Fourth-graders' health literacy Results from an explorative cross-sectional study in North Rhine-Westphalia, Germany

Background The health literacy (HL) of young people is increasingly being acknowledged by research and policy as an entry point for health promotion and prevention. However, there is little research on children's health literacy, particularly in Germany. This study addresses this research gap by investigating fourth-graders' HL in the German federal state of North Rhine-Westphalia (NRW). Objectives To explore the extent of children's HL taking into consideration socioeconomic characteristics. Materials and methods A classroom-based pen-and-paper survey was conducted. The questionnaire, which was developed specifically for 9- to 10-year-olds, addresses three dimensions of HL: self-reported general HL, functional HL (health-related literacy and numeracy), and health knowledge. Results Data were collected from 899 students visiting 32 schools. A high level of self-reported HL was observed: participants reported that it was easy for them to deal with health information. Children that had the lowest family affluence scored significantly lower in all dimensions of HL. With the exception of self-reported HL, this also applies for children that report a home language other than German. Conclusions This is the first study to investigate fourth-graders' HL in NRW, Germany. Although self-reported HL is high, a social gradient related to family affluence and home language can already be observed in this young age group. While the available evidence is inconclusive and more research is needed, our results suggest that there is a need for early prevention to ensure that all children, irrespective of their background, can develop a level of HL that helps promote their health.