Digital Silence and Adolescent Health Literacy in Remote Learning Environments

Evaluation of Factors Influencing Health Literacy in Adolescents and Adults with Sickle Cell Disease

Health literacy describes how people use health information to make informed decisions in context of healthcare, disease prevention and health promotion. Enhancing health literacy of populations is critical and in particular important at an early age, which is understood to be more sustainable because health literacy contributes to improved personal health and development. Low health literacy in child and adolescent populations has been linked to worse health outcomes and health disparities in Europe, making health literacy of children and adolescents an important public health topic. Developing and delivering target group specific interventions and services requires precise data generation on the state of health literacy in early age. In the past decade, several conceptual approaches have been undertaken but methodological sound, validated and reliable measurement tools are still scarce. Available systematic reviews show that most tools originated from North America and/or English speaking countries. However, in the past years European researchers have been involved with research on health literacy in childhood and adolescence, the result of which culminated into heavy progress regarding the development of health literacy measurement instruments, including generic health literacy, digital health and mental health literacy. These new developments lead to the availability of validated tools for school-aged children, including primary and secondary school children. The purpose of this workshop is to bring together five contemporary health literacy studies conducted in child and adolescent populations across Europe, including national and European-wide studies. Both methodological findings regarding the measurement tool and empirical data will be introduced. The first presentation emerges from the HLCA HL-Kids project, which has been conducted in Germany and focusses on primary schoolchildren, using the HLS-Child-Q15 tool. The second presentation originates from the Netherlands where the HLS-Child-Q15 tool was adapted to Dutch children. The third presentation aims at health literacy of adolescents in secondary school-age in Germany, by using the MOHLAA-Q tool. The fourth presentation originates from the WHO-led HBSC study, which has been conducted by using the HLSAC questionnaire. The final presentation will focus on the first digital health literacy measurement tool for secondary schoolchildren, which has been developed within a German study in schools. Each project will be given ten minutes to present their findings, including questions, which will be followed by Q&A and an open discussion with the audiences. This workshop offers a forum for researchers, practitioners and policy-makers interested in health literacy measurement in children and adolescents. By dialogue and two-way communication, vivid interaction will be ensured, allow building synergies, and facilitate networking and capacity building.Key messages• Health literacy contributes to improved personal health and development of children and adolescents.• The measurement of health literacy is key to public health intervention success and needs theory driven, validated and reliable instruments.

The objective of this study was to analyse the associations between health literacy, health status and health-promoting behaviours among Taiwan adolescents. Limited health literacy is associated with poor health outcomes such as low use of preventive services, poor self-reported health conditions and absence of health-promoting behaviours in adults. However, these factors have not been analysed in adolescents. The associations between health literacy and health outcome in adolescents provide helpful insights in conducting health education programmes for health professionals. A cross-sectional survey. The survey analysed a purposive sample of 1601 senior/vocational high school students from six counties in Taiwan. Data for health literacy and health-promoting behaviours were collected by the Chinese version (short form) of the Test of Functional Health Literacy in Adolescents (c-sTOFHLAd) and health-promoting behaviour scale with subscales for the following health-promoting behaviours: nutrition, exercise, stress management, interpersonal relations, health responsibility and self-actualisation. Adolescents with low health literacy were less likely to perceive good health status [adjusted odd ratio, (AOR) = 0·59, 95%CI = 0·41-0·86] and less likely to exhibit health-promoting behaviours (AOR = 0·58, 95%CI = 0·39-0·86) than those with high health literacy were, especially in nutrition (AOR = 0·62, 95%CI = 0·43-0·89) and interpersonal relations (AOR = 0·61, 95%CI = 0·43-0·87) subscales. Adolescents with high and low health literacy did not significantly differ in the following health-promoting behaviours: exercise, stress management, health responsibility and self-actualisation. Health literacy is vital for promoting health in adolescents, especially in the domains of nutrition and interpersonal relations. Health professionals should conduct health literacy assessments for adolescents prior to designing health education programmes for those with low health literacy to develop health literacy skills as to perform health promoting behaviours.

