Prevention and health promotion literacy in schoolchildren: measurement and associated factors

Background

Early development of health literacy is crucial for fostering lifelong healthy behaviours. Yet, evidence on children’s prevention and health promotion literacy remains limited, partly due to the lack of appropriate measurement tool. This study aimed to develop a dedicated instrument to assess and characterise prevention and health promotion literacy in children aged 8-11.

Methods

Questionnaire development followed three steps: i) item selection from key prevention and health promotion domains (such as nutrition, physical activity, and screen use), categorized according to the dimensions of the Capability, Opportunity, Motivation, Behaviour model; ii) pre-testing and refinement; and iii) administration to a sample of primary school children in a 2024 cross-sectional study. Psychometric properties were assessed and factors associated with prevention and health promotion literacy were analysed using multivariate mixed models.

Results

The study included 699 children from 30 schools. The final questionnaire had a three-dimensional structure (health-related motivation: 15 items; screen use behaviours: 7 items; multi-thematic health knowledge: 7 items), with satisfactory internal consistency (Cronbach’s alpha=0.77). In the study sample, standardized scores (0-20) for health-related motivation, screen use behaviours and health knowledge scores were 12.3±3.5, 12.0±4.4, and 7.7±4.7, respectively. Multivariate analyses showed higher scores in girls. Health education sessions were associated with higher motivation and larger family with lower health knowledge. Children attending less advantaged schools had lower health knowledge and screen use behaviours scores.

Conclusions

The tool we developed to assess prevention and health promotion literacy in schoolchildren showed good psychometric properties. Disparities related to sociodemographic factors were highlighted. These findings may inform interventions to strengthen health literacy in children.

Key messages

• This study provides a tool with satisfactory psychometric properties to measure prevention and health promotion literacy in children.

• This tool highlights the role of motivation and screen use behaviours, in addition to knowledge, in shaping prevention and health promotion literacy in children.