Access to information is a general human right. A set of capabilities to find, compare and assess the trustworthiness of information on health (referred here as HL-Info) is needed to secure equity in access to information, and to avoid being misinformed or uninformed. Recent PISA findings showed that only 7.2% of students can differentiate “between fact and opinion as applied to complex or abstract statements” (OECD, 2023). The proportion of adolescents who self-report finding it easy to differentiate whether online information is true or false is much bigger, 59 % in Europe (Smahel et al., 2020). Nevertheless, both figures show that there is a big proportion of those students who lack these central skills. Deprivations and disparities in capabilities to access health information present challenges on their own. However, they matter even more in terms of hampering opportunities to adopting health promoting behaviours (e.g. following physical activity (PA) recommendations) and pursuing good health (e.g. self-rated health, SRH). Co-occurrence of extensive amounts of misinformation, limited capabilities to access valid information, and disparities in health is a clear public health challenge, also among adolescents.

Health literacy (HL) has been recognized as an independent, important and modifiable determinant of health and health behaviour across the lifespan (e.g. Lim et al., 2021; Paakkari et al., 2019), and an important outcome of school health education (World Health Organization, 2021). Among adolescents, good general HL has been associated with various positive health indicators such as PA (Fleary et al., 2021) and good SRH (Paakkari et al., 2020). Also, HL has proven to act as a moderator between individual factors and health (incl., health behaviour), and in such a way that it promotes better health outcomes, especially among those in vulnerable situations (Lahti et al., 2024). Country differences in general HL have been noticed (Paakkari et al., 2020). 

To assess if health information is equally available for adolescents in Europe (via HL-Info) and to inform education/public health police and practice, we need further research on low level of HL-Info in different European countries, and if different individual and familial factors place some adolescents in more vulnerable situations in terms of low HL-Info and thereby poorer health. 

To address these gaps in understanding, we examined (i) if there are country differences in low HL-Info (in its distributions and correlators), and (ii) if low HL-Info serves as a correlator of SRH and PA across countries?

Cross-sectional self-report 2021/22 Health Behaviour in School-aged Children study survey data were used. Data were collected through a stratified cluster sampling method using the school as the primary sampling unit. Ethical approvals and consent from the students and their guardians were collected. Participation was voluntary and anonymous. This paper reports findings from 11 countries (Belgium (fl.), Bulgaria, Czechia, Germany, Finland, France, Croatia, Kazakhstan, Malta, Poland and Slovakia) and 45,994 (N = 22939 girls, X = 22746 boys) 13- and 15-year-old adolescents in total. Measures. (1) HL-Info: The Health Literacy for School-Aged Children (HLSAC; Paakkari O et al., 2019) instrument. To describe HL-Info, four out of ten items were used: having good knowledge on health, an ability to find information one understands, an ability to compare information from different sources and an ability to assess the trustworthiness of the information. In the analysis, HL-Info was used as a categorical (low-moderate-high; two lowest response options were combined to describe “low HL-Info”); (2) Individual factors: self-report (a) gender (girl, boy) and (b) age (13-years old, 15-years old); (3) Family affluence, measured with Family affluence scale (FAS; Torsheim et al., 2016); (4) Parental support (Zimet et al., 1988); (5) SRH (Kaplan & Camacho, 1983), used as a categorical variable; (6) PA (Persons meeting the PA guidelines; Moderate-to Vigorous-Physical-Activity (MVPA) Prochaska et al., 2001). Data analysis involved cross-tabulation of 4 health literacy (HL) items for each country and age group, corrected for study design. Mean calculations for the HL scale, ANOVA testing, and Spearman correlations with mentioned variables were calculated. Linear mixed-effect models were used to predict HL with individual and familial factors.

The preliminary findings showed that, via HL-Info, health information is not equally available for adolescents in Europe. Disparities in access relate to both individual factors as well as familial and country environmental factors. The proportions of those with 'low HL-Info' varied between countries: having information from 4.3% (Finland) to 27.1% (Kazakhstan), finding information one understands from to 7.9% (Finland) to 29.4% (Bulgaria), in comparing information from different sources from 10.5% (Finland) to 38.2% (Bulgaria), and in assessing the trustworthiness of information from 11.2% (Finland) to 36.1% (Bulgaria). Across the countries, low HL-Info was associated with all measured background variables except gender. Low HL-Info was statistically significantly more prevalent among 13 year olds (than 15 year olds), lower affluent (compared to more affluent) families, and those with low support (compared to moderate or high support) from parents. Country specific analysis revealed gender differences only in one country (Belgium), age differences in three countries (Belgium, Poland, Kazakhstan), and family affluence differences in seven countries (Belgium, Czechia, Germany, Finland, Poland, Slovakia, France). Low HL-Info was associated with parental support in all measured countries. Low HL-Info was associated with SRH (poor/fair SRH more common) among all countries and following PA recommendations (not following more common) in seven countries. To foster equity in access to valid health information and in health calls for educational and public health policies and practices targeted proportionally at population needs.

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