Developing Indicators to Measure Critical Health Literacy in the Context of Norwegian Lower Secondary Schools
Abstract
:1. Introduction
1.1. Measures of HL for Adolescents
1.2. Aims and Structure
2. Materials and Methods
2.1. Design
2.2. Stage 1: Item Development
2.2.1. Literature Review
2.2.2. Focus Group Interviews (Step 2)
2.2.3. Pre-Testing (Steps 4–5)
2.3. Stage 2: Scale Development
2.3.1. Cross-Sectional Survey (Step 6)
2.3.2. Analysis of Psychometric Properties (Step 6)
2.3.3. Post-Survey Focus Group Interviews (Step 7)
2.4. Ethical Considerations
3. Results
3.1. Stage 1: Item Development
Focus Group Interviews (Step 1)
3.2. Stage 2: Scale Development (Step 6)
3.2.1. Scale A: Critical Information Appraisal
3.2.2. Scale B: Awareness of Social Determinants of Health
3.2.3. Scale C: Citizenship for Health and Well-Being in the School Context
3.2.4. Convergent Validity
3.3. Stage 2: Post-Survey Focus Group Interviews and Revision of the Third Draft (Step 7)
4. Discussion
Limitations and Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Scale A: Critical Information Appraisal | |||||
---|---|---|---|---|---|
Items | F1 | F2 | h2 | u2 | com |
chl9 | 0.86 | 0.74 | 0.26 | 1.0 | |
chl8 | 0.76 | 0.66 | 0.34 | 1.0 | |
chl7 | 0.68 | 0.38 | 0.62 | 1.1 | |
chl5 | 0.90 | 0.77 | 0.23 | 1.0 | |
chl4 | 0.68 | 0.54 | 0.46 | 1.0 | |
chl6 | 0.40 | 0.31 | 0.69 | 1.6 | |
chl1 | 0.33 | 0.27 | 0.73 | 1.9 | |
Eigenvalue | 2.0 | 1.7 | |||
Prop var | 0.28 | 0.24 | |||
Cronbach’s α = 0.83 (αF1 = 0.80, αF2 = 0.75) | |||||
TLI = 0.97 RSMEA = 0.055 [CI 90%, 0–0.132] |
Scale B: Awareness of Social Determinants of Health | ||||
---|---|---|---|---|
Items | F1 | h2 | u2 | com |
chl12 | 0.80 | 0.63 | 0.37 | 1 |
chl14 | 0.37 | 0.13 | 0.87 | 1 |
chl16 | 0.55 | 0.30 | 0.70 | 1 |
chl13 | 0.46 | 0.21 | 0.79 | 1 |
Eigenvalue | 1.3 | |||
Prop var | 0.32 | |||
Cronbach’s α = 0.61 | ||||
TLI = 1.05 RMSEA = 0.00 [CI 90%, 0–0.16] |
Scale C: Citizenship for Health and Well-Being | |||||
---|---|---|---|---|---|
Items | F1 | F2 | h2 | u2 | com |
chl26 | 0.98 | 0.87 | 0.13 | 1.0 | |
chl24 | 0.70 | 0.69 | 0.31 | 1.2 | |
chl20 | 0.63 | 0.54 | 0.46 | 1.2 | |
chl25 | 0.52 | 0.46 | 0.54 | 1.4 | |
chl28 | 0.71 | 0.44 | 0.56 | 1.1 | |
chl22 | 0.57 | 0.39 | 0.61 | 1.1 | |
chl18 | 0.56 | 0.45 | 0.55 | 1.2 | |
chl23 | 0.56 | 0.43 | 0.57 | 1.2 | |
Eigenvalue | 2.4 | 1.8 | |||
Prop var | 0.30 | 0.23 | |||
Cronbach’s α = 0.85 (αF1 = 0.86, αF2 = 0.73) TLI = 0.95 RMSEA = 0.074 [CI 90%, 0–0.13] |
Revised or Added in Step 7 | Source | Scale A1: Critical Information Appraisal How Easy or Difficult Is It for You to… | Component |
---|---|---|---|
(chl4) revised | MOHLAA-Q [35] | …decide whether media information about illness can be trusted (media: internet, TV, newspapers) | Accuracy/impartiality |
(chl6) revised | Self-developed | …decide whether information about healthy habits is also a commercial (healthy habits: what you eat/drink, physical activity) | Accuracy/impartiality |
(chl4) revised | MOHLAA-Q | …decide whether media information about healthy habits can be trusted (healthy habits: what you eat/drink, physical activity) | Accuracy/impartiality |
(chl8) revised | Self-developed | …find out whether health information is relevant to you when you are ill | Relevance |
New | HLS-Child-Q15 [34] | …judge what food is healthy for you | Relevance |
(chl9) revised | Self-developed | …judge whether information on healthy habits is relevant to you (healthy habits: what you eat/drink, physical activity) | Relevance |
(chl4) revised | MOHLAA-Q | …judge whether information about unhealthy habits can be trusted (unhealthy habits: alcohol, tobacco, what you eat/drink) | Accuracy/impartiality |
Revised or added in step 7 | Source | Scale A2: Critical information appraisal I am a person who… | |
(chl1) revised | HELMA [30] | …compares health information from different sources (sources: internet, parents, friends) | Accuracy/impartiality |
New | HLS-Child-Q15 | …can decide what I need to do to stay healthy and what doesn’t help that much | Accuracy/impartiality |
(chl5) revised | HELMA | …can decide whether a source of health information can be trusted (source: internet, TV, newspapers) | Accuracy/impartiality |
(chl7) revised | Self-developed | …asks for help if I am unsure about the trustworthiness of health information | Accuracy/impartiality/Help seeking |
