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To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS19-NAV measurement scale applied in the European Health Literacy Population Survey 2019–2021 (HLS19). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS19-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data–model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS19-NAV demonstrated high internal consistency. To ensure content validity, the HLS19-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS19-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial.

To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS

Accurate and precise measures of health literacy (HL) is supportive for health policy making, tailoring health service design, and ensuring equitable access to health services. According to research, valid and reliable unidimensional HL measurement instruments explicitly targeted at young people (YP) are scarce. Thus, this study aims at assessing the psychometric properties of existing unidimensional instruments and developing an HL instrument suitable for YP aged 16-25 years.Applying the HLSThe HLSCompared to other parsimonious 12-item short versions of HLS

The aim of this study was to explore bachelor-level nursing students' experiences with concept cartoons as an active learning strategy and formative assessment to develop conceptual understanding in anatomy and physiology (AP).Many first-year nursing students struggle to understand central concepts in AP. Concept cartoons-cartoon characters proposing scientifically acceptable statements and misconceptions combined with an illustration-might facilitate active learning in lectures, overcome misconceptions and promote deep learning. Voting on the most precise statement using a student response system gives formative information about the students' conceptual understanding.Parallel mixed methods design with an emphasis on a qualitative approach.Nine concept cartoons were developed based on former students' written answers to exam items and applied in lectures at three universities/university colleges. Qualitative data of students' experiences were collected in three focus group interviews during November 2019, one focus group at each of the three universities/university colleges (n = 5, 8 and 8). A short questionnaire was also applied (n = 343) to all students at the three universities/university colleges. Qualitative data were analysed using qualitative content analyses, whereas frequency analysis and Chi-square statistics were applied for the quantitative data. The study was approved by the Norwegian Centre for Research Data, ref. 779586.Qualitative data analysis indicated that the use of concept cartoons addresses different learning styles and could promote deep learning and enhance the environment for learning. The concept cartoons were also seen as valuable for examination preparation. Regarding potential improvements, more information about concept cartoons, how they were developed and how they were supposed to be used would be beneficial, and the cartoons could be used in a more time-efficient manner during lectures. Quantitative data indicated that most of the students thought that concept cartoons were useful and inspiring in learning AP, and they would recommend further use to increase their understanding of central concepts. There were no significant differences across sex, age, or entrance qualifications when it comes to the benefits of using concept cartoons in learning AP. Compared to students born in Scandinavia, a larger proportion of students born outside Scandinavia found the use of concept cartoons inspiring for their learning in AP.The use of concept cartoons was appreciated by the students to develop a conceptual understanding in AP. Most students recommended future use.At point of submission put this on title page Tweetable abstract: Concept cartoons are appreciated as an active learning strategy and formative assessment in developing nursing students' conceptual understanding of anatomy and physiology.

Abstract Efforts targeting adolescents’ dietary behaviour have often focused on improving their access to nutrition information; however, adolescents report finding nutrition information difficult to understand. Exploring adolescents’ critical nutrition literacy might provide insight into how best to improve their use of available nutrition information. Purpose The purpose of this article is to explore how the two aspects of the critical nutrition literacy - critical evaluation of nutrition information’ and ‘engagement in dietary behaviour’ are linked at personal level. Additionally, the study sought to establish the association between critical nutrition literacy and self-efficacy in nutrition related subjects. Methods Applying a cross-sectional study design, the study sampled 1622 adolescents aged 15-16years, enrolled in 58 secondary schools in Norway. The adolescents responded to scales measuring self-efficacy and CNL. Using Lisrel 9.30, the study evaluated a structural equation model linking CNL and SEBH. Results The study yielded a simple yet theoretically sound model depicting the link between CNL and self-efficacy. Conclusion Efforts promoting adolescents’ nutrition literacy might benefit from increasing their self-efficacy in nutrition-related subjects.

