Introduction and objective:
The results of the Health Behaviour in School-aged Children (HBSC) surveys conducted in 2018 and 2022 allow for a comparison of selected health-related indicators from before the COVID-19 pandemic and from its final phase. The aim of the study is to assess the level of health literacy (HL) among Polish students aged 13–17 years.

Material and methods:
The surveys were conducted with nationwide samples of students (N2018=5648 and N2022=4994, respectively). Changes in the overall HLSAC-5 index and its five dimensions were examined.

The findings indicate a significant decline in the average HLSAC-5 scores from 15.35±2.40 to 14.84±2.80, alongside an increase in the proportion of students with low HL from 9.85% – 23.67%. Concurrently, the percentage of students rating their health as poor rose from 3.5% to 9.1%. An increasing disparity in HL levels across schools was also observed, with the intraclass correlation coefficient (ICC) escalating from 3.4% to 6.1%. General linear model confirmed a significant influence of gender, age, place of living, family affluence, self-rated health, and eight significant 2-way or 3-way interactions between independent variables. Notably, there were five significant 3-way interactions involving the year of the survey and self-rated health, with the third factor, gender, age, family wealth, presence of a chronic disease, and place of residence, respectively.

The study highlights the dynamic nature of HL and its evolving relationship with various socio-demographic and health factors over time. The changes in students’ HL may have been influenced by factors related to living and learning during the COVID-19 pandemic.

