Adolescents' understanding of the Nepalese version of HLS-CHILD-Q15: qualitative pre-testing in ninth-graders.

INTRODUCTION: Research on health literacy is still at an early stage, lacking a dedicated measurement instrument for assessing children's and adolescents' health literacy. Such tools are necessary to generate the evidence required for informed intervention development. This study translated the validated German HLS-Child-Q15 into the Nepalese context, creating the HLS-Child-Q22-NEP. METHODS: The research team initially created the HLS-Child-Q22-NEP using an additional item pool. We conducted thirteen one-on-one cognitive interviews with adolescent students from community schools in three districts of Nepal during the pre-test. We employed verbal probing techniques and deductively analysed the interviews based on Tourneau's model, uncovering four main themes: (1) comprehension (with the two sub-categories: a) item comprehension and b) word comprehension); (2) retrieval; (3) judgement; and (4) response. RESULTS: Overall, participants responded positively to the HLS-Child-Q22-NEP. However, this study revealed comprehension challenges such as unfamiliarity, misunderstandings, and translation issues. Additionally, the study identified retrieval challenges and poor judgement, indicating limitations in the assessment. Participants experienced varying levels of difficulty with some items, emphasising the need for revised instructions. Subsequent revisions, guided by pretest insights, led to the development of the HLS-Child-Q24-NEP. CONCLUSION: The development of the HLS-Child-Q22-NEP is a significant step in addressing Nepali adolescents' lack of health literacy measurement. Despite its generally positive reception, this study encountered challenges in comprehending the scale, prompting enhancements, and developing the HLS-Child-Q24-NEP. Further research, both qualitative and quantitative, is necessary to evaluate the validity and reliability of the modified items.

Measuring General Health Literacy in Chinese adults: validation of the HLS19-Q12 instrument.

BACKGROUND: Health literacy measurement lays a solid foundation to identify associations with health outcomes and monitor population health literacy levels over time. In mainland China, most existing health literacy instruments are either knowledge-based or practice-based, making health literacy results incomparable between China and other countries. This study aimed to examine the reliability and validity of the 12-item Health Literacy Population Survey (HLS19-Q12) in a general population of Chinese adults. METHODS: A cross-sectional study was conducted to recruit primary carers of students from 11 schools in Zhengzhou, Henan Province, using convenience cluster sampling. Participants completed an online self-administered survey that collected information on key sociodemographics, health literacy (HLS19-Q12 and a comparison tool: Health Literacy Questionnaire (HLQ)), and health-related outcomes. Using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist as a guideline, we tested internal consistency, test-retest reliability, content validity, structural validity, concurrent predictive validity, and convergent validity of the HLS19-Q12. RESULTS: Overall, 14,184 participants completed the full survey. The HLS19-Q12 showed excellent internal consistency (Cronbach's α = 0.93), moderate test-retest reliability (intra-class correlation coefficient = 0.54), satisfactory content validity (based on the 12-matrix health literacy model), and strong structural validity (comparative fit index = 0.94, Tucker and Lewis's index of fit = 0.93, root mean square error of approximation = 0.095). Concurrent predictive validity results showed health literacy was associated with both health determinants and health-related outcomes. The HLS19-Q12 had weak to strong correlations (coefficients = 0.24 to 0.42) with the nine scales of the HLQ. Respondents had an average score of 81.6 (± 23.0) when using the HLS19-Q12, with 35.0% and 7.5% having problematic and inadequate levels of health literacy, respectively. CONCLUSIONS: The HLS19-Q12 is a reliable and valid instrument to measure health literacy in our sample. Further validation is needed with a more nationally representative sample of Chinese adults. The HLS19-Q12 could be used as a comprehensive, skills-based, and easy-to-administer health literacy assessment tool integrated into population surveys and intervention evaluations.

eHealth Literacy and Web-Based Health Information-Seeking Behaviors on COVID-19 in Japan: Internet-Based Mixed Methods Study.