As experience in many countries has shown, measuring population health literacy is important for putting health literacy on the agenda of health policy, practice and research and to inform health policy where there is specific need for improving health literacy by interventions. There is growing evidence that there exists limited comprehensive health literacy for considerable proportions of the general population, that there is a social gradient for health literacy and that limited health literacy has problematic consequences for healthy lifestyles, self-reported health and utilization of professional health services. It was also shown that distributions and associations of health literacy differ considerable between countries. WHÓs Solid Facts - Health Literacy (2013) recommended that health literacy should be monitored regularly by standardized measures in as many countries as possible. Therefore WHO-Europe has initiated the Action Network Measuring Population and Organizational Health Literacy (M-POHL) of national policy experts and researchers. M-POHL has initiated as its first project the European Health Literacy Survey 2019 (HLS19). Based on the European Health Literacy Survey HLS-EU (2011), HLS19 has further developed instruments for measuring general comprehensive health literacy and specific measures for measuring e.g. digital health literacy. This survey is taking place in more than 15 countries of the WHO Europe Region and will have available preliminary first results in October 2020. Therefore the workshop is intended to present first internally comparative results and exemplary national results for health literacy and its correlates and discuss possible consequences of these results for health policy. The workshop will focus on measuring comprehensive health literacy and digital health literacy in general populations of selected member states of the WHO European Region. Design of the workshop: Introduction (5′), Presentation 1: Results of measuring comprehensive health literacy in general populations - An international comparison (20′), Statements of Panelists (10′), Discussion with audience (10′), Presentation 2: Results of measuring digital health literacy in general populations - An international comparison (20′), Statements of Panelists (10′), Discussion with audience (10′), Closing (5′). Key messages Distributions of comprehensive health literacy of general populations and associations with its social determinants and health consequences differ considerably between countries of WHO-Europe. A new measure for digital health literacy in general populations is related to comprehensive health literacy and varies considerably between countries of the WHO-Europe Region.

Background Due to the digital transformation in late modern society, digital (or e-) health literacy (DHL) is becoming increasingly relevant for people to take health related decisions. Yet despite its importance for evidence-based policy, very few tools have been developed to measure DHL, and even fewer studies have measured DHL in general populations. The Action Network on Measuring Population and Organizational Health Literacy (M-POHL) is one of the first to include a measure of DHL and its relevant correlates in the Health Literacy Survey 2019 (HLS19). Methods Based on an existing instrument (Van der Vaart & Drossaert, 2017), adapted to the format of the HLS-EU questionnaire for measuring comprehensive health literacy, 10 items with four Likert categories were developed to measure self-reported DHL, as well as 6 questions measuring the use of digital resources to obtain health related information and communicate with their health care system, as an optional package of the HLS19 study. Ten of the 15 countries participating in HLS19 included this optional package into their national survey. Data were collected from probability samples of at least 1.000 respondents per country, taken from the general population 18+ by personal interviews, telephone interviews or internet. Results For comparisons between countries, distributions of the answers to single items as well as psychometric validation and descriptive data for an index of DHL will be presented. Associations of DHL with general comprehensive health literacy, with the use of digital resources, and with other selected correlates based on correlational and regression analysis will also be presented comparatively for countries. Conclusions This study is the first to present standardized comparative data for the distributions of DHL and its correlates in the general population of WHO-Europe region Member States. The relevance of these results for national and European health policy will be discussed. Panelists: Doris Schaeffer Interdisciplinary Centre for Health Literacy Research, Bielefeld University, Bielefeld, Germany Contact: doris.schaeffer@uni-bielefeld.de Maria Lopatina Department of Public Health, National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia Contact: ms.lopatina@gmail.com Miguel Arriaga Division of Literacy, Health and Well-being, Directorate-General on Health, Lisbon, Portugal Contact: miguelarriaga@dgs.min-saude.pt

Background: Whereas the majority of efforts targeting adolescents’ dietary behaviour have predominantly focused on improving their access to nutrition information, findings indicate that this approach has had little if any effect on their short-term dietary behaviour. Among the reasons for this is that adolescents report finding it difficult to understand the nutrition information that they access, and are thus unable to use the information as intended. Exploring critical nutrition literacy (CNL) might provide insight into how adolescents evaluate and apply the nutrition information that they get from different sources.Methods: The present study employed a cross-sectional study design, in which we sampled 1620 tenth graders, aged 15 and 16 years, enrolled at 58 secondary schools in Norway. Data collection: Using an electronic survey system, the participants responded to scales measuring ‘self-efficacy in Body and Health’ (SEBH), ‘evaluation of nutrition information’ (CNLEval and ‘engagement in dietary behaviour’ (CNLEng). Study hypotheses: We hypothesized that SEBH influences adolescents’ CNLEval and CNLEng, and that CNLEval influences CNLEng directly and mediates the effect of SEBH on CNLEng. Statistical analyses: Using Lisrel 9.30, the present study formulated and evaluated a hypothesized structural equation model (SEM) linking the two subdomains of CNL (CNLEval, CNLEng) and SEBH.Results: The study yielded a simple yet theoretically sound model linking CNL and SEBH; the adequate fit to the goodness-of-fit indices showed that the proposed model adequately described the data.Conclusions: The present study strengthened the hypothesis that there exists a strong association between CNL and SEBH, and between the two aspects of CNL-CNLEval and CNLEng. Hence, efforts aimed at promoting positive dietary behaviour in adolescents and enhancing their nutrition literacy efforts might benefit from enhancing their perceived self-efficacy in nutrition related subjects.

