{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T06:35:08Z","timestamp":1784010908322,"version":"3.55.0"},"reference-count":33,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T00:00:00Z","timestamp":1623628800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Scand J Public Health"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Health literacy (HL) is an important determinant for maintaining and improving health throughout the lifespan. This underlines the need to monitor HL, including among adolescents, and to understand the factors explaining HL, with a view to decreasing differences in HL. The aim of this study was to objectively measure HL, and the relationship between HL and socio-demographic factors (gender, language of instruction, pupils\u2019 educational aspirations, parents\u2019 educational background and pupils\u2019 school achievement) among pupils ( n = 3652) at the end of basic education in Finland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A nationally representative assessment, which included 55 items on HL, was conducted as a traditional paper-and-pencil test in schools. The data were analysed via descriptive statistics and a two-level hierarchical linear model to determine how the socio-demographic factors affected HL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The pupils\u2019 average score on the HL test items was 58.9%, indicating a satisfactory HL level. A two-level hierarchical linear model showed that the variables (gender, language of instruction, pupils\u2019 educational aspirations, parents\u2019 educational background and pupils\u2019 school achievement) predicting the HL level had statistically significant effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Among ninth graders (15\u201316 years old), almost one third of the boys and 8% of the girls exhibited an unsatisfactory HL level. The study also confirmed the importance of school-related factors in explaining HL differences. Since low HL has been linked to several unfavourable health indicators and has been viewed as an underestimated problem in times of pandemic and other health crises, the findings suggest that the HL level of Finnish ninth graders is a clear public-health issue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/14034948211019798","type":"journal-article","created":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T03:59:56Z","timestamp":1623643196000},"page":"646-653","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Objective health literacy skills among ninth graders in Finland: outcomes from a national learning assessment"],"prefix":"10.1177","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4836-4666","authenticated-orcid":false,"given":"Anna-Mari","family":"Summanen","sequence":"first","affiliation":[{"name":"Faculty of Sport and Health Sciences, University of Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juhani","family":"Rautopuro","sequence":"additional","affiliation":[{"name":"Finnish Institute for Educational Research, University of Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lasse K.","family":"Kannas","sequence":"additional","affiliation":[{"name":"Faculty of Sport and Health Sciences, University of Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4130-9202","authenticated-orcid":false,"given":"Leena T.","family":"Paakkari","sequence":"additional","affiliation":[{"name":"Faculty of Sport and Health Sciences, University of Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,6,14]]},"reference":[{"key":"bibr1-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/15.3.259"},{"key":"bibr2-14034948211019798","unstructured":"Rowlands G, Russell S, O\u2019Donnel A, et al. What is the evidence on existing policies and linked activities and their effectiveness for improving health literacy at national, regional and organizational levels in the WHO European Region? Geneva: World Health Organization, Health Evidence Network synthesis report 57, http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0006\/373614\/Health-evidence-network-synthesis-WHO-HEN-Report-57.pdf?ua=1 (2018, accessed 20 March 2019)."},{"key":"bibr3-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-80"},{"key":"bibr4-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/13.4.349"},{"key":"bibr5-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1108\/09654281211203411"},{"key":"bibr6-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(20)30086-4"},{"key":"bibr7-14034948211019798","doi-asserted-by":"publisher","DOI":"10.17265\/2159-5313\/2016.09.003"},{"key":"bibr8-14034948211019798","volume-title":"Draft WHO European roadmap for implementation of health literacy initiatives through the life course","author":"World Health Organization","year":"2019"},{"key":"bibr9-14034948211019798","volume-title":"National Core Curriculum for Basic Education 2014","author":"Finnish National Agency for Education","year":"2016"},{"key":"bibr10-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-5054-0"},{"key":"bibr11-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1108\/HE-02-2017-0014"},{"key":"bibr12-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cky229"},{"key":"bibr13-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1016\/j.adolescence.2017.11.010"},{"key":"bibr14-14034948211019798","volume-title":"Health Literacy Interventions and Outcomes: An updated systematic review","author":"Berkman ND","year":"2011"},{"key":"bibr15-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckz011"},{"key":"bibr16-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2017-209605"},{"key":"bibr17-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-5224-0"},{"key":"bibr18-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2008.09.050"},{"key":"bibr19-14034948211019798","volume-title":"Terveystiedon oppimistulokset perusopetuksen p\u00e4\u00e4tt\u00f6vaiheessa 2013","author":"Summanen A-M.","year":"2014"},{"key":"bibr20-14034948211019798","unstructured":"Finnish parliament. Basic Education Act, 628\/1998\n                      ."},{"key":"bibr21-14034948211019798","volume-title":"National Core Curriculum for Basic Education 2004","author":"Finnish National Agency for Education","year":"2004"},{"key":"bibr22-14034948211019798","volume-title":"Metodit arvioinnin apuna. [Methods assisting the assessment.] Perusopetuksen oppimistulosarviointien ja -seurantojen menetelm\u00e4ratkaisut Opetushallituksessa","author":"Mets\u00e4muuronen J","year":"2009"},{"key":"bibr23-14034948211019798","doi-asserted-by":"crossref","unstructured":"Summanen A-M, Rautopuro J, Kannas L, et al. Measuring health literacy in basic education: the development of a competence-based instrument. 2021 (manuscript).","DOI":"10.3390\/ijerph192215170"},{"key":"bibr24-14034948211019798","doi-asserted-by":"publisher","DOI":"10.4324\/9780203852279"},{"key":"bibr25-14034948211019798","first-page":"93","volume":"31","author":"Cronbach L.","year":"1951","journal-title":"Psychometrika"},{"key":"bibr26-14034948211019798","first-page":"127","volume-title":"Handbook of Item Response Theory","volume":"1","author":"Muraki E","year":"2016"},{"key":"bibr27-14034948211019798","volume-title":"Changing Subjects, Changing Pedagogies: Diversities in school and education","author":"Hild\u00e9n R","year":"2017"},{"key":"bibr28-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijer.2011.03.002"},{"key":"bibr29-14034948211019798","doi-asserted-by":"publisher","DOI":"10.1080\/00131881.2014.898917"},{"issue":"2","key":"bibr30-14034948211019798","first-page":"161","volume":"130","author":"Suominen S.","year":"2014","journal-title":"Duodecim"},{"key":"bibr31-14034948211019798","unstructured":"School for Health in Europe (SHE). 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