Health Lit Res Pract. 2021 Jan 11;5(1):e1-e14. doi: 10.3928/24748307-20201117-01.
Health literacy enables a person to make good decisions regarding health care, disease prevention, and health promotion to maintain and improve health. Although health literacy research in China has gained increasing attention in recent years, most existing studies focus on adults rather than adolescents. In addition, little theory-driven empirical research has been conducted to fully understand the relationship among health literacy, its influencing factors, and health outcomes scored on a skills-based health literacy instrument.
This study applied Manganello's framework to investigate how health literacy was related to its antecedents and health status in secondary students in Beijing, China.
A cross-sectional study was conducted with 650 students in Years 7 to 9 (age 11-17 years) from four secondary schools. Students completed a self-administered questionnaire based on Manganello's health literacy framework, which measured key upstream determinants, including health literacy and self-report health status. Health literacy was measured on an 8-item skills-based instrument that assesses a person's ability to find, understand, appraise, and communicate health information in everyday life (scores range from 0-37). Descriptive statistics and path analysis were conducted to investigate the mediating role of health literacy in predicting health status.
Overall, the average scores of students' health literacy was 26.37 (±5.89). Manganello's framework was supported by the data collected (χ/df = 2.049, p = .001, comparative fix index = 0.966, root mean square error of approximation = 0.041). Personal self-efficacy (r = 0.11, p = .007), social support (r = 0.18, p < .001), and school environment (r = 0.27, p < .001) predicted health literacy, which in turn predicted students' health status (r = 0.12, p = .005).
Adolescent health literacy is not only a person's capability to protect health, but also an interactive outcome with the broader environment. Promoting health literacy could be a useful strategy to improve health status for adolescents; however, a holistic approach is needed to increase students' self-efficacy, promote social support, and create positive school environments to achieve optimal health literacy and health outcomes. [HLRP: Health Literacy Research and Practice. 2021;5(1):e1-e14.] PLAIN LANGUAGE SUMMARY: We investigated how health literacy was related to its influencing factors and health status among secondary students in Years 7 to 9 in Beijing, China. Students with low self-efficacy, low social support, and low perceptions of positive school environment were more likely to have low health literacy, which in turn predicted poor health status.
健康素养使一个人能够就医疗保健、疾病预防和健康促进做出明智的决策，以维持和改善健康。尽管近年来中国的健康素养研究受到越来越多的关注，但大多数现有研究都集中在成年人，而不是青少年。此外，很少有基于理论的实证研究来充分了解健康素养及其影响因素与基于技能的健康素养工具衡量的健康结果之间的关系。
本研究应用 Manganello 的框架来探讨北京中学生的健康素养与其前因和健康状况之间的关系。
本研究采用横断面研究，选取北京 4 所中学的 7 至 9 年级（11-17 岁）的 650 名学生为研究对象。学生完成了基于 Manganello 健康素养框架的自我管理问卷，该框架测量了关键的上游决定因素，包括健康素养和自我报告的健康状况。健康素养采用 8 项基于技能的工具进行测量，评估个人在日常生活中查找、理解、评估和交流健康信息的能力（分数范围为 0-37）。采用描述性统计和路径分析来探讨健康素养在预测健康状况方面的中介作用。
总体而言，学生健康素养的平均得分是 26.37（±5.89）。Manganello 的框架得到了数据的支持（χ/df = 2.049，p =.001，比较拟合指数 = 0.966，均方根误差逼近值 = 0.041）。个人自我效能（r = 0.11，p =.007）、社会支持（r = 0.18，p <.001）和学校环境（r = 0.27，p <.001）预测健康素养，而健康素养又预测学生的健康状况（r = 0.12，p =.005）。
青少年健康素养不仅是个人保护健康的能力，也是与更广泛环境相互作用的结果。促进健康素养可能是提高青少年健康状况的有效策略；然而，需要采取整体方法来提高学生的自我效能感、促进社会支持和创造积极的学校环境，以实现最佳的健康素养和健康结果。