BACKGROUND: During the COVID-19 pandemic, much misinformation and disinformation emerged and spread rapidly via the internet, posing a severe public health challenge. While the need for eHealth literacy (eHL) has been emphasized, few studies have compared the difficulties involved in seeking and using COVID-19 information between adult internet users with low or high eHL. OBJECTIVE: This study examines the association between eHL and web-based health information-seeking behaviors among adult Japanese internet users. Moreover, this study qualitatively shed light on the difficulties encountered in seeking and using this information and examined its relationship with eHL. METHODS: This cross-sectional internet-based survey (October 2021) collected data from 6000 adult internet users who were equally divided into sample groups by gender, age, and income. We used the Japanese version of the eHL Scale (eHEALS). We also used a Digital Health Literacy Instrument (DHLI) adapted to the COVID-19 pandemic to assess eHL after we translated it to Japanese. Web-based health information-seeking behaviors were assessed by using a 10-item list of web sources and evaluating 10 topics participants searched for regarding COVID-19. Sociodemographic and other factors (eg, health-related behavior) were selected as covariates. Furthermore, we qualitatively explored the difficulties in information seeking and using. The descriptive contents of the responses regarding difficulties in seeking and using COVID-19 information were analyzed using an inductive qualitative content analysis approach. RESULTS: Participants with high eHEALS and DHLI scores on information searching, adding self-generated information, evaluating reliability, determining relevance, and operational skills were more likely to use all web sources of information about COVID-19 than those with low scores. However, there were negative associations between navigation skills and privacy protection scores when using several information sources, such as YouTube (Google LLC), to search for COVID-19 information. While half of the participants reported no difficulty seeking and using COVID-19 information, participants who reported any difficulties, including information discernment, incomprehensible information, information overload, and disinformation, had lower DHLI score. Participants expressed significant concerns regarding "information quality and credibility," "abundance and shortage of relevant information," "public trust and skepticism," and "credibility of COVID-19-related information." Additionally, they disclosed more specific concerns, including "privacy and security concerns," "information retrieval challenges," "anxieties and panic," and "movement restriction." CONCLUSIONS: Although Japanese internet users with higher eHEALS and total DHLI scores were more actively using various web sources for COVID-19 information, those with high navigation skills and privacy protection used web-based information about COVID-19 cautiously compared with those with lower proficiency. The study also highlighted an increased need for information discernment when using social networking sites in the "Health 2.0" era. The identified categories and themes from the qualitative content analysis, such as "information quality and credibility," suggest a framework for addressing the myriad challenges anticipated in future infodemics.

Improving adolescent health literacy through school-based health literacy intervention: a mixed-method study protocol.

BACKGROUND: Health-promoting actions might benefit from adolescent health literacy (AHL), however, there is scant research on it in Nepal. This study identifies adolescent students' health literacy (HL) needs and trials an intervention to improve their HL and intention to take health-promoting actions. METHODS: This study employs a pre-and post-test mixed-method intervention involving three phases. First, we will conduct a formative and summative evaluation to identify participants' HL needs and design an intervention using quantitative and qualitative methods. Second, the intervention will be administered to the intervention group. Finally, formative and summative post-tests will be conducted to assess the effectiveness of the intervention. We will select four community schools from Birendranagar municipality based on random sampling. In quantitative research, data will be collected from adolescents selected through a census with standardized scales such as the HLS-Child-Q15, self-efficacy, social support, and health-promoting actions. A framework analysis was conducted to analyze qualitative data collected from focus group discussions with purposively chosen adolescents and key informant interviews with Health and Physical Education teachers and school nurses. The difference in difference approach will be used to analyze the intervention's outcome, i.e., the participants' improved HL, and health-promoting actions. DISCUSSION: This is one of the first studies to explore HL in this group in Nepal. This study will provide the first insights into the overall level of AHL, potential AHL determinants, and the relationship between AHL and the intention to participate in health-promoting activities. The data can then be used to inform health promotion and health literacy initiatives.

