Mapping the terrain: A comprehensive exploration of health literacy among youth

Olzhas Zhamantayev 1, Karina Nukeshtayeva 1 * , Gaukhar Kayupova 1, Zhaniya Dauletkaliyeva 1, Zhanerke Bolatova 1, Aliya Takuadina 2, Nurbek Yerdessov 1
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1 School of Public Health, Karaganda Medical University, Karaganda, Kazakhstan
2 School of Informatics and Biostatistics, Karaganda Medical University, Karaganda, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 6, pp. 12-22. https://doi.org/10.23950/jcmk/13917
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ABSTRACT

Health literacy is identified as a crucial public health concept that demands the attention of policymakers due to its profound impact on population health. This comprehensive review explores the landscape of health literacy among youth, examining current circumstances, relevant policies, available resources, tools, and effective strategies. We aimed to comprehensively map and synthesize the existing literature on the current state of health literacy among young individuals. Employing a data-centric methodology, the review meticulously analyzes existing literature and research in the domain of youth health literacy. We displayed the results of the analysis, distributing them into appropriate blocks. The review emphasizes the need for deeper research to assess health literacy gaps among youth and select appropriate assessment tools. It also highlights the imperative to enhance the health literacy of young individuals, which presents a significant global challenge. Developed nations' governments show considerable interest in this issue, with potential legislative measures to foster competencies from early personal development. The review notes that multiple factors such as socioeconomic status, health risk behaviors, health status, gender, and age interplay with health literacy, requiring attention to disparities among at-risk populations. Despite numerous tools available for assessing general health literacy, the lack of a standardized international tool remains a concern for public health professionals. Addressing health literacy necessitates a multifaceted approach that considers diverse influences on health education, communication, and behavior, especially among youth. Tailored interventions designed for specific populations can bridge literacy gaps and enhance overall well-being.

CITATION

Zhamantayev O, Nukeshtayeva K, Kayupova G, Dauletkaliyeva Z, Bolatova Z, Takuadina A, et al. Mapping the terrain: A comprehensive exploration of health literacy among youth. J CLIN MED KAZ. 2023;20(6):12-22. https://doi.org/10.23950/jcmk/13917

REFERENCES

  • Ministerial declaration of the 2009 high-level segment of the Economic and Social Council”: “Implementing the internationally agreed goals and commitments in regard to global public health. Ministerial Declaration-2009
  • Sørensen K, Levin-Zamir D, Duong T V., Okan O, Brasil VV, Nutbeam D. Building health literacy system capacity: a framework for health literate systems. Health Promot Int. 2021;36(Supplement_1):I13-I23. https://doi.org/10.1093/HEAPRO/DAAB153
  • Sørensen K. Defining health literacy: Exploring differences and commonalities. International Handbook of Health Literacy. 2022; 5-20. https://doi.org/10.51952/9781447344520.CH001
  • Health Promotion. Accessed August 24, 2023. https://www.who.int/teams/health-promotion/enhanced-wellbeing/seventh-global-conference
  • Rudd RE. The evolving concept of Health literacy: New directions for health literacy studies. 2015;8(1):7-9. https://doi.org/10.1179/1753806815Z.000000000105
  • Borzekowski DLG. Considering children and health literacy: a theoretical approach. Pediatrics. 2009; 124(Suppl 3). https://doi.org/10.1542/PEDS.2009-1162D
  • Bröder J, Okan O, Bauer U, et al. Health literacy in childhood and youth: A systematic review of definitions and models. BMC Public Health. 2017; 17(1):1-25. https://doi.org/10.1186/S12889-017-4267-Y/TABLES/6
  • Sørensen K, Van Den Broucke S, Fullam J, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012; 12(1):1-13. https://doi.org/10.1186/1471-2458-12-80/TABLES/4
  • Schulenkorf T, Sørensen K, Okan O. International Understandings of Health Literacy in Childhood and Adolescence-A Qualitative-Explorative Analysis of Global Expert Interviews. Int J Environ Res Public Health. 2022; 19(3). https://doi.org/10.3390/IJERPH19031591
  • Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011; 155(2):97-107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
  • Sørensen K, Pelikan JM, Röthlin F, et al. Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015; 25(6):1053-1058. https://doi.org/10.1093/EURPUB/CKV043
  • Svendsen MT, Bak CK, Sørensen K, et al. Associations of health literacy with socioeconomic position, health risk behavior, and health status: A large national population-based survey among Danish adults. BMC Public Health. 2020; 20(1):1-12. https://doi.org/10.1186/S12889-020-08498-8/FIGURES/2
  • Arriaga M, Francisco R, Nogueira P, et al. Health Literacy in Portugal: Results of the Health Literacy Population Survey Project 2019-2021. Int J Environ Res Public Health. 2022; 19(7). https://doi.org/10.3390/IJERPH19074225
  • Duong T V., Aringazina A, Baisunova G, et al. Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries. J Epidemiol. 2017; 27(2):80-86. https://doi.org/.1016/J.JE.2016.09.005
  • Aringazina AM, Ainakulov DA, Kamkhen YuB, Khegai YeL. Health Literacy in Kazakhstan: future perspectives. Vestnik KazNMU. 2018; 3:405-410.
