Background Childhood and early adolescence are critical periods for promoting health literacy (HL), a foundational factor that influences health-promoting participation throughout life. Evidence-based, theory-informed interventions to improve participation in school-aged children are scarce. This study aims to clarify the HL framework and to understand its role in guiding tailored interventions.Methods Within the HL framework, this study conceptualized health participation improvement through knowledge, skills, and motivation. Two pathways, knowledge-driven and motivation-driven, were proposed and validated for their relative contributions. From January to July 2023, a multistage cluster sampling method was used to recruit 3,325 elementary school students in China, including 1,070 students in Grades 1-2, 1,190 in Grades 3-4, and 1,065 in Grades 5-6. HL was assessed using the Chinese Rapid Health Literacy Questionnaire (CRHLQ) for Elementary School Students, a validated assessment tool comprising three sub-questionnaires. Chain mediation models were constructed to examine the two pathways, with gender, academic performance, and personality included as control variables. Indirect effects were estimated using a bootstrap method with 5,000 replications.Results In Grades 1-2, health participation is primarily mediated through motivation and skills for the knowledge-driven pathway, while motivation exerts a strong direct effect in the motivation-driven pathway. In Grades 3-4, knowledge has a total direct effect on health participation, whereas motivation influences participation indirectly via knowledge. In Grades 5-6, the knowledge-driven pathway operates mainly through motivation, with no direct effect, while motivation again shows a strong direct effect on participation. To sum up, pathways for improving health participation differ across elementary grade levels: motivation-driven in lower grades, knowledge-driven in middle grades, and combined knowledge- and motivation-driven in upper grades.Conclusion Guided by the HL framework, patterns of health participation improvement differ across grade levels. HL interventions should be tailored using developmentally appropriate strategies and tools. Adapting health education content to grade level, balancing motivation-driven and knowledge-driven strategies, can maximize its educational effectiveness.

The improvement of children’s health literacy is crucial for their physical and mental health development, and exploring the internal pathway of health literacy by age group is essential for improving the health literacy level at different age stages. We explored internal pathways within health literacy among elementary school students at different grade levels, utilizing a mediated effects model. A total of 3325 Chinese elementary students participated in a cross-sectional study between January to July 2023 using Health Literacy Questionnaire. IBM SPSS V.27 was used for descriptive statistics and correlation analysis of all variables. PROCESS SPSS was used to analyze chain-mediated effects. In grades 1-2, health motivation correlated with health participation through two paths: the mediating role of health skill, and the serial mediating roles of health knowledge and skill, presenting a partial mediating effect. In grades 3-4, health knowledge correlated with health participation through two paths: the mediating role of health motivation, and the mediating role of health skill, presenting a partial mediating effect. In grades 5-6, health knowledge correlated with health participation through one path: the mediating role of health motivation, presenting a total mediating effect. Our study suggests that elementary school students at different grade levels have different ways of improving health literacy because of the different pathways within health literacy. This provides new ideas for health education among children.

Background:This study aimed to develop and validate test-based physical literacy scales (PLSs) for primary school students across different grades. Methods:Data were collected through a field survey conducted from June 1 to July 31, 2022, involving 3,275 primary school students from four provinces in China. The questionnaires assessed four domains: physical knowledge, physical competence, physical motivation, and physical behavior. The Rasch model was employed for psychometric analysis. Results:The variance explained by measures for the PLSs was 53.1%, 50.3%, and 54.7%, all exceeding the 50% threshold, confirming unidimensionality and robust internal consistency. This enabled effective differentiation among students with varying proficiency levels. The item-person map demonstrated optimal alignment between item difficulty and participant ability levels. Most items showed favorable fit statistics, with Infit mean square (MNSQ) and Outfit MNSQ values ranging between 0.5 and 1.5. Conclusions:The PLSs demonstrate validity and reliability in measuring physical literacy among Chinese primary school students across four components: physical knowledge, physical competence, physical motivation, and physical behavior. The scales measure a unidimensional construct, supporting the use of summed total scores for assessment.

