Connecting Adolescents’ Health Literacy and Health Decision-Making Using Qualitative Data

Introduction: Health literacy (HL) is the ability to obtain, process, and understand health information to make good health decisions. However, beyond the few studies linking HL and health behaviors, little is known about adolescents’ understanding of and utilization of HL in their health decision-making. This study qualitatively explored the relationship between HL and health-decision making in adolescents. Given the lack of research on adolescents’ HL in a behavioral change framework, this study also explored whether the HL/health decision-making relationship fit within an existing preventive health model.

Methods: Six focus groups were conducted with adolescents (n=42). Adolescents answered semi-structured questions about their use of HL skills in health decision-making. Focus groups were transcribed and analyzed using thematic analyses. After overarching themes and subthemes were defined, an existing preventive health model with constructs similar to the defined themes was identified and applied to the focus group results.

Results: Thematic analyses resulted in three major categories: types of HL use, factors influencing acquisition and use of HL, and confidence in HL skills and usage. Within each of these categories, several major themes and subthemes emerged. Adolescents viewed their HL use as active and/or passive and their acquisition and use of HL skills in health decision-making were influenced by individual characteristics, environmental factors, and health information/knowledge. They judged their confidence in their HL skills on the quality of their communication with providers/peers/parents, consultation with multiple sources of information, ability to integrate knowledge with information from reliable sources, understanding of medical terminology, questioning of media content, and medical adherence. Their explanations of how they acquired and used HL in decision-making align with the health-related information and personal and social motivation constructs outlined in the Information-Motivation-Behavioral Skills Model (IMBM) while their confidence in their HL skills and usage align with the behavioral skills construct and outcomes in the model. The IMBM is a predictive model of behavior change with three core determinants of performance of health behaviors (health-related information, personal and social motivation, and behavioral skills for behavior engagement) that work together to predict behavior.

Conclusions: This study confirms that HL is important in adolescents’ ability to and confidence in engaging in good decision-making. Further, the results support the inclusion of complex HL skills (e.g., interactive HL, critical HL) when determining the role of HL in adolescents’ health decision-making and behaviors. This study also supports the use of IMBM as a behavioral change framework in adolescent HL research.