Measuring adolescent health literacy: development and application of the Q LIS SON tool

Background

Health literacy is a key determinant of health equity, particularly during adolescence, a critical period for developing lifelong health behaviours. Existing instruments rarely integrate general, nutritional and oral health literacy in youth‑appropriate formats.

Objectives

To develop and apply an integrated questionnaire (Q‑LIS‑SON) to assess general, nutritional and oral health literacy among Portuguese adolescents and young people.

Methods

A cross‑sectional study was conducted in 2022 with a convenience sample of 90 participants aged 12–19 years from different Portuguese cities. The Q‑LIS‑SON includes 20 items across three domains—general health, nutrition and oral health—and assesses access, understanding and use of health information. Data were collected online and in paper format and analysed descriptively.

Results

Participants reported overall positive self‑perceptions of health literacy, with most responses in the categories “Somewhat true” and “Absolutely true”. Higher scores were observed for general and oral health literacy, particularly at the knowledge and understanding levels. However, lower scores were observed in the “use” dimension, particularly for nutritional and oral health behaviours. Around one‑third of participants reported difficulty consistently choosing healthy foods, and over 40% reported challenges in refusing unhealthy options. Nearly one‑quarter reported limited ability to provide oral health advice to peers. Younger adolescents (<16 years) showed greater uncertainty, and gender differences were observed, with females reporting higher oral health literacy and males higher confidence in nutrition‑related knowledge.

Conclusions

The Q‑LIS‑SON highlights gaps between health knowledge and its practical application among adolescents, supporting the need for integrated, equity‑oriented school and community‑based health literacy interventions.

Key messages

• Adolescents show high health knowledge but weaker ability to apply it, especially in nutrition and oral health behaviours, highlighting a gap critical for addressing future health inequities.

• Q‑LIS‑SON is an innovative, integrated tool for assessing health literacy among adolescents and supporting nutrition and oral health school-based interventions focused on equity and prevention.