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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement the National Natural Science Foundation of China under Grant [number 71904205] ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of the Chinese Academy of Medical Sciences & Peking Union Medical College I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Physical literacy (PL) is pivotal for improving sedentary behaviors, enhancing intrinsic motivation for physical activity, and supporting the growth and development of adolescents. This study aims to measure the current situation and internal pathway of PL among Chinese elementary school students. This study was conducted from June to July 2022 and used multistage cluster sampling to select the study subjects. Questionnaire measurements were used to report the levels of PL among elementary school students and to explain the internal association among the various PL dimensions. The average PL score among primary school students was 63.46 points. The qualification rates for PL in the three academic stages were 76.35

Objective To develop a framework for a comprehensive health literacy assessment system for primary school students that will provide a basis for establishing measurement tools and promoting healthy student development.Methods An expert survey questionnaire was developed using literature review,Delphi method,expert meeting,and other methods.From December 2021 to February 2022,13 experts in health literacy and related fields were selected for two rounds of Delphi questionnaire surveys.A comprehensive health literacy assessment index system was constructed for primary school students in different grades,including grades 1-2,3-4,and 5-6.The weight coefficient was calculated using the percentage weighting method.Results The constructed comprehensive assessment system includes three grade-specific subsystems.For students in grades 1-2 and 3-4,the subsystem includes six primary indicators(personal hygiene,healthy diet,physical activity,disease prevention and control,safety literacy,and mental health)and fifteen secondary indicators;each of the six primary indicators includes four capability dimensions of health knowledge,motivation,behavior,and skills;the subsystem for students in grades 5-6 has an additional primary indicator of e-health literacy,with seven primary indicators and twenty secondary indicators,along with the same four capability dimensions.The effective response rate to the expert questionnaire was 100％in the two rounds of consultation,indicating high enthusiasm of the experts;the coefficients of authority for the two rounds of consultation were greater than 0.7,confirming the reliability of the results;the Kendall's coefficients of 0.302,0.327,and 0.340 for the primary indicators,secondary indicators,and the four ability dimensions of the primary indicators in the second round of consultation were higher than those in the first round of consultation(P＜0.05 for all).Conclusion The constructed framework of a comprehensive health literacy assessment system for Chinese primary school students can serve as a reference for related research on assessing students'health literacy.

Background : Physical literacy(PL) is pivotal in improving sedentary behaviors, enhancing intrinsic motivation for physical activity, and supporting the growth and development of adolescents. The study is to measure the current situation and internal pathway of physical literacy among Chinese elementary school students. Methods : In this study, a questionnaire was developed to measure the PL of elementary school students in China. The results obtained from the questionnaire measurements were used to report on the levels of PL among elementary school students and to explain the internal causal relationships among the various dimensions of PL. Results : The average score for physical literacy among primary school students is 63.46 points. The qualification rates for physical literacy in three academic stages are 76.35%, 73.45%, and 59.17%. As primary school students advance in grades, the qualification rate for physical competency increases. The qualification rates for physical motivation in the three academic stages are 91.03%, 61.30%, and 63.78%, while the qualification rates for physical participation are 14.48%, 9.97%, and 3.95%. The correlation between physical literacy and physical motivation consistently increases across the three grade levels (r=0.529, r=0.596, r=0.674, P<0.01), but correlations with physical competency (r=0.826, r=0.770, r=0.767) and physical participation (r=0.852, r=0.701, r=0.615) continuously decrease. Physical competency serves as the mediating variable in the influence of physical motivation on physical participation, explaining 56.40% of the effect. Conclusion : As grades advance, the overall physical literacy qualification rate experiences a yearly decline. Physical competency explains 56.40% of the effect in the influence of physical motivation on physical participation.

