Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Archives of Public Health
Published in: Archives of Public Health 1/2018

Open Access 01-12-2018 | Research

Do adolescents understand the items of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) – German version? Findings from cognitive interviews of the project “Measurement of Health Literacy Among Adolescents” (MOHLAA) in Germany

Authors: Olga Maria Domanska, Christiane Firnges, Torsten Michael Bollweg, Kristine Sørensen, Christine Holmberg, Susanne Jordan

Published in: Archives of Public Health | Issue 1/2018

Login to get access

Abstract

Background

In Germany, there are no measurement tools to assess the general health literacy of adolescents. The aim of the study “Measurement of Health Literacy Among Adolescents” (MOHLAA) is to develop such a tool for use among adolescents aged 14–17. The German version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47-GER) served as a blueprint for the development of the tool. The present study examined the extent to which the HLS-EU-Q47-GER can be applied to the measurement of general health literacy in adolescents.

Methods

The applicability of the HLS-EU-Q47-GER for adolescents was tested qualitatively using cognitive interviewing (CI). Purposive sampling was used to achieve an equal distribution of participants regarding age groups, educational backgrounds and gender. CI was standardized on the basis of an interview guide. Verbal probing and the retrospective think-aloud technique were applied. The interviews were audio-recorded, transcribed and analyzed using the criteria of theory-based analysis, which were derived from the model of cognitive processes. The analysis focused on identifying terms and questions that were difficult to understand and on scrutinizing the extent to which the content of the items is appropriate for assessing adolescents’ health literacy.

Results

Adolescent respondents were unfamiliar with some terms of the HLS-EU-Q47-GER or provided heterogeneous interpretations of the terms. They had limited or no experience regarding some health-related tasks in health care and disease prevention that are addressed by HLS-EU-Q-items. A few items seemed to be too “difficult” to answer due to a high abstraction level or because they lacked any reference to the everyday lives of youth. Despite comprehension problems with some of the HLS-EU items, the respondents assessed the covered health-related tasks as “very easy” or “fairly easy”. CI stressed the importance of interpersonal agents, especially parents, in helping adolescents understand and judge the reliability of health information.

Conclusions

The results of CI indicated that the applicability of the HLS-EU-Q47-GER to the measurement of general health literacy among adolescents aged 14–17 is limited. In order to prevent biased data, some items of the questionnaire should be adjusted to adolescents’ state of development and experiences with health care and disease prevention.
Appendix
Available only for authorised users
Footnotes
1
IDs refer to individual participants
 
