title: Development of the Health Literacy Assessment Scale for Adolescents (HAS-A).
abstract: BACKGROUND
  Health literacy has been found to be a crucial component of successful communication and navigation in health care. Various tools have been developed to measure health literacy skills, but few have been developed specifically for adolescents, and most require in-person administration. This study sought to develop a self-report health literacy scale for adolescents to assess four key health literacy domains: the ability to obtain, communicate, understand, and process health information.
  
  
  METHODS
  We collected data from 272 youth aged 12-19 recruited from a pediatrics clinic (37%) and the community (63%). We administered the Rapid Estimate of Adolescent Literacy in Medicine-Teen, Newest Vital Sign, and three surveys, and used factor analysis to identify scale items.
  
  
  RESULTS
  Using multiple health literacy assessments, it was clear that many teens struggle with low health literacy skills. When identifying items that can be used as self-report items in future research, factor analysis identified three subscales; a 5-itemcommunicationscale (alpha = 0.77), a 4-itemconfusionscale (alpha = 0.73), and a 6-itemfunctional health literacyscale (alpha = 0.76). The scales performed reasonably well when compared with validation items.
  
  
  CONCLUSIONS
  Self-report items can be used to assess health literacy skills for adolescents when in-person administration is not possible or feasible. Such items will allow for greater study of how health literacy impacts communication in not only health care settings, but for all levels of health communication. The tool will also allow researchers to better understand how adolescent health literacy is related to a variety of health outcomes. Further testing of these scales with different populations is warranted.
authors.affiliation: Department of Health Policy, Management & Behavior, University at Albany School of Public Health, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Manganello
authors.affiliation: Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: DeVellis
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, USA; Department of Pediatrics, Louisiana State University Health Sciences Center-Shreveport, USA.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.affiliation: Division of General Pediatrics, The Children's Hospital at Albany Medical College, USA.
authors.forename: Carrin
authors.initials: C
authors.lastname: Schottler-Thal
keywords: Adolescent; Attitudes; Communication; Health knowledge; Health literacy; Practice; Psychometrics; Validation studies; Young adult