Development and Validation of a Rapid Health Literacy Assessment Tool for Chinese Primary and Secondary School Students

Health literacy (HL) plays a critical role in shaping health behaviors in children and adolescents. Although children and adolescents are marked by increased involvement in health decision-making, most HL studies and measures of HL have focused primarily on adults. There is a lack of an appropriate test-based validated tool for measuring comprehensive health literacy. This study aimed to develop a rapid-assessment health literacy questionnaire for primary and secondary students to address gaps in existing tools. A health literacy indicator system was first established through literature analysis, the Delphi method, and expert interviews. Items were then generated for each domain of the indicator system. Finally, a stratified sampling survey with 3,325 primary school students and 2,788 secondary school students was conducted. The Rasch model was applied to evaluate reliability and validity. Reliability analysis demonstrated favorable overall fit between observed data and the model. Validity results showed internal consistency. We developed a robust and contextually tailored assessment tool for Chinese primary and secondary students, which is expected to comprehensively measure HL of students aged 6 to 15 years. Future cross-cultural validation is recommended to enhance its global applicability.