Revised or added in step 7 | Source | Scale B: Awareness of social determinants of health To what extent do you agree with the following statements? | |
(chl12) unchanged | Self-developed | Some groups in society have fewer opportunities for good health. | Health inequality |
(chl13) unchanged | Self-developed | Everybody has the same opportunities to be healthy. | Health inequality |
(chl14) revised | Self-developed | Where you grow up could have a significant impact on your health. | Health inequality |
(chl16) unchanged | Self-developed | It is unfair that some groups in society have poorer health than others. | Health inequality |
Revised or added in step 7 (revised/new) | Scale C: Citizenship for health and well-being I am a person who… | ||
(chl26) unchanged | UiL/self-developed [53] | …can support others if they are feeling sad. | Citizenship/social support |
(chl24) unchanged | UiL/self-developed | …can help others if they are not doing well. | Citizenship/social support |
(chl20) unchanged | Self-developed | …can contribute to the well-being of others in my class. | Citizenship/social support |
(chl25) unchanged | UiL | …can help find solutions that are acceptable to all parties. | Citizenship/social support |
(chl28) unchanged | Self-developed | …can easily talk to others, even if I don’t know them very well. | Citizenship/democratic participation |
(chl18) unchanged | HELMA | …can share information about factors that influence health with others. | Citizenship/democratic participation |
(chl23) unchanged | Self-developed | …believes my knowledge about health could be useful for others. | Citizenship/democratic participation |
(chl22) unchanged | HLSAC [32] | …is aware of how my actions can influence others (e.g., attitude, mood). | Citizenship/democratic participation |
Measurement Domain | Key Content | |
---|---|---|
Scale A Critical information appraisal of health-related information | Appraisal leads to decisions about the credibility and relevance of health-related information. Important criteria adolescents can use include the extent to which a piece of information is accurate, impartial, and relevant to them [33]. During appraisal, adolescents investigate the characteristics of information (e.g., who wrote it, when it was published, and what sources the writer used) and compare information from different sources. They apply prior knowledge and seek help [54]. Sometimes they feel helpless. | (A1) Perceived difficulty of performing cognitive tasks. (A2) Self-efficacy to perform cognitive tasks |
Scale B Awareness of social determinants of health (SDH) | Awareness of SDH involves a deeper understanding of health and encourages an understanding that health is influenced by more than individual lifestyle choices [21]. Recognizing health inequities is crucial to understanding the causes behind these inequities [55] | Attitudes/self-reported knowledge |
Scale C Citizenship for health and well-being in the school context | Citizenship in HL centers on the ability to understand and act on the rights and responsibilities that come with participation in a democratic collective [1]. Key components are self-efficacy to provide social support and participate in democratic discussions on matters that concern health and well-being. | Self-efficacy to perform social and communicative tasks |
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Haugen, A.L.H.; Riiser, K.; Esser-Noethlichs, M.; Hatlevik, O.E. Developing Indicators to Measure Critical Health Literacy in the Context of Norwegian Lower Secondary Schools. Int. J. Environ. Res. Public Health 2022, 19, 3116. https://doi.org/10.3390/ijerph19053116
Haugen ALH, Riiser K, Esser-Noethlichs M, Hatlevik OE. Developing Indicators to Measure Critical Health Literacy in the Context of Norwegian Lower Secondary Schools. International Journal of Environmental Research and Public Health. 2022; 19(5):3116. https://doi.org/10.3390/ijerph19053116
Chicago/Turabian StyleHaugen, Anders L. Hage, Kirsti Riiser, Marc Esser-Noethlichs, and Ove Edvard Hatlevik. 2022. "Developing Indicators to Measure Critical Health Literacy in the Context of Norwegian Lower Secondary Schools" International Journal of Environmental Research and Public Health 19, no. 5: 3116. https://doi.org/10.3390/ijerph19053116