father’s edu,
r = .22
GPA, r = .48
Time reading/
study,
r = .40 ‘fair’
9 Yu et al., 2012 [45]
China
Chinese
Health Literacy Questionnaire
New instrument
Subjective measurement/self-report To assess the students’ health literacy gained through school health education N = 8008
Elementary School (n = 77)
Pupils n = 4011
Middle School (n = 76)
Pupils n = 3997
Knowledge;
Attitude;
Practice (health behaviour and lifestyle)
37 items (not provided)
close-ended and open-ended
n.a. Internal
consistency:
α = .0.73 Spearman-Brown coefficient 0.75
n.a.
10 Chinn et al., 2013 [49]
England
English
All Aspects of Health Literacy Scale (AAHLS)
New instrument
Subjective measurement/self-report To develop a health literacy instrument to use in primary care settings N = 146
Range: 15–82 y.
n = 114 female; n = 32 male
Ethnicity
Asian: 81
Black: 5
Mixed race: 2
White: 51
Other: 7
Healthcare setting
Functional HL;
Communicative HL;
Critical HL
14 items (provided)
Functional: 4 items
Communicative: 3 items
Critical: 7 items
Approx. 7 mins. Internal
consistency:
α = .75
Functional HL
α = .82
Communicative HL
α = .69
Critical HL
α = .42
Convergent:
Functional vs
Communicative, r = .39
Functional vs Critical,
r = .59
Communicative vs
Critical, r = .19
11 Wallmann et al., 2012 [46]
Germany
German
Health Quiz
New instrument
Objective measurement / performance based assessment To measure and assess health knowledge as part of health literacy N = 699 7th grade adolescents in Germany
N = 375 male; n = 324 female
4 school types: Gymnasium; secondary school (n = 195), Realschule; secondary modern/intermediate school (n = 231), Gesamtschule; comprehensive school (n = 81), general school; Hauptschule (n = 192).
School setting
Knowledge 49 items (partly provided)
Nutrition: 7 items;
Prevention: 6 items;
Spare time activity (health promotion): 4 items;
Human body: 32 items (12 Items health behaviour / 20 items human anatomy)
Response: 4 response categories, only one right choice
20 min n.a. n.a.
12 Massey et al., 2013 [47]
USA
English
Multidimensional health literacy instrument
New instrument
Subjective measurement / self-report To develop a multidimensional health literacy instrument for adolescents concerning the health environment
This study was part of a larger study that examined the effectiveness of a health literacy intervention
N = 1208
13–17 y.
Mean age 14.8 y.
Over 60% females
Hispanic/Latino 33.7%
White 22.1%
Black 13.2%
Asian 7.9%
Other 1.9%
Multi-Ethnic 20.4%
Healthcare setting
(1) Patient-provider encounter;
(2) Interacting with the healthcare system;
(3) Rights and responsibilities;
(4) Health information seeking;
(5) Confidence in health information from personal source;
(6) Confidence in health information from media source
24 items (provided)
(1) 4 items
(2) 5 items
(3) 7 items
(4) 3 items
(5) 3 items
(6) 3 items
5 point Likert scale paper and pencil or online
n.a. Internal
consistency:
α = .834
Corresponding factors (related to six dimension)
1: α = .815
2: α = .803
3: α = .827
4: α = .638
5: α = .834
6: α = .709
n.a.
13 Röthlin et al., 2013 [53]
Austria
German
HLS-EU-Q47 and -Q16
Existing tool
Subjective measurement / self-report To apply and validate the HLS-EU instrument in the Austrian youth population N = 571
15 y.
Female 52.7%
Male 46.8%
No answer 0.5%
Parents born in Austria 84.1%
One parent born in Austria 7%
Not born in Austria 9%
No setting information
Access;
Understand;
Appraise;
Apply
47 items provided including short scale of 16 items
Dichotomous response format (easy and difficult)
Access: 4 items
Understand: 6 items
Appraise 3 items
Apply: 3 items
n.a. Internal consistency
α = .90
Healthcare: α = .69
Disease prevention: α = .81
Health promotion: α = .81
Convergent:
HLS-EU-Q4 and:
NVS r = .09
HLS-EU-Q16 and NVS r = .14
Concurrent:
HLS-EU-Q16
r = .82
14 Driessnack et al., 2014 [52]
USA
English
Newest Vital Sign
Existing instrument
Objective measurement / performance based assessment To explore the feasibility, utility, and validity of using the Newest Vital Sign (NVS) tool to assess health literacy in children N = 94; N = 47 parent-child-dyads
n = 47 children
7-8y, n = 18 (38%)
9-10y, n = 18 (38%)
11-12y, n = 11 (23%)
Science center
Reading comprehension;
Numeracy
6 items (provided) (all reading and numeracy) Up to 3 min Internal consistency
Children α = .71
Parents α = .79
n.a.
15 Naigaga et al., 2015 [54]
Uganda
English and oga
Maternal Health Literacy Scale (MaHeLi scale)
Short form of existing instrument
Subjective measurement/self-report To use a short form of the validated MaHeLi scale in Uganda N = 384 adolescent pregnant girls
15–19 y.
49% 15 y.
51% 16–19 y.
62% at least level 5 education
38% = < level 5 education
Healthcare setting
Appraisal of health information (AHI);
Competence and coping (CCS)
12 items (provided);
Short version of MaHeLi scale
n.a. n.a. n.a.