Enhancing health literacy of children and adolescents is a critical means for health promotion and sustainable development. This is mainly because childhood and adolescence represent key stages for addressing health, social, cognitive, emotional and educational development and influencing health behavior and healthy lifestyles over the life-course. The education sector is particularly important, and schools represent a critical setting to facilitate health literacy teaching and learning, for example in health education classes or whole-of-school approaches. Regarding the question of what makes health literacy so important for children and adolescents these days, there are three key themes and recent developments which amplified the meaning and relevance of health literacy for public health and societies: (i) A globalizing world: Globalization and digitalization change the ways in which health is negotiated and promoted, including that today health information is almost limitlessly accessible in everyday life. (ii) The information overload: The overload of information - a.k.a. infodemic (short for information epidemic) - makes health literacy a critical skill-set in managing the overabundance of information that is available through digital communication channels; while at the same time children and adolescents are increasingly turning to the Internet and social media as sources of health information and for communication about health issues with their peers or social contacts. (iii) The COVID-19 pandemic: The pandemic has once again underlined how important health literacy is not only for understanding public health recommendations, applying health behaviours, avoiding unnecessary risks, and protecting individual, family, and population health, but also to learn about the importance of vaccination, to become knowledgeable and skilled in navigating the infodemic, and to identifying fake news and disinformation about COVID-19. The purpose of this workshop is to bring together five contemporary projects on health literacy from Germany in and with schools that reflect the above issues: (i) A cross-sectional pen-and-paper survey in primary schools on children's health literacy; (ii) A survey on adolescents health literacy; (iii) The development of a toolbox for health literacy interventions in schools; (iv) An intervention for improving adolescent's mental health literacy in schools, (v) A whole school approach and organizational health literacy in schools. Each project will be given ample time to present their findings, which will be followed by Q&A and an open discussion with the audiences. This workshop offers a forum for researchers, practitioners and policymakers interested in school related health literacy and school health promotion. By dialogue and two-way communication, vivid interaction will be ensured, allow building synergies, and facilitate networking and capacity building.Key messages Health literacy contributes to promoting and maintaining child and adolescent health in times of crisis like the COVID19 pandemic.Health literacy needs to be strengthened through investments in the education sector and school health promotion programs.

Introduction: People with low health literacy have poorer self-management of chronic diseases like asthma. Studies of parent health literacy and education level on the management of children’s chronic illnesses reveal inconclusive results. We hypothesized a correlation between parent and adolescent health literacy in teens with asthma. Methods: Sociodemographic data were obtained; health literacy was assessed on adolescents and parents with three instruments: Rapid Estimate of Adolescent/Adult Literacy in Medicine (REALM), Single Item Literacy Screener (SILS) and Newest Vital Sign (NVS). Agreement between scores was examined by calculating weighted kappa statistics and performing Bowkers test of symmetry. Results: In all, 243 adolescents and 203 parents completed health literacy assessments yielding 198 paired observations. 9th–12th graders, 60.6% female, 72.7% African-American (AA), mean age: 15.3 years (±0.9). Parent education ranged from < high school (19.1%) to college graduate (24.0%). Agreement between adolescent and parent scores was poor: REALM (κw = 0.26), SILS (κw = 0.12), and NVS (κw = 0.29) and disagreement did not significantly differ by race. Positive correlations of moderate strength (overall and between racial groups) were found between reading scores and both REALM and NVS scores, and between REALM and NVS scores. Due to the inverse relationship of SILS scores with health literacy level, SILS scores (overall and between racial groups) were weakly and negatively correlated with reading scores, REALM and NVS. Conclusion: Correlation between education level and traditional literacy suggests that these are contributing factors to the health literacy of adolescents with asthma. Correlation between adolescent and caregiver health literacy was not supported.