Evaluating the effect of an adapted mental health literacy intervention on mental health related stigma among secondary students in Germany: results of a pre-post evaluation study.

BACKGROUND: Most mental health problems develop during youth, with about three quarter emerging before age 25. In adolescence, stigmatizing attitudes related to mental illness become more nuanced and consolidate into one's belief system. As the stigma of mental illness is still one of the leading barriers to help-seeking, intervention measures should explicitly address it before it becomes entrenched over time. Preventive measures, for example, based on promoting mental health literacy (MHL), can be used to address and tackle stigmatizing attitudes. The Canadian MHL-based intervention "the Guide" was translated and adapted for the use in German schools. The present study evaluates the effect of the German version of the Guide on attitudes towards mental illness among students in Germany. METHODS: The first-time application of the Guide (German version) was evaluated with a pre-post-evaluation study with an intervention and a control group. The evaluation data of 188 students (intervention group n = 106, control group n = 82) were statistically analyzed focusing on the outcomes social stigma, social distance, and self-stigma. RESULTS: The analysis showed that participants do not tend to hold stigmatizing attitudes even before the intervention. Nevertheless, the intervention was effective in reducing social stigma, but not in reducing social distance and self-stigma. Neither gender, pre-existing experience with mental illness, nor the delivery modality of the contact element within the intervention (speaker vs. video) seemed to influence the outcomes. CONCLUSIONS: The German version of the MHL-based intervention, the Guide, seems to be a suitable intervention to improve attitudes towards mental illness among students in Germany. More extensive research is necessary to confirm the findings and further explore factors that influence the program's effects on attitudes short- and long-term.

Vaccination as a social practice: towards a definition of personal, community, population, and organizational vaccine literacy.

BACKGROUND: A comprehensive and agreed-upon definition of vaccine literacy (VL) could support the understanding of vaccination and help policy-makers and individuals make informed decisions about vaccines. METHODS: To shed some light on this debate and provide clarity, a scoping review was conducted to collect, summarize, and analyse available definitions of VL. Based on the findings of the scoping review, a new and comprehensive definition was proposed by a panel of experts. RESULTS: Fifty-three articles were included, and two of them appeared to be the milestones around which the other definitions were grouped. The new definition proposed by the panel of experts included not only the personal perspective, but also the community, population, and organizational perspectives. Moreover, due to the increasing complexity of the social context with respect to the ability to navigate, understand, and use information and services, the definition of organizational vaccine literacy and the attributes of a vaccine literate healthcare organization have been proposed. CONCLUSION: The new definition can contribute to the overall paradigm of health literacy and its distinct component of vaccine literacy, possibly improving the implementation of public health strategies to allow vaccination to be understood as a social practice by the entire community. This study describes the conceptual foundations, the competencies, and the civic orientation to be considered when developing measurement tools devoted to assessing VL at the different levels and in different contexts.

Health literacy as a social vaccine in the COVID-19 pandemic.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus in the coronavirus family, causing the coronavirus disease (COVID-19). Biomedical vaccines are key but alongside biomedical vaccines, a social vaccine can be similarly useful to prevent infection from SARS-CoV-2, if applied as a health promotion strategy. In order to slow down and control the spread of SARS-CoV-2, applying the social vaccine concept should be considered in parallel. From a health promotion perspective, a social vaccine is a process of social and political mobilization driven by governmental and non-governmental organizations aiming at populations by applying interventions such as health communication, education and mass media campaigns as well as determinant-based programs to address environmental factors influencing personal behavior and community capacities to cope with and overcome the societal burdens of COVID-19. In this context, health literacy is significant, as seen in the role it plays in empowering citizens during the COVID-19 pandemic and enabling them to deal with health information considering COVID-19. As a public health strategy, health literacy as a social vaccine will enable individuals and communities to mitigate the spread of the virus by understanding and applying information as provided through governments and health authorities. The aim of this article is to explore health literacy as a promising social vaccine and opportunity to utilize social vaccination and thus be considered as a key public health approach-both bottom-up and top-down-to support the combat of COVID-19 and future states of emergency.

