Health literacy among adolescents: a cluster analysis

Abstract

Adolescents represent a critical target group for health literacy (HL) research, as this stage of life involves increasing independence and responsibility for personal health behaviors. The growing burden of health challenges among adolescents highlights the importance of HL, as it equips individuals to navigate such challenges and actively engage with their health. Despite growing recognition of HL as a critical determinant of health, research on adolescent HL remains limited. This study aimed to describe HL among adolescents aged 14–16 years and to identify and characterize HL cluster affiliations. This cross-sectional study included adolescents aged 14–16 years across six schools in Southern Norway. Data were collected between March and September 2023 using a web-based questionnaire. The study employed the Health Literacy for School-Aged Children (HLSAC) instrument (range 10–40). HL clusters were identified based on the instrument’s five core HL components (theoretical knowledge, practical knowledge, individual critical thinking, self-awareness, and citizenship) using Ward’s method. We employed multiple multinomial regression analyses to examine factors associated with different cluster affiliations. The total sample’s ( n  = 440) mean score for HL was 31.6. The analysis indicated four HL clusters, reflecting ordered levels of HL, from low (Cluster A) to high (Cluster D). Adolescents with higher academic ambitions and fathers with a higher educational level had a lower relative risk (RRR) of being affiliated with the lowest HL cluster. Males had a lower RRR than females of being affiliated with the second-lowest HL cluster compared to the highest HL cluster. This study used cluster analysis to examine HL among adolescents, identifying four HL clusters ranging from low to high. The findings reveal social influences on HL, such as academic ambition and parental education, and how health determinants might shape its distribution at the population level. These data-driven insights underscore the need for further research into health outcomes.