Psychometric properties of the 7-item health literacy scale for children and adolescents

Introduction

Measuring health literacy in children and adolescents is essential for identifying early deficits that may influence lifelong health outcomes. The European Health Literacy Survey Questionnaire (HLS-EU-Q) has already been adapted and validated for younger populations (HLS-Q15); however, no short version of this instrument has yet been validated for children and adolescents. Especially in child and adolescent health research, short versions of questionnaires are useful for reducing the length and thus the burden on respondents.

Methods

The HLS-Q7 was validated in a representative sample of schoolchildren aged 9–18 years (N = 1,444) using Rasch analysis. Data were collected through face-to-face interviews in October and November 2022. The scale consists of seven items rated on a 4-point Likert scale. Using Andrich’s Rating Scale Model, ordinal responses were transformed into linear measures. Unidimensionality, item fit statistics, and additional validity indices were calculated to evaluate the quality of the measurement instrument.

Results

The questionnaire is unidimensional. The rating scale functioned as intended, with all response categories being used by participants. Item fit could be verified. Person measures were acceptable, with a person separation index of 1.95 and person reliability of .79. Item reliability indices were excellent, with an item separation index of 5.85 and item reliability of .97.

Discussion

The HLS-Q7 seems to be a reliable and valid short questionnaire, which has not previously been validated. These findings support its use for assessing health literacy in adolescent populations. Future studies should examine its applicability in diverse cultural and educational contexts.

Key messages

• The HLS-Q7 is a brief and time-efficient measurement tool for assessing health literacy in children and adolescents.

• Future research should further examine other types of validity and reliability, including convergent and divergent validity as well as test–retest reliability.