Development and Validation of a Rapid Health Literacy Questionnaire for Chinese Primary and Secondary School Students

Health literacy (HL) is critical for shaping health behaviors in children and adolescents. Though children and adolescence are marked by increased involvement in health decision-making, most HL studies and measures of HL have focused on adults. There is a lack of an appropriate test-based validated tool for measuring comprehensive health literacy employing grounded theory approaches. This study aimed to develop and validate a rapid health literacy questionnaire for primary and secondary students to address gaps in exiting tools. Firstly, a health literacy indicator system was constructed through literature analysis, Delphi method, and expert interviews. Secondly, for each domain indicator, items were generated. Finally, a stratified sampling survey with 3,325 primary school students and 2,788 secondary school students was conducted, Rasch model approach was applied to evaluate reliability and validity. Reliability analysis confirmed consistent results, demonstrating favorable overall fit between observed data and the model. Validity results showed internal consistency. We developed a robust assessment tool tailored to Chinese primary and secondary students, which is expected to comprehensively measure the health literacy of students aged 6 to 15 years. Future cross-cultural validation is recommended to enhance its global applicability.