A WHO global health literacy assessment tool for adolescents: a systematic review

Background

Despite significant global and regional efforts to advance health literacy (HL), no standardised tool currently exists for measuring adolescent HL that aligns with the WHO definition and allows for international comparison. This study aims to develop an assessment tool to measure HL levels among school-aged adolescents in a global context.

Methods

Building on previous reviews, a systematic literature search was conducted in PubMed, Scopus, and Web of Science from 2018 to 2025, supplemented by hand searching. Eligible studies included tools targeting adolescents aged 13–17 years that assessed general, digital, eHealth, or skill-specific types of HL in school or non-school settings worldwide.

Results

Of N = 511 identified records, 47 studies using HL tools were included. Tools were from 23 countries, with the majority from the USA (21.2%) and Germany (10.6%). The majority were from high-income countries (65.9%), with only 31.9% from low- and middle-income countries. Most tools were school-based (80.9%), compared to 19.1% coming from non-school settings. The focus of HL varied across tools; specific types of HL were the most common (48.9%), while general and digital HL were less common (36.1%, 14.8%, respectively). Self-administered tools were more frequent (63.8%), followed by performance-based (21.3%) and mixed tools (14.9%). The number of items across the 47 tools ranged from 5 to 72 items.

Conclusions

Regardless of the growing relevance of digital and eHealth literacy, tools addressing these areas in adolescents remain underrepresented. Most tools focus on specific rather than general HL and rely on self-administered measurement, leaving a clear gap in the availability of globally applicable tools. Although still underway, this review provides a foundation for the development of a WHO-aligned, globally applicable HL assessment tool for adolescents that can be adapted to diverse contexts worldwide.

Key messages

• This review informs the development of a WHO-aligned HL assessment tool adaptable across diverse contexts for international comparison.

• Most identified tools are self-administered and originated from high-income countries, highlighting the absence of a standardised, globally comparable HL measurement tool for adolescents.