Health literacy among early adolescents in Umbria, Italy: a cross-sectional study

Introduction Health literacy represents individuals’ ability to understand and use health information. It is related to health behaviors and outcomes; therefore, its monitoring is important. This analysis investigated health literacy among Italian adolescents using data collected within a broader study on adolescents’ vaccination and its determinants. Methods A secondary analysis of a broader cross-sectional study on adolescent vaccination was conducted. The online survey ran from 23 April to 9 June 2024 in lower secondary schools in Umbria. The Regional School Office contacted all 72 schools; 18 participated (25.0%). The questionnaire was distributed through schools’ electronic registers to third-year students and their parents. Of 6,996 eligible adolescents, 340 completed the mandatory 29-item MOHLAA-Q (4.9%). The Italian MOHLAA-Q was translated by authors. No independent validation, back-translation, or cognitive testing was performed; the original instrument was validated in adolescents aged 14–17 years. Descriptive analyses used exploratory proportional-odds ordinal logistic regression with school-clustered standard errors. Results Among 340 adolescents, 53.3% reported some and 17.6% many difficulties in dealing with health-related information (Scale A), while 25.3% reported few and 3.8% barely/no difficulties. For communication and interaction skills (Scale B), 8.2% were classified as low, 28.5% moderate, 31.2% rather high, and 32.1% high. For attitudes toward health and health information (Scale C), 2.9% were passive, 45.9% partly passive–partly active, and 51.2% active. For health-related knowledge (Scale D), 51.5% were classified as low, 40.9% moderate, and 7.6% high. Exploratory ordinal analyses identified associations with selected adolescent and family characteristics, including adolescent sex for Scale A and parental health literacy for Scale D; findings were considered hypothesis-generating. Conclusion In this opportunistic, non-representative regional sample, difficulties in dealing with health-related information and low health-related knowledge were relatively common, while communication skills and attitudes showed more favorable distributions. Findings provide descriptive evidence on health-literacy domains among younger adolescents in Umbria but should be interpreted cautiously given the low individual response rate, non-representative recruitment, use of a translated but not formally validated MOHLAA-Q in a younger age group, and exploratory associations. Further studies using age-appropriate, validated instruments and representative samples are warranted.