Health Literacy Among Young People in Africa: Evidence Synthesis

Figures & data

Figure 1 Eligible studies selection process and results (PRISMA flow diagram).

Note: Adapted from Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Reprint—Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther. 2009;89(9):873–880.^30,

Table 1 Overview of the Articles/Studies Included in This Study

Author(s), Year	Country	Objective of the Study	Design/Method	Study Setting	Study Population (Sample Size in Analysis); Age (Years)	Sampling Technique	Measure of Health Literacy	Summary of Important Findings
Adewole et al, 2021^Citation37	Nigeria	To compare HL status and health-promoting behavior of adolescents with or without obesity, and to identify the relationship between HL status and health-promoting behavior of the two groups of adolescents	Cross-sectional (mixed-method study)	School	Private secondary school adolescents (300: 150 with obesity + 150 without obesity); age range 10–19	Multistage sampling (local government areas randomly, schools purposively, adolescents based on their body weight)	AAHLS	70% of adolescents without obesity had a higher level of health literacy compared to 59% of their counterparts with obesity. Adolescents with obesity had a mean score of 19.82±2.86 but adolescents without obesity had a mean score of 21.14±3.07 out of 39. There was a significant association between low HL levels and obesity
Amoah et al, 2017^Citation33	Ghana	To assess GHL status and its relationship with self-perceived health status among street youth	Cross-sectional (quantitative study)	Urban	Street youth (290); age range 12–24, mean 18±3.1	Purposive sampling was used to select street youth from five areas	HLS-EU-Q6	The majority, 78%, of the respondents demonstrated low GHL. Factors significantly associated with their GHL included age, education, and acknowledging the streets as home. Limited GHL was inversely related to self-perceived health status among the respondents after adjusting for many of the socio-demographic factors
Amoah et al, 2019^Citation34	Ghana	To explore FHL status and its socio-demographic correlates among street-involved youth	Cross-sectional (quantitative study)	Urban	Street-involved youth (337); age range 12–24, mean 18±3.3	Purposive sampling	SFHL	About 48%, 37%, and 15% of the respondents had inadequate, problematic, and sufficient FHL, respectively. Factors associated with FHL were sex, ethnicity, education, and duration of life on the streets
Evans et al, 2019^Citation28	Ghana	To assess HL status and its socio-demographic predictors among undergraduate university students	Cross-sectional (quantitative study)	University	Undergraduate university students (485); mean age 21.6±3.2	Faculty, program, and class were randomly selected	HLS-EU-16	More than half, 55%, of the respondents had limited HL status. Factors related to limited HL generally included college type, self-esteem, health status, year of study, and financial status, although they differed for each gender
Ewa, 2017^Citation35	Ghana	To assess HL status, obesity prevalence, and the relationship between HL status and obesity among adolescents, including associations between their HL status and behavioral risk factors for obesity	Cross-sectional (quantitative study)	School	Public and private school adolescent students (292); age range 10–15	Simple random sampling technique	NVS test	The majority, 53.4%, had limited HL, but 46.6% had adequate HL. The prevalence of obesity among the adolescents was 9.9%. However, there were no significant relationships between HL and overweight and obesity
Hamilton-Ekeke et al, 2020^Citation38	Nigeria	To assess level of HL, using drug abuse as an indicator of HL among secondary school students	Cross-sectional (quantitative)	School	Secondary school students (260); age range unspecified	Simple random sampling technique	Standardized test of knowledge questions and researcher-developed application of knowledge questionnaire	The study indicated that respondents had a fair knowledge of drug abuse, as the mean score of their knowledge of the issue was 59.28; however, there was no association between knowledge and application
Koduah et al, 2021^Citation36	Ghana	To assess HL knowledge of student nurses and practicing nurses, and identify the factors associated with that knowledge	Cross-sectional (quantitative)	Healthcare facilities and nursing training institutions	Student nurses and practicing nurses (876; 477 of them were student nurses); mean age 23.3±3.4	Convenience and snowball sampling techniques	Adapted version of HLKES	HL knowledge was low (average score of 5.8 out of 20) among the student nurses. Gender, trust in others, cultural values, year of study, and frequency of curative care use were factors associated with HL knowledge among respondents
Mostafa et al, 2021^Citation40	Egypt	To examine levels of HL and their association with antibiotic use, knowledge of antibiotics, and awareness of antibiotic resistance among university students	Cross-sectional (quantitative)	University	Non-medical university students (508); mean age 20.5±1.3	Convenience sampling	HLS-EU-Q16	Only 35.1% of the respondents had sufficient HL. The majority, 79.7%, of them had poor knowledge of antibiotics; 39.9% of them had used antibiotics in the past month without a prescription, and 92.2% of the respondents had limited antibiotic resistance awareness. Except for their year of study, students’ background characteristics did not significantly differ by their HL status and knowledge scores. But students’ high awareness of antibiotic resistance was independently related to sufficient HL
Shabi and Oyewusi, 2018^Citation39	Nigeria	To assess the association between HL abilities and internet health information use among school adolescents	Cross-sectional (quantitative)	School	Senior secondary school adolescents (1186); age range 11–19	Multistage random sampling method	Adapted from e-HEALS Scale	Only 37.7% of the respondents had adequate HL skills. The majority, 63.0%, used internet health information weekly. The most sought-out health information on the internet was information on nutrition, body size, and sexuality. There was a significant association between HL status and internet health information use

