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Background Health literacy (HL) is an important determinant of health and health behaviours, and there is a need to monitor HL levels among all population groups. It is therefore essential to develop instruments to assess HL during childhood and adolescence. The aim of this study was to examine the cross-national measurement invariance of the instrument Health Literacy for School-aged Children (HLSAC) in four European countries. Methods The data were collected via standardized self-administered anonymous questionnaires within classrooms in Finland, Poland, Slovakia, and Belgium. There were in total 1468 respondents (aged 13, N = 690; aged 15, N = 778). The HLSAC instrument was used to measure the subjective HL of adolescents in each country. A multigroup confirmatory factor analysis was applied to test measurement invariance. Results Configural and metric invariance was established, but scalar invariance did not hold. However, the instrument exhibited high internal consistency (α = 0.85) and showed adequate fit with the data. Moreover, the partial invariance allowed comparison of mean values across the countries in question. There were significant mean value differences between countries and age-groups. Conclusions HL mean values (as assessed via the HLSAC instrument) can be compared across countries. The instrument has utility for large-scale international HL studies on adolescents. [ABSTRACT FROM AUTHOR]

The role of supportive environments on health, wellbeing, and longevity has been widely recognized. However, there is no strong empirical evidence on the association between health literacy (HL) as a particular health-related competence and neighbourhoods. Therefore, the aim of the study was to assess the association between the features of neighbourhoods and the level of HL competencies of young people from three countries (Czech Republic, Poland, Slovakia). Self-reported data from an international sample of 11,521 students aged 13-15 years participating in the Health Behaviour in School-aged Children Study (HBSC) in the year 2018 were included in the analyses. The level of HL shows a strong positive relationship with family wealth, and a significant relationship is maintained in all studied countries. Both social and structural features of neighbourhoods turned out to have an impact on students' HL. However, HL is most clearly explained by the school environment. This study confirms the school effect on higher levels of HL competences in adolescents. This indicates the need to invest in schools located in less affluent areas to generally improve the level of education, implement modern health education combined with HL, and strengthen the social and health competencies of students.

Objective: Background: Recent years saw the development of international tools for measuring health competencies understood as health literacy (HL). One of them is the short index Health Literacy for School-Aged Children (HLSAC) implemented by the members of the Health Behaviour in School-aged Children (HBSC) network. So far, when researching the properties of this instrument, less attention has been devoted to the correlation of HLSAC with other tools related to health. The aim of the paper is to present selected psychometric features of the HLSAC index in a sample of Polish pupils, supplemented by the preliminary analysis of its association with the health locus of control., Patients and Methods: Material and methods: The information collected relates to 630 junior secondary school students surveyed in Poland in 2016 as part of the HLSAC questionnaire pilot study. The Multidimensional Health Locus of Control (MHLC) scale by K. Wallston was used as the additional module for Poland. It differentiates among three dimensions of health control: internal, external - dependent on other people, and external - dependent on random factors. It was checked which HLC dimension correlates most strongly with HL., Results: Results: It was demonstrated that the HLSAC scale consisting of 10 questions has a very good reliability in the Polish version (Cronbach alfa = 0.851) and a one-factor structure. Confirmatory factor analysis supported a unidimensional model (RMSEA = 0.082; CFI=0.922; TLI=0.877). The HLSAC most strongly correlates with the internal health locus of control (r=0.376; p<0.001), slightly less with the influence of other people (r=0.153; p<0.001), while the correlation with the random factor health locus of control is insignificant (p=0.947). It was found that there is a weak, however significant, positive correlation between family affluence and HLSAC (p=0.041)., Conclusion: Conclusions: The analyses conducted demonstrated that the Polish version of HLSAC has good psychometric features. The relatively higher correlation between HLSAC and internal rather than external health locus of control was confirmed. The practical effect of the pilot study was to develop an improved version of the HLSAC scale, which has been recommended for the mainstream HBSC 2018 survey.