Measuring health literacy and its associations with health behaviors of adolescents in Germany

Abstract Background The questionnaire “Measurement of Health Literacy Among Adolescents Questionnaire” (MOHLAA-Q) was developed and validated in a multi-stage process to measure generic health literacy among 14- to 17-year-olds. The MOHLAA-Q combines subjective and objective measurements, consisting of four scales. The instrument was applied to explore associations between generic health literacy and different health behaviors among adolescents in Germany. The data should contribute to the age-appropriate development of health promotion interventions. Methods We carried out a nationwide cross-sectional online survey with 1,235 adolescents aged 14-17 years in Germany in 2019. Data on generic health literacy were collected using the four scales of the MOHLAA-Q and data on health behaviors were collected using single established single-item questions on sports, diet, alcohol consumption, and smoking. Bivariate and multiple analyses were performed for investigating associations between generic health literacy and health behaviors, adjusted for age, gender, education and self-efficacy. Results Not consuming fruit and vegetables daily was associated with lower health literacy levels in all examined scales. Doing no sports as well as smoking showed positive associations with low levels in “health-related communication and interaction skills” and “attitudes toward one's own health and health information”. No associations were found between risky alcohol consumption and health literacy. Conclusions The results indicate that strengthening health literacy should be part of health promotion activities for increasing physical activity and healthy diet among adolescents. The MOHLAA-Q allows us to identify which specific dimensions of health literacy might be addressed in order to promote different health behaviors.


Background:
Although children are identified as a key target group for interventions targeting the development of health literacy, little data is available on children's health literacy and how it is related to health outcomes at a young age. This study addresses this research gap by providing data on fourth-graders' health literacy and associated health outcomes.

Methods:
A cross-sectional study was conducted among fourth-grade students in the state of North-Rhine Westphalia, Germany. The study was designed as a representative survey starting in 12/2020, which could, however, not be realized due to pandemic-related constraints. Data collected between 07/20 and 11/20 is included in the analyses presented here. Among others, we assessed self-reported health literacy with the HLS-Child-Q15 questionnaire, while also assessing various selfreported health outcomes. Results: n = 364 students are included in the analysis, 49,5% of which are female. The mean age is 9.5 years (SD = .7). The HLS-Child-Q15 demonstrated high internal consistency (Cronbach's a = .812). Self-reported health literacy is high, with a HLS-Child-Q15 mean score of 3.13, indicating that it is rather easy for participants to deal with health-related information. Health literacy is significantly associated with a number of outcomes related to health status (KINDL-R subscales physical wellbeing and mental wellbeing, Spearman's r = .280 and r = .271, respectively; p < .001) and health behaviour (freq. of brushing teeth: r = .173; p < .01; freq. of eating fruit and vegetable: r = .217 and r = .299; p < .001; freq. of physical activity: r = .279; p < .001).

Conclusions:
While the overall level of health literacy in our sample is high, higher health literacy is associated with better health behaviours, as well as improved mental and physical wellbeing. Further analyses are necessary to explore the causal pathways between the investigated variables, and representative survey are needed to verify these findings.

Background:
The questionnaire ''Measurement of Health Literacy Among Adolescents Questionnaire'' (MOHLAA-Q) was developed and validated in a multi-stage process to measure generic health literacy among 14-to 17-year-olds. The MOHLAA-Q combines subjective and objective measurements, consisting of four scales. The instrument was applied to explore associations between generic health literacy and different health behaviors among adolescents in Germany. The data should contribute to the age-appropriate development of health promotion interventions.

Methods:
We carried out a nationwide cross-sectional online survey with 1,235 adolescents aged 14-17 years in Germany in 2019. Data on generic health literacy were collected using the four scales of the MOHLAA-Q and data on health behaviors were collected using single established single-item questions on sports, diet, alcohol consumption, and smoking. Bivariate and multiple analyses were performed for investigating associations between generic health literacy and health behaviors, adjusted for age, gender, education and self-efficacy.

Results:
Not consuming fruit and vegetables daily was associated with lower health literacy levels in all examined scales. Doing no sports as well as smoking showed positive associations with low levels in ''health-related communication and interaction skills'' and ''attitudes toward one's own health and health information''. No associations were found between risky alcohol consumption and health literacy.

Conclusions:
The results indicate that strengthening health literacy should be part of health promotion activities for increasing physical activity and healthy diet among adolescents. The MOHLAA-Q allows us to identify which specific dimensions of health literacy might be addressed in order to promote different health behaviors.