Development and Validation of Adolescent Health Literacy Assessments: A Rasch Measurement Model Approach

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BMC Public Health. 2022 Mar 25;22(1):585. doi: 10.1186/s12889-022-12924-4.


BACKGROUND: Health literacy (HL) is implicated in improving decision-making and health promotion, and in reducing racial, ethnic, and socioeconomic disparities in health. The three main domains of HL include functional, interactive, and critical HL. HL skills develop throughout life as individuals’ psychosocial and cognitive abilities develop and they accumulate experiences with navigating health systems. Although adolescence is marked by increased involvement in health decision-making, most studies and measurements of HL have focused on adults. The literature on HL in adults and adolescents is also limited by the lack of validated test-based measures to assess HL. Existing validated, test-based LH measures for adolescents were originally designed for adults. However, adolescents are at an earlier stage of developing their LH skills (eg, fewer experiences navigating the healthcare system) than adults, and measures originally designed for adults may assume prior knowledge that adolescents may lack, thereby underestimating adolescent HL. This study developed and validated test-based assessments of adolescent functional, interactive, and critical HL.

METHODS: Items were generated in an iterative process: focus groups with adolescents informed about item content, cognitive interviews with adolescents, and expert consultation established the content and face validity of the initial items, and items have been revised or deleted where appropriate. Secondary students (n = 355) completed a battery of measures including the revised HL items. Items were assessed and validated using Rasch measurement models.

RESULTS: The final 6-item functional, 10-item interactive, and 7-item critical assessments and their composite (23 items) correspond to their respective Rasch models. Item-level invariance was established for gender (male vs. female), age (12-15 vs. 16-18), and ethnicity across all assessments. The ratings had good convergent validity with an established measure of functional LH, and ratings scores were positively related to reading instructions before taking medication and questioning the veracity of health information found online.

CONCLUSIONS: These assessments are the first interactive and critical LH test-based measures of adolescents, the first functional LH test-based measure designed for adolescents, and the first composite assessment based on tests of the three major domains of HL. These assessments should be used to inform strategies for improving adolescent health, decision-making, and behaviors.

PMID:35331182 | DOI:10.1186/s12889-022-12924-4

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