Health literacy is a growing health promotion and health education topic for the 21^st century. Health literacy has been described and acknowledged as a direct outcome of health education, and can be seen as a quantifiable measure of an individual’s health potential. Furthermore, the health literacy of an individual has been observed to impact upon the behaviour and health of that individual. The paper describes the theoretical background and developmental processes/methodology involved with the development and implementation of a comprehensive measurement of health literacy in an adolescent population of school children (15 years-old) in both Finland and England. The health domains of physical activity and nutrition are used as the subject matter.

In the quest to contribute towards the development of effectual school health education via a health literacy approach, a Delphi survey was conducted with a representative panel of experts in Finland. The survey aimed to discover the group (expert) opinion regarding the most important components of health education in the domains (topics) of physical activity and nutrition. A list of health education components was devised from available literature and composed in learning outcome, or competencies format using a health literacy framework (Knowledge, skills, abilities etc.). The Delphi survey consisted of two rounds with 28 panel members (93% and 86% response rate respectively). The first round presented 62 components to the panel who indicated the importance of each component on a four-point Likert scale (from very important to not important at all). The second round consisted of a list of 24 components which had been collectively (mean score ≥ 2) judged to be important from the first round. The panel members chose their 10 most important components from the list and ranked them from 1 to 10 (10 being the most important).

To compliment the findings of the Delphi survey, and contribute further to the creation of an accurate and comprehensive measurement tool, a systematic review of literature was conducted in order to discover the current research activity in the measurement of child/adolescent health literacy. 16 papers were selected for analysis from an initial screen of 4969 articles, and 4 key research questions were asked and answered.

The Delphi survey resulted in a ranked list of health education learning outcomes (competences) deemed to be the most important topics for teaching in school physical activity and nutrition health education. This list also provided confirmation that the teaching and assessment of a full spectrum of health literacy components/competencies is achievable within these topics. The results of the systematic review also presented which health topics had been investigated, as well as the measurement instruments used and developed, the components of health literacy identified as important by the authors, and the efficacy of the measurement methods to achieve the desired aims.

The findings of the Delphi survey and systematic review form the foundation of the design of the new, comprehensive measurement tool of child/adolescent health literacy.

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