The work carried out as part of the statutory project of the Institute of Mother and Child, entitled: Evaluation of trends in health indicators and health behaviours of school-aged children and adolescents aged 11, 13, 15, and 17 years, taking into account the influence of the Covid-19 pandemic. (Ocena kierunków zmian wskaźników zdrowia i zachowań zdrowotnych dzieci i młodzieży szkolnej w wieku 11,13,15 i 17 lat z uwzględnieniem wpływu pandemii Covid-19).
Bröder J, Okan O, Bauer U, et al. Health literacy in childhood and youth: A systematic review of definitions and models. BMC Public Health. 2017;17:361.
Sørensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.
Perrenoud B, Velonaki VS, Bodenmann P, et al. The effectiveness of health literacy interventions on the informed consent process of health care users: a systematic review protocol. JBI Database System Rev Implement Rep. 2015;13(10):82–94.
Tavousi M, Mohammadi S, Sadighi J, et al. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS One. 2022;17(7):e0271524.
Okan O, Lopes E, Bollweg TM, et al. Generic health literacy measurement instruments for children and adolescents: a systematic review of the literature. BMC Public Health. 2018;18(1):166.
Malloy-Weir LJ, Charles C, Gafni A, et al. A review of health literacy: Definitions, interpretations, and implications for policy initiatives. J Public Health Policy. 2016;37(3):334–352.
Paakkari L, Paakkari O. Health literacy as a learning outcome in schools. Health Educ. 2012;112:133–152.
Paakkari O, Kulmala M, Lyyra N, et al. The development and cross-national validation of the short health literacy for school-aged children (HLSAC-5) instrument. Sci Rep. 2023;13(1):18769.
Kleszczewska D, Mazur J, Porwit K. et al. Who Is Able to Resist What Is Forbidden? The Relationship between Health Literacy and Risk Behaviours in Secondary School Students in the Broader Social and Educational Context. Int J Environ Res Public Health. 2022;19(15):9381.
Lahti H, Kulmala M, Hietajärvi L, et al. What Counteracts Problematic Social Media Use in Adolescence? A Cross-National Observational Study. J Adolesc Health. 2024;74(1):98–112.
Betthäuser BA, Bach-Mortensen AM, Engzell P. A systematic review and meta-analysis of the evidence on learning during the COVID-19 pandemic. Nat Hum Behav. 2023;7(3):375–385.
Kleszczewska D, Mazur J, Dzielska A, et al. Adolescent Loneliness in the COVID-19 Era. The perspective of Health Behaviour in School-Aged Children study in Poland. Fam Med Prim Care Rev. 2024;1 (in press).
Vamos SD, McDermott RJ. Rebranding School Health: The Power of Education for Health Literacy. J Sch Health. 2021;91(8):670–676.
DeWalt DA, Hink A. Health literacy and child health outcomes: a systematic review of the literature. Pediatrics 2009;124 Suppl 3:S265–S274.
Fretian A, Bollweg TM, Okan O, et al. Exploring Associated Factors of Subjective Health Literacy in School-Aged Children. Int J Environ Res Public Health. 2020;17(5):1720.
Smętkowski M, Płoszaj A, Rok J. Local concentration of deprivation in Poland. In European Regional and Local Studies EUROREG; Center for European Regional and Local Studies EUROREG: Warsaw, Poland, 2016.
Paakkari O, Torppa M, Boberova Z, et al. The cross-national measurement invariance of the health literacy for school-aged children (HLSAC) instrument. Eur J Public Health. 2019;29(3):432–436.
Currie C, Alemán Díaz A, Bosáková L, et al. The international Family Affluence Scale (FAS): Charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities. SSM Popul Health. 2023;25:101599.
Mazur J, Sentenac M, Brooks F, et al. Burden of chronic health conditions in adolescence measured by school surveys. Med Wieku Rozwoj. 2013;17(2):157–64.
Schnohr CW, Molcho M, Rasmussen M, et al. Trend analyses in the health behaviour in school-aged children study: methodological considerations and recommendations. Eur J Public Health. 2015;25 Suppl 2:7–12.
Paakkari L, Torppa M, Mazur J, et al. A Comparative Study on Adolescents’ Health Literacy in Europe: Findings from the HBSC Study. Int J Environ Res Public Health. 2020;17(10):3543.
Velasco V, Gragnano A, Vecchio LP, et al. Health Literacy Levels among Italian Students: Monitoring and Promotion at School. Int J Environ Res Public Health. 2021;18(19):9943.
Duplaga M, Grysztar M. Socio-Economic Determinants of Health Literacy in High School Students: A Cross-Sectional Study. Int J Environ Res Public Health. 2021 Nov 21;18(22):12231.
Simonsen N, Wackström N, Roos E, et al. Does health literacy explain regional health disparities among adolescents in Finland? Health Promot Int. 2021;36(6):1727–1738.
Avvisati F. The measure of socio-economic status in PISA: a review and some suggested improvements. Large-scale Assess Educ. 2020;8:8.
Summanen AM, Rautopuro J, Kannas LK, et al. Objective health literacy skills among ninth graders in Finland: outcomes from a national learning assessment. Scand J Public Health. 2022;50(5):646–653.
Kühn L, Bachert P, Hildebrand C, Kunkel J, et al. Health Literacy Among University Students: A Systematic Review of Cross-Sectional Studies. Front Public Health. 2022;9:680999.
Stienstra K, Karlson KB. The nature-nurture of academic achievement at the intersection between gender, family background, and school context. Soc Sci Res. 2023;111:102870.
Riemann L, Lubasch JS, Heep A, et al. The Role of Health Literacy in Health Behavior, Health Service Use, Health Outcomes, and Empowerment in Pediatric Patients with Chronic Disease: A Systematic Review. Int J Environ Res Public Health. 2021;18(23):12464.
Zhong Y, Patel N, Ferris M, et al. Health literacy, nutrition knowledge, and health care transition readiness in youth with chronic kidney disease or hypertension: A cross-sectional study. J Child Health Care. 2020;24(2):246–259.
Loer AM, Domanska OM, Stock C, et al. Exploring pandemic-related health literacy among adolescents in Germany: a focus group study. Arch Public Health. 2022;80(1):182.
Kotseva B, Vianini I, Nikolaidis N, et al. Trend analysis of COVID-19 mis/disinformation narratives – A 3-year study. PLoS One. 2023;18(11):e0291423.
McCaffery K, Dodd R, Cvejic E, et al. Health literacy and disparities in COVID-19–related knowledge, attitudes, beliefs, and behaviors in Australia. Public Health Res Pract. 2020;30(4):30342012.
Šmigelskas K, Lukoševičiūtė J, Vaičiūnas T, et al. Measurement of Health and Social Behaviors in Schoolchildren: Randomized Study Comparing Paper Versus Electronic Mode. Zdr Varst. 2019;58(1):1–10.
Kleszczewska D, Porwit K, Boberova Z, et al. Adolescent Health Literacy and Neighbourhood Features: HBSC Findings from Czech Republic, Poland, and Slovakia. Int J Environ Res Public Health. 2021;18(14):7388.
Korzycka M, Bójko M, Radiukiewicz K, et al. Demographic analysis of difficulties related to remote education in Poland from the perspective of adolescents during the COVID-19 pandemic. Ann Agric Environ Med. 2021;28(1):149–157.
Perkins A, Clarke J, Smith,A, et al. Barriers and enablers faced by regional and rural schools in supporting student mental health: A mixed-methods systematic review. Aust J Rural Health. 2021;29(6):835–849.
Flavell JH. Metacognition and cognitive monitoring: A new area of cognitive developmental inquiry. Am Psychol. 1979;34:906–11.
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