Background The self-reported European Health Literacy Survey Questionnaire (HLS-EU-Q47) is a widely used measure for population health literacy. Based on confirmatory factor analyses and Rasch modelling, the short form HLS-Q12 was developed to meet the Rasch unidimensional measurement model expectations. After its publication, there was a worldwide call to identify HLS-Q12 cutoff scores and establish clearly delineated standards regarding the skills assessed. This study therefore aims to identify the HLS-Q12 scores associated with statistically distinct levels of proficiency and to construct a proficiency scale that may indicate what individuals typically know and can do at increasingly sophisticated levels of health literacy. Methods We applied the unidimensional Rasch measurement model for polytomous items to responses from 900 randomly sampled individuals and 388 individuals with type 2 diabetes. Using Rasch based item calibration, we constructed a proficiency scale by locating the ordered item thresholds along the scale. By applying Wright’s method for the maximum number of strata, we determined the cutoff scores for significantly different levels. By directly referring to item content that people who achieved the cutoff scores viewed as ‘easy’, we suggested what these gradually more advanced levels of health literacy might mean in terms of item content. Results Analysing the population sample, we identified statistically distinct levels of health literacy at the empirically identified cutoff scores 27, 33 and 39. We confirmed them by analysing the responses from individuals with diabetes. Using item calibration, the resulting HLS-Q12 proficiency scale expresses typical knowledge and skills at these three statistically distinct levels. The scale’s cumulative nature indicates what it may mean qualitatively to move from low to high health literacy. Conclusions By identifying levels of health literacy, we may initiate the improvement of current models of health literacy. Determining how to adapt information to patients’ health literacy level is a possible clinical outcome. A substantial methodological outcome is the inevitability of Rasch modelling in measurement. We found that Wright’s method identified rating scale cutoff scores consistently across independent samples. To reveal sources of potential biases, threats to validity and imprecision of benchmarks, replication of our study in other contexts is required

ObjectivesScientific literacy is assumed necessary for appraising the reliability of health claims. Using a national science achievement test, we explored whether students located at the lower quartile on the latent trait (scientific literacy) scale were likely to identify a health claim in a fictitious brief news report, and whether students located at or above the upper quartile were likely to additionally request information relevant for appraising that claim.DesignSecondary analysis of cross-sectional survey data.Setting and participants2229 Norwegian 10th grade students (50% females) from 97 randomly sampled lower secondary schools who performed the test during April–May 2013.Outcome measuresUsing Rasch modelling, we linked item difficulty and student proficiency in science to locate the proficiencies associated with different percentiles on the latent trait scale. Estimates of students’ proficiency, the difficulty of identifying the claim and the difficulty of making at least one request for information to appraise that claim, were reported in logits.ResultsStudents who reached the lower quartile (located at −0.5 logits) on the scale were not likely to identify the health claim as their proficiency was below the difficulty estimate of that task (0.0 logits). Students who reached the upper quartile (located at 1.4 logits) were likely to identify the health claim but barely proficient at making one request for information (task difficulty located at 1.5 logits). Even those who performed at or above the 90th percentile typically made only one request for information, predominantly methodological aspects.ConclusionsWhen interpreting the skill to request relevant information as expressing students’ proficiency in critical appraisal of health claims, we found that only students with very high proficiency in science possessed that skill. There is a need for teachers, healthcare professionals and researchers to collaborate to create learning resources for developing these lifelong learning skills.