ObjectiveTo develop a nutrition health literacy questionnaire for pupils of different grades based on item response theory and to validate the questionnaire with the Rasch model. MethodsAn index system for evaluating nutrition health literacy among pupils was established through literature study on researches and reports published at home and aboard and expert consultation for the complication of nutrition health literacy questionnaires for pupils of grade 1 – 2, 3 – 4, and 5 – 6. The developed questionnaires were then assessed among 1 074, 1 045 and 553 pupils of the three grade groups recruited with stratified random cluster sampling at 8 elementary schools in Beijing municipality, Xining city of Qinghai province and Taiyuan city of Shanxi province during June – July 2021. Based on Rasch model, the questionnaires' item discrimination, item reliability and item fitting were validated with unidimensional test, Wright map and other indicators using Winsteps software. ResultsValid responses were collected from 1 066, 921 and 543 pupils of the three grade groups, with an overall efficient rate of 94.7%. The questionnaires for the three grade groups were all consistent with the one-dimensional hypothesis and most of the items of the questions were of high goodness of fit. For the questionnaire towards pupils of grade 1 – 2, 3 – 4, and 5 – 6, the item discrimination indexes were 9.57, 6.03, and 13.68; the item reliability indexes were 0.99, 0.97, and 0.99; and the difficulty indexes were 2.72, – 0.18, and – 0.42, respectively, indicating a higher difficulty of the questionnaire for pupils of grade 1 – 2 and a lower difficulty of questionnaires for pupils of grade 3 – 4 and 5 – 6. ConclusionThe developed nutrition health literacy questionnaire for pupils of different grades fits with the Rasch model well and is of good reliability and discriminability; the questionnaire could be used in relevant surveys in pupils.

Abstract Background: At this stage, Chinese research on physical activity literacy is still in its infancy, and the domestic primary school students' physical activity literacy assessment questionnaire is also in a state of development. In this study, a set of questionnaire scales for measuring the physical activity literacy of primary school students was compiled according to the characteristics of primary school students in different school stages, and the population measurement was carried out by using this scale, and then the accuracy of the scale and the fit according to the Rasch model were judged. Methods: We compiled a set of scales for measuring the physical activity literacy of primary school students, and directly distributed the questionnaires to primary school students in four regions of Hebei Province, Sichuan Province, Shenzhen City and Qinghai Province for actual measurement. We also used Rasch analysis to study the single-dimensionality, reliability, resolution and fitting degree of the questionnaire to judge the accuracy of the scale, aiming to provide a strong reference for the subsequent revision and wide application of the questionnaire. Results: The item reliability coefficient of all questionnaires was 1, and the item separation degree was 16.08, 16.71 and 18.18, respectively, all of which were greater than 3, indicating that the internal consistency of the questionnaire was better and the students with different ability levels could be better distinguished. The one-dimensional hypothesis of the three questionnaires holds. The project-person figure shows that the difficulty of the questionnaire items can be well matched with the subject's ability level. The average values of Infit MNSQ and Outfit MNSQ in the questionnaire were between 0.5-1.5, and the overall fit was good, and the data were in good agreement with the ideal model. In the fitting statistics of a single entry, it was found that the three grade levels generally showed poor fitting on the questions of whether they should continue to exercise after injury, whether it was appropriate to be sedentary and inactive, whether weather with severe air pollution was suitable for outdoor sports, and motivation for sports tests and motivation to like challenges. In subsequent modifications, we will delete and improve these questions or modify the statements of these questions to appropriately increase the difficulty of the questions. Conclusion: The one-dimensional test passed, reliable and internally consistent of the questionnaire was high, the difficulty of the item and the matching degree of population ability were high, and the questionnaire fit the model well. The questionnaire as a whole can form a questionnaire on sports health literacy of primary school students with good reliability and validity.

