Current address: Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY, 10027, USA.
Eliot-Pearson Department of Child Study and Human Development, Tufts University, 105 College Ave, Medford, MA, 02155, USA.
BMC Public Health. 2022 Mar 25;22(1):585. doi: 10.1186/s12889-022-12924-4.
Health literacy (HL) is implicated in improved health decision-making and health promotion, and reduced racial, ethnic, and socioeconomic health disparities. Three major areas of HL include functional, interactive, and critical HL. HL skills develop throughout the lifespan as individuals' psychosocial and cognitive capacities develop and as they accumulate experiences with navigating health systems. Though adolescence is marked by increased involvement in health decision-making, most HL studies and measures of HL have focused on adults. Both the adult and adolescent HL literature are also limited by the paucity of validated test-based measures for assessing HL. The existing test-based validated HL measures for adolescents were originally designed for adults. However, adolescents are at an earlier phase of developing their HL skills (e.g., fewer experiences navigating the health system) compared to adults and measures originally designed for adults may assume prior knowledge that adolescents may lack therein underestimating adolescents' HL. This study developed and validated test-based assessments of adolescents' functional, interactive, and critical HL.
Items were generated in an iterative process: focus groups with adolescents informed item content, cognitive interviews with adolescents and expert consultation established content and face validity of the initial items, and items were revised or removed where indicated. High school students (n = 355) completed a measurement battery including the revised HL items. The items were evaluated and validated using Rasch measurement models.
The final 6-item functional, 10-item interactive, and 7-item critical HL assessments and their composite (23 items) fit their respective Rasch models. Item-level invariance was established for gender (male vs. female), age (12-15-year-olds vs. 16-18-year-olds), and ethnicity in all assessments. The assessments had good convergent validity with an established measure of functional HL and scores on the assessments were positively related to reading instructions before taking medicine and questioning the truthfulness of health information found online.
These assessments are the first test-based measures of adolescents' interactive and critical HL, the first test-based measure of functional HL designed for adolescents, and the first composite test-based assessment of all three major areas of HL. These assessments should be used to inform strategies for improving adolescents' HL, decision-making, and behaviors.
健康素养（HL）与改善健康决策和促进健康以及减少种族、民族和社会经济健康差距有关。HL 有三个主要领域，包括功能性、互动性和批判性 HL。随着个人的社会心理和认知能力的发展以及他们积累了驾驭卫生系统的经验，HL 技能在整个生命周期中都得到发展。尽管青春期涉及更多的健康决策，但大多数 HL 研究和 HL 衡量标准都集中在成年人身上。成人和青少年 HL 文献也受到用于评估 HL 的经过验证的基于测试的衡量标准稀缺的限制。现有的针对青少年的基于测试的经过验证的 HL 衡量标准最初是为成年人设计的。然而，与成年人相比，青少年在发展 HL 技能方面处于更早的阶段（例如，在导航卫生系统方面的经验较少），而最初为成年人设计的衡量标准可能会假设青少年缺乏这方面的先验知识，从而低估青少年的 HL。本研究开发并验证了基于测试的青少年功能性、互动性和批判性 HL 评估方法。
项目是通过迭代过程生成的：与青少年进行焦点小组讨论以提供项目内容，与青少年进行认知访谈并咨询专家以确定初始项目的内容和表面有效性，并根据需要修改或删除项目。高中生（n=355）完成了一个测量工具包，其中包括经过修订的 HL 项目。使用 Rasch 测量模型对项目进行评估和验证。
最终的 6 项功能性、10 项互动性和 7 项批判性 HL 评估及其综合（23 项）符合各自的 Rasch 模型。在所有评估中，性别（男性与女性）、年龄（12-15 岁与 16-18 岁）和种族的项目水平具有不变性。这些评估与功能性 HL 的既定衡量标准具有良好的收敛效度，并且评估得分与服药前阅读说明和质疑在线上找到的健康信息的真实性呈正相关。
这些评估是青少年互动性和批判性 HL 的第一个基于测试的衡量标准，是专为青少年设计的功能性 HL 的第一个基于测试的衡量标准，也是所有三个主要 HL 领域的第一个基于测试的综合评估。这些评估应用于为改善青少年的 HL、决策和行为提供信息。