Background The self-reported European Health Literacy Survey Questionnaire (HLS-EU-Q47) is a widely used health literacy measure. Based on confirmatory factor analyses and Rasch-modelling, the short form HLS-Q12 was developed to meet the Rasch unidimensional measurement model expectations. After its publication, there has been a worldwide call to identify HLS-Q12 cut-off scores and establish clearly delineated standards in terms of the skills assessed. This study therefore aims to identify the HLS-Q12 scores associated with statistically distinct levels of proficiency and construct a proficiency scale that expresses progression – what individuals typically know and can do at increasingly more sophisticated levels of health literacy. Methods We applied the unidimensional Rasch measurement model for polytomous items to responses from 900 randomly sampled individuals and 388 individuals with type 2 diabetes. Using Rasch-based item calibration, we constructed a proficiency scale by locating the ordered item thresholds along the scale; by applying Wright’s method for the maximum number of strata, we determined the cut-off scores for significantly different levels. By directly referring to item content that people who reached the cut-off scores view as ‘easy’, we could describe these gradually more advanced levels of health literacy. Results We identified statistically distinct levels of health literacy at the empirically identified cut-off scores 27, 33 and 39 and confirmed them by analysing the responses from individuals with diabetes. Individuals who reach these cumulative benchmarks of marginal, intermediate and advanced literacy can typically access, appraise and apply information relevant to stay healthy, improve health and critically judge health claims and compare treatments, respectively. Conclusions By revealing progression in health literacy, we extended the current models of health literacy and inform policy-makers aiming to bridge literacy gaps. Determining how to best adapt information to patients’ literacy level and thereby assist them in managing their own health is a significant clinical outcome. A substantial methodological consequence is the inevitability of Rasch modelling in measurement. We also found that Wright’s method identified rating scale cut-off scores consistently across independent samples. To unveil sources of potential biases, threats to validity and imprecision of benchmarks, replicating our study in other contexts is required.

Background Over the recent past, there has been an increase in nutrition information available to adolescents from various sources, which resulted into confusion and misinterpretation of the dietary advice. Results from international assessment frameworks such as PISA and TIMMS reflect the need for adolescents to critically appraise health information. While a number of scales measuring the critical health literacy of individuals exist; very few of these are devoted to critical nutrition literacy. More so, these scales target individuals with an advanced level of nutrition education, often gaging their proficiency in information appraisal in relation to principles of evidence-based medical research. The purpose of the present study was to examine the psychometric properties of a newly developed critical nutrition literacy scale (CNL-E) measuring adolescents’ perceived proficiency in ‘critically evaluating nutrition information from various sources’. Methods During spring 2015, more than 1600 tenth graders aged 15–16 years from approximately 60 schools in Norway responded to the five-item questionnaire using an electronic survey system. Applying Rasch analysis approach, we examined the psychometric properties of the CNL-E scale employing the RUMM2030 statistical package. To further investigate the dimensionality of the scale and test the underlying structure, we applied multidimensional Rasch modelling using the ConQuest 4 software and confirmatory factor analysis (CFA) using the Lisrel 9.30 software. Results In our sample, the CNL-E stood out as a valid, reliable and well-targeted scale with good overall fit to the partial credit parameterization of the polytomous unidimensional Rasch model (PCM). All the items were sufficiently statistically independent, had ordered response categories and showed acceptable individual fit to the PCM. No item displayed within-item bias or differential item functioning (DIF). Conclusions From the observed CNL-E sum score, it is possible to draw plausible conclusions about how individuals critically evaluate nutrition information. Efforts to improve communication of nutrition information could benefit from applying validated measures such as the CNL-E scale. The CNL-E scale provides insight into how individuals without an advanced level of nutrition education, such as adolescents, determine the validity and reliability of nutrition information from various sources.

This is the final text version of the article. The article has been peer-reviewed, but does not include the publisher’s layout, page numbers and proof-corrections. Citation for the published paper: Finbråten, H. S., Guttersrud, Ø., Nordström, G., Pettersen, K. S., Trollvik, A., & Larsson, B. W. (2018). Validating the Functional, Communicative and Critical Health Literacy Scale Using Rasch Modeling and Confirmatory Factor Analysis. Journal of Nursing Measurement, 26(2), 341-363. http://dx.doi.org/10.1891/1061-3749.26.2.341 Background and Purpose: The functional, communicative, and critical health literacy (FCCHL) scale is widely used for assessing health literacy (HL) in people with chronic diseases, such as type 2 diabetes (T2DM). Despite related subscales, researchers continue to apply a consecutive modeling approach, treating the three subscales as independent. This article studies the psychometric characteristics of the FCCHL by applying multidimensional modeling approaches. Methods: Rasch modeling and confirmatory factor analyses were applied to responses (paper-and-pencil) from 386 adults with T2DM. Results: Using a six-point rating scale and a three-dimensional Rasch model, this study found that a 12-item version of the FCCHL reduced within-item bias and improved subscale reliability indexes. Conclusion: This study suggests a parsimonious 12-item version of the FCCHL. The data fit a three-dimensional Rasch model best. Validating the Functional, Communicative and Critical Health Literacy Scale Using Rasch Modeling and Confirmatory Factor Analysis

