Background: Up to now, the under-13s have received little attention in research on health literacy (HL). Although some tools assess children’s HL, no validated tool is available that

assesses self-reported HL in a systematic and comparable way. The HLS-EU

questionnaire is a valid and reliable measure of adolescents’ and adults’ self-reported

HL, but has never been adapted for use with children. However, it would be worth

adapting for younger age groups so that self-reported HL could be assessed

continuously.

Objective: To quantitatively test an adapted scale based on the HLS-EU-Q developed

for German-speaking 9- to 10-year-olds.

Methods: An adapted 26-item HLS-EU-Q scale was given in a paper-and-pencil survey

to 907 fourth-grade students in North Rhine-Westphalia, Germany. The psychometric

properties of the scale were investigated with item analysis and factor analyses, and

both concurrent and discriminant validity were assessed.

Key Results: Of the 26 tested items, 9 were discarded due to poor performance in

terms of missing values, item difficulty, and dimensionality. This left a 15-item scale

with a high internal consistency (α = .791) that takes only a short time to administer.

The scale had a low correlation with functional health literacy (r = .107, p < .001), and a

moderate correlation with indicators of self-efficacy (ρ = .280–.306, p < .001). The latter

indicates adequate discriminant validity; whereas the former points to a need to further

investigate concurrent validity.

Conclusions: This is the first study in applying an age-adapted version of the HLS-EUQ

to children. Statistical analyses indicated the successful development of a promising

instrument, but further research is needed on its dimensionality and validity. This study

contributes significantly to the comparative assessment of HL across the life course by

providing a promising measurement tool for children aged 9 to 10.