  • Rababah JA, Al-Hammouri MM, Drew BL, Aldalaykeh M. Health literacy: Exploring disparities among college students. BMC Public Health. 2019;19(1):1-11. https://doi.org/10.1186/S12889-019-7781-2/TABLES/5
  • Vozikis A, Drivas K, Milioris K. Health literacy among university students in Greece: determinants and association with self-perceived health, health behaviours and health risks. Archives of Public Health. 2014; 72(1):15. https://doi.org/10.1186/2049-3258-72-15
  • Patil U, Kostareva U, Hadley M, et al. Health Literacy, Digital Health Literacy, and COVID-19 Pandemic Attitudes and Behaviors in U.S. College Students: Implications for Interventions. International Journal of Environmental Research and Public Health. 2021; 2021;18(6):3301. https://doi.org/10.3390/IJERPH18063301
  • Ran M, Peng L, Liu Q, Pender M, He F, Wang H. The association between quality of life (QOL) and health literacy among junior middle school students: a cross-sectional study. BMC Public Health. 2018; 18(1). https://doi.org/10.1186/S12889-018-6082-5
  • D.C. Law 22-66. Health Literacy Council Establishment Act of 2017. | D.C. Law Library. Accessed August 24, 2023. https://code.dccouncil.gov/us/dc/council/laws/22-66
  • National Action Plan to Improve Health Literacy | health.gov. Accessed August 24, 2023. https://health.gov/our-work/national-health-initiatives/health-literacy/national-action-plan-improve-health-literacy
  • National Action Plan to Improve Health Literacy | health.gov. Accessed August 24, 2023. https://health.gov/our-work/national-health-initiatives/health-literacy/national-action-plan-improve-health-literacy
  • Organizations and Committees | Health Literacy | CDC. Accessed August 24, 2023. https://www.cdc.gov/healthliteracy/organizations-committees.html
  • The Constitution — Official website of the President of the Republic of Kazakhstan. Accessed August 24, 2023. https://www.akorda.kz/en/official_documents/constitution
  • Mardanova G. Informacionno-pravovoye obecpecheniye pravovoi gramonosti v sfere zdravookhraneniya (Information and legal support of legal literacy in the field of healthcare) [in Russian]. Jurnal yuridicheskih isssleedovanii. 2018; (4).
  • Dauleetkaliyeva Zh. Azamatardyn oz densaulygy ushin yntymakty zhauapkershilik mekhanizmnin koncepciyasyn azirleu (Development of the concept of the mechanism of joint responsibility of citizens for their own health) [in Kazakh]. PhD Dissertation.