BackgroundHealth-promoting actions might benefit from adolescent health literacy (AHL), however, there is scant research on it in Nepal. This study identifies adolescent students’ health literacy (HL) needs and trials an intervention to improve their HL and intention to take health-promoting actions.MethodsThis study employs a pre-and post-test mixed-method intervention involving three phases. First, we will conduct a formative and summative evaluation to identify participants’ HL needs and design an intervention using quantitative and qualitative methods. Second, the intervention will be administered to the intervention group. Finally, formative and summative post-tests will be conducted to assess the effectiveness of the intervention. We will select four community schools from Birendranagar municipality based on random sampling. In quantitative research, data will be collected from adolescents selected through a census with standardized scales such as the HLS-Child-Q15, self-efficacy, social support, and health-promoting actions. A framework analysis was conducted to analyze qualitative data collected from focus group discussions with purposively chosen adolescents and key informant interviews with Health and Physical Education teachers and school nurses. The difference in difference approach will be used to analyze the intervention’s outcome, i.e., the participants’ improved HL, and health-promoting actions.DiscussionThis is one of the first studies to explore HL in this group in Nepal. This study will provide the first insights into the overall level of AHL, potential AHL determinants, and the relationship between AHL and the intention to participate in health-promoting activities. The data can then be used to inform health promotion and health literacy initiatives.

Evaluation of adolescents' cardiovascular health behaviors and health literacy levels in Turkey

Adolescent health literacy and health behaviors: A systematic review

There are over 100,000 individuals with sickle cell disease (SCD) in the United States, most of whom are Black, poor, and publically insured. In combination with a chronic illness, these demographics lead to significant barriers to healthcare for patients with SCD, leaving them exceptionally vulnerable within the healthcare system. This unique vulnerability is especially notable when transitioning adolescents with SCD from pediatric to adult care, as this is a significant time of morbidity and mortality for these patients. It is postulated that health literacy influences transition from pediatric to adult care in adolescents with SCD. To better understand this relationship, more adolescent health literacy research must be conducted with both adolescents with and without SCD. Therefore, the purpose of this study is to systematically compare health literacy in adolescents with and without SCD. This is a cross-sectional, descriptive, exploratory study. One hundred and thirty-four adolescents with SCD and 105 adolescents without SCD were recruited for this study. The Newest Vital Sign (NVS) health literacy instrument was used to evaluate health literacy. Pearson correlations were conducted to evaluate relationships among health literacy and the influencing factors of age, grade level, income, and parental education level. Differences in NVS scores between groups were assessed using independent samples t tests. There was a significant relationship between health literacy, age (r = .286, p < .01) and grade level (r = .317, p = .00) in adolescents with SCD. In adolescents without SCD, there was a significant relationship between health literacy, income (r = .235; p < .05) and parental education (r = .263; p < .01). The mean NVS score was 2.66 for adolescents with SCD and 3.77 for adolescents without SCD. A statistically significant difference in NVS scores was found between groups (t = 4.772; p < .001). Adolescents with SCD demonstrated significantly lower NVS scores than adolescents without SCD. There are significant differences in health literacy scores and influencing factors in adolescents with and without SCD. Thus, this article provides unique insight for nurses as they design, implement and evaluate health promotion, patient education, and future research initiatives for adolescents and families, both with and without SCD. Further research is needed to gain more insight into this phenomenon.