Coronavirus-related health literacy levels among school administrators and influencing factors.

Our study aimed to determine the level of coronavirus-related health literacy among school administrators and the factors that influence this. The sample of this cross-sectional study consisted of 402 school administrators serving in primary, secondary and high schools in Ankara. The data were collected between September 2021 and February 2022 using the descriptive characteristics questionnaire and the Coronavirus-Related Health Literacy Questionnaire (HLS-COVID-Q22). It was seen that 64.4% of the participants were male, 34.6% were 40 years old or younger and 35.6% were working in primary schools; 77.6% of the participants had a sufficient, 16.2% had a problematic and 6.2% had an inadequate level of coronavirus-related health literacy. Age, gender, chronic disease status, type of school they work in, level of knowledge about coronavirus, level of confusion due to knowledge about coronavirus, willingness to be vaccinated, believing that vaccines are safe/effective/compatible with their religious beliefs were found to affect coronavirus-related health literacy (p < 0.05). Gender, age, information satisfaction on coronavirus, confusion due to information on coronavirus and 'Overall, I believe that vaccinations are effective' explained 24.9% of HLS-COVID-Q22 variance (Adjusted R2 = 0.249, F = 13.080, p < 0.001). This study found the coronavirus-related health literacy level among school administrators to be sufficient. It found that their level of health literacy was affected by gender, age, chronic disease status, type of school they worked at, level of knowledge about coronavirus, level of confusion due to information about coronavirus, desire to be vaccinated and their thoughts about vaccines.

Online health information-seeking behaviour and mental well-being among Finnish higher education students during COVID-19.

Online health information-seeking behaviour has increased since the World Health Organization declared COVID-19 a global pandemic in March 2020. This study examined whether health-related information on COVID-19 searched on the internet was associated with mental well-being among higher education students. A cross-sectional internet survey was conducted among 18- to 34-year-old students in Finland (N = 2976; mean age 24.61 years and median 24) in the spring of 2020. The data were analysed using descriptive statistics, Pearson's chi-square tests, Kruskal-Wallis nonparametric H tests, and a two-way ANOVA. The results indicated that most students (86% of females, 82% of males) used the internet to search for information on COVID-19. Students' self-perceived abilities to determine the relevance of online information on COVID-19 were associated with mental well-being.

Gender differences in sense of coherence among university students during the COVID-19 pandemic in Turkey.

Non-pharmaceutical interventions (NPIs) implemented to mitigate the COVID-19 pandemic halted everyday life in higher education along with social and psychological impacts. The objective of our study was to explore the factors related to sense of coherence (SoC) from a gender perspective among university students in Turkey. This is a cross-sectional survey conducted online with a convenience sampling method as part of the international COVID-Health Literacy (COVID-HL) Consortium. SoC was measured by a nine-item questionnaire that was adapted to the Turkish language, including socio-demographic information and health status, including psychological well-being, psychosomatic complaints, and future anxiety (FA). 1595 students from four universities, of whom 72% were female, participated in the study. Cronbach's alpha for the SoC scale was 0.75. Based on the median split of the individual scores, levels of SoC showed no statistically significant difference according to gender. Logistic regression analysis indicated that higher SoC was associated with medium and high subjective social status, studying in private universities, high psychological well-being, low FA, and none/one psychosomatic complaint. While results were similar among female students, type of university and psychological well-being showed no statistically significant association with SoC among males. Our results indicate that structural (subjective social status) and contextual (type of university) factors, along with gender-based variations, are associated with SoC among university students in Turkey.

[Perspective Paper "Future Prevention Research" - Current and Future Coordinated Research on Prevention and Health Promotion]. / Perspektivpapier "Zukunft Präventionsforschung": Koordinierte Forschung zu Prävention und Gesundheitsförderung ­ aktuell und in der Zukunft.

