Representative Survey on Children’s Health Literacy in one Federal State of Germany


HL-Kids-NRW aims to assess the level of health literacy in a representative sample of children attending fourth grade of primary school in North Rhine-Westphalia, Germany. A questionnaire will be used that has been developed in the previous funding phase. This questionnaire will also be translated and adapted for the target group of young people aged 11 to 13.


Project Background

To address the demand for reliable data on children’s health literacy and to continue the research conducted in the project MoMChild (2015-2018), the follow-up project HL-Kids-NRW (2018-2021) will pursue the following aims:

  • to apply the questionnaire developed in the first funding phase in a representative survey on 4th grade schoolchildren’s health literacy
  • to translate the questionnaire into English and Portuguese, and to promote comparative surveys
  • to develop a questionnaire to assess health literacy of children aged 11-13 by building on the tools developed in the research projects MoMChild and MOHLAA.

The representative health literacy survey will be conducted in North Rhine-Westphalia (NRW), the most populous federal state of Germany. According to current scientific knowledge, this will be the first representative survey on primary schoolchildren’s health literacy with an adapted version of the HLS-EU-Q. The survey will contribute to the overall goals of the consortium and

  • provide for the first time representative data on the health literacy of children in NRW, Germany
  • add significantly to the evidence base on children’s health literacy
  • allow to determine the distribution of health literacy levels among 4th grade schoolchildren
  • explore the relationship between health literacy levels, gender, migration background, socio-economic status, school characteristics as well as other variables
  • allow for evidence-informed recommendations regarding the promotion of health literacy through interventions, curricula and policies.

To stimulate international empirical research on children’s health literacy, the questionnaire will be translated into an English version that will serve as a blueprint for research activities in other countries and for further translations. The questionnaire will also be translated into Portuguese, and a partnership has already been initiated with Luis Saboga-Nunes from the New University of Lisbon, Portugal. Within the frame of this cooperation, the MoMChild questionnaire will be applied in a national Portuguese school survey led by our partner. This will allow for the first time for a cross-country comparison between health literacy levels of children in Germany and Portugal. More translations in various other languages are planned, as we face an international demand for child-specific comprehensive health literacy measures [7, 27]. These translations will be conducted in close collaboration with partners from the international research community, and will be made freely available to be discussed, adjusted, validated and used for comparative surveys on children’s health literacy.

Both MoMChild and MOHLAA questionnaires will be combined and adapted to develop a comprehensive measure of health literacy tailored to children aged 11-13. This work will be conducted in close collaboration with the subproject MOHLAA2. For the development of this first questionnaire draft, several phases of qualitative testing will be conducted to ensure the appropriateness of items for the age group. By the end of the second funding period, a tested draft of the questionnaire will be available for field test.


Torsten Michael Bollweg
Bielefeld University