Marchant Emily, Lowthian Emily, James Michaela, Davies Nia, Crick Tom
Department of Education and Childhood Studies, Swansea University, Swansea, SA2 8PP, United Kingdom.
National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea University, Swansea, SA2 8PP, United Kingdom.
Health Promot Int. 2025 Mar 5;40(2). doi: 10.1093/heapro/daaf026.
Childhood is a period of significant formative development where knowledge, skills, and capacities for adequate health literacy are acquired, particularly within school settings. The new Curriculum for Wales (CfW), phasing in from September 2022 for learners aged 3-16 years, places statutory focus on health and well-being and school-level curriculum design, providing unprecedented opportunities to empower children as agents in making health-enhancing decisions. Designing, tracking, and evaluating impacts of the CfW on children's health literacy requires scalable monitoring tools; however, research efforts have focused on adolescent populations. This national-scale scoping and pilot study, the first to explore children's health literacy in Wales, piloted the Health Literacy for School-Aged Children (HLSAC-5) within the existing nationwide Health and Attainment of Pupils in Primary EducatioN (HAPPEN-Wales) health and well-being survey to examine the health literacy of children aged 8-11 (n = 2607) and explore associations between health literacy and health behaviours. Children's health literacy was categorized as low (22.6%), moderate (50.4%), and high (27.0%). Multinomial logistic regression analyses suggest high health literacy compared to low health literacy was associated with higher sleep [relative risk ratio (RRR): 1.08, 95% CI 1.01-1.15], higher weekly physical activity (RRR: 1.13, 95% CI 1.03-1.25), fewer sedentary days per week (RRR: 0.89, 95% CI 0.81-0.99), and higher health-related well-being (RRR: 1.35, 95% CI 1.27-1.44). This study offers a sustainable measure of pre-adolescent children's health literacy and health behaviours and tracking of CfW impacts. This enables efforts to be tailored to person-centred (understanding children's health literacy needs), place-based (examining specific organizational health literacy context within schools and CfW design), and policy-focused approaches (re-energizing health literacy within current/emerging policies in Wales including the CfW).
童年是一个重要的成长发展时期，在这个阶段，人们尤其是在学校环境中获得了具备足够健康素养所需的知识、技能和能力。从2022年9月开始逐步实施的威尔士新课程（CfW），适用于3至16岁的学习者，法定重点关注健康与福祉以及学校层面的课程设计，为赋予儿童权力使其成为做出促进健康决策的主体提供了前所未有的机会。设计、跟踪和评估CfW对儿童健康素养的影响需要可扩展的监测工具；然而，研究工作主要集中在青少年人群。这项全国范围的概述性和试点研究是首次在威尔士探索儿童健康素养，在现有的全国性小学生健康与学业成就（HAPPEN - Wales）健康与福祉调查中试点了学龄儿童健康素养（HLSAC - 5），以检查8至11岁儿童（n = 2607）的健康素养，并探索健康素养与健康行为之间的关联。儿童的健康素养被分为低（22.6%）、中（50.4%）和高（27.0%）三类。多项逻辑回归分析表明，与低健康素养相比，高健康素养与更高的睡眠质量[相对风险比（RRR）：1.08，95%置信区间1.01 - 1.15]、更高的每周体育活动量（RRR：1.13，95%置信区间1.03 - 1.25）、每周较少的久坐天数（RRR：0.89，95%置信区间0.81 - 0.99）以及更高的与健康相关的幸福感（RRR：1.35，95%置信区间1.27 - 1.44）相关。本研究提供了一种可持续的方法来衡量青春期前儿童的健康素养和健康行为，并跟踪CfW的影响。这使得我们能够针对以个人为中心（了解儿童的健康素养需求）、基于地点（检查学校内特定的组织健康素养背景和CfW设计）以及以政策为重点的方法（在威尔士当前/新出现的政策包括CfW中重新激发健康素养）做出努力。
