Aims: The present paper focuses on the measurement of health literacy (HL), which is an important determinant of health and health behaviours. HL starts to develop in childhood and adolescence; hence, there is a need for instruments to monitor HL among younger age groups. These instruments are still rare. The aim of the project reported here was, therefore, to develop a brief, multidimensional, theory-based instrument to measure subjective HL among school-aged children. Methods: The development of the instrument covered four phases: item generation based on a conceptual framework; a pilot study (n = 405); test–retest (n = 117); and construction of the instrument (n = 3853). All the samples were taken from Finnish 7th and 9th graders. Results: Initially, 65 items were generated, of which 32 items were selected for the pilot study. After item reduction, the instrument contained 16 items. The test–retest phase produced estimates of stability. In the final phase a 10-item instrument was constructed, referred to as Health Literacy for School-Aged Children (HLSAC). The instrument exhibited a high Cronbach alpha (0.93), and included two items from each of the five predetermined theoretical components (theoretical knowledge, practical knowledge, critical thinking, self-awareness, citizenship). Conclusions: The iterative and validity-driven development process made it possible to construct a brief multidimensional HLSAC instrument. Such instruments are suitable for large-scale studies, and for use with children and adolescents. Validation will require further testing for use in other countries.

(1) Background: There is a need for studies on population-level health literacy (HL) to identify the current state of HL within and between countries. We report comparative findings from 10 European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia) on adolescents’ HL and its associations with gender, family affluence (FAS), and self-rated health (SRH). (2) Methods: Representative data (N = 14,590; age 15) were drawn from the HBSC (Health Behavior in School-Aged Children) study. The associations between HL, gender, FAS, and SRH were examined via path models. (3) Results: The countries exhibited differences in HL means and in the range of scores within countries. Positive associations were found between FAS and HL, and between HL and SRH in each country. Gender was associated with differences in HL in only three countries. HL acted as a mediator between gender and SRH in four countries, and between FAS and SRH in each country. (4) Conclusions: The findings confirm that there are differences in HL levels within and between European countries, and that HL does contribute to differences in SRH. HL should be taken into account when devising evidence-informed policies and interventions to promote the health of adolescents.

The Health Literacy for School-Aged Children (HLSAC) is a brief, generic instrument measuring health literacy among school-aged children. Given its brevity and broad conceptualization of health literacy, the HLSAC is a potentially valuable measuring instrument among adults as well. This validation study aimed to adapt the HLSAC questionnaire to an adult population through assessment of content validity and subsequently determine the structural validity of the adapted instrument, the Brief Health Literacy scale for Adults (B-HLA). The content validity of the HLSAC was assessed through interviews with respondents and experts, and the structural validity of the adapted instrument (B-HLA) was evaluated using Rasch analysis. The content validity assessment (n = 25) gave rise to adjustments in the wording of five items. The B-HLA demonstrated an overall misfit to the Rasch model (n = 290). Items 6 and 8 had the poorest individual fits. We found no signs of local dependency or differential item functioning concerning sex, age, education, and native language. The B-HLA demonstrated unidimensionality and ability to discriminate across health literacy levels (PSI = 0.80). Discarding items 6 or 8 resulted in an overall model fit and individual fit of all items. In conclusion, the B-HLA appears to be a valid and reliable instrument for assessing health literacy among adults.

Health literacy is an asset for and indicator of adolescents’ health and wellbeing, and should therefore be monitored and addressed across countries. This study aimed to develop and validate a shorter version of the original 10-item health literacy for school-aged children instrument in a cross-national context, using data from the health behaviour in school-aged children 2017/18 survey. The data were obtained from 25 425 adolescents (aged 13 and 15 years) from seven European countries. Determination was made of the best item combination to form a shorter version of the health literacy instrument. Thereafter, the structural validity, reliability, measurement invariance, and criterion validity of the new 5-item instrument were examined. Confirmatory factor analysis showed a good model fit to the data across countries and in the total sample, confirming the structural validity (CFI = 0.995, TLI = 0.989, SRMR = 0.011, RMSEA = 0.031). The internal consistency of the instrument was at a good level across countries (α = 0.87–0.98), indicating that the instrument provided reliable scores. Configural and metric invariance was established across genders, ages, and countries. Scalar invariance was achieved for age and gender groups, but not between countries. This indicated that the factor structure of the scale was similar, but that there were differences between the countries in health literacy levels. Regarding criterion validity, structural equation modelling showed a positive association between health literacy and self-rated health in all the participating countries. The new instrument was found to be valid and reliable for the purposes of measuring health literacy among adolescents in a cross-national context.

