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Public health
Research
Quality of health literacy instruments used in children and adolescents: a systematic review
  1. Shuaijun Guo1,2,
  2. Rebecca Armstrong1,
  3. Elizabeth Waters1,
  4. Thirunavukkarasu Sathish1,3,
  5. Sheikh M Alif1,4,
  6. Geoffrey R Browne1,
  7. Xiaoming Yu5
  1. 1School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2Centre for Community Child Health, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  3. 3Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  4. 4School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  5. 5Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
  1. Correspondence to Dr Shuaijun Guo; gshj1986{at}gmail.com and Prof Xiaoming Yu; yxm{at}bjmu.edu.cn

Abstract

Objective Improving health literacy at an early age is crucial to personal health and development. Although health literacy in children and adolescents has gained momentum in the past decade, it remains an under-researched area, particularly health literacy measurement. This study aimed to examine the quality of health literacy instruments used in children and adolescents and to identify the best instrument for field use.

Design Systematic review.

Setting A wide range of settings including schools, clinics and communities.

Participants Children and/or adolescents aged 6–24 years.

Primary and secondary outcome measures Measurement properties (reliability, validity and responsiveness) and other important characteristics (eg, health topics, components or scoring systems) of health literacy instruments.

Results There were 29 health literacy instruments identified from the screening process. When measuring health literacy in children and adolescents, researchers mainly focus on the functional domain (basic skills in reading and writing) and consider participant characteristics of developmental change (of cognitive ability), dependency (on parents) and demographic patterns (eg, racial/ethnic backgrounds), less on differential epidemiology (of health and illness). The methodological quality of included studies as assessed via measurement properties varied from poor to excellent. More than half (62.9%) of measurement properties were unknown, due to either poor methodological quality of included studies or a lack of reporting or assessment. The 8-item Health Literacy Assessment Tool (HLAT-8) showed best evidence on construct validity, and the Health Literacy Measure for Adolescents showed best evidence on reliability.

Conclusions More rigorous and high-quality studies are needed to fill the knowledge gap in measurement properties of health literacy instruments. Although it is challenging to draw a robust conclusion about which instrument is the most reliable and the most valid, this review provides important evidence that supports the use of the HLAT-8 to measure childhood and adolescent health literacy in future school-based research.

  • measurement properties
  • health literacy
  • children
  • adolescents
  • systematic review

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-020080

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    Footnotes

    • Contributors SG conceived the review approach. RA and EW provided general guidance for the drafting of the protocol. SG and SMA screened the literature. SG and TS extracted the data. SG drafted the manuscript. SG, GRB, RA, EW, XY, SMA and TS reviewed and revised the manuscript. All authors contributed to the final manuscript.

    • Funding This paper is part of SG’s PhD research project, which is supported by the Melbourne International Engagement Award. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional data available.