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.

[Evaluation of the theatre play Have Courage! A powerful play about feelings, boundaries and trust in the frame of the national campaign for the prevention of child sexual abuse]. / Evaluation des Theaterstücks "Trau dich! Ein starkes Stück über Gefühle, Grenzen und Vertrauen" im Rahmen der bundesweiten Initiative zur Prävention des sexuellen Kindesmissbrauchs.

This article reports on the evaluation of the effectiveness of a school-based preventive theatre play. The play is part of a national campaign for the prevention of child sexual abuse called Trau dich! (Have courage!). A total of 639 students in third to sixth grade from Schleswig-Holstein and Saxony participated in the study. Scenarios in the play imparted prevention messages and self-protective skills regarding situations of sexual assault or abuse, targeting children aged 8 to 12. Acquisition of knowledge about access to help systems and children's rights were measured pre- and post viewing as well as at a follow-up point two to six months later. Children estimated their competences regarding sensibility, sensing/setting boundaries, social support/to entrust oneself to somebody and knowledge. Based on cognitive empathy, children suggested self-protective skills for situations of conflict. The theatre play contributed to the acquisition of knowledge and an increase of children's self-assessed knowledge and competences. They estimated their competences of distinguishing between good and bad secrets, safe and unsafe touching, and disclosing oneself to somebody; their suggestions for self-protective skills improved compared to baseline data. The effects were still present at follow-up. Girls estimated their competences and self-protective skills to have improved more than boys. Measured negative effects were only temporary. The results indicate that the interactive educative theatre play contributed effectively to the prevention of child sexual abuse through imparting knowledge, self-protective skills, and sensitization.

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.