SynthesisBMJ open2018
Quality of health literacy instruments used in children and adolescents: a systematic review.
Synthesis in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 75 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
75 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- A COSMIN Systematic Review of Sexual Health Literacy Self-Report Measures for Adolescents.Archives of sexual behavior · 2025Pooled it
- Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021.PloS one · 2022Pooled it
- The Role of Health Literacy in Health Behavior, Health Service Use, Health Outcomes, and Empowerment in Pediatric Patients with Chronic Disease: A Systematic Review.International journal of environmental research and public health · 2021Pooled it
- Effectiveness of a school-based oral health literacy promotion intervention: a randomized controlled trial (RCT) among adolescents.BMC public health · 2025Trial
- Adolescents' health literacy and health-related quality of life: The mediating role of self-efficacy.Public health in practice (Oxford, England) · 2026Article
- Development and validation of a rapid health literacy assessment tool for Chinese primary and secondary school students.Health promotion international · 2026Article
- The Relationship between Health Literacy, Nutrition Literacy, and Food Literacy and Dietary Behaviors in Adults: A Systematic Review.Nutrition reviews · 2026Article
- Systematic Review of Health Literacy and Health Behavior in Adolescents Research.Epidemiologia (Basel, Switzerland) · 2026Review
- Measuring adolescent health literacy in Nigeria: psychometric validation of the health literacy assessment scale for adolescents.BMC public health · 2026Article
- Methodological quality of health literacy instruments used among school children in Asian countries: a systematic review.Journal of pharmaceutical policy and practice · 2026Review
- The effects of self-efficacy and e-health literacy on depressive symptoms in Chinese college students: a cross-sectional survey study.BMC psychology · 2025Article
- Association of school leaders' COVID-19 health literacy with the implementation of health promotion in schools in Germany: a cross-sectional study.BMC public health · 2025Article
- Digital tools to promote or measure health literacy in children aged 3-5 years: scoping review.Health promotion international · 2025Article
- Validity and reliability of Health Literacy for School-Aged Children (HLSAC) scale to understand the health literacy among adolescents in Bangladesh: An observational study.BMC public health · 2025Observational
- An Ongoing Teacher Professional Development Programme to Enhance Critical Health Literacy Pedagogies and Assessment.Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals · 2025Article
- Adolescents' health literacy perspectives and implications.BMC public health · 2025Article
- Examining the health literacy and health behaviours of children aged 8-11 in Wales, UK.Health promotion international · 2025Article
- [Health literacy and health behaviour-insights into a developing field of research and action for public health].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2025Article
- [Measuring health literacy: methods and tools for assessing general health literacy in adults].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2025Review
- Health Literacy Profiles and Disparities Among Adolescents and Implications in Ethiopia.Journal of multidisciplinary healthcare · 2025Article
15 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveImproving health literacy at an early age is crucial to personal health and development. Although health literacy in children and adolescents has gained momentum in the past decade, it remains an under-researched area, particularly health literacy measurement. This study aimed to examine the quality of health literacy instruments used in children and adolescents and to identify the best instrument for field use.
designSystematic review.
settingA wide range of settings including schools, clinics and communities.
participantsChildren and/or adolescents aged 6-24 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Measurement properties (reliability, validity and responsiveness) and other important characteristics (eg, health topics, components or scoring systems) of health literacy instruments.
resultsThere were 29 health literacy instruments identified from the screening process. When measuring health literacy in children and adolescents, researchers mainly focus on the functional domain (basic skills in reading and writing) and consider participant characteristics of developmental change (of cognitive ability), dependency (on parents) and demographic patterns (eg, racial/ethnic backgrounds), less on differential epidemiology (of health and illness). The methodological quality of included studies as assessed via measurement properties varied from poor to excellent. More than half (62.9%) of measurement properties were unknown, due to either poor methodological quality of included studies or a lack of reporting or assessment. The 8-item Health Literacy Assessment Tool (HLAT-8) showed best evidence on construct validity, and the Health Literacy Measure for Adolescents showed best evidence on reliability.
conclusionsMore rigorous and high-quality studies are needed to fill the knowledge gap in measurement properties of health literacy instruments. Although it is challenging to draw a robust conclusion about which instrument is the most reliable and the most valid, this review provides important evidence that supports the use of the HLAT-8 to measure childhood and adolescent health literacy in future school-based research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.