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      Health literacy in childhood and youth: a systematic review of definitions and models

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          Abstract

          Background

          Children and young people constitute a core target group for health literacy research and practice: during childhood and youth, fundamental cognitive, physical and emotional development processes take place and health-related behaviours and skills develop. However, there is limited knowledge and academic consensus regarding the abilities and knowledge a child or young person should possess for making sound health decisions. The research presented in this review addresses this gap by providing an overview and synthesis of current understandings of health literacy in childhood and youth. Furthermore, the authors aim to understand to what extent available models capture the unique needs and characteristics of children and young people.

          Method

          Six databases were systematically searched with relevant search terms in English and German. Of the n = 1492 publications identified, N = 1021 entered the abstract screening and N = 340 full-texts were screened for eligibility. A total of 30 articles, which defined or conceptualized generic health literacy for a target population of 18 years or younger, were selected for a four-step inductive content analysis.

          Results

          The systematic review of the literature identified 12 definitions and 21 models that have been specifically developed for children and young people. In the literature, health literacy in children and young people is described as comprising variable sets of key dimensions, each appearing as a cluster of related abilities, skills, commitments, and knowledge that enable a person to approach health information competently and effectively and to derive at health-promoting decisions and actions.

          Discussion

          Identified definitions and models are very heterogeneous, depicting health literacy as multidimensional, complex construct. Moreover, health literacy is conceptualized as an action competence, with a strong focus on personal attributes, while also recognising its interrelatedness with social and contextual determinants. Life phase specificities are mainly considered from a cognitive and developmental perspective, leaving children’s and young people’s specific needs, vulnerabilities, and social structures poorly incorporated within most models. While a critical number of definitions and models were identified for youth or secondary school students, similar findings are lacking for children under the age of ten or within a primary school context.

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          Most cited references64

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          Risk Society : Towards a New Modernity

          This panoramic analysis of the condition of Western societies has been hailed as a classic. This first English edition has taken its place as a core text of contemporary sociology alongside earlier typifications of society as postindustrial and current debates about the social dimensions of the postmodern.</p> <p></p> <p>Underpinning the analysis is the notion of the `risk society'. The changing nature of society's relation to production and distribution is related to the environmental impact as a totalizing, globalizing economy based on scientific and technical knowledge becomes more central to social organization and social conflict.
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                Author and article information

                Contributors
                Janine.broeder@uni-bielefeld.de
                Orkan.okan@uni-bielefeld.de
                ullrich.bauer@uni-bielefeld.de
                dirk.bruland@uni-bielefeld.de
                sandra.schlupp@uni-bielefeld.de
                torsten.bollweg@uni-bielefeld.de
                saboga@ensp.unl.pt
                e.bond@UCS.AC.UK
                contact@globalhealthliteracyacademy.org
                evamaria.bitzer@ph-freiburg.de
                JordanS@rki.de
                DomanskaO@rki.de
                FirngesC@rki.de
                graca@ie.uminho.pt
                uwe.bittlingmayer@ph-freiburg.de
                diamos@zahav.net.il
                juergen.pelikan@goeg.at
                diana.sahrai@fhnw.ch
                a.lenz@katho-nrw.de
                p.wahl@katho-nrw.de
                mlt@aber.ac.uk
                fabian.kessl@uni-due.de
                paulo.pinheiro@uni-bielefeld.de
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                26 April 2017
                26 April 2017
                2017
                : 17
                : 361
                Affiliations
                [1 ]ISNI 0000 0001 0944 9128, GRID grid.7491.b, Centre for Prevention and Intervention in Childhood and Adolescence CPI, , Bielefeld University, ; Bielefeld, Germany
                [2 ]ISNI 0000000121511713, GRID grid.10772.33, National School of Public Health, , Universidade NOVA de Lisboa, ; Lisbon, Portugal
                [3 ]ISNI 0000 0004 0628 6070, GRID grid.449668.1, , University of Suffolk, ; Ipswich, UK
                [4 ]Global Health Literacy Academy, Urmond, The Netherlands
                [5 ]ISNI 0000 0001 2192 9976, GRID grid.466241.3, , University of Education, ; Freiburg i.Br, Germany
                [6 ]ISNI 0000 0001 0940 3744, GRID grid.13652.33, , Robert Koch Institute, ; Berlin, Germany
                [7 ]ISNI 0000 0001 2159 175X, GRID grid.10328.38, CIEC, Institute of Education, , University of Minho, ; Braga, Portugal
                [8 ]ISNI 0000 0004 1937 0562, GRID grid.18098.38, School of Public Health, , University of Haifa, ; Haifa, Israel
                [9 ]Austrian Public Health Institute, Gesundheit Österreich GmbH, Wien, Austria
                [10 ]School of Education, Basel, Switzerland
                [11 ]ISNI 0000 0001 1010 8830, GRID grid.466086.a, , Katholische Hochschule Nordrhein-Westfalen, ; Paderborn, Germany
                [12 ]ISNI 0000000121682483, GRID grid.8186.7, School of Education and Lifelong Learning, , Aberystwyth University, ; Aberystwyth, UK
                [13 ]ISNI 0000 0001 2187 5445, GRID grid.5718.b, , University Duisburg-Essen, ; Essen, Germany
                Author information
                http://orcid.org/0000-0002-0399-7649
                Article
                4267
                10.1186/s12889-017-4267-y
                5405535
                28441934
                0af723fa-dd68-44cb-941b-584f28d54bcb
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 July 2016
                : 13 April 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100002347, Bundesministerium für Bildung und Forschung;
                Award ID: 01EL1424A
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Public health
                health literacy,health competencies,children,young people,adolescents,pupils,definitions,conceptual models,dimensions,literature review

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