AIM: To validate the European Health Literacy Survey Questionnaire (HLS-EU-Q47) in people with type 2 diabetes mellitus. BACKGROUND: The HLS-EU-Q47 latent variable is outlined in a framework with four cognitive domains integrated in three health domains, implying 12 theoretically defined subscales. Valid and reliable health literacy measurers are crucial to effectively adapt health communication and education to individuals and groups of patients. DESIGN: Cross-sectional study applying confirmatory latent trait analyses. METHODS: Using a paper-and-pencil self-administered approach, 388 adults responded in March 2015. The data were analysed using the Rasch methodology and confirmatory factor analysis. RESULTS: Response violation and trait violation (multidimensionality) of local independence were identified. Fitting the 'multidimensional random coefficients multinomial logit' model, 1-, 3- and 12-dimensional Rasch models were applied and compared. Poor model fit and differential item functioning were present in some items and several subscales suffered from poor targeting and low reliability. Despite multidimensionality in the data, we did not observe any unordered response categories. CONCLUSION: Interpreting the domains as distinct but related latent dimensions, the data fit a 12-dimensional Rasch model and a 12-factor confirmatory factor model best. Therefore, the analyses did not support the estimation of one overall 'health literacy score'. To support the plausibility of claims based on the HLS-EU score(s), we suggest: removing the health care aspect to reduce the magnitude of multidimensionality; rejecting redundant items to confine response dependency; adding 'harder' items and applying a six-point rating scale to improve subscale targeting and reliability; and revising items to improve model fit. This article is protected by copyright. All rights reserved.

Background The Claim Evaluation Tools database contains multiple-choice items for measuring people’s ability to apply the key concepts they need to know to be able to assess treatment claims. We assessed items from the database using Rasch analysis to develop an outcome measure to be used in two randomised trials in Uganda. Rasch analysis is a form of psychometric testing relying on Item Response Theory. It is a dynamic way of developing outcome measures that are valid and reliable. Objectives To assess the validity, reliability and responsiveness of 88 items addressing 22 key concepts using Rasch analysis. Participants We administrated four sets of multiple-choice items in English to 1114 people in Uganda and Norway, of which 685 were children and 429 were adults (including 171 health professionals). We scored all items dichotomously. We explored summary and individual fit statistics using the RUMM2030 analysis package. We used SPSS to perform distractor analysis. Results Most items conformed well to the Rasch model, but some items needed revision. Overall, the four item sets had satisfactory reliability. We did not identify significant response dependence between any pairs of items and, overall, the magnitude of multidimensionality in the data was acceptable. The items had a high level of difficulty. Conclusion Most of the items conformed well to the Rasch model’s expectations. Following revision of some items, we concluded that most of the items were suitable for use in an outcome measure for evaluating the ability of children or adults to assess treatment claims.

This study aimed at developing teaching material and strategies emphasising representations and modelling in upper secondary physics teaching. Representations are tools for modelling and understanding representations and how these can be manipulated is therefore believed to be a prerequisite for developing modelling skills. The study, accordingly, wanted mathematical representations and modelling to be an underlying focus in physics lessons. The study worked with physics teachers over 2 years to develop and trial teaching material and strategies, and in a third year tested this material in an intervention with experimental and control classes. Research questions asked what effects the material had on teaching, how teacher conceptualised the physics curriculum and teaching from using the material, and what influence the teaching had on students’ learning. The methodology included classroom observations with video recordings and note taking, questionnaires to teachers and students, analysis of teachers’ lesson plans, notes from discussions with teachers, interviews with teachers and an achievement test to measure learning. Student questionnaire data showed increased focus on representation in the experimental classrooms as compared to the control group, but no better effect in students’ achievement score in test for using representations. Significant differences were found between schools independently of being in the intervention or not, which makes us believe teacher and teaching characteristics were more important than the teaching material. Classroom observations, for example, showed that teachers varied in doing explicit or implicit teaching of representations, having a dialogical or authoritative style of teaching, and having an interactive or no-interactive communicative approach.

