Health literacy in young children (age 4-8): A mixed-methods systematic review

Abstract Background In recent years, there has been an increased focus on health literacy within children and adolescents, yet there is a paucity of research within the period of early childhood despite specific developmental and cognitive differences to older children in how they understand and conceptualise health. To best support the development and maintenance of health literacy within this specific population, we undertook a systematic review to identify theoretical definitions, models and outcomes in studies of health literacy in young children aged 4-8. Methods This review used the SPIDER framework; conducting a systematic search for studies published in English using PsycInfo, CINAHL, PubMed, Web of Science, Science Direct, grey literature and citation searching. Studies were included if they included an age range of 4-8 years; a definition or model of Health Literacy; and reported Health Literacy or Health Behavioural outcomes. Qualitative, quantitative and mixed-methods were included. Results Out of 5991 studies, 15 were included totalling 4082 (range 18-1235) participants. Health topics focused on nutrition (n = 5) or a mixture (e.g. exercise, nutrition, safety, communication; n = 4). Several studies used a validated measure of health literacy (n = 6) or food literacy (n = 1) compared to a behavioural or health measure (n = 5). Studies that included a definition of health literacy tended to use an adult/life-course definition rather than a child-specific definition (n = 2). Another two studies used a health literacy model as a theoretical basis for their understanding. Outcomes were grouped into four themes: general health literacy, appraisal of health information, understanding & knowledge, and communication. Conclusions Findings suggest that health behaviour of young children can be positively influenced by health literacy, but quality of the evidence is variable and further interventions are needed to support the public health of this unique population. Key messages • To improve health literacy of young children, interventions should use child-specific theories reflecting their unique cognitive and developmental ways of interpreting and applying health information. • Quality of evidence is variable and further targeted interventions are needed for this population.