Background The contribution of geriatric health examination services of national essential public health services to the detection of abnormal health conditions in the elderly and the awareness of examination results of the elderly has been rarely reported in the current studies. Objective To investigate the abnormal detection of several common diseases including abnormal blood pressure,abnormal blood glucose,overweight and obesity,anemia,fatty liver disease,gallstones or cholecystitis in the health examination of the older adults aged 65 years and above. Methods The older adults aged 65 years and above who visited 20 primary care institutions in 5 cities of 3 provinces in eastern,central and western China were selected as study subjects（excluding those with unclear health examination results in this year） from November to December 2019 by using a multistage stratified sampling method,and divided into the general older adults（without hypertension or diabetes）,older adults with hypertension,older adults with diabetes. A one-on-one questionnaire survey was conducted on all respondents（The questionnaire included the general demographic characteristics of the respondents and the abnormal detection in the health examination of the elderly）. Results Among 3 018 older adults,2 033（67.36%） reported abnormalities in the health examination. There were statistically significant differences in the abnormal detection rates of health examination for the older adults with different types of residence,population,and household registration（P＜0.05）. Among 3 018 older adults,1 174（38.90%） self-reported abnormal blood pressure detection,747（24.75%） self-reported abnormal blood glucose detection,719（23.82%） self-reported dyslipidemia detection,445（14.74%） self-reported fatty liver detection,393（13.02%） reported overweight and obesity detection,238（7.89%） reported gallstones or cholecystitis detection,and 60（1.99%） reported anemia detection. Abnormal blood pressure was detected in 49.13% of the older adults diagnosed with hypertension during the annual health examination,with the blood pressure control rate of 50.87%. Abnormal blood glucose was detected in 60.48% of the older adults diagnosed with diabetes during health examination with the control rate of blood glucose of 39.52%. Multivariate Logistic regression analysis showed that the detection rate of abnormal blood pressure was 2.57 times[95%CI（2.01,3.29）] higher in the older adults with diabetes than in the general older adults;the detection rate of dyslipidemia was 1.64 times[95%CI（1.29,2.08）] and 1.42 times[95%CI（1.10,1.84）] higher in the older adults with hypertension and diabetes than in the general older adults,respectively;the detection rate of overweight and obesity was 2.79 times[95%CI（1.94,4.00）] and 2.64 times[95%CI（1.80,3.87）] higher in the older adults with hypertension and diabetes than in the general older adults,respectively;the detection rate of fatty liver was 2.10 times[95%CI（1.55,2.85）] higher in the the older adults with hypertension than the general older adults;while the detection rate of anemia was 0.25 times[95%CI（0.13,0.47）] and 0.47 times[95%CI（0.25,0.86）] higher in the older adults with hypertension and diabetes than in the general older adults;the detection rate of dyslipidemia,gallstones or cholecystitis was 0.76 [95%CI（0.64,0.90）]and 1.32[95%CI（1.01,1.73）] times higher in the rural older adults than the urban older adults,respectively（P＜0.05）. Conclusion The physical examination program for the elderly in the national essential public health services plays an important role in early detection and wareness of health problems.

背景 国家基本公共卫生服务项目自2009年至今已开展13年，是我国迄今为止针对高血压患者开展的最大范围的人群干预实践，了解该人群对干预实践的反馈，对于推动国家基本公共卫生服务的持续发展非常重要。目的 探讨高血压患者的国家基本公共卫生服务自评受益率与满意度，为促进国家基本公共卫生服务实现高质量发展提供科学依据。方法 采用多阶段分层抽样方式，于2019年11—12月在我国东、中、西部地区5市10区（县）20个社区卫生服务中心或乡镇卫生院抽取2 419例≥35岁的高血压患者进行问卷调查。问卷由两部分组成：一般人口学信息和高血压患者健康管理情况。结果 86.26%（2 072/2 402）的调查对象认为其所接受的基本公共卫生服务对其健康改善具有帮助。分别有97.15%（2 349/2 418）、94.09%（2 275/2 418）、88.16%（2 129/2 415）、87.81%（2 118/2 412）、61.36%（1 469/2 394）、95.04%（2 297/2 417）、83.67%（2 013/2 406）、82.34%（1 981/2 406）、95.53%（2 310/2 418）的高血压患者对医护人员服务态度、医护人员服务水平、体格检查、健康教育、中医药治疗、随访服务、高血压并发症筛查、血压控制效果及总体服务表示满意。不同文化程度、不同自评健康状况、是否在基层首次发现血压异常、过去1年内接受不同随访服务次数的高血压患者的自评获益率比较，差异有统计学意义（P＜0.05）；不同文化程度、是否在基层首次发现血压异常、过去1年内接受不同随访服务次数的高血压患者总体服务满意度比较，差异有统计学意义（P＜0.05）。结论 高血压患者的国家基本公共卫生服务自评受益率及满意度较高，应注重国家基本公共卫生服务的规范提供及城乡同质化，以促进国家基本公共卫生服务实现高质量、可持续的发展。

