Methods of Measuring Health Literacy of Children

The MoMChild subproject is aiming at the development, construction and validation of a health literacy instrument for children at the age of 9–10. Within the Health Literacy in Childhood and Adolescence Consortium (HLCA), it is allocated in the basic research work block (WB1).


Since the 1990ies, the amount of health literacy measurement tools is continuously increasing. Until a couple of years ago the focus mainly remained on adult populations when developing such tools. However, recent trends in health literacy research provide slightly observable movements considering methodologies for the child and adolescent population. Thereby, difficulties mainly arise from the gap in theories, conceptual frameworks, models and definition designed to meet the needs and demands of the young population in context of health literacy. Past studies related to children often used their own understanding of health literacy and they developed models that are foremost only applicable in their own specific study what in turn makes it difficult to transfer them to new study designs. Fast screening tool originally developed for adults in health care setting are being used in the child population as well but are inadequate to measure more than only functional health literacy skills such as reading, writing, and numeracy. The same is true for tools that are based on broader models of health literacy but addressing adults rather than children or adolescents. Development of an effectively measurable and assessable concept of health literacy needs to test existing questionnaires and those models underlying these tools, and to develop entirely new models and tools if nessecary.


The overall objective of MoMChild is the development and construction of a health literacy questionnaire for children at the age of 9–10, who will undergo the evaluation of its psychometric properties in order to be validated. The questionnaire will include a core health literacy instrument, further scales related to distinct concepts which are currently being examined (e.g. self-determination, health behaviour, self-reported health, and self-efficacy), and information such as socio demographic and psychographic data. The project is aiming at

  • Development and validation of a health literacy questionnaire for children at the age of 9–10
  • Lifestyle / milieu typology based on the collection of socio demographic and psychographic data
  • Collecting data on further distinct concepts such as self-determination, health behaviour, self-reported health, and self-efficacy

Research questions

  • What is the state of current health literacy levels in children 9 and 10 years old in primary school?
  • What role has health literacy as resource for autonomy, empowerment and patterns of health behaviour?
  • Is there a relation between self-efficacy and learning and doing health literacy in children?
  • Is there a relation between self-reported health status and health literacy in children?
  • How is health literacy of children related to social structures?
  • Who are children’s primary agents in their process of health socialisation (Parents, caregivers, teachers, friends, media, others)?
  • What knowledge do children have about health and health promotion?


The study design includes the adaptation and testing of methods to measure and assess health literacy and lifestyle/milieu related patterns (general sociodemographic and specific psychgraphic characteristics) of children at the age of 9–10. Measurements of milieu-related patterns of attitude, interest and orientation, and health literacy will be adapted to children by cognitive testing.

Project stages from 2015–2018

  1. Developmental stage: field access, concept clarification and questionnaire development
  2. Qualitative pilot: cognitive testing of the preliminary instrument; interviews; experimental control
  3. Developmental stage: scale and variables modification; completion of the tool for field test
  4. Quantitative stage: class room based pretest in primary schools
  5. Analysis: Data analysis: pre-test data will be analysed for validity and variance explanation. Scale analysis will focus on a multivariate regression models. A preliminary typology of milieu-specific, multi-dimensional health literacy will be developed by using dimensionality reduction techniques (latent class model (LCM)Latent Class Analysis (LCA); factor analysis; IRT).
  6. Questionnaire finalising: validated MoMChild-Q
Prof. Dr. Ullrich Bauer
Bielefeld University
Torsten Bollweg
Bielefeld University
Prof. Dr. Frank Faulbaum
Sozialwissenschaftliches Umfragezentrum GmbH
Orkan Okan
-contact person-
Bielefeld University
Dr. Paulo Pinheiro
-subproject leader-
Bielefeld University