Literature
1.
Manganello JA. Health literacy and adolescents: a framework and agenda for future research. Health Educ Res. 2008;23:840–7.CrossRefPubMed
2.
Driessnack M, Chung S, Perkhounkova E, Hein M. Using the “newest vital sign” to assess health literacy in children. J Pediatr Health Care. 2014;28:165–71.CrossRefPubMed
3.
Borzekowski DL. Considering children and health literacy: a theoretical approach. Pediatrics. 2009;124(Suppl 3):S282–8.CrossRefPubMed
4.
5.
Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H, European CHLP. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.
6.
Institute of Medicine Committee on Health Literacy. In: Nielsen-Bohlman L, Panzer AM, Kindig DA, editors. Health literacy: a prescription to end confusion. Washington (DC): The National Academies Press; 2004.
7.
Abel T, Sommerhalder K. Gesundheitskompetenz/Health Literacy: Das Konzept und seine Operationalisierung Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015; 58:923–929.
8.
Mackert M, Champlin S, Su Z, Guadagno M. The many health literacies: advancing research or fragmentation? Health Commun. 2015;30:1161–5.CrossRefPubMed
9.
Bröder J, Okan O, Bauer U, Bruland D, Schlupp S, Bollweg TM, Saboga-Nunes L, Bond E, Sørensen K, Bitzer EM, et al. Health literacy in childhood and youth: a systematic review of definitions and models. BMC Public Health. 2017;17:361.
10.
Connell JP, Furman W. The study of transitions. Conceptual and methodological issues. In: Emde RN, Harmon RJ, editors. Continuities and discontinuities in development. New York. London: Plenum Press; 1984. p. 153–73.CrossRef
11.
Silbereisen RK, Weichold K. Jugend (12–19 Jahre). In: Schneider W, Lindenberger U, editors. Entwicklungspsychologie. 7th ed. Weinheim, Basel: Beltz Verlag; 2012: 235–258.
12.
Hurrelmann K, Quenzel G. Lebensphase Jugend. Eine Einführung in die sozialwissenschaftliche Jugendforschung. 13th ed. Beltz Juventa: Weinheim; 2016.
13.
Franzkowiak P. Risikoverhalten und Gesundheitsbewusstsein bei Jugendlichen. Der Stellenwert von Rauchen und Alkoholkonsum im Alltag von 15-bis 20jährigen. Berlin, Heidelberg, New York. Tokyo: Springer-Verlag; 1986.
14.
Institute of Medicine and National Research. Adolescent risk and vulnerability: concepts and measurement. Washington (DC): The National Academies Press; 2001.
15.
Ortega FB, Ruiz JR, Castillo MJ, Sjostrom M. Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes. 2008;32:1–11.CrossRef
16.
Hallal PC, Victora CG, Azevedo MR, Wells JC. Adolescent physical activity and health: a systematic review. Sports Med. 2006;36:1019–30.CrossRefPubMed
17.
Mathers M, Toumbourou JW, Catalano RF, Williams J, Patton GC. Consequences of youth tobacco use: a review of prospective behavioural studies. Addiction. 2006;101:948–58.CrossRefPubMed
18.
19.
Wartella E, Rideout V, Montague H, Beaudoin-Ryan L, Lauricella A. Teens, health and technology: a National Survey. Media and Communication. 2016;4:13–23.CrossRef
20.
Fergie G, Hunt K, Hilton S. What young people want from health-related online resources: a focus group study. J Youth Stud. 2013;16:579–96.CrossRefPubMed
21.
Fleary SA, Joseph P, Pappagianopoulos JE. Adolescent health literacy and health behaviors: a systematic review. J Adolesc. 2018;62:116–27.CrossRefPubMed
22.
Okan O, Lopes E, Bollweg TM, Broder J, Messer M, Bruland D, Bond E, Carvalho GS, Sorensen K, Saboga-Nunes L, et al. Generic health literacy measurement instruments for children and adolescents: a systematic review of the literature. BMC Public Health. 2018;18:166.CrossRefPubMedPubMedCentral
23.
Ormshaw MJ, Paakkari LT, Kannas LK. Measuring child and adolescent health literacy: a systematic review of literature. Health Educ. 2013;113:433–55.CrossRef
24.
Wallmann B, Gierschner S, Froböse I. Gesundheitskompetenz: Was wissen unsere Schüler über Gesundheit? Prävention und Gesundheitsförderung. 2011;7:5–10.CrossRef
25.
Steckelberg A, Hulfenhaus C, Kasper J, Rost J, Muhlhauser I. How to measure critical health competences: development and validation of the critical health competence test (CHC test). Adv Health Sci Educ Theory Pract. 2009;14:11–22.CrossRefPubMed
26.
Steckelberg A, Hulfenhaus C, Kasper J, Muhlhauser I. Ebm@school--a curriculum of critical health literacy for secondary school students: results of a pilot study. Int J Public Health. 2009;54:158–65.CrossRefPubMed
27.
Schmidt CO, Fahland RA, Franze M, Splieth C, Thyrian JR, Plachta-Danielzik S, Hoffmann W, Kohlmann T. Health-related behaviour, knowledge, attitudes, communication and social status in school children in eastern Germany. Health Educ Res. 2010;25:542–51.CrossRefPubMed
