Developing Indicators to Measure Critical Health Literacy in the Context of Norwegian Lower Secondary Schools.

Anders L Hage Haugen,Ove Edvard Hatlevik,Kirsti Riiser,Marc Esser-Noethlichs

doi:10.3390/ijerph19053116

Abstract

A critical health literacy (CHL) approach is recommended for promoting health in the school context. This construct is complex and includes three interconnected domains: (A) appraisal of critical information, (B) awareness of the social determinants of health (SDH), and (C) collective action to promote health and well-being. In recent literature reviews, no measurement instrument that covers all three domains of CHL in the school-context was found. Our aim was to develop self-reported measurement scales for each domain of CHL. The development process reported in this study was conducted in two stages. In the first stage, an initial item pool was generated based on literature reviews and focus group interviews (N = 15) with adolescents (steps 1–2). In the next steps, items were adjusted and removed based on the feedback from an expert panel and from representatives from the target group (steps 3–5). In stage two, we aimed to reduce the number of items and develop scales for each domain. We then piloted the current draft, which consists of 28 items (N = 114). A sub-sample (N = 10) of the participants were interviewed after they completed the survey to examine the instrument’s face validity. Cronbach’s α was used to assess the internal reliability of the scales; the reliability was promising for scales A (α = 0.83) and C (α = 0.85) but was below the recommended value for scale B (α = 0.61). The model fit indices were promising (TLIscaleA = 0.97, RSMEAscaleA = 0.055, TLIscaleB = 1.05, RMSEAscaleB = 0.00, TLIscaleC = 0.95, RMSEAscaleC = 0.074). The piloted version of scales A and C were positively correlated with subjective health literacy, health-related quality of life, and subjective health; however, we found no such correlations for scale B. The post-survey group interviews led to some adjustments in scales A and B. The revised version of CHLA-Q must be tested using a larger sample; this will enable more robust statistical testing of the properties of the items and the scale.

Highlights

Health Literacy (HL) has become a crucial goal of health education efforts across the globe [1–4]
This study reports on the development of three scales in a questionnaire measuring adolescents’ critical health literacy (CHL), named the Critical Health Literacy for Adolescents Questionnaire, CHLA-Q (Figure 1)
Health education in schools that increase adolescents CHL is of great importance in modern society and considering the recent COVID-19 pandemic

Summary

Introduction

Health Literacy (HL) has become a crucial goal of health education efforts across the globe [1–4]. Adolescents frequently engage with health-related information provided by their peers, adults, the media, social media, and commercial forces [1]. COVID-19 pandemic, the processing of health information has become even more important for individual and collective health. Considering the recent pandemic, researchers have emphasized the need to see HL in relation to social responsibility and solidarity [5]. According to the Norwegian Education Act [8], children and adolescents should gain knowledge, skills, and attitudes that will help them to master their lives and participate in and contribute to adult life and the communities in society. A recent update to the national curriculum introduces a new cross-curricular subject, Health and Life Skills (HLS) [9].

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Conclusion