背景 我国国家基本公共卫生服务为65岁及以上老年人每年免费提供一次健康体检服务，健康体检是对老年常见疾病“早发现、早诊断、早治疗”的第一步。基本公共卫生服务的老年健康体检服务对老年健康异常状况检出的贡献及老年人获悉情况，相关研究报道较少。本文主要着眼于基本公共卫生服务中老年人健康体检异常检出率进行研究，从需方视角了解国家基本公共卫生服务项目中老年健康体检的效果。目的 了解基本公共卫生服务为65岁以上老年人提供的健康体检服务中异常检出率情况。方法 采用多阶段分层抽样从我国东、中、西部的3省5市20个基层医疗机构中就诊的>=65岁老年人作为调查对象，根据基本公共卫生管理情况，分为一般老年人（不患有高血压或糖尿病）、高血压老年人、糖尿病老年人三类，对所有调查对象进行一对一问卷调查。结果 （1）老年人健康体检异常检出率为67.4%，农村老年人高于城市（70.6%＞64.1%，P＜0.001）；（2）血压异常：老年人体检异常检出率最高的是血压异常，有38.9%的调查对象自报在最近一次的年度体检结果中显示血压异常，农村高于城市（41.2%＞36.6%，P=0.010）；有49.1%的已被诊断为高血压的老年人在年度体检中的血压值异常，36.1%的糖尿病老年人血压值异常，18.3%的一般老年人在最近一次体检中发现了血压值异常。（3）血糖异常：24.8%的调查对象自报最近一次体检中发现了血糖异常；已被诊断为糖尿病的老年人在体检中测量血糖，血糖异常的比例为60.5%，高血压老年人的血糖异常率为9.7%，一般老年人的血糖异常筛查率为8.4%。（4）贫血的总体检出率是2.0%，农村老年人高于城市（2.6%＞1.4%，P=0.021）；脂肪肝的总检出率14.7 %，城市老年人高于农村（17.2%＞12.3%，P＜0.001）。（5）与一般老年人相比，高血糖老年人血压异常检出率是其2.66倍，高血压、高血糖老年人血脂异常检出率分别是其1.64、1.41倍，高血压、高血糖老年人超重肥胖检出率分别是其2.81、2.57倍，高血压、高血糖老年人脂肪肝检出率分别是其2.10、1.52倍，而高血压、高血糖老年人贫血检出率则是一般老年人的0.26、0.50倍；与城市相比，农村老年人的血压异常、血糖异常、贫血分别是其1.29、1.36和1.76倍，而农村老年人的脂肪肝检出率是其0.30倍。结论 健康体检中血压异常检出率较高，高血压、糖尿病老年人自身血压血糖控制有所改善，农村老年人健康防治不如城市。