  • V Kazakhstane realizuyetsya Dorozhnaya karta po propagande zdorovogo obraza zhizni (Kazakhstan is implementing a Roadmap to promote a healthy lifestyle) [in Russian]. Accessed August 24, 2023. https://ortcom.kz/en/novosti/1691118550
  • Vamos S, Yeung P, Bruckermann T, et al. Exploring Health Literacy Profiles of Texas University Students. Health Behav Policy Rev. 2016; 3(3):209-225. https://doi.org/10.14485/HBPR.3.3.3
  • Vashe A, Sekaran VC, Chandnani DG, Batcha NA binti A, Moganadass K, Saghadevan S. Psychometric properties of health literacy measure for adolescents (HELMA) and predictors of health literacy among youth from Malaysia and Sri Lanka. Journal of Turkish Science Education. 2022; 19(4):1206-1221. https://doi.org/10.36681/tused.2022.170
  • Loer AKM, Domanska OM, Kuhnert R, Houben R, Albrecht S, Jordan S. Online Survey for the Assessment of Generic Health Literacy among Adolescents in Germany (GeKoJu): Study Protocol. Int J Environ Res Public Health. 2020; 17(5). https://doi.org/10.3390/IJERPH17051518
  • Sukys S, Cesnaitiene VJ, Ossowsky ZM. Is health education at university associated with students’ health literacy? evidence from cross-sectional study applying HLS-EU-Q. Biomed Res Int. 2017. https://doi.org/10.1155/2017/8516843
  • Lee HY, Lee J, Kim NK. Gender Differences in Health Literacy Among Korean Adults: Do Women Have a Higher Level of Health Literacy Than Men? Am J Mens Health. 2015; 9(5):370-379. https://doi.org/10.1177/1557988314545485
  • Chakraverty D, Baumeister A, Aldin A, et al. Gender differences of health literacy in persons with a migration background: a systematic review and meta-analysis. BMJ Open. 2022; 12(7):e056090. https://doi.org/10.1136/BMJOPEN-2021-056090
  • Guo S, Yu X, Davis E, Armstrong R, Naccarella L. Comparison of Health Literacy Assessment Tools among Beijing School-Aged Children. Children (Basel). 2022; 9(8). https://doi.org/10.3390/CHILDREN9081128
  • Basargekar P, Singhavi C, Sinkar T, Goel M. How Socioeconomic and Demographic Factors Affect Health Literacy? Assessment of health literacy level in different socioeconomic classes in India. Asia Pacific Journal of Health Management. 2023; 18(1). https://doi.org/10.24083/APJHM.V18I1.1681
  • Milner A, Shields M, Scovelle AJ, Sutherland G, King TL. Health Literacy in Male-Dominated Occupations. Am J Mens Health. 2020; 14(5). https://doi.org/10.1177/1557988320954022/ASSET/IMAGES/LARGE/10.1177
  • Li Z, Tian Y, Gong Z, Qian L. Health Literacy and Regional Heterogeneities in China: A Population-Based Study. Front Public Health. 2021; 9:603325. https://doi.org/10.3389/FPUBH.2021.603325/BIBTEX
  • Bánfai-Csonka H, Bánfai B, Jeges S, Betlehem J. Understanding Health Literacy among University Health Science Students of Different Nationalities. Int J Environ Res Public Health. 2022; 19(18). https://doi.org/10.3390/IJERPH191811758
  • Chisolm DJ, Manganello JA, Kelleher KJ, Marshal MP. Health literacy, alcohol expectancies, and alcohol use behaviors in teens. Patient Educ Couns. 2014; 97(2):291-296. doi:10.1016/J.PEC.2014.07.019
  • Evans AY, Anthony E, Gabriel G. Comprehensive Health Literacy Among Undergraduates: A Ghanaian University-Based Cross-Sectional Study. HLRP: Health Literacy Research and Practice. 2019; 3(4):227-237. https://doi.org/10.3928/24748307-20190903-01
  • Elsborg L, Krossdal F, Kayser L. Health literacy among Danish university students enrolled in health-related study programmes. Scand J Public Health. 2017; 45(8):831-838. https://doi.org/10.1177/1403494817733356
  • Uysal N, Ceylan E, Koç A. Health literacy level and influencing factors in university students. Health Soc Care Community. 2020; 28(2):505-511. https://doi.org/10.1111/HSC.12883
  • Juvinyà-Canal D, Suñer-Soler R, Porquet AB, Vernay M, Blanchard H, Bertran-Noguer C. Health Literacy among Health and Social Care University Students. International Journal of Environmental Research and Public Health. 2020;17(7):2273. https://doi.org/10.3390/IJERPH17072273
  • Mao Y, Xie T, Zhang N. Chinese Students’ Health Literacy Level and Its Associated Factors: A Meta-Analysis. International Journal of Environmental Research and Public Health. 2020;18(1):204. https://doi.org/10.3390/IJERPH18010204
  • Hanik, Hanik B, Stellefson ;, Michael. E-Health Literacy Competencies among Undergraduate Health Education Students: A Preliminary Study. International Electronic Journal of Health Education. 2011; 14:46-58.