BackgroundSustained remote learning environments, like those experienced in late 2020 due to the COVID-19 pandemic, share characteristics with online courses but were not intentionally designed to delivered virtually. The purpose of this study was to investigate the impact of Community of Inquiry, a widely used online learning environment framework, and self-efficacy on perceived student attitudes within sustained remote learning environments.MethodsAn interinstitutional team of health professions education researchers collected survey data from 205 students representing a wide range of health professions in five U.S. institutions. Latent mediation models under structural equation modeling framework were used to examine whether student self-efficacy mediates the relationship between Community of Inquiry presence and student’s favorability of sustained remote learning delivered in the prolonged stages of the COVID-19 pandemic.ResultsHigher levels of teaching presence and social presence in the remote learning environment were associated with higher levels of remote learning self-efficacy which, in turn, predicts variance in positive attitudes toward remote learning. When mediated by self-efficacy, significant variance in student’s favorability of sustained remote learning was explained by teaching presence (61%), social presence (64%), and cognitive presence (88%) and self-efficacy. Significant direct and indirect effects for teaching and social presence, and only direct effects for cognitive presence were observed.ConclusionsThis study establishes the Community of Inquiry and its three presence types as a relevant and stable framework for investigating sustained remote health professions teaching and learning environments, not only carefully designed online learning environments. Faculty may focus course design strategies which enhance presence and increase student self-efficacy for the sustained remote learning environment.

BackgroundAdolescence is an essential stage of life during which individuals develop knowledge, attitudes, and behaviors that can have significant impacts on their present and future health. Therefore, health literacy issue among adolescents is a pressing matter. Understanding adolescents’ perspectives of health literacy is crucial for making informed interventions. However, the topic remains unexplored in developing countries like Ethiopia. This study seeks to explore adolescents’ perspectives of health literacy within their socio-environmental context in Ethiopia and draw out the implications.MethodsThis study employed qualitative research approach, utilizing in-depth interviews and focus group discussions as methods of data collection. Data collection took place from March to October 2023, involving 86 participants (41 male and 45 female) selected through purposive sampling (maximum variation sampling) to capture a wide range of perspectives on the issue. The data analysis followed a thematic analysis approach, using Atlas.ti (version 7.5.18) software.ResultsFrom the adolescents’ perspectives, health literacy or being health literate is regarded as comprising various competencies and qualities essential for health, including health awareness and knowledge, abilities to deal with health information, practicing healthy behaviors, upholding healthy norms and values of the community, and being a responsible citizen. The adolescents regard health literacy or being health literate as highly beneficial in healthcare, disease prevention, health maintenance and enhancement, and in taking responsibility not only for ones’ own health but also for the health of others, thereby benefiting those around them and their community and society. However, this study found notable gaps in health literacy among the adolescents, influenced by various factors ranging from individual to community and societal levels.ConclusionThe study explored health literacy from adolescents’ perspectives in Ethiopia, and contributed to understanding of the issue. It identified notable gaps in adolescent health literacy and provided insights into the enabling and hindering factors. This study laid the ground for developing a health literacy tool sensitive to the Ethiopian sociocultural context and for broader studies to enhance understanding and to develop effective interventions to improve and promote health literacy among adolescents and within the broad society.

Health literacy (HL) is hypothesized to be associated with physical literacy (PL), but studies have rarely examined this association in adolescents. This study aimed to investigate the possible relationships between PL and physical activity levels (PAL), with HL in high-school adolescents. The participants in this cross-sectional study were high school students (n=204; 100 females; 16 to 19 years of age). Variables included evaluation of the HL, PL, and PAL. The Physical Activity Questionnaire for Adolescents was used for analysis of the PAL. PL was assessed by the Canadian Assessment of Physical Literacy, and the Physical Literacy Assessment of Youth (PLAYself). HL was evaluated using the European Health Literacy Survey Questionnaire. Univariate and multivariate correlations were calculated for the total sample and stratified by gender. Boys had greater PAL than girls (t test =6.76, p&lt;0.001), but no significant gender differences were found in PL and HL. The results showed no significant association between PL and HL in boys. PL was significantly associated with HL in girls (17% of the explained variance, p&lt;0.001), with PLAYself being a significant partial regressor (Beta =0.38, p&lt;0.001). Due to the established gender-specific associations between HL and PL, in developing and implementing educational strategies aimed at improving PL and HL in adolescents, a gender-specific approach is warranted.