Objective To construct an effect-oriented comprehensive evaluation index system for national basic public health services, and to provide methods and tools for innovating evaluation method of basic public health projects and promoting the transformation from process evaluation to health outcome evaluation. MethodsPrimary, secondary and tertiary indexes were constructed and selected with literature review, field interview of senior professionals, expert Delphi consulting and logical analysis; subjective and objective weights of the indexes were calculated through analytic hierarchy process and entropy weight method. ResultsThrough literature analysis and interview consultation, an index pool consisting of 3 first-, 25 second- and 104 third-level indicators was preliminarily formed, including 47 third-level indicators reflecting health effects. For the first round of expert Delphi consultation on indicator screening, the positive coefficient of experts is 97.5%, the expert authority coefficient is 0.82, and the expert familiarity coefficient is 0.88. The final comprehensive evaluation index system consists of three first-level indexes of project investment, implementation and health effect, with the weights of 11.35%, 26.48% and 62.18%, along with 20 second- and 54 third-level indexes. Among the health effect indicators, the weight of awareness of and satisfaction to health services was the highest (16.39%), followed by the weight of health management in chronic disease patients (14.97%), children′s health management (12.42%), maternal health management (12.42%), and health education (5.43%). Among the three-level effect indexes, the weight of residents′ satisfaction to health service was the highest (7.25%), followed by the incidence of hypertension and diabetes complications in the managed population (5.35%) and the incidence of diabetes complications in the managed population (5.27%). Besides the health statistics from routine monitoring system in China, the electronic health records in residents′ information system can be used as a main data source for health effect indicators. ConclusionThe comprehensive index system constructed in this study for the evaluation on essential national public health service is effect-oriented and can be used for regular and periodical evaluation on the basis of making full use of residents′ health records in the basic public health information system.

目的 对国际通用量表"最新关键指标(NVS)"进行汉化,探讨其在我国青少年群体中的信效度,从而为我国青少年健康素养测量提供一个更经典更简短的工具,并且可用于进行国际间青少年健康素养水平的比较.方法 采用Brislin翻译原则对NVS量表进行翻译和文化调适.选取2018年1—2月泸州市3754名中小学生进行调查,评价量表的信度和效度.结果 汉化版NVS量表保留了原量表全部6个条目,Cronbach'sα系数为0.748,重测信度为0.685,与《中国居民健康素养调查问卷》得分呈正相关(r=0.506,P<0.001).探索性因子分析共提取出两个特征根>1的公因子,累计方差解释率为63.694％.验证性因子分析总体拟合较好,GFI=0.993,RMSEA=0.051,CFI=0.987,NFI=0.985,SRMR=0.021.结论 汉化版NVS量表在青少年群体中具有良好的信效度,可用来测量我国青少年健康素养水平.

目的:利用扎根理论探讨基本公共卫生服务提供质量的影响因素,为促进高质量均等化的基本公共卫生服务提供建议与参考.方法:2019年11-12月,采用目的抽样法抽取浙江省、山西省、重庆市进行调查,对3省市的基层医疗机构管理人员进行访谈,并对转录资料进行三级编码分析.结果:通过三级编码抽象出基本公共卫生服务提供重要影响因素9个,并将其归纳为基层公共卫生人力资源、基层医疗卫生机构建设和外部环境3个层面,形成基本公共卫生服务提供影响因素的框架.外部政策环境会影响基层医疗卫生机构建设和基层公共卫生人员现状,二者的能力及水平会直接影响服务项目提供的质量;居民的认知会影响其对基本公共卫生服务的利用.结论:应该增强人员与机构的整体服务能力,建立健全人才引进机制,减轻基层工作负担,加大项目宣传力度.

目前我国儿童青少年健康素养水平亟待提高,但国内针对儿童青少年健康素养测评工具的研究十分有限,一方面是根据我国相关政策标准自制的测量工具,另一方面是国际已有测量工具的本土化.国外应用较多的儿童青少年健康素养测评工具,多将成人经典健康素养量表进行适宜化改造,评估儿童青少年健康素养水平.本文对国内外儿童青少年健康素养的定义及测评工具进行综述总结,以期为相关研究提供参考和依据.