A secondary analysis of 340 eighth-grade students in Umbria, Italy, found that more than half struggled to process health information and more than half scored low on health-related knowledge. Researchers caution that the small, non-representative sample and an unvalidated survey translation limit how far the results can be generalized.
What the study measured
The analysis drew on a broader study of adolescent vaccination determinants, surveying third-year lower-secondary students across 18 schools in Umbria - 25% of the schools contacted by the regional school office. Of 6,996 eligible students, only 340 took part, a response rate of 4.9%. Participants completed a 29-item questionnaire known as MOHLAA-Q, translated into Italian by the study authors for this project. The instrument was originally validated for adolescents aged 14 to 17, but the translated version used here was not independently validated, back-translated or cognitively tested for this younger age group, a limitation the researchers flag explicitly.
Four domains, uneven results
The questionnaire assessed four areas of health literacy. On difficulties handling health information, 53.3% reported "some difficulties" and 17.6% reported "many difficulties," while only 29.1% combined reported few or no barriers. Communication and interaction skills showed a more favorable pattern, with 63.3% rated high or rather high, though 36.7% fell into moderate or low categories. Attitudes toward health information were largely positive: 51.2% were classified as actively engaged and 45.9% as partly active, with only 2.9% passive. The weakest domain was health-related knowledge itself, where 51.5% scored low, 40.9% moderate, and just 7.6% high - a result the authors say aligns with the reported difficulties in processing health information.
Associations flagged, not confirmed
Exploratory statistical analysis found links between adolescent sex and difficulties processing health information, and between parental health literacy and adolescents' own health knowledge scores. The researchers describe these associations as "hypothesis-generating" rather than proof of cause and effect, meaning they point to questions worth studying further rather than established relationships.
Why the limitations matter
The authors are direct about the constraints on their findings: a low response rate, a recruitment method that does not represent the broader adolescent population, and a translated survey instrument lacking formal validation for younger teens. They describe the study as opportunistic rather than representative, and they recommend that future research use age-appropriate, validated tools with representative samples before drawing firmer conclusions about adolescent health literacy in the region or elsewhere.