From 2014 to 2022, the BMBF has funded five research networks in prevention research and health promotion that are also jointly coordinated (Research Network Primary Prevention and Health Promotion, www.fp2g.net). The researchers have produced a large number of relevant research outputs with insights gained into essential aspects of prevention research and health promotion. The networks research focused on basic principles, application-relevant findings, and implementation conditions of long-term prevention and health promotion for non-communicable diseases (NCDs). The constraints imposed by the pandemic from 2020 onwards were partly addressed by integrating Corona-related research and transfer activities. The importance of resilience for dealing with multiple health and social challenges got increased attention and was analyzed and discussed during the pandemic. For prevention research, research questions such as how to better implement prevention measures through digital tools are gaining additional importance. Together, the research networks have presented achievements and desiderata for future research. This perspective paper with its nine theses formulated in conclusion is intended as a stimulus for discussion among funders as well as the communty of researchers on the subject of successful prevention and health promotion. It is explicitly part of the continuity of the memoranda on prevention research developed in 2012.

The Children of Risk Communication.

For the management of the COVID-19 pandemic, risk communication has been a much-needed preventive and educative action to support citizens - including children - to adopt preventive and health protective measures. However, the COVID-19 pandemic is not the only health concern at hand that has raised concerns about the health status of children and required disease-preventive strategies. Bearing in mind the mental health problems and learning losses reported during the pandemic, in this commentary, we will argue that by now, it is time to consider critically if there could be more space for positive communication and education, both alongside and as an integral part of risk communication, to help adolescents not just to survive but also to live the fullest possible life now and in the future. Otherwise, the adolescents of COVID-19 could become 'the children of risk communication' to the detriment of their health and well-being.

Differences in digital health literacy and future anxiety between health care and other university students in England during the COVID-19 pandemic.

BACKGROUND: This study investigates university students' digital health literacy and web-based information-seeking behaviours during the early stages of the COVID-19 pandemic in England. It compares undergraduate and postgraduate students in non-health related subjects with health care students, many of whom were preparing for, or working in, frontline roles. The survey was conducted as part of a wider study by the COVID-HL research consortium. METHODS: A cross-sectional study was conducted among n = 691 university students aged ≥18 years from 25 universities across England using an adapted digital survey developed by COVID-HL. Data were collected regarding sociodemographic characteristics and specific measures drawn from the Future Anxiety Scale and the Digital Health Literacy Instrument (DHLI). These had been adapted for use in an English setting and to the specific context of the COVID-19 pandemic. Other data collected included students' anxiety or worries about the future using the Dark Future Scale as well as behaviours in online information-seeking. Data were analysed using correlations to test for relationships between constructs and also between group comparisons to test for differences between students studying health and non-health related subjects. RESULTS: Across digital health literacy dimensions, there was no significant difference between students studying health-related subjects and other students. Health care students did report greater difficulties in relation to how to behave online. They also relied less on public body sources for information about the pandemic. A significant difference was found between the two student populations in relation to their anxiety about the future with health care students reporting fewer fears about the future. CONCLUSIONS: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with evaluating online information which may frustrate public health efforts. This could be addressed by ensuring health students' curriculum in particular encompasses digital health literacy.

Sense of coherence mediates the relationship between digital health literacy and anxiety about the future in aging population during the COVID-19 pandemic: a path analysis.

