Methodological quality of health literacy instruments used among school children in Asian countries: a systematic review

Background This study aimed to examine the methodological quality of measurement properties of health literacy instruments used in children, specifically in Asian countries, and to identify the most suitable instrument for field application.Methods This systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Health literacy studies conducted between 2013 and 2023 and involving children aged 6–18 years old were identified through searches in PubMed, Scopus and Web of Science. Only studies that assessed methodological qualities were included. Quality appraisal was conducted using COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN).Result A total of 10 studies met the inclusion criteria from the screening process. The quality of measurement properties in these studies varied. With 9 items on the COSMIN checklist and 10 studies assessed, this resulted in a total of 90 checklist items evaluated. Based on this, 25 items were classified as very good (primarily for structural validity and general criteria), 7 as adequate (mainly for content validity), 14 as inadequate (mostly for internal consistency), 10 as doubtful (mostly for reliability) and 34 as unknown (primarily for measurement error, cross-cultural validity and responsiveness). Nearly 40% (37.7%) of measurement quality ratings were either unknown or not reported. Among the tools assessed, the 8-item Health Literacy Assessment Tool Chinese version (C-HLAT-8) demonstrated very good quality across most measurement properties compared to others. C-HLAT-8 includes functional, interactive and critical health literacy domains and has been assessed in children aged 11–17 in China.Conclusion Despite the global interest in health literacy, studies focusing on methodological quality in the context of school children and Asian countries remain limited. The C-HLAT 8 emerges as a promising tool for field application due to its strong methodological quality and adaptability.