Health Literacy Among Adolescents: A Cluster Analysis Approach

Background

Developing and maintaining health literacy (HL) from an early age is essential. High levels of HL are associated with improved population health and reduced health inequalities, as well as with cardiovascular disease and diabetes outcomes. The study was conducted within the framework of the project JACARDI.

Methods

In 2024, a questionnaire-based survey was conducted in eight municipalities among 1104 adolescents. HL was assessed using the Lithuanian version of the Health Literacy Questionnaire (HLQ), a multidimensional instrument comprising nine scales capturing different HL domains. ANOVA was used to assess differences between adolescent groups. Cluster analysis was applied to the HLQ scale scores to identify groups characterized by similar multidimensional HL profiles. The mean scores of each of the nine scales were standardized and converted to Z-scores. Hierarchical classification using Ward’s method was applied, based on the Ophelia (Optimizing Health Literacy and Access) methodology.

Results

The mean age of respondents was 16.3 years; over two thirds lived in cities (71.8%), the gender distribution was balanced, with a slightly higher proportion of girls than boys (52.4% vs. 47.6%). HL, indicating fewer health-related challenges, was observed among girls, adolescents with healthy habits, those who are physically active, eat healthily and perceive their weight as normal. Perceived social support for health posed the fewest challenges for adolescents, whereas appraising health information was the most challenging domain. 13 distinct HL profiles were identified, reflecting diverse strengths and needs among adolescents. 13.4% of adolescents assigned to Clusters 1–3 exhibited few HL challenges, whereas 15% of those classified within Clusters 11–13 demonstrated HL challenges across all nine scales of the HLQ.

Conclusions

A profile-based understanding of adolescent health literacy may facilitate more precise targeting of health promotion efforts.

Key messages

• Adolescents experience the greatest challenges in appraising health information, while social support for maintaining health is the highest-rated domain of health literacy.

• Cluster-based segmentation enables more targeted health education interventions by addressing the distinct needs and risk profiles of different adolescent groups.