Health literacy is an important health promotion concern and recently children and adolescents have been the focus of increased academic attention. To assess the health literacy of this population, researchers have been focussing on developing instruments to measure their health literacy. Compared to the wider availability of instruments for adults, only a few tools are known for younger age groups. The objective of this study is to systematically review the field of generic child and adolescent health literacy measurement instruments that are currently available. A systematic literature search was undertaken in five databases (PubMed, CINAHL, PsycNET, ERIC, and FIS) on articles published between January 1990 and July 2015, addressing children and adolescents ≤18 years old. Eligible articles were analysed, data was extracted, and synthesised according to review objectives. Fifteen generic health literacy measurement instruments for children and adolescents were identified. All, except two, are self-administered instruments. Seven are objective measures (performance-based tests), seven are subjective measures (self-reporting), and one uses a mixed-method measurement. Most instruments applied a broad and multidimensional understanding of health literacy. The instruments were developed in eight different countries, with most tools originating in the United States (n = 6). Among the instruments, 31 different components related to health literacy were identified. Accordingly, the studies exhibit a variety of implicit or explicit conceptual and operational definitions, and most instruments have been used in schools and other educational contexts. While the youngest age group studied was 7-year-old children within a parent-child study, there is only one instrument specifically designed for primary school children and none for early years. Despite the reported paucity of health literacy research involving children and adolescents, an unexpected number of health literacy measurement studies in children’s populations was found. Most instruments tend to measure their own specific understanding of health literacy and not all provide sufficient conceptual information. To advance health literacy instruments, a much more standardised approach is necessary including improved reporting on the development and validation processes. Further research is required to improve health literacy instruments for children and adolescents and to provide knowledge to inform effective interventions.

(1) Background: Health literacy is considered a personal asset, important for meeting health-related challenges of the 21st century. Measures for assisting students’ health literacy development and improving health outcomes can be implemented in the school setting. First, this is achieved by providing students with learning opportunities to foster their personal health literacy, thus supporting behavior change. Second, it is achieved by measures at the organizational level promoting social change within the proximal and distal environment and supporting the school in becoming more health-literate. The latter approach is rooted in the concept of organizational health literacy, which comprises a settings-based approach aiming at changing organizational conditions to enhance health literacy of relevant stakeholders. The HeLit-Schools project aims to develop the concept of health-literate schools, describing aspects that need to be addressed for a school to become a health-literate organization. (2) Method: The concept development builds on existing concepts of organizational health literacy and its adaptation to the school setting. (3) Results: The adaptation results in the HeLit-Schools concept describing a health-literate school with eight standards. Each standard depicts an area within the school organization that can be developed for fostering health literacy of school-related persons. (4) Conclusions: The HeLit-Schools concept offers an approach to organizational development for sustainably strengthening health literacy.

The application of salutogenesis in curative settings is specific, since it is about implementing salutogenesis into a territory which is still predominantly dominated by the paradigm of pathogenesis. But a case can be made that health care and its different curative settings would profit by integrating the principles of salutogenesis into their quality philosophy and management. Health gain for patients, their families, for health care professionals, and citizen could be improved by using a salutogenic orientation, parts of the salutogenic model and the concept and instrument of the sense of coherence in health care practice, research, and policy. This chapter summarizes how and why this could be done in different kinds of curative and other health care settings and what the actual status of practice and research using concepts and instruments from salutogenesis in these settings already is and how it could be further developed. The specific health care settings included are: salutogenic architecture in health care settings, the application of salutogenesis in hospitals, in mental health care settings, in the training of health professionals, in vocational rehabilitation settings, to aged and highly aged persons: residential care and community—dwelling settings, and in health development in youth with chronic conditions. Even, if for most health care settings health promotion practice still is limited, and outside hospitals salutogenic research is scarce, there exists enough promising evidence to recommend more extended integration of salutogenesis into health care practice and more and more systematic and complex salutogenic research in health care settings.

The chapters of Part VI demonstrate for different services of health or disease care that applying the salutogenic orientation, the salutogenic model and the concept, and instrument of the sense of coherence (SOC) has the potential to improve the health-promoting quality of structures, processes, and outcomes of these services for enhancing health gain and well-being of different stakeholders. There already exists impressive research-based evidence for this, but also quite a potential for further more systematic and complex research.

Zusammenfassung Niklas Luhmann hat seine Theorie der Funktionssysteme am Beispiel verschiedener konkreter Systeme entwickelt, bestimmte Aspekte auch in Die Gesellschaft der Gesellschaft systematisiert. Der Krankenbehandlung (Medizin) hat er zwar den Charakter eines großen Funktionssystems zuerkannt, diesem aber nur drei kleinere randständige Ausätze gewidmet und deren Ergebnisse auch nicht in Die Gesellschaft der Gesellschaft aufgenommen. Er bestimmt, vor allem gestützt auf semantische Kriterien, Krankenbehandlung (Medizin), als ein »absonderliches« System, mit einem »perversen« Code, und der Abwesenheit einer Reflexionstheorie, eines symbolisch generalisierten Kommunikationsmediums und eines symbiotischen Mechanismus. Für drei dieser Kriterien wird eine »Normalisierung« angeboten, um Krankenbehandlung (Medizin) soziologisch adäquater zu beschreiben und neue systemtheoretische Optionen für ein entstehendes »Gesundheitssystems« zu eröffnen. Mit »krank / nichtkrank « wird - in Abweichung von Luhmanns Vorschlag, aber konsistent mit seinen theoretischen Ansprüchen - ein eigener Codevorschlag gemacht und begründet. Für die angeblichen Defizite, Kommunikationsmedium und symbiotischer Mechanismus, werden ebenfalls konkrete Vorschläge entwickelt.