28.
Berens EM, Vogt D, Messer M, Hurrelmann K, Schaeffer D. Health literacy among different age groups in Germany: results of a cross-sectional survey. BMC Public Health. 2016;16:1151.CrossRefPubMedPubMedCentral
29.
Quenzel G, Schaeffer D, Messer M, Vogt D. Health literacy among less well-educated young people: influencing factors and consequences. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015;58:951–7.CrossRefPubMed
30.
Firnges C, Domanska O, Jordan S. Adolescent Health Literacy: Implications for Measurement Tools. In: Bauer U, Pinheiro P, Okan O, Sørensen K, Levin-Zamir D, editors. Health Literacy across the Life-Span: Research, Practice, and Policy - A Handbook. Bristol: Policy Press (in review); 2019.
31.
Hopker T, Lampert T, Spallek J. Identifizierung und Charakterisierung von Gesundheitsverhaltenstypen bei 11- bis 17-Jährigen Jungen und Mädchen – Eine Clusteranalyse auf Basis der Daten des Kinder- und Jugendgesundheitssurveys (KiGGS). Gesundheitswesen. 2014;76:453–61.CrossRefPubMed
32.
Richter M, Settertobulte W. Gesundheits- und Freizeitverhalten von Jugendlichen. In: Hurrelmann K, Klocke A, Melzer W, Ravens-Sieberer U, editors. Jugendgesundheitssurvey Internationale Vergleichsstudie im Auftrag der Weltgesundheitsorganisation WHO. Weinheim, München: Juventa Verlag; 2003. p. 99–157.
33.
34.
Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, Fullam J, Kondilis B, Agrafiotis D, Uiters E, et al. Health literacy in Europe: comparative results of the European Health Literacy Survey (HLS-EU). Eur J Pub Health. 2015;25:1053–8.
35.
Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, Kondilis B, Stoffels V, Osborne RH, Brand H, Consortium H-E. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13:948.
36.
37.
Tiller D, Herzog B, Kluttig A, Haerting J. Health literacy in an urban elderly east-German population - results from the population-based CARLA study. BMC Public Health. 2015;15:883.CrossRefPubMedPubMedCentral
38.
Jordan S, Hoebel J. Health literacy of adults in Germany: findings from the German Health Update (GEDA) study. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015;58:942–50.
39.
Zok K. Unterschiede bei der Gesundheitskompetenz. Ergebnisse einer bundesweiten Repräsentativ-Umfrage unter gesetzlich Versicherten. WIdOmonitor. 2014;2:1–12.
40.
Röthlin F, Pelikan JM, Ganahl K. Die Gesundheitskompetenz von 15-jährigen Jugendlichen in Österreich. Abschlussbericht der österreichischen Gesundheitskompetenz Jugendstudie im Auftrag des Hauptverbands der österreichischen Sozialversicherungsträger (HVSV). Wien: Ludwig Boltzmann Institut Health Promotion Research (LBIHPR); 2013.
41.
Jordan S, Rattay P, Mauz E, Kamtsiuris P. Interview and Examination Survey for Children and Adolescents’ Wave 2 (KiGGS Wave 2) - First pretest results. In The 2nd European Health Literacy Conference. 10–11 April 2014. Aarhus. Book of Abstracts. pp.33.
42.
Rothman RL, Yin HS, Mulvaney S, Co JP, Homer C, Lannon C. Health literacy and quality: focus on chronic illness care and patient safety. Pediatrics. 2009;124(Suppl 3):S315–26.CrossRefPubMed
43.
Parvizi S, Hamzehgardeshi Z. Adolescents’ view of health concept and its risk factors: a literature review. Int J Adolesc Med Health. 2014;26:351–9.CrossRefPubMed
44.
Pieter A, Fröhlich M, Stark R, Emrich E, Klein M. “Conceptual Change” als Basis gesundheitsbezogener Wissenskonstruktionen bei Kindern und Jugendlichen. Prävention und Gesundheitsförderung. 2015;10:159–66.CrossRef
45.
Mason J. Qualitative researching. 2nd ed. London: Sage; 2002.
46.
47.
48.
49.
Willis G, Lawrence D, Thompson F, Kudela M, Levin K, Miller K. The use of cognitive interviewing to evaluate translated survey questions: lessons learned. In conference of the Federal Committee on Statistical Methodology 2005.
50.
Beatty PC, Willis GB. Research synthesis: the practice of cognitive interviewing. Public Opinion Quarterly. 2007;71:287–311.CrossRef
51.
52.
Willis GB, Cognitive Interviewing A. Tool for improving questionnaire design: Sage Publications; 2005.
53.
Tourangeau R. Cognitive sciences and survey methods. Cognitive aspects of survey methodology: Building a bridge between disciplines; 1984. p. 73–100.
54.
Collins D. Analysing and interpreting cognitive interview data: a qualitative approach. In: Proceedings of the 6th questionnaire evaluation standard for testing conference. Statistics Canada Ottawa; 2007. p. 64–73.
