title: Defining Taiwanese children's health literacy abilities from a health promotion perspective.
abstract: BACKGROUND
  Health literacy is related to health inequality, health behaviors, and health status. Globally, health literacy has primarily focused on adults and has been based on the medical model. It is necessary to understand children's life experiences as they relate to health; thus, this study attempted to evaluate and describe the health literacy abilities of sixth-graders in Taiwan.
  
  
  METHODS
  Interviews were conducted with 10 teachers and 11 caregivers, and focus groups were conducted with 32 children. Health literacy abilities corresponding to real-life situations were identified from life skills and the Taiwanese Curriculum Guidelines for health education. Three expert meetings were held to redefine children's health literacy using a health promotion perspective and confirmed indicators.
  
  
  RESULTS
  An operational definition of three aspects of children's health literacy and 25 abilities was proposed: 11 functional health literacy abilities (e.g. understands the connection between personal health care behaviors and health); seven interactive health literacy abilities (e.g. obtains and understands information from various channels); and seven critical health literacy abilities (e.g. analyzes the relationship between personal needs and diet choices for a balanced diet). These indicators cover 10 health education categories.
  
  
  CONCLUSIONS
  These findings highlight the importance of understanding Taiwanese children's health literacy, and the urgency of developing an appropriate measurement tool. The definition and indicators in this study were identified using a child-centered approach focusing on children's real-life experiences. The result serves as a solid basis for the development of the Taiwan Children's Health Literacy Scale, and provides information for the decision-making sector on health education.
authors.affiliation: 1 Department of Health Management, I-Shou University, Taiwan.
authors.forename: Li-Ling
authors.initials: LL
authors.lastname: Liao
authors.affiliation: 2 Department of Health Promotion and Health Education, National Taiwan Normal University, Taiwan.
authors.forename: Chieh-Hsing
authors.initials: CH
authors.lastname: Liu
authors.affiliation: 3 Department of Public Health, Fu Jen Catholic University, Taiwan.
authors.forename: Chi-Chia
authors.initials: CC
authors.lastname: Cheng
authors.affiliation: 4 Graduate Institute of Environmental Education, National Taiwan Normal University, Taiwan.
authors.forename: Tzu-Chau
authors.initials: TC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers; D002648:Child; D000067576:Child Health; D005260:Female; D017144:Focus Groups; D057220:Health Literacy / Q000379:methods*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000070777:School Teachers; D011795:Surveys and Questionnaires; D013624:Taiwan
keywords: children; health literacy; qualitative