Abbreviations: HL, health literacy; FHL, functional health literacy; GHL general health literacy.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Reprint—preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther. 2009;89(9):873–880. doi:10.1093/ptj/89.9.873

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Adewole KO, Ogunfowokan AA, Olodu M. Influence of health literacy on health promoting behaviour of adolescents with and without obesity. Int J Africa Nurs Sci. 2021;15:100342. doi:10.1016/j.ijans.2021.100342

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Amoah PA, Phillips DR, Gyasi RM, Koduah AO, Edusei J. Health literacy and self-perceived health status among street youth in Kumasi, Ghana. Cogent Med. 2017;4(1):1275091. doi:10.1080/2331205X.2016.1275091

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Amoah PA, Koduah AO, Gyasi RM, Gwenzi GD, Anaduaka US. The relationship between functional health literacy, health-related behaviours, and sociodemographic characteristics of street-involved youth in Ghana. Int J Health Promo Educ. 2019;57(3):116–132. doi:10.1080/14635240.2018.1552835

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Evans A-Y, Anthony E, Gabriel G. Comprehensive health literacy among undergraduates: a Ghanaian university-based cross-sectional study. Health Literacy Res Pract. 2019;3(4):e227–e237.

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Ewa V. The Association Between Health Literacy and Obesity Among Adolescents in Selected Schools in Adentan Municipality. University of Ghana; 2017.

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Hamilton-Ekeke J-T, Abam RP, Ogobiri E. Health literacy in the promotion of wellness among secondary school students in Bayelsa State, Nigeria. J Health Educ Teach. 2020;11(1):1–7.

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Koduah AO, Amoah PA, Nkansah JO, Leung AY. A comparative analysis of student and practising nurses’ health literacy knowledge in Ghana. In: Book a Comparative Analysis of Student and Practising Nurses’ Health Literacy Knowledge in Ghana. Multidisciplinary Digital Publishing Institute; 2021:38.

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Mostafa A, Abdelzaher A, Rashed S, et al. Is health literacy associated with antibiotic use, knowledge and awareness of antimicrobial resistance among non-medical university students in Egypt? A cross-sectional study. BMJ open. 2021;11(3):e046453. doi:10.1136/bmjopen-2020-046453

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Shabi IN, Oyewusi FO. Health literacy and internet health information use among in-school adolescents in Osun State, South-West, Nigeria. J Consum Health Internet. 2018;22(1):