55.
Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:1–8.CrossRef
56.
Bühner M. Einführung in die Test-und Fragebogenkonstruktion. 3rd revised ed. München: Pearson Deutschland Education GmbH; 2011.
57.
Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, Mockbee J, Hale FA. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3:514–22.CrossRefPubMedPubMedCentral
58.
Diersch N, Walther E. Umfrageforschung mit Kindern und Jugendlichen. In: Walter E, Preckel F, Mecklenbräuker S, editors. Befragung von Kindern und Jugendlichen - Grundlagen, Methoden und Anwendungsfelder. Göttingen: Hogrefe; 2010. p. 297–318.
59.
Gerich J, Moosbrugger R. Subjective estimation of health literacy-what is measured by the HLS-EU scale and how is it linked to empowerment? Health Commun. 2018;33:254–63.CrossRefPubMed
60.
Frisch AL, Camerini L, Diviani N, Schulz PJ. Defining and measuring health literacy: how can we profit from other literacy domains? Health Promot Int. 2012;27:117–26.CrossRefPubMed
61.
de Leeuw C, Borger N, Smits A. Pretesting questionnaires for children and adolescents. In: Presser S, Rothgeb JM, Coupler MP, Lessler JT, Martin E, Martin J, Singer E, editors. Methods for testing and evaluating survey questionnaires. Hoboken: Wiley; 2004. pp. 409–29.
62.
63.
Ghanbari S, Ramezankhani A, Montazeri A, Mehrabi Y. Health literacy measure for adolescents (HELMA): development and psychometric properties. PLoS One. 2016;11:e0149202.CrossRefPubMedPubMedCentral
64.
Cusack L, Desha LN, Del Mar CB, Hoffmann TC. A qualitative study exploring high school students’ understanding of, and attitudes towards, health information and claims. Health Expect. 2017;
65.
Higgins JW, Begoray D, MacDonald M. A Social Ecological Conceptual Framework for Understanding Adolescent Health Literacy in the Health Education Classroom. Am J Community Psychol. 2009;44(3-4):350-62.
66.
Gray NJ, Klein JD, Noyce PR, Sesselberg TS, Cantrill JA. The internet: a window on adolescent health literacy. J Adolesc Health. 2005;37:243.PubMed
67.
Hansen DL, Derry HA, Resnick PJ, Richardson CR. Adolescents searching for health information on the internet: an observational study. J Med Internet Res. 2003;5:e25.CrossRefPubMedPubMedCentral
68.
Subramaniam M, St Jean B, Taylor NG, Kodama C, Follman R, Casciotti D. Bit by bit: using design-based research to improve the health literacy of adolescents. JMIR Res Protoc. 2015;4(2):e62.
69.
Conrad FG, Blair J. Sources of error in cognitive interviews. Public Opinion Quarterly. 2009;73:32–55.CrossRef
70.
71.
Horn A, Vogt D, Messer M, Schaeffer D. Strengthening health literacy of people with migration background: results of a qualitative evaluation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015;58:577–83.CrossRefPubMed
72.
Reinders H. In: Leitfaden E, editor. Qualitative Interviews mit Jugendlichen führen. 3rd ed. Berlin: Walterde Gruyter, Oldenbourg Wissenschaftsverlag; 2016.
73.
Lobe B, Livingstone S, Olafsson K, Simões JA. Best practice research guide: how to research children and online technologies in comparative perspective. London: EU Kids Online (Deliverable D4.2); 2008.
Metadata
Title
Do adolescents understand the items of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) – German version? Findings from cognitive interviews of the project “Measurement of Health Literacy Among Adolescents” (MOHLAA) in Germany
Authors
Olga Maria Domanska
Christiane Firnges
Torsten Michael Bollweg
Kristine Sørensen
Christine Holmberg
Susanne Jordan
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Archives of Public Health / Issue 1/2018
Electronic ISSN: 2049-3258
DOI
https://doi.org/10.1186/s13690-018-0276-2

Other articles of this Issue 1/2018

Archives of Public Health 1/2018 Go to the issue

Research

Exploring the knowledge, attitudes and practices (KAP) of health care professionals on viral hepatitis notification in Gauteng, South Africa, 2015

Research

Utility of passive malaria surveillance in hospitals as a surrogate to community infection transmission dynamics in western Kenya

Research

A study on the implementation fidelity of the performance-based financing policy in Burkina Faso after 12 months

Research

Socio – economic determinants of abortion among women in Mozambique and Ghana: evidence from demographic and health survey

Research

Fidelity monitoring in complex interventions: a case study of the WISE intervention

Systematic review

Farming, Q fever and public health: agricultural practices and beyond