Development and validation of a rapid health literacy assessment tool for Chinese primary and secondary school...

Health literacy (HL) plays a vital role in shaping health behaviors and long-term well-being. Existing HL assessment tools for children and adolescents remain fragmented, with limited theoretical foundations, limited age adaptability, and insufficient psychometric validation. A scientifically developed, developmentally appropriate, and psychometrically strong measurement tool specifically designed for younger populations can support HL monitoring, health promotion, and educational evaluation. This study conceptualized HL for children and adolescents and developed the Chinese Rapid Health Literacy Questionnaire for Primary and Secondary Students (CRHLQ-PS). Using an exploratory sequential design, we combined policy and literature reviews, expert interviews, and Delphi consensus to develop an indicator system comprising seven domains-hygiene, nutrition, physical activity, safety, preventive health, psychosocial adaptation, and digital health-with 20 indicators organized across four dimensions: knowledge, skills, motivation, and participation. Items were generated for each indicator. The CRHLQ-PS includes four age-specific sub-questionnaires for Grades 1-2 (39 items), 3-4 (40 items), 5-6 (52 items), and junior high school (58 items). A total of 7113 students from four regions in China participated in psychometric testing. Reliability and validity were evaluated using the Rasch Partial Credit Model. Delphi findings indicated high expert authority and moderate consensus. Rasch analysis supported strong psychometric performance, with good model-data fit, high item reliability, and acceptable person reliability. The scale exhibited a predominantly unidimensional structure and appropriate targeting overall, although it appeared relatively easy for the current sample. The CRHLQ-PS provides a rapid, theory-informed, and developmentally appropriate instrument for assessing HL among school-aged children and adolescents. Future research should broaden item difficulty and undertake cross-cultural validation to enhance its global applicability and comparability.