Objectives: During the COVID-19 pandemic, older adults experience various challenges, including information uncertainties, financial pressure, and visit restrictions, which may lead to anxiety about the future. As a protective factor, sense of coherence (SOC) may play a role to reduce some psychological discomfort. This study aimed to analyze the relationships of SOC with anxiety, digital health literacy (DHL), information, and financial satisfaction among older adults during the outbreak.Methods: This is part of a large-scale DHL study with a cross-sectional survey across 41 countries. This study extracted data from three Asian countries (China, the Philippines, and Singapore) and included people aged ≥60. Structural equation modeling with path analysis was utilized to examine the relationships of SOC with anxiety about the future and other variables.Results: A total of 266 older adults were included, with 43.2% expressed anxiety about the future. DHL (ß=-0.13, p < 0.05) and SOC (ß=-0.26, p = 0.01) were negatively associated with anxiety, while financial and information satisfaction were not. However, financial satisfaction (ß = 0.34, p < 0.01) and DHL (ß = 0.32, p = 0.01) were positively associated with SOC. Higher SOC further mediated the negative relationships of DHL (ß= -0.11, p = 0.004) and financial satisfaction (ß= -0.12, p = 0.004) on anxiety of older adults.Conclusions: SOC had direct negative effect on anxiety and mediated the relationships between anxiety and DHL/financial satisfaction. Strategies should be developed to enhance SOC and DHL among older adults, as these capacities may help to manage anxiety during the pandemic.

University students' sense of coherence, future worries and mental health: findings from the German COVID-HL-survey.

Early-on in the COVID-19 pandemic when universities were closed as part of the nation-wide public health response to the COVID-19 outbreak, studying and student life significantly changed. Based on limited evidence the aim of this study was to explore the relationship between sense of coherence (SoC), future worries and mental health outcomes among German university students during the early phase of the pandemic. A cross-sectional online survey with n = 14 916 participants was carried out by inviting all private and public universities in Germany. All data were analysed using univariate, bivariate and multivariate statistics. Findings indicate a low and very low wellbeing for 38% of university students. Moreover, 29% reported being affected by at least two health complaints more than once week. Both health outcomes follow a social gradient and could be more frequently observed for respondents with lower subjective social status and female students. Regression analysis revealed significant association between the SoC dimensions and wellbeing (OR: 1.2-2.03) as well as health complaints (OR: 1.58-1.71). A high level of future worries was associated with low/very low wellbeing (OR: 2.83) and multiple health complaints (OR: 2.84). Based on the results, the public health response to the pandemic and university health promotion should therefore consider student mental health as an important target within their policy and action frameworks.

[DNVF Memorandum Health Literacy (Part 2) - Operationalisation and Measuring of Health Literacy from a Health Services Research Perspective]. / DNVF Memorandum Gesundheitskompetenz (Teil II) ­ Operationalisierung und Messung von Gesundheitskompetenz aus Sicht der Versorgungsforschung.

The "DNVF Memorandum Health Literacy (Part 2): Operationalization and Measurement of Health Literacy from the Perspective of Health Services Research" of the German Network for Health Services Research represents the continuation of the memorandum "DNVF Memorandum Health Literacy (Part 1): Background, Subject and Issues in Health Services Research". In addition to the general requirements for the measurement of health literacy, this memorandum also deals with the specific requirements, such as the differentiation of health literacy from related constructs, the differences between performance-based and self-assessment methods, the differences between generic and specific instruments, the use of screening instruments, and the measurement of health literacy in special populations. Furthermore, special considerations about the measurement of digital health literacy, potentials of qualitative and participatory research approaches as well as research ethics in the measurement of health literacy will be elaborated on. A special emphasis is placed on practical relevance for health services researchers. Finally, the authors will give an outlook on challenges and research desiderata in connection with the measurement of health literacy in the context of health services research.

Adaptation and validation of the Digital Health Literacy Instrument for Portuguese university students.

