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      Do adolescents understand the items of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) – German version? Findings from cognitive interviews of the project “Measurement of Health Literacy Among Adolescents” (MOHLAA) in Germany

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          Abstract

          Background

          In Germany, there are no measurement tools to assess the general health literacy of adolescents. The aim of the study “Measurement of Health Literacy Among Adolescents” (MOHLAA) is to develop such a tool for use among adolescents aged 14–17. The German version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47-GER) served as a blueprint for the development of the tool. The present study examined the extent to which the HLS-EU-Q47-GER can be applied to the measurement of general health literacy in adolescents.

          Methods

          The applicability of the HLS-EU-Q47-GER for adolescents was tested qualitatively using cognitive interviewing (CI). Purposive sampling was used to achieve an equal distribution of participants regarding age groups, educational backgrounds and gender. CI was standardized on the basis of an interview guide. Verbal probing and the retrospective think-aloud technique were applied. The interviews were audio-recorded, transcribed and analyzed using the criteria of theory-based analysis, which were derived from the model of cognitive processes. The analysis focused on identifying terms and questions that were difficult to understand and on scrutinizing the extent to which the content of the items is appropriate for assessing adolescents’ health literacy.

          Results

          Adolescent respondents were unfamiliar with some terms of the HLS-EU-Q47-GER or provided heterogeneous interpretations of the terms. They had limited or no experience regarding some health-related tasks in health care and disease prevention that are addressed by HLS-EU-Q-items. A few items seemed to be too “difficult” to answer due to a high abstraction level or because they lacked any reference to the everyday lives of youth. Despite comprehension problems with some of the HLS-EU items, the respondents assessed the covered health-related tasks as “very easy” or “fairly easy”. CI stressed the importance of interpersonal agents, especially parents, in helping adolescents understand and judge the reliability of health information.

          Conclusions

          The results of CI indicated that the applicability of the HLS-EU-Q47-GER to the measurement of general health literacy among adolescents aged 14–17 is limited. In order to prevent biased data, some items of the questionnaire should be adjusted to adolescents’ state of development and experiences with health care and disease prevention.

          Electronic supplementary material

          The online version of this article (10.1186/s13690-018-0276-2) contains supplementary material, which is available to authorized users.

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          Physical fitness in childhood and adolescence: a powerful marker of health.

          This review aims to summarize the latest developments with regard to physical fitness and several health outcomes in young people. The literature reviewed suggests that (1) cardiorespiratory fitness levels are associated with total and abdominal adiposity; (2) both cardiorespiratory and muscular fitness are shown to be associated with established and emerging cardiovascular disease risk factors; (3) improvements in muscular fitness and speed/agility, rather than cardiorespiratory fitness, seem to have a positive effect on skeletal health; (4) both cardiorespiratory and muscular fitness enhancements are recommended in pediatric cancer patients/survivors in order to attenuate fatigue and improve their quality of life; and (5) improvements in cardiorespiratory fitness have positive effects on depression, anxiety, mood status and self-esteem, and seem also to be associated with a higher academic performance. In conclusion, health promotion policies and physical activity programs should be designed to improve cardiorespiratory fitness, but also two other physical fitness components such us muscular fitness and speed/agility. Schools may play an important role by identifying children with low physical fitness and by promoting positive health behaviors such as encouraging children to be active, with special emphasis on the intensity of the activity.
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            Research Synthesis: The Practice of Cognitive Interviewing

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              Adolescent physical activity and health: a systematic review.

              Physical activity in adolescence may contribute to the development of healthy adult lifestyles, helping reduce chronic disease incidence. However, definition of the optimal amount of physical activity in adolescence requires addressing a number of scientific challenges. This article reviews the evidence on short- and long-term health effects of adolescent physical activity. Systematic reviews of the literature were undertaken using a reference period between 2000 and 2004, based primarily on the MEDLINE/PubMed database. Relevant studies were identified by examination of titles, abstracts and full papers, according to inclusion criteria defined a priori. A conceptual framework is proposed to outline how adolescent physical activity may contribute to adult health, including the following pathways: (i) pathway A--tracking of physical activity from adolescence to adulthood; (ii) pathway B--direct influence of adolescent physical activity on adult morbidity; (iii) pathway C--role of physical activity in treating adolescent morbidity; and (iv) pathway D - short-term benefits of physical activity in adolescence on health. The literature reviews showed consistent evidence supporting pathway 'A', although the magnitude of the association appears to be moderate. Thus, there is an indirect effect on all health benefits resulting from adult physical activity. Regarding pathway 'B', adolescent physical activity seems to provide long-term benefits on bone health, breast cancer and sedentary behaviours. In terms of pathway 'C', water physical activities in adolescence are effective in the treatment of asthma, and exercise is recommended in the treatment of cystic fibrosis. Self-esteem is also positively affected by adolescent physical activity. Regarding pathway 'D', adolescent physical activity provides short-term benefits; the strongest evidence refers to bone and mental health. Appreciation of different mechanisms through which adolescent physical activity may influence adult health is essential for drawing recommendations; however, the amount of exercise needed for achieving different benefits may vary. Physical activity promotion must start in early life; although the 'how much' remains unknown and needs further research, the lifelong benefits of adolescent physical activity on adult health are unequivocal.
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                Author and article information

                Contributors
                DomanskaO@rki.de
                firngesc@zedat.fu-berlin.de
                torsten.bollweg@uni-bielefeld.de
                contact@globalhealthliteracyacademy.org
                Christine.Holmberg@mhb-fontane.de
                JordanS@rki.de
                Journal
                Arch Public Health
                Arch Public Health
                Archives of Public Health
                BioMed Central (London )
                0778-7367
                2049-3258
                10 July 2018
                10 July 2018
                2018
                : 76
                : 46
                Affiliations
                [1 ]ISNI 0000 0001 0940 3744, GRID grid.13652.33, Department of Epidemiology and Health Monitoring, Robert Koch Institute, ; Berlin, Germany
                [2 ]ISNI 0000 0001 0944 9128, GRID grid.7491.b, Centre for Prevention and Intervention in Childhood and Adolescence (CPI), , Bielefeld University, ; Bielefeld, Germany
                [3 ]Global Health Literacy Academy, Risskov, Denmark
                [4 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Institute of Public Health, , Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, ; Berlin, Germany
                [5 ]Institute of Social Medicine and Epidemiology, Medical School Brandenburg Theodor Fontane, Brandenburg/Havel, Germany
                Author information
                http://orcid.org/0000-0003-2831-3351
                Article
                276
                10.1186/s13690-018-0276-2
                6040081
                878e5f4d-b7d7-4148-9ca1-148237ba8832
                © The Author(s). 2018

                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
                : 20 October 2017
                : 5 June 2018
                Funding
                Funded by: the German Federal Ministry of Education and Research (BMBF)
                Award ID: 01EL1424D
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Public health
                health literacy,measurement,hls-eu-q,qualitative,cognitive interviewing,adolescents,germany
                Public health
                health literacy, measurement, hls-eu-q, qualitative, cognitive interviewing, adolescents, germany

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