{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:16:22Z","timestamp":1792512982783,"version":"4.5.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adolescents\u2019 ability to evaluate health information is an increasingly important area in public health and health promotion; however, there is a scarcity of brief, psychometrically sound self-report tools focused on adolescents\u2019 information appraisal abilities. In this study, we aim to validate a unidimensional short form of the Critical Health Literacy for Adolescents Questionnaire (CHLA-QA) domain A and to examine its convergent and known-groups validity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a cross-sectional survey among Norwegian students (\n                      <jats:italic>N<\/jats:italic>\n                      \u202f=\u202f522; response rate 33%) aged 13\u201315\u202fyears old. We employed stepwise confirmatory factor analysis (CFA) to compare three models. Known-groups validity was assessed by examining the distribution of CHLA-QA across variables: sex, grade level, parents\u2019 education, books at home, and generic health literacy (HLSAC), with analyses based on the Kruskal-Wallis test, the Wilcoxon rank-sum test, and effect sizes (\u03b5\n                      <jats:sup>2<\/jats:sup>\n                      , r). We assessed convergent validity through Spearman correlations with HLSAC, self-rated health, HRQoL, and academic achievement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Analysis yielded a five-item solution with acceptable fit (CFI\u202f=\u202f0.98; RMSEA\u202f=\u202f0.097 [0.065\u20130.132]; SRMR\u202f=\u202f0.037, uSRMR\/2\u202f=\u202f0.055), strong standardized loadings (0.582\u20130.839), and satisfactory reliability (\n                      <jats:italic>\u03b1<\/jats:italic>\n                      \u202f=\u202f0.79). Known-groups analyses showed higher scores among girls than boys (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001; r\u202f=\u202f0.169), a small grade effect (\u03b5\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.013; grade 9\u202f&amp;gt;\u202fgrades 8 and 10), and a socioeconomic gradient was found, with higher scores associated with parents\u2019 education (r\u202f=\u202f0.111) and number of books at home (\u03b5\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.024). HLSAC increased stepwise across low, moderate, and high groups based on the CHLA-QA scale (\u03b5\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.132). Convergent validity was supported by moderate correlations with HLSAC (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.461), self-rated health (\u03c1\u202f=\u202f0.316), and HRQoL (\u03c1\u202f=\u202f0.346). Correlations with academic achievement were weak but significant for five of six school subjects. Higher scores were correlated with asking parents for help regarding health information (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f0.233).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study advances the measurement of adolescents\u2019 CHL by developing and evaluating a brief, unidimensional instrument for assessment of information appraisal (CHLA-QA). The scale showed strong validity and acceptable reliability. Future studies in independent samples are warranted to further establish validity and measurement invariance across relevant populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1881570","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:35:34Z","timestamp":1783575334000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring adolescents\u2019 ability to appraise health information: validation of the self-report short-form Critical Health Literacy Questionnaire"],"prefix":"10.3389","volume":"14","author":[{"given":"Anders L. Hage","family":"Haugen","sequence":"first","affiliation":[{"name":"Department of Primary and Secondary Teacher Education, Faculty of Teacher Education and International Studies","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsti","family":"Riiser","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University","place":["Oslo, Norway"]},{"name":"Norwegian Institute of Public Health, Child and Adolescent Health Promotion Services","place":["Levanger, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1093\/heapro\/15.3.259","article-title":"Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century","volume":"15","author":"Nutbeam","year":"2000","journal-title":"Health Promot Int"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2072","DOI":"10.1016\/j.socscimed.2008.09.050","article-title":"The evolving concept of health literacy","volume":"67","author":"Nutbeam","year":"2008","journal-title":"Soc Sci Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1177\/0017896917714812","article-title":"Conceptualising a new approach to adolescent health literacy","volume":"76","author":"Peralta","year":"2017","journal-title":"Health Educ J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.socscimed.2011.04.004","article-title":"Critical health literacy: a review and critical analysis","volume":"73","author":"Chinn","year":"2011","journal-title":"Soc Sci Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1205716","DOI":"10.3389\/fspor.2023.1205716","article-title":"Fostering pupils\u2019 critical health literacy: examining the potential of physical education in lower secondary school","volume":"5","author":"Haugen","year":"2023","journal-title":"Front Sports Act Living"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1093\/heapro\/daq049","article-title":"Teaching critical health literacy in the US as a means to action on the social determinants of health","volume":"26","author":"Mogford","year":"2010","journal-title":"Health Promot Int"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1177\/1757975918789352","article-title":"Challenges and opportunities in building critical health literacy","volume":"25","author":"Sykes","year":"2018","journal-title":"Glob Health Promot"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"167","DOI":"10.51952\/9781447344520.ch011","volume-title":"International Handbook of Health Literacy\u2014Research, Practice and Policy across the Lifespan","author":"Sykes","year":"2019"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1186\/1471-2458-13-150","article-title":"Understanding critical health literacy: a concept analysis","volume":"13","author":"Sykes","year":"2013","journal-title":"BMC Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"56","DOI":"10.29173\/hsi319","article-title":"When social media met nutrition: how influencers spread misinformation, and why we believe them","volume":"11","author":"Lofft","year":"2020","journal-title":"Health Sci Inq"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.3928\/24748307-20181214-01","article-title":"On the centrality of information appraisal in health literacy research","volume":"3","author":"Diviani","year":"2019","journal-title":"Health Lit Res Pract"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"3116","DOI":"10.3390\/ijerph19053116","article-title":"Developing indicators to 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Kong","volume":"16","author":"Zhong","year":"2026","journal-title":"Sci