ObjectivesTo describe the development of the Claim Evaluation Tools, a set of flexible items to measure people's ability to assess claims about treatment effects.SettingMethodologists and members of the community (including children) in Uganda, Rwanda, Kenya, Norway, the UK and Australia.ParticipantsIn the iterative development of the items, we used purposeful sampling of people with training in research methodology, such as teachers of evidence-based medicine, as well as patients and members of the public from low-income and high-income countries. Development consisted of 4 processes: (1) determining the scope of the Claim Evaluation Tools and development of items; (2) expert item review and feedback (n=63); (3) cognitive interviews with children and adult end-users (n=109); and (4) piloting and administrative tests (n=956).ResultsThe Claim Evaluation Tools database currently includes a battery of multiple-choice items. Each item begins with a scenario which is intended to be relevant across contexts, and which can be used for children (from age 10 and above), adult members of the public and health professionals. People with expertise in research methods judged the items to have face validity, and end-users judged them relevant and acceptable in their settings. In response to feedback from methodologists and end-users, we simplified some text, explained terms where needed, and redesigned formats and instructions.ConclusionsThe Claim Evaluation Tools database is a flexible resource from which researchers, teachers and others can design measurement instruments to meet their own requirements. These evaluation tools are being managed and made freely available for non-commercial use (on request) through Testing Treatments interactive (testingtreatments.org).Trial registration numbersPACTR201606001679337 and PACTR201606001676150; Pre-results.

Accompanying the rise in the number of working parents is a growing demand for after-school care schemes for children. After-school care schemes, in addition to school, provide pupils with more learning opportunities than the experiences that school provides. The hypothesis is that after-school care schemes offer a better knowledge-basis for learning science than the school and home environments only. This article investigates how after-school care schemes affect learning in grades 5 and 8. While taking into account the socio-economic and ethnic backgrounds of pupils, results indicate that after-school care is of significance. The influence of after-school care is roughly explained by the increased number of learning opportunities. We discuss the implications for research and the limitations of this survey.

In this paper we describe a teaching approach focusing on modelling in physics, emphasizing scientific reasoning based on empirical data and using the notion of multiple representations of physical phenomena as a framework. We describe modelling activities from a project (PHYS 21) and relate some experiences from implementation of the modelling approach in Norwegian upper secondary physics classrooms.

Background and Purpose: The purpose of this article is to test the requirement of “local independence” in the newly developed “Maternal Health Literacy” (MaHeLi) composite scale measuring health literacy in pregnant adolescents attending antenatal care. Methods: The 20-item scale was administered to 384 adolescents aged 15–19 years attending antenatal care in Uganda during the period July–December 2013. Rasch analysis was conducted using RUMM2030. Results: Differential item functioning was observed for 3 items. One item had disordered response categories. One subscale brought substantial multidimensionality into the MaHeLi scale. Conclusions: Results support the use of a 12-item version of the MaHeLi scale. The article shows how Rasch analyses help us to identify violations of local independence in scales.

There is widespread concern for the situation of school physics regarding recruitment, contents, teaching methods, etc. In this study based on questionnaire and focus group data, we explore how upper secondary pupils and teachers perceive physics as a subject, how they experience physics instruction, and how physics compares to other subjects. Our study shows that pupils find physics interesting, but difficult and work-intensive; formalistic in nature, but still describing the world and everyday phenomena. Pupils express that “exoti” topics like astrophysics are closer to their life-world than mechanics etc. Whereas teachers complain about pupils' poor mathematics skills, pupils do not see this as a major problem. Physics instruction is still dominated by traditional content knowledge and seems to attract and reward pupils with this orientation. Pupils have a relatively weak understanding of the central role of experiments in science. Generally, pupils appear conservative in their views on teaching and learning; however, they would like stronger emphasis on qualitative and pupil-centred approaches. Based on our findings, we suggest that an upper secondary physics education preparing pupils for tomorrow's society should be characterized by variety, both within and among courses, integration of mathematics in the physics courses, more pupil-centred instruction, and a stronger emphasis on knowledge in context. © 2004 Wiley Periodicals, Inc. Sci Ed88:683–706, 2004

