Table 2 Health literacy instruments for children and adolescents

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.