This paper focuses on describing and measuring health literacy in relation to physical activity in children. Health literacy is important, because it is increasingly being recognised as an intermediate factor on the pathway to health (Kickbusch et al., 2013). In children, low child-health literacy is shown to be associated with both being overweight (Sharif & Blank, 2010) and risky behaviour (DeWalt & Hink, 2009).

Health literacy is a complex concept with at least 17 different definitions (Sørensen et al., 2012). Nevertheless, many of these are in tune with the World Health Organisation’s definition of health literacy that depicts the skills, motivation, and ability to access, understand, and use information to promote and maintain good health (Nutbeam, 1998). To understand health literacy as a concept, we must view it as both content- and context specific (Abel, 2008). Health literacy will be different for a person with diabetes receiving patient education compared to a child exposed to health education in school (Nutbeam, 2009). Content-specific health literacies are described with regard to nutrition literacy, oral health literacy and media health literacy, but very little research has focused on physical activity health literacy. We found only one study that dealt with parents’ physical activity literacy (Dominick et al., 2013).

Progress has been made in measuring health literacy in adults, especially in health care settings since the first instruments were introduced, for instance, TOFLA, Test of Functional Literacy in Adults, (Parker et al, 1995). Within the field of health promotion, however, measuring health literacy remains a challenge, particularly regarding indices tailored to different types of health content, contexts, and ages, as well as distinguishing among different levels of health literacy (Nutbeam, 2009). With regard to measuring health literacy in children, a systematic review identified 16 studies (Ormshaw, Paakkari, & Kannas, 2013). Of these, only three included physical activity-related health literacy (Hubbard & Rainey, 2007; Levin-Zamir, Lemish, & Gofin, 2011; Schmidt et al., 2010). Moreover, none focused on physical activity as a sole topic, but instead included it together with nutrition, tobacco use, and/or other health issues. To the best of our knowledge, no research has yet focused on physical activity health literacy in children.

Therefore, our research objective is to describe and measure physical activity health literacy in school children aged 10–14 years.

Nutbeam (2000) highlights health literacy as an outcome of health education and makes the distinction among three levels of health literacy: functional health literacy that concerns factual knowledge about health and risks; interactive health literacy that concerns personal skills to act on knowledge and a motivation to act; and critical health literacy that concerns cognitive skills oriented towards social and political action (Nutbeam, 2000). We chose Nutbeam’s levels of literacy as a framework to use in our understanding of children’s physical activity health literacy.

In the literature, one finds two basic ways to measure health literacy: self-assessment, commonly used with adults, and task-performance, commonly used with children. As our research pertains to children, we chose the task-performing method. Concerning which questions to ask, we took inspiration from the Danish national health guidelines on physical activity for children, and the few studies that had measured at least one of the health literacy levels: from Dominick et al. (2013) regarding the functional literacy level, and from Schmidt et al. (2010) regarding the interactive level. Regarding the critical level, we did not find any reference about physical activity literacy, why we took inspiration from the “general” critical health literacy concept of Abel (2008).

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