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Health literacy is a promising approach to promoting health and preventing disease among children and adolescents. Promoting health literacy in early stages of life could contribute to reducing health inequalities. However, it is difficult to identify concrete needs for action as there are few age-adjusted measures to assess generic health literacy in young people. Our aim was to develop a multidimensional measure of health literacy in German to assess generic health literacy among 14- to 17-year-old adolescents, namely, the &ldquo, Measurement of Health Literacy Among Adolescents Questionnaire&rdquo, (MOHLAA-Q). The development process included two stages. Stage 1 comprised the development and validation using a literature review, two rounds of cognitive interviews, two focus groups and two rounds of expert assessments by health literacy experts. Stage 2 included a standard pretest (n = 625) of the questionnaire draft to examine the psychometric properties, reliability and different validity aspects. The MOHLAA-Q consists of 29 items in four scales: (A) &ldquo, Dealing with health-related information (HLS-EU-Q12-adolescents-DE)&rdquo, (B) &ldquo, Communication and interaction skills&rdquo, (C) &ldquo, Attitudes toward one&rsquo, s own health and health information&rdquo, and (D) &ldquo, Health-related knowledge&rdquo, The confirmatory factor analysis indicated a multidimensional structure of the MOHLAA-Q. The internal consistency coefficients (Cronbach&rsquo, s &alpha, ) of the scales varied from 0.54 to 0.77. The development of the MOHLAA-Q constitutes a significant step towards the comprehensive measurement of adolescents&rsquo, health literacy. However, further research is necessary to re-examine its structural validity and to improve the internal consistency of two scales.

Profound data on adolescent health literacy are needed as a requirement for the development of health literacy promoting interventions. This paper aims to study the level of generic health literacy among adolescents and to explore associations between health literacy and socio-demographic (age, sex, family affluence, migration background), social (social support by family and friends) and personal (self-efficacy) factors. We conducted a representative cross-sectional online survey. Four health literacy dimensions were captured among 14&ndash, 17 years old adolescents living in Germany (n = 1235) with the &ldquo, Measurement of Health Literacy Among Adolescents-Questionnaire&rdquo, (MOHLAA-Q). Descriptive, bivariate and multiple logistic regression analyses were used to analyse the data (n = 1202). We found poor health literacy levels&mdash, to varying degrees&mdash, in all examined health literacy dimensions: dealing with health-related information (8.41% with many difficulties), health-related communication skills (28.13% with low skills), attitudes toward one&rsquo, s own health and health information (8.81% with passive attitudes) and health-related knowledge (22.73% with low levels). We identified significant associations between poor health literacy levels and all factors studied except for age. Our results indicate a need for the implementation of evidence-based health literacy-related promoting interventions, preferentially in education and training institutions.

The promotion of health literacy at a young age can protect, maintain and improve health across the life course. Yet to date, a sound data basis on adolescent health literacy as a requirement for the development of strategies to promote health literacy has not been given. This paper presents a study protocol for the online survey “Health Literacy Among Adolescents” (GeKoJu) that collects the first nation-wide representative data on self-reported generic health among adolescents aged 14−17 years in Germany. The objectives of the survey are (1) to assess the distribution of generic health literacy among adolescents in Germany, (2) to identify socio-demographic and social factors in regard to health literacy and (3) to assess the association of health literacy and health-related outcomes. The cross-sectional survey was conducted from September 2019 through December 2019. A two-stage stratified cluster sampling strategy was applied. Individuals invited to participate in the survey (N = 6608) were randomly selected among German-speaking adolescents aged 14−17 years, with permanent residence in Germany. Generic health literacy is measured with the “Measurement of Health Literacy Among Adolescents-Questionnaire” (MOHLAA-Q). Data collection also covers questions on health behavior, subjective health status, personal and social resources, socio-demographic and social factors and health services use. Results of the GeKoJu survey will provide data for the development of strategies to promote generic health literacy among families, in schools, communities and health care.