Related Experiment Video

Updated: Jan 7, 2026

Qualitative and Quantitative Validation of Tools with Rating Scales Aimed at Assessing the Quality of University Service-Learning

Qualitative and Quantitative Validation of Tools with Rating Scales Aimed at Assessing the Quality of University Service-Learning

Published on: August 29, 2025

Development and Validation of a Critical Health Literacy Scale: Exploring Media Literacy, Social Determinants, and

Mi Zhou¹, A Susana Ramírez², Sandie Ha³

¹Department of Nutrition, Food Science, and Packaging, San Jose State University, San Jose, USA.

Critical Public Health

|December 29, 2025

Abstract

Introduction:

Critical health literacy has attracted much attention as an indicator of success beyond individual behavior change objectives in health promotion and as a tool to assess public health education. Despite its importance, there remains no consensus about how to operationalize critical health literacy. Building on Freire's concepts of critical consciousness and empowerment, we conceptualize critical health literacy as comprising reflection (media literacy and awareness of social determinants) and action (psychological empowerment).

Methods:

We developed and validated an 18-item critical health literacy scale among young adult Latinas (N=1,029) aged 18-29 years (mean age=19.6). The scale measures three dimensions: media literacy, awareness of social determinants of health, and psychological empowerment. Face and content validity were established through focus groups and expert panel reviews. We used exploratory factor analysis (EFA) on half the sample to identify the dimensional structure, followed by confirmatory factor analysis (CFA) on the remaining half to assess convergent and discriminant validity.

Results:

The EFA and CFA confirmed a five-factor structure with acceptable fit indices (TLI=.96, CFI=.95, RMSEA=.04, SRMR=.03). The scale demonstrated high internal consistency and composite reliability. Convergent and discriminant validity were established for most subscales, with the community control subscale showing weaker but theoretically important psychometric properties.

Discussion:

The validated critical health literacy scale provides a reliable tool for assessing understanding of social and commercial determinants of health and the degree to which young people feel empowered to engage in social change. This instrument can evaluate health promotion interventions at multiple levels within a socio-ecological framework and advance research on factors influencing health inequities among populations experiencing health disparities.

Keywords:

Latinas commercial determinants of health empowerment measurement psychological empowerment racialized marketing social determinants of health socio-ecological model young adults

More Related Videos

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack

Published on: May 15, 2020

Involving Individuals with Developmental Language Disorder and Their Parents/Carers in Research Priority Setting

Involving Individuals with Developmental Language Disorder and Their Parents/Carers in Research Priority Setting

Published on: June 6, 2020

Related Concept Videos

Health Literacy

Health Literacy

Health literacy is an individual's or a community's capacity to comprehend, receive, read, and use relevant healthcare information and services. The World Health Organization (WHO, 2018) defines health literacy as the cognitive and social skills that determine the ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health. As a result, the WHO helps individuals manage long-term health concerns, participate in preventative...

Levels of Health Promotion and Illness Prevention

Levels of Health Promotion and Illness Prevention

Health promotion allows a person to control the determinants of health, resulting in an improved health status. It enhances the quality of life and reduces premature deaths. Health promotion and illness prevention programs help people make beneficial choices to reduce the risk of disease and disabilities. There are three health promotion and illness prevention levels: primary, secondary, and tertiary prevention.
In primary prevention, actions taken before disease onset prevent the disease from...

Dimensions of Health and Illness

Dimensions of Health and Illness

The factors influencing the health-illness continuum can be internal or external and may or may not be under conscious control. They are related to the following eight human dimensions, and each dimension is interrelated to one other.

Models of Health Promotion and Illness Prevention II

Models of Health Promotion and Illness Prevention II

The person's health status fluctuates continually, varying from being in good health to becoming ill and returning to being healthy. To understand the concept of illness prevention, there are two models. First, the health-illness continuum model is a graphic representation of an individual's wellness. It states that a person is considered healthy in the absence of physical disease and the presence of good emotional health.
The agent-host-environment model states that disease results...

Models of Health Promotion and Illness Prevention I

Models of Health Promotion and Illness Prevention I

A model is a theoretical way to understand a concept or an idea. Models can overcome barriers to health regardless of diverse economic and cultural backgrounds. In addition, models make the task easier by providing different ways to approach complex issues. There are two major health promotion models: the health belief model and the health promotion model.
The health belief model (HBM) attempts to predict health-related behavior in specific belief patterns. According to the HBM, a person's...

Data Validation

Data Validation

Data validation is an essential part of a comprehensive assessment. Validation is confirming or verifying and opening the door to gathering more assessment data as it clarifies vague or unclear data. The process of checking and verifying the collected information is called data validation. The primary purpose of data validation is to ensure data is as free from error, bias, and misinterpretation as possible.
Nursing assessment guides are generally based on holistic models rather than medical...

Articles linked to this work by shared authors, journal, and citation graph.

Nanotechnology for targeted modulation of mitophagy: molecular mechanisms, therapeutic applications, and translational perspectives.

Biomedical materials (Bristol, England)·2026

Beyond Conventional Messaging: Critical Communication Strategies to Boost Vaccine Intentions.

Journal of health communication·2026

Mindset versus circumstance: How fatalism and food insecurity shape sugar-sweetened beverage consumption in young adult Latinas.

Journal of health psychology·2026

Cannabis Use Disorder and Suicidal Ideation in the United States: Persistent Risk and Stable Trends, 2014-2023.

Journal of studies on alcohol and drugs·2026

Association between dietary self-perception and sugar-sweetened beverage consumption among young adult Latinas.

Public health nutrition·2026

Message Design Strategies for Empowerment and Resistance to Racialized Marketing: A Randomized Trial.

American journal of health promotion : AJHP·2026

See all related articles