Rep"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1108\/HE-02-2017-0014","article-title":"Subjective health literacy among school-aged children","volume":"118","author":"Paakkari","year":"2018","journal-title":"Health Educ"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1177\/14034948251358570","article-title":"Health literacy and screen use among 13-year-old students in Norway \u2013 a cross-sectional study","author":"Waldum-Grevbo","year":"2025","journal-title":"Scand J Public Health"},{"key":"ref19","year":"2019"},{"key":"ref20","year":"2017"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1111\/josh.13352","article-title":"Understanding critical health literacy among adolescents: psychometric properties of the CHLA questionnaire in lower secondary schools in Norway","volume":"93","author":"Haugen","year":"2023","journal-title":"J Sch Health"},{"key":"ref22","volume-title":"Social Learning Theory","author":"Bandura","year":"1977"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1177\/1090198104263660","article-title":"Health promotion by social cognitive means","volume":"31","author":"Bandura","year":"2004","journal-title":"Health Educ Behav"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1017\/9781316823279.005","volume-title":"The Cambridge Handbook of Motivation and Learning","author":"Ahn","year":"2019"},{"key":"ref25","author":"Walseth","year":"2016"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1177\/140349481666963","article-title":"Subjective health literacy: development of a brief instrument for school-aged children","author":"Paakkari","year":"2016","journal-title":"Scand J Public Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1093\/eurpub\/cky229","article-title":"The cross-national measurement invariance of the health literacy for school-aged children (HLSAC) instrument","volume":"29","author":"Paakkari","year":"2019","journal-title":"Eur J Pub Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.ijnurstu.2010.10.001","article-title":"Health related quality of life in children and adolescents: reliability and validity of the Norwegian version of KIDSCREEN-52 questionnaire, a cross sectional study","volume":"48","author":"Haraldstad","year":"2011","journal-title":"Int J Nurs Stud"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/S0140-6736(02)07466-4","article-title":"Understanding self-rated health","volume":"359","author":"Fayers","year":"2002","journal-title":"Lancet"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.21105\/joss.01686","article-title":"Welcome to the tidyverse","author":"Wickham","year":"2019","journal-title":"J Open Source 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Res"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705511.2019.1611434","article-title":"Assessing fit in ordinal factor analysis models: SRMR vs. RMSEA","volume":"27","author":"Shi","year":"2020","journal-title":"Struct Equ Model Multidiscip J"},{"key":"ref36","volume-title":"Confirmatory factor Analysis for Applied Research","author":"Brown","year":"2015"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"936","DOI":"10.3758\/s13428-015-0619-7","article-title":"Confirmatory factor analysis with ordinal data: comparing robust maximum likelihood and diagonally weighted least squares","volume":"48","author":"Li","year":"2016","journal-title":"Behav Res Methods"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1037\/met0000093","article-title":"The performance of ML, DWLS, and ULS estimation with robust corrections in structural equation models with ordinal variables","volume":"21","author":"Li","year":"2016","journal-title":"Psychol Methods"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1080\/10705510701301834","article-title":"Sensitivity of goodness of fit indexes to lack of measurement invariance","volume":"14","author":"Chen","year":"2007","journal-title":"Struct Equ Model Multidiscip J"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"5","DOI":"10.11613\/bm.2026.010101","article-title":"Effect sizes for nonparametric tests","volume":"36","author":"Fiel Peres","year":"2026","journal-title":"Biochem Med (Zagreb)"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1002\/jcpy.1292","article-title":"How to calculate, use, and report variance explained effect size indices and not die trying","volume":"33","author":"Iacobucci","year":"2023","journal-title":"J Consum Psychol"},{"key":"ref42","volume-title":"Scale Development\u2014Theory and Applications","author":"DeVellis","year":"2003"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"149","DOI":"10.3389\/fpubh.2018.00149","article-title":"Best practices for developing and validating scales for health, social, and behavioral research: a primer","volume":"6","author":"Boateng","year":"2018","journal-title":"Front Public Health"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low health literacy and health outcomes: an updated systematic review","volume":"155","author":"Berkman","year":"2011","journal-title":"Ann Intern Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1093\/eurpub\/ckab213","article-title":"The role of health literacy in the association between academic performance and substance use","volume":"32","author":"Kinnunen","year":"2022","journal-title":"Eur J Pub Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1038\/nn.3177","article-title":"Decision-making in the adolescent brain","volume":"15","author":"Blakemore","year":"2012","journal-title":"Nat Neurosci"},{"key":"ref47","year":"2020"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"62","DOI":"10.15388\/ActPaed.44.5","article-title":"A phenomenographic study of adolescents\u2019 conceptions of health information appraisal as a critical component of adolescent health literacy","volume":"44","author":"Stars","year":"2020","journal-title":"Acta Paedagog Vilnensia"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1111\/hex.13450","article-title":"Seeking a deeper understanding of \u2018distributed health literacy\u2019: a systematic review","volume":"25","author":"Muscat","year":"2022","journal-title":"Health Expect"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"101524","DOI":"10.1016\/j.ijer.2019.101524","article-title":"Students\u2019 expected and actual academic achievement \u2013 a meta-analysis","volume":"100","author":"Pinquart","year":"2020","journal-title":"Int J Educ Res"},{"key":"ref51","year":"2022"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1093\/her\/cyr007","article-title":"Media health literacy (MHL): development and measurement of the concept among adolescents","volume":"26","author":"Levin-Zamir","year":"2011","journal-title":"Health Educ Res"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"136","DOI":"10.23860\/jmle-4-2-4","article-title":"Exploring the borderlands between media and health: conceptualizing \"critical media health literacy\"","volume":"4","author":"Higgins","year":"2013","journal-title":"J Media Lit Educ"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1080\/10810730.2014.954083","article-title":"Advancing health literacy measurement: a pathway to better health and health system performance","volume":"19","author":"Pleasant","year":"2014","journal-title":"J Health Commun"}],"container-title":["Frontiers in Public 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