Exploring the Association Between Adolescents' Health Literacy and Health Behavior by Using the Short Health Literacy...

Health literacy (HL) is an important element of public health that is linked to health behavior in children and adolescents. This study aimed to investigate the structural validity and reliability of the HLS₁₉-Q12 in the adolescent population, to measure the general HL of adolescents, and to assess the relationship between adolescents' HL and health behavior.

This cross-sectional study involved 825 students aged 15-19 years attending Lithuanian gymnasiums. The participants completed an online survey that collected information on key sociodemographic, HL, and health behavior indicators. Factor analysis, Cronbach's alpha, and McDonald's omega were used to validate the Lithuanian version of the HLS₁₉-Q12. Health behavior indicators, including physical activity, smoking, alcohol consumption, self-rated health, and body mass index (BMI), were measured. We used regression analyses to assess the associations.

The HLS₁₉-Q12 showed an acceptable reliability index (Cronbach's α = 0.885, McDonald's omega ω = 0.877) and adequate structural validity (comparative fit index  =  0.89, Tucker and Lewis's index of fit  =  0.88, root mean square error of approximation  =  0.06). We found that 67.1% of the adolescents had excellent or sufficient HL, 27.7% had problematic HL, and 5.2% had inadequate HL. Compared with girls, boys had greater HL. HL was positively related to physical activity and self-rated health and negatively related to alcohol use and smoking.

HLS₁₉-Q12 is a reliable and valid measure of HL among adolescents in upper grades; higher levels of HL have been found to result in better health behaviors.