Teachers play a crucial role in students’ learning and in the development of health literacy. Hence, the aim of this study was to identify the core competencies needed for teachers of health education in supporting student learning. A three-round Delphi study was carried out over an 8-week period, through consultation with 25 Finnish experts in health education. An open-ended question was used to identify the core competencies for school health educators. The data were analysed using inductive content analysis. In subsequent rounds, experts were asked to assess the importance of the identified competencies on a 7-point Likert scale, and finally to rank the most important competencies. In total, 52 competencies were identified and categorized into eight core competence domains. Thereafter, 40 competencies were assessed and selected for the third round, in which the experts ranked the 15 most important competencies, encompassing four core domains, i.e. pedagogic and subject-specific didactic, social and emotional, content knowledge and continuous professional development. Other domains of competence identified in the present study were ethical competence, competence in school health promotion, contextual competence and professional well-being competence. The study defines health education teacher core competencies and domains, and the information can be used in teacher education programmes, for developing teaching and for teachers’ self-evaluation.

WHO-Koululaistutkimus on Suomessa käytetty nimi Health Behaviour in School-aged Children (HBSC) -tutkimukselle, jonka kyselyyn vastasi 11-, 13- ja 15-vuotiaita koululaisia yli 50 maasta aineistokeräyksessä 2021/2022. Ensimmäisen aineistonkeräys oli 40 vuotta sitten vuonna 1983 ja vuonna 2022 aineistoa kerättiin 11. kerran. Suomessa anonyymiin kyselyyn vastaavat koululaiset ovat perusopetuksen 5., 7. ja 9. luokalta. WHO-Koululaistutkimuksen tavoitteena on tuottaa kansainvälisesti vertailukelpoista ja kansallisesti tärkeää tietoa koululaisten terveyskäyttäytymisestä, terveydestä ja hyvinvoinnista sekä niiden taustalla olevista tekijöistä. Lisäksi tavoitteena on lisätä ymmärrystä terveyden eriarvoisuudesta ja arvioida terveyden eriarvoisuuden kehittymistä eri aineistonkeruuvuosien välillä. Tutkimus tuottaa tietoa lasten ja nuorten terveyden edistämisen käytänteiden ja poliittisen päätöksenteon tueksi. Tutkimuksesta vastaa tutkijaryhmä Jyväskylän yliopiston Liikuntatieteellisessä tiedekunnassa toimivasta Terveyden edistämisen tutkimuskeskuksesta. Tutkimusta johtavat apulaisprofessori Leena Paakkari ja yliopistonlehtori Nelli Lyyra. Tässä raportissa esitetään WHO-Koululaistutkimuksen 2022 tuloksia 5-, 7- ja 9-luokkalaisten koululaisten koetusta terveydestä, yksinäisyydestä, mielen hyvinvoinnista, koulukokemuksista, terveystottumuksista sekä terveyttä vaarantavasta käyttäytymisestä ja terveyden voimavaroista. Ajallisia muutoksia tarkastellaan vertaamalla vuoden 2022 tuloksia vuosiin 2014 ja 2018. Raportti sisältää myös suomen- ja ruotsinkielisten nuorten hyvinvoinnin vertailua vuoden 2022 tulosten perusteella. Raportti päättyy terveyden ylläpitämiselle ja edistämiselle tärkeän terveyden lukutaidon tilan sekä sen ja koetun terveyden ja terveyskäyttäytymisen välisten yhteyksien tarkasteluun.