Since the 1990s the concept of health literacy has gained continuously more awareness in Europe and is by now considered crucial when it comes to promoting public health (Ormshaw, Paakkari, & Kannas, 2013). Currently, due to the COVID-19 pandemic, an adequate level of health literacy seems to be more important than ever (Sentell et al., 2020) as health literacy is closely linked to behaviors and measurable health parameters (Ormshaw, Paakkari, & Kannas, 2013) .

According to Sørensen et al. (2012) health literacy is “linked to general literacy and entails people’s knowledge, motivation and competences to access, understand, appraise, and apply health information […]“ (Sørensen et al., 2012, p. 3). Consequently, health literacy entails the competent dealing with health-related information (Norman & Skinner, 2006). Since health-related information is increasingly obtained from the internet, especially among younger people (Rossmann, Lampert, Stehr, & Grimm, 2018), the ability to use information technology appropriately is of further relevance. This means that people must be able to work with technology, think critically about media and science issues, and navigate through a variety of information tools and sources to get the information they need to make decisions (Norman & Skinner, 2006). Especially in times of the COVID-19 infodemic (“a global epidemic of misinformation—spreading rapidly through social media platforms and other outlets […]” (Zarocostas, 2020, p. 376)), it is important that children and young people develop an appropriate level of health literacy. They need to be able to evaluate health information and relate it to their personal situation in order to make health-promoting decisions (Skyes & Wills, 2019). Since respective information is often provided in the form of text, reading literacy serves as a crucial component of health literacy (Norman & Skinner, 2006).

Previous research identified various relevant factors influencing reading literacy. These are in particular socio-economic and cultural factors, such as the occupation and educational level of parents, the number of books in the household, the home language and the migration background (McElvany, Becker, & Lüdtke, 2009).  Furthermore, these factors have been shown to impact health related knowledge and communication (Schmidt et al., 2010). 

Therefore, it seems necessary to consider the influence of family background on health literacy, i.e., the competent dealing with health information, particularly in children and adolescents. 

In the present study we examine the relationship between general health literacy, critical health literacy, internet related health literacy, and health knowledge on one side, and socio-economic and cultural factors (i.e., the parents’ employment status and educational level, number of books in the household, the country of birth of the parents and the child as well as the home language) on the other side, by addressing the following research question: 

 Is there a difference in health literacy (general, critical and Internet-related health literacy) and health knowledge of students with different socio-economic and cultural background? We assume that the migration background as well as the socio-economic background should correlate with all four aspects of health-related competences.

The present study is based on Pre-Test data collected during an intervention study (Pre-Test-Post-Test design with control group) that aimed to promote health literacy with an adaptive digital training program. The sample consists of 689 Austrian students in grades 6 and 7, 46.4 % of them were female. The average age of the students was 13.01 (SD=0.84). 41.5% (n=284) of the students have a migration background and 64.6% (n=445) speak German as their home language. 8.7% (n=60) of students’ parents have at least a general qualification for university entrance and of 383 (71,5%) students, both parents are employed. To assess internet-related health literacy of the students we used a translated version of the eHEALS (8 items, 5-point Likert Scale, range: 1-5) by Norman and Skinner (2006). To assess the general health literacy an adapted short version (13 items) of the HLS-EU questionnaire (5-point Likert Scale, range: 1-5) was used. An adapted 10-item pilot version of the CLAIM instrument (three pre-formulated answers in single choice design; Steckelberg & Hinneburg et al., in preparation) was used to assess critical health literacy. Also, the students were asked 10 questions about health topics previously defined as interesting for this age group during a participatory workshop with 38 7th graders (Maitz & Gasteiger-Klicpera, 2020) to assess their health knowledge. To answer the questions, the students could choose from four pre-formulated answers in single choice design. For statistical analysis SPSS 26 was used. First, we conducted Kolmogorv-Smirnov tests and determined that the data for eHEALS, HLS-EU, CLAIM und health knowledge are normally distributed in our sample. Second, we calculated t-Tests to analyze if there are differences in the students’ internet-related health literacy, general health literacy, critical health literacy and health knowledge dependent on their home language and their migration background. Third, we conducted univariate analyses of variance and post-hoc-test to investigate differences in internet-related health literacy, general health literacy, critical health literacy and health knowledge dependent on the employment status of parents. Last, we calculated spearman correlations to analyze if there is a relationship between students’ internet-related health literacy, general health literacy, critical health literacy and health knowledge and the number of books in their household as well as the parents’ educational level.

Results revealed that students without migration background showed significantly higher levels of general health literacy, critical health literacy and health knowledge than students with migration background. Furthermore, children with German as home language, showed significantly higher levels of general health literacy, critical health literacy and health knowledge than children with another home language. Also, the number of books at home and the parents’ educational level correlated positively with the students’ general health literacy, critical health literacy and health knowledge. In addition, it was determined that the parents' employment status affects general health literacy and health knowledge. The results showed that students whose parents were both employed had significantly higher levels of general health literacy and health knowledge than children where only one or neither parent was employed. Critical health literacy was not related to parents’ employment status. The examination of the relationship between Internet-related health literacy and socio-economic and cultural factors yielded no significant results. The results of these study showed, that the migration background, the home language, parents’ educational level and employment status as well as the number of books at home are crucial factors for developing general health literacy, critical health literacy and health knowledge in children and adolescents. These findings are in line with other research, suggesting that the individual factors of parents such as educational level and employment status (Buot & Dy, 2020) are important factors influencing health literacy and health knowledge of students and with results from studies focusing on the health literacy of adults, that determined a correlation between language proficiency and health literacy (e.g., Sentell & Braun, 2012). However, our results also differ from previous research. Unlike, for example, Gazibara, Cakic, Pekmezovic, & Grgurevic (2019), we did not find any significant correlations between Internet-related health literacy and socio-economic and cultural background factors.

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