Health Literacy throughout adolescence: Invariance and validity study of three measurement scales in the general population

Patient Educ Couns. 2022 Apr;105(4):996-1003. doi: 10.1016/j.pec.2021.07.044. Epub 2021 Jul 28.


Objective: To simultaneously investigate the psychometric properties of three recently developed health literacy measurement scales throughout adolescence in the general population.

Methods: French versions of the Health Literacy for School-Aged Children (HLSAC, unidimensional) scale, the Health Literacy Assessment Scale for Adolescents (HAS-A, multidimensional) and the 16-item European Health Literacy Survey questionnaire (HLS-EU-Q16, unidimensional) were completed by 1 444 adolescents in 8th, 9th, 11th grade in general school and 11-12th grade in vocational school. Psychometric properties were studied using confirmatory factor analysis, McDonald's omega coefficient and hypothesis testing.

Results: Structural validity was acceptable (HLS-EU-Q16) to good (HAS-A and HLSAC), no measurement invariance issue was found and internal consistency was acceptable for the three scales (0.68-0.84). Convergent validity was low (Pearson correlation coefficients<0.5) and the only scale for which results were in agreement with a priori hypotheses was the HLSAC.

Conclusions: Our results were supportive of the use of HLSAC to assess health literacy during adolescence but the HAS-A, with a slightly better structural validity, can also be promoted due to its three measured dimensions.

Practice implications: The use of these scales in practice will help to focus on health literacy, a critical factor for prevention and health promotion in adolescence.

Keywords: Adolescence; HAS-A; HLS-EU-Q16; HLSAC; Health literacy; Psychometric properties.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Factor Analysis, Statistical
  • Health Literacy*
  • Humans
  • Psychometrics
  • Reproducibility of Results
  • Surveys and Questionnaires