ObjectiveThe present study validates a revised scale measuring individuals’ level of the ‘engagement in dietary behaviour’ aspect of ‘critical nutrition literacy’ and describes how background factors affect this aspect of Norwegian tenth-grade students’ nutrition literacy.DesignData were gathered electronically during a field trial of a standardised sample test in science. Test items and questionnaire constructs were distributed evenly across four electronic field-test booklets. Data management and analysis were performed using the RUMM2030 item analysis package and the IBM SPSS Statistics 20 statistical software package.SettingStudents responded on computers at school.SubjectsSeven hundred and forty tenth-grade students at twenty-seven randomly sampled public schools were enrolled in the field-test study. The engagement in dietary behaviour scale and the self-efficacy in science scale were distributed to 178 of these students.ResultsThe dietary behaviour scale and the self-efficacy in science scale came out as valid, reliable and well-targeted instruments usable for the construction of measurements.ConclusionsGirls and students with high self-efficacy reported higher engagement in dietary behaviour than other students. Socio-economic status and scientific literacy – measured as ability in science by applying an achievement test – did not correlate significantly different from zero with students’ engagement in dietary behaviour.

Aims and objectives The aim of this paper is to describe how selected demographic characteristics ‘explain’ the observed variance in the distribution of maternal health literacy estimates in adolescents attending antenatal care in Uganda, as estimated by the ‘Maternal health literacy scale’. Background By the age of 20 years, more than 60% of Ugandan females are mothers. In the Busoga region of Uganda, the percentage of pregnant adolescents and adolescent mothers is at its highest (above 30%). Design Validated questionnaire survey. Methods The Maternal health literacy scale was administered to 384 adolescents aged 15–19 years attending antenatal care in Jinja and Iganga districts of the Busoga region during the period of July 2013–December 2013. The Mann–Whitney U test in SPSS21 was used to determine if the two levels of dichotomised person factors, i.e. demographic characteristics, relate to ‘significantly’ different mean maternal health literacy estimates, not strictly following the normal distribution, as measured by the Maternal health literacy scale. Results The person factors, age, education level, pregnancy order and prepregnancy awareness about conception, explained approximately 12% of the observed variance in maternal health literacy estimates. Conclusions Prepregnancy awareness about conception was the single most contributory factor to the observed variance in estimated maternal health literacy levels. More research on women of childbearing age is warranted to explore the impact of further person factors on the maternal health literacy in pregnant adolescents. Relevance to clinical practice Using the person factors found to show ‘significant’ impact on maternal health literacy in pregnant adolescents, target-specific interventions aimed at improving maternal health literacy in pregnant adolescents can be formulated. By accounting for these factors in reproductive health policy designs, one might take preventive actions to curb the prevalence of adolescent pregnancies in both developing and developed countries.

ObjectiveCritical nutrition literacy (CNL), as an increasingly important area in public health nutrition, can be defined as the ability to critically analyse nutrition information, increase awareness and participate in action to address barriers to healthy eating behaviours. Far too little attention has been paid to establishing valid instruments for measuring CNL. The aim of the present study was to assess the appropriateness of utilizing the latent scales of a newly developed instrument assessing nursing students’ ‘engagement in dietary habits’ (the ‘engagement’ scale) and their level of ‘taking a critical stance towards nutrition claims and their sources’ (the ‘claims’ scale).DesignData were gathered by distributing a nineteen-item paper-and-pencil self-report questionnaire to university colleges offering nursing education. The study had a cross-sectional design using Rasch analysis. Data management and analysis were performed using the software packages RUMM2030 and SPSS version 20.SettingSchool personnel handed out the questionnaires.SubjectsFour hundred and seventy-three students at ten university colleges across Norway responded (52 % response rate).ResultsDisordered thresholds were rescored, an under-discriminating item was discarded and one item showing uniform differential item functioning was split. The assumption of item locations being differentiated by stages was strengthened. The analyses demonstrated possible dimension violations of local independence in the ‘claims’ scale data and the ‘engagement’ scale could have been better targeted.ConclusionsThe study demonstrates the usefulness of Rasch analysis in assessing the psychometric properties of scales developed to measure CNL. Qualitative research designs could further improve our understanding of CNL scales.