Background: Adolescence is a high-risk period. Teenagers experience risky behaviors in this period, including using abusive drugs and addiction. Meanwhile, sufficient awareness helps a person to interpret and analyze health-threatening factors. This study aimed to determine the relationship between health literacy and susceptibility to addiction in adolescents living in the western part of Tehran City, Iran. Methods: This descriptive-correlational study was performed on 265 senior high school students in the western part of Tehran in 2021. The subjects were recruited by cluster random sampling. The study data were collected online using the addiction susceptibility questionnaire and health literacy measure for adolescents. The obtained data were sorted by frequency distribution, Mean±SD and analyzed utilizing the Pearson correlation coefficient, independent t-test, and analysis of variance in SPSS software, version 16. The significance level was set at 0.05. Results: Most study subjects (56.4%) were female. Their Mean±SD score of health literacy was 65.31±21.15. Among the subscales of health literacy, “calculation”, with a Mean±SD score of 68.96±35.89, and “utilization”, with 61.29±25.05, had the highest and lowest mean scores, respectively. The Mean±SD score of addiction susceptibility was 25.3±30.05, and among its subscales, “showing off” with a mean score of 33.09±32.64 and “family dissatisfaction” with 19.75±35.47 had the highest and lowest mean scores, respectively. Health literacy and its dimensions had a negative correlation with addiction susceptibility (P&lt;0.001). Conclusion: According to the findings, it is recommended to use appropriate strategies to increase adolescent health literacy by health service providers, school officials, school health nurses, and teachers. The results of this study can be used as a source for further research on addiction and health literacy in adolescents.

Recent research into definitions and concepts of health literacy has widened the meaning from individual functional skills in medical word recognition, text comprehension, and numeracy to other skills required to access, appraise and use health information. Current integrative health literacy concepts put a stronger focus on underlying competences and motivation and therefore encompass social and life skills. In addition, the widened understanding of health literacy has also been recognized for its quality to shift the focus from individual-level skills to social, economic, or environmental forces that have impact on health at population- and system-levels. The recent conceptual developments make health literacy a promising target for health promoting and primary prevention because they a) allow for integrating behavioural and contextual factors, b) can be linked to related approaches from e.g. social epidemiology or socialisation research, and c) serve for the development of measurement tools to assess dimensions other than those that are usually used to inform on health literacy levels in populations. So far children and adolescents have poorly been included into health literacy research. Health literacy theoretical models also implicitly target rather adults than younger age groups. Only little information is available for children and adolescents and gaps encompass e.g. definitions, concepts and models refined for different age groups, the formulation of needs of and demands on health literacy for children and adolescents, or for adults who impact on child health. This contrasts with the importance given to children and adolescents for health promotion and primary prevention. Here, we present the German „Health Literacy in Childhood and Adolescence – HLCA” consortium that was launched to meet the needs as outlined above. The consortium aims to research into health literacy in childhood and adolescence by developing, adjusting, implementing, and evaluating theoretical, conceptual, and methodological health literacy approaches linked to children and adolescents. The consortium aims to target not only children and adolescents, but also adults and systems with impact on child development. We will focus on mental health, ehealth literacy and media education with a strong focus on socially disadvantaged children. We target electronic media as a source of communication with high importance for child and youth health development twofold: with a cluster randomized trial on the effectiveness of a brief parent oriented intervention to reduce screen media use in children and with ethnograhic studies on health associated internet usage of youth migrants.

This cross-sectional German study examined the frequency of health literacy (HL) in adolescents and young adult (AYA) cancer patients and the factors associated with HL. A sample of 206 AYA-aged patients (80.1% female; age 15-39 years) completed measures of HL, health-related quality of life (HRQoL), depression, and sociodemographic characteristics; 28% had a sufficient HL score. Males and patients with higher education levels reported higher HL scores. Regression revealed positive associations between HL and HRQoL and depressive symptoms. Results suggest the need to further examine HL and its predictors in AYAs with cancer to develop interventions for improving HL.