BACKGROUND: Health literacy is an important skill to deal with information and positively influences individual and community health. Information concerning health is available from a plethora of online resources. The concept of digital health literacy has gained prominence with the pandemic. The absence of valid tools to analyse digital literacy levels are scant. This study aims to translate, adapt and validate the Portuguese version of the Digital Health Literacy Instrument (DHLI) as used in the global COVID-HL Network. METHODS: Participants were mostly students from social sciences, psychology, education and health sciences. The Portuguese version of the DHLI contained five dimensions each consisting of three items. An online survey with university students (n = 1815, 75.1% female, average age: 24.15 years) was administered to test the validity of the Portuguese version of the DHLI. Data were analysed using exploratory and confirmatory factor analysis. Pearson correlations were also studied. RESULTS: Two items revealed symmetry and kurtosis problems. We chose to eliminate them from the analysis. Different exploratory factor analysis attempts were made, obtaining two possible models to be tested in the confirmatory factor analysis: a three-factor model and a four-factor model. A four-factor structure of the instrument (information searching, adding self-generated content, evaluating reliability, determining relevance) was supported by confirmatory factor analysis and had good internal consistency. CONCLUSIONS: The Portuguese version of the Digital Health Literacy Instrument met adequate psychometric criteria. Therefore, it can be confidently used in Portuguese students' assessment of digital health literacy. Representative studies are needed to shed light on different target groups and their COVID-19-related DHLI.

[Health-literate schools: concept development for organizational health literacy in schools]. / Gesundheitskompetente Schule: Konzeptentwicklung für organisationale Gesundheitskompetenz in der Schule.

BACKGROUND: Health literacy is considered a crucial resource nowadays. Schools are important venues for youth that can significantly contribute to promoting health literacy. This can be done in the traditional behavior-focused approach by providing learning opportunities and through an environment-orientated approach by optimizing the school to be a health-literate organization. This perspective is based on the concept of organizational health literacy, which is used in different settings to change organizational conditions to strengthen the health literacy of the respective clientele. The project "HeLit-Schools" (Health-Literate Schools) follows this approach and transfers it to the school setting. OBJECTIVES: In the HeLit-Schools project, a concept should be developed that provides standards for the development of organizational health literacy in schools and identifies which aspects need to be addressed. MATERIALS AND METHODS: The concept development was based on existing concepts of organizational health literacy. The concept was developed by involving key school stakeholders in commenting and revision loops. RESULTS: The HeLit-Schools concept includes eight standards that depict different areas within the school organization for optimizing and thus sustainably strengthening health literacy. CONCLUSIONS: Promoting health literacy in and through schools requires a comprehensive environment-oriented approach. The organization development concept HeLit-Schools enables schools to become health-literate using setting-based development.

[School health promotion in pandemic times. Results of the COVID-HL school principal study]. / Schulische Gesundheitsförderung in pandemischen Zeiten. Ergebnisse der COVID-HL-Schulleitungsstudie.

BACKGROUND: This study examines the extent to which schools implement activities on health promotion and prevention during the COVID-19 pandemic. Moreover, potential differences with regard to demographic variables, school type, state, and participation in state health promotion initiatives are determined. METHODS: As part of the international COVID Health Literacy Network, an online-based study was conducted from March to April 2021 with 2186 school principals from the German federal states of Baden-Württemberg, Hesse, Lower Saxony, and North Rhine-Westphalia. The implementation status of COVID-19-related school health promotion was assessed using a self-developed instrument. After examining the factorial structure of the instrument, univariate and bivariate data analyses were performed. RESULTS: Three dimensions of implementing school health promotion can be identified: (1) COVID-19-related support for pupils, (2) health promoting design of teaching, learning, and working conditions, and (3) the principles of Health Promoting Schools. A low level of implementation is observed for aspects of teaching, learning, and working conditions as well as for participation and cooperation with community stakeholders. Significant differences are observed, with female, older, and primary school principals reporting a higher implementation status, while for federal states non-homogenous differences are found. Stratified by participation in state health promotion initiatives, only schools with a certificate in health promotion show a higher level of implementation. DISCUSSION: The results indicate that the COVID-19 pandemic is a disruptive event for schools, impeding the implementation of holistic activities on health promotion and prevention. In particular, more attention should be given to the creation of health promoting working conditions, participation, and community cooperation.

Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19-related information and service environments. OBJECTIVE: This study aimed to investigate university students' digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany. METHODS: A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses. RESULTS: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of "information searching" and "evaluating reliability." Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites. CONCLUSIONS: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key.