A causal relationship model of health literacy and health behavior for obesity prevention among primary school students in Bangkok, Thailand

The conceptualization and development of critical health literacy in children: a scoping review

The cognitive and social practices associated with critical health literacy, such as critical appraisal of health messages and participation in political processes to address wider determinants of health, are of lifelong benefit. Understanding how and where critical health literacy development can be supported early in the life course may improve health outcomes now and in the future. This scoping review focuses on how critical health literacy in children is conceptualized and the supportive environments available for its development. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines are used in reporting. Evidence retrieved was eligible for inclusion if it contained a substantive conceptual or empirical study of critical health literacy in populations aged 7-11 (middle childhood). From the included 18 peer-reviewed and grey literature sources, schools are identified as the setting most associated with the development of critical health literacy in the target age group. However, the action-oriented dimension of critical health literacy is rarely supported in the school setting. The review concludes that further research is needed to clarify how and where to support children to develop critical health literacy in and outside of school settings.

A causal relationship model of health literacy and health behavior for obesity prevention among primary school students in Bangkok, Thailand

Background: The aim of the study was to develop a research instrument to study the levels of health literacy for obesity prevention (HLFOP), as well as health behavior for obesity prevention (HBFOP). In addition, we investigated the causal relationship model between health literacy and health behavior for obesity prevention among primary school students in Bangkok, Thailand. Methods: A cross-sectional study among 600 participants who were primary school students (aged 9-13 years) was conducted. The participants were selected from schools in all parts of Bangkok using multi-stage random sampling technique. The research instrument to assess HLFOP and HBFOP, constructed by the researchers, were utilized for data collection. Data were analyzed using descriptive statistics, exploratory and confirmatory factor analyses, and structural equation model through linear structural relationship. Results: We found that HBFOP was directly influenced by heath literacy in the category of Critical Literacy with an effect size of 0.65 (p < 0.01), and was indirectly influenced in the category of Basic Literacy and Interactive Literacy through Critical Literacy with effect sizes of 0.46 and 0.58 (p<0.01), respectively. The model was consistent with the empirical data, with Chi-Square=13.68, df=7, p=0.05721, RMSEA (root mean square error of approximation)= 0.040,  SRMR (standardized root mean square residual)= 0.017 NFI (normal fit index)=0.99, GFI (goodness of fit index)=0.99, and AGFI (adjusted goodness of fit index)=0.97. Conclusions: HLFOP was influential on HBFOP in primary school students in the Bangkok Metropolis. The categories that were particularly influential were: 1) Basic Literacy: accessing health information skills; 2) Interactive Literacy: communication skills; and 3) Critical Literacy: media literacy and self-management skills.