  • Mullan J, Burns P, Weston K, et al. Health Literacy amongst Health Professional University Students: A Study Using the Health Literacy Questionnaire. Education Sciences. 2017;7(2):54. https://doi.org/10.3390/EDUCSCI7020054
  • Mather C, Douglas T, Jacques A. Health literacy of undergraduate health profession students in Australia: A comparison of the island state of Tasmania and other Australian universities. Kontakt. 2018; 20(4):386-393. https://doi.org/10.1016/j.kontakt.2018.08.008
  • Zhang Y, Zhang F, Hu P, et al. Exploring Health Literacy in Medical University Students of Chongqing, China: A Cross-Sectional Study. PLoS One. 2016; 11(4):e0152547. https://doi.org/10.1371/JOURNAL.PONE.0152547
  • Sarhan MBA, Fujii Y, Kiriya J, et al. Exploring health literacy and its associated factors among Palestinian university students: a cross-sectional study. Health Promot Int. 2021; 36(3):854-865. https://doi.org/10.1093/HEAPRO/DAAA089
  • Rong H, Cheng X, Garcia JM, et al. Survey of health literacy level and related influencing factors in military college students in Chongqing, China: A cross-sectional analysis. PLoS One. 2017; 12(5):e0177776. https://doi.org/10.1371/JOURNAL.PONE.0177776
  • Schricker J, Rathmann K, Dadaczynski K. Social differences in health literacy among university students: results of a web-based survey at the Technical University of Dortmund. Pravention und Gesundheitsforderung. 2020; 15(1):8-14. https://doi.org/10.1007/S11553-019-00731-6
  • Fatemeh Zahra Ahmadi, Mahmoud Mehr-Mohammadi, Ebrahim Talaee, et al. Health Literacy among students of Farhangian University. Payesh (Health Monitor). 2018; 17(3):257-266. Accessed August 24, 2023. http://payeshjournal.ir/article-1-44-en.html
  • Ramón-Arbués E, Granada-López JM, Antón-Solanas I, et al. Factors related with nursing students’ health literacy: a cross sectional study. Front Public Health. 2023; 11. https://doi.org/10.3389/FPUBH.2023.1053016
  • Journal of Clinical Medicine of Kazakhstan. Accessed August 24, 2023. https://www.clinmedkaz.org/article/does-health-literacy-affect-attitudes-towards-healthy-eating-and-health-anxiety-in-young-adults-13485
  • Tavousi M, Mohammadi S, Sadighi J, et al. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS One. 2022;17(7). https://doi.org/10.1371/JOURNAL.PONE.0271524
  • Davis TC, Wolf MS, Arnold CL, et al. Development and validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): A tool to screen adolescents for below-grade reading in health care settings. Pediatrics. 2006; 118(6). https://doi.org/10.1542/peds.2006-1139
  • Parker RM, Baker DW, Willia M V., Nurss JR. The test of functional health literacy in adults: A new instrument for measuring patients’ literacy skills. J Gen Intern Med. 1995; 10(10):537-541. https://doi.org/10.1007/BF02640361/METRICS
  • Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005; 3(6):514-522. https://doi.org/10.1370/AFM.405
  • Kanj M, Mitic W. Health Literacy and Health Promotion: Definitions, Concepts and Examples in the Eastern Mediterranean Region. Individual Empowerment Conference Working Document.
  • Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health. 2013; 13(1):1-17. https://doi.org/10.1186/1471-2458-13-658/TABLES/5
  • Health Literacy Tool Shed. Accessed August 24, 2023. https://healthliteracy.bu.edu/hls-eu-q
  • Sørensen K, Van Den Broucke S, Pelikan JM, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013; 13(1). https://doi.org/10.1186/1471-2458-13-948
  • Duong T V., Aringazina A, Baisunova G, et al. Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries. J Epidemiol. 2017; 27(2):80-86. https://doi.org/10.1016/J.JE.2016.09.005
  • Soares VL, Lemos S, Barbieri-Figueiredo M do C, Morais MCS, Sequeira C. Diabetes Mellitus Family Assessment Instruments: A Systematic Review of Measurement Properties. Int J Environ Res Public Health. 2023; 20(2). https://doi.org/10.3390/IJERPH20021325
  • Seng JB, Yeam C, Huang C, Tan N, Low L. Pandemic-related health literacy: a systematic review of literature in COVID-19, SARS and MERS pandemics. Singapore Med J. 2023. https://doi.org/10.4103/SINGAPOREMEDJ.SMJ-2021-026
  • Organization WH. Shanghai declaration on promoting health in the 2030 Agenda for Sustainable Development. Health Promot Int. 2017; 32(1):7-8. https://doi.org/10.1093/HEAPRO/DAW103
  • Okan O, Lopes E, Bollweg TM, et al. Generic health literacy measurement instruments for children and adolescents: A systematic review of the literature. BMC Public Health. 2018; 18(1). https://doi.org/10.1186/s12889-018-5054-0
  • Davis TC, Wolf MS, Arnold CL, et al. Development and validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): a tool to screen adolescents for below-grade reading in health care settings. Pediatrics. 2006; 118(6). https://doi.org/10.1542/PEDS.2006-1139
  • Chisolm DJ, Buchanan L. Measuring adolescent functional health literacy: a pilot validation of the Test of Functional Health Literacy in Adults. J Adolesc Health. 2007; 41(3):312-314. https://doi.org/10.1016/J.JADOHEALTH.2007.04.015
  • Driessnack M, Chung S, Perkhounkova E, Hein M. Using the “Newest Vital Sign” to assess health literacy in children. J Pediatr Health Care. 2014; 28(2):165-171. https://doi.org/10.1016/J.PEDHC.2013.05.005
  • Vamos S, Okan O, Sentell T, Rootman I. Making a Case for “Education for Health Literacy”: An International Perspective. Int J Environ Res Public Health. 2020; 17(4). https://doi.org/10.3390/IJERPH17041436
  • Nutbeam D, McGill B, Premkumar P. Improving health literacy in community populations: a review of progress. Health Promot Int. 2018;33(5):901-911. https://doi.org/10.1093/HEAPRO/DAX015
  • Walters R, Leslie SJ, Polson R, Cusack T, Gorely T. Establishing the efficacy of interventions to improve health literacy and health behaviours: A systematic review. BMC Public Health. 2020; 20(1):1-17. https://doi.org/10.1186/S12889-020-08991-0/TABLES/4
  • Mullings J, Thoms-Rodriguez CA, McCaw-Binns AM, Paul T. Strategies to Reduce Hospital Mortality in Lower and Middle Income Countries (LMICs) and Resource-Limited Settings. 2019. https://doi.org/10.5772/INTECHOPEN.73957
  • Visscher BB, Steunenberg B, Heijmans M, et al. Evidence on the effectiveness of health literacy interventions in the EU: a systematic review. BMC Public Health. 2018; 18(1). https://doi.org/10.1186/S12889-018-6331-7
  • Geboers B, Reijneveld SA, Koot JAR, de Winter AF. Moving towards a Comprehensive Approach for Health Literacy Interventions: The Development of a Health Literacy Intervention Model. Int J Environ Res Public Health. 2018; 15(6). https://doi.org/10.3390/IJERPH15061268
  • Şipal ŞB, Türkoğlu N. Effect of women’s health literacy levels on their beliefs about breast cancer screening. Journal of Clinical Medicine of Kazakhstan. 2022; 19(6):89-95. https://doi.org/10.23950/JCMK/12720
  • Li Y, Lv X, Liang J, Dong H, Chen C. The development and progress of health literacy in China. Front Public Health. 2022; 10. https://doi.org/10.3389/FPUBH.2022.1034907
  • Beauchamp A, Batterham RW, Dodson S, et al. Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia). BMC Public Health. 2017; 17(1):1-18. https://doi.org/10.1186/S12889-017-4147-5/FIGURES/4
  • Meherali S, Punjani NS, Mevawala A. Health Literacy Interventions to Improve Health Outcomes in Low- and Middle-Income Countries. Health Lit Res Pract. 2020; 4(4):e251-e266. https://doi.org/10.3928/24748307-20201118-01
  • Meppelink CS, Van Weert JCM, Haven CJ, Smit EG. The Effectiveness of Health Animations in Audiences With Different Health Literacy Levels: An Experimental Study. J Med Internet Res. 2015;17(1):e11. https://doi.org/10.2196/JMIR.3979
  • Truong M, Fenton SH. Understanding the Current Landscape of Health Literacy Interventions within Health Systems. Perspect Health Inf Manag. 2022; 19(Spring).
  • Austvoll-Dahlgren A, Bjørndal A, Odgaard-Jensen J, Helseth S. Evaluation of a web portal for improving public access to evidence-based health information and health literacy skills: a pragmatic trial. PLoS One. 2012; 7(5). https://doi.org/10.1371/JOURNAL.PONE.0037715
  • Saunders C, Palesy D, Lewis J. Systematic Review and Conceptual Framework for Health Literacy Training in Health Professions Education. Health Professions Education. 2019; 5(1):13-29. https://doi.org/10.1016/J.HPE.2018.03.003
  • Connell L, Finn Y, Sixsmith J. Original research: Health literacy education programmes developed for qualified health professionals: a scoping review. BMJ Open. 2023; 13(3). https://doi.org/10.1136/BMJOPEN-2022-070734
  • Gilbert HM, Leurent B, Sutton S, Alexis-Garsee C, Morris RW, Nazareth I. ESCAPE: a randomised controlled trial of computer-tailored smoking cessation advice in primary care. Addiction (Abingdon, England). 2013; 108(4):811-819. https://doi.org/10.1111/ADD.12005
  • Faigenbaum AD, MacDonald JP, Carvalho C, Rebullido TR. The Pediatric Inactivity Triad: A Triple Jeopardy for Modern Day Youth. ACSMs Health Fit J. 2020; 24(4):10-17. https://doi.org/10.1249/FIT.0000000000000584
  • Faigenbaum AD, Faigenbaum AD, Rebullido TR, Zaichkowsky L. Heads-up: Effective Strategies for Promoting Mental Health Literacy in Youth Fitness Programs.
  • Fernández-Gutiérrez M, Bas-Sarmiento P, Albar-Marín MJ, Paloma-Castro O, Romero-Sánchez JM. Health literacy interventions for immigrant populations: a systematic review. Int Nurs Rev. 2018; 65(1):54-64. https://doi.org/10.1111/INR.12373
  • Schaefer CT. Integrated review of health literacy interventions. Orthop Nurs. 2008; 27(5):302-317. https://doi.org/10.1097/01.NOR.0000337283.55670.75
  • Groysman AY, Majety P, Dong Z, Hou R. Enhancing Patient Literacy on Calcium Supplementation: A Quality Improvement Initiative. Endocrine Practice. 2023; 29(1):48-52. https://doi.org/10.1016/J.EPRAC.2022.10.011
  • Carbone ET, Zoellner JM. Nutrition and health literacy: A systematic review to inform nutrition research and practice. J Acad Nutr Diet. 2012; 112(2):254-265. https://doi.org/10.1016/J.JADA.2011.08.042
  • Johnson SA, Kirkpatrick CF, Miller NH, Carson JAS, Handu D, Moloney L. Saturated Fat Intake and the Prevention and Management of Cardiovascular Disease in Adults: An Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet. 2023. https://doi.org/10.1016/J.JAND.2023.07.017
  • McNaughton D, Balandin S, Kennedy P, Sandmel T. Health transitions for youth with complex communication needs: The importance of health literacy and communication strategies. J Pediatr Rehabil Med. 2010; 3(4):311-318. https://doi.org/10.3233/PRM-2010-0143
  • Health literacy development for the prevention and control of noncommunicable diseases: volume 4: case studies from WHO national health literacy demonstration projects. Accessed August 24, 2023. https://apps.who.int/iris/handle/10665/364206
  • Kripalani S, Weiss BD. Teaching About Health Literacy and Clear Communication. J Gen Intern Med. 2006; 21(8):888. https://doi.org/10.1111/J.1525-1497.2006.00543.X
  • Guo S, Yu X, Davis E, Armstrong R, Naccarella L. Health Literacy: An Interactive Outcome Among Secondary Students in Beijing. Health Lit Res Pract. 2021; 5(1):e1-e14. https://doi.org/10.3928/24748307-20201117-01
  • Milford E, Morrison K, Teutsch C, et al. Out of the classroom and into the community: Medical students consolidate learning about health literacy through collaboration with Head Start. BMC Med Educ. 2016; 16(1):1-9. https://doi.org/10.1186/S12909-016-0635-Z/TABLES/4
  • Marks Ray. Health literacy and school-based health education. 2012; 271.
  • Scheckel M, Emery N, Nosek C. Addressing health literacy: the experiences of undergraduate nursing students. J Clin Nurs. 2010; 19(5-6):794-802. https://doi.org/10.1111/J.1365-2702.2009.02991.X
  • Saito AS, Creedy DK. Determining mental health literacy of undergraduate nursing students to inform learning and teaching strategies. Int J Ment Health Nurs. 2021; 30(5):1117-1126. https://doi.org/10.1111/INM.12862
  • McMichael C, Gifford S. “It is Good to Know Now…Before it’s Too Late”: Promoting Sexual Health Literacy Amongst Resettled Young People With Refugee Backgrounds. Sexuality & Culture. 2009; 13(4):218-236. Accessed August 24, 2023. https://www.academia.edu/20797344/It_is_Good_to_Know_Now_Before_its_Too_Late_Promoting_Sexual_Health_Literacy_Amongst_Resettled_Young_People_With_Refugee_Backgrounds
  • Peterson FL, Cooper RJ, Laird JM. Enhancing teacher health literacy in school health promotion: a vision for the new millennium. J Sch Health. 2001; 71(4):138-144. https://doi.org/10.1111/J.1746-1561.2001.TB01311.X
  • Devraj R, Butler LM, Gupchup G V., Poirier TI. Active-learning strategies to develop health literacy knowledge and skills. Am J Pharm Educ. 2010; 74(8). https://doi.org/10.5688/AJ7408137
  • Suwono H, Permana T, Saefi M, Fachrunnisa R. The problem-based learning (PBL) of biology for promoting health literacy in secondary school students. Journal of Biological Education. 2021; 57. 1-15. https://doi.org/10.1080/00219266.2021.1884586
  • ​Ross PT, Lukela MP, Agbakwuru U, Lypson ML. Medical students’ recognition of health literacy in a single embedded curricular activity. Int J Med Educ. 2013; 4:115-119. https://doi.org/10.5116/IJME.51AA.3508
  • Tappe MK, Galer-Unti RA. Health educators’ role in promoting health literacy and advocacy for the 21st century. J Sch Health. 2001; 71(10):477-482. https://doi.org/10.1111/J.1746-1561.2001.TB07284.X
  • Mogford E, Gould L, Devoght A. Teaching critical health literacy in the US as a means to action on the social determinants of health. Health Promot Int. 2011; 26(1):4-13. https://doi.org/10.1093/HEAPRO/DAQ049
  • Toronto CE, Weatherford B. Health Literacy Education in Health Professions Schools: An Integrative Review. J Nurs Educ. 2015; 54(12):669-676. https://doi.org/10.3928/01484834-20151110-02
  • Torres-Toukoumidis A, Vintimilla-León D, De-Santis A, Cárdenas-Tapia J, Mäeots M. Playful Experience in Health Literacy. Beyond Gamification and Serious Games. Smart Innovation, Systems and Technologies. 2023; 318:511-525. https://doi.org/10.1007/978-981-19-6347-6_46
  • Haruna H, Zainuddin Z, Okoye K, et al. Improving instruction and sexual health literacy with serious games and gamification interventions: an outlook to students’ learning outcomes and gender differences. Interactive Learning Environments. 2023; 31(4):2392-2410. https://doi.org/10.1080/10494820.2021.1888754
  • Taba M, Allen TB, Caldwell PHY, et al. Adolescents’ self-efficacy and digital health literacy: a cross-sectional mixed methods study. BMC Public Health. 2022;22(1):1-13. https://doi.org/10.1186/S12889-022-13599-7/FIGURES/1
  • Kim S, Oh J. The Relationship between E-Health Literacy and Health-Promoting Behaviors in Nursing Students: A Multiple Mediation Model. Int J Environ Res Public Health. 2021; 18(11). https://doi.org/10.3390/IJERPH18115804
  • Li S, Cui G, Kaminga AC, Cheng S, Xu H. Associations Between Health Literacy, eHealth Literacy, and COVID-19-Related Health Behaviors Among Chinese College Students: Cross-sectional Online Study. J Med Internet Res. 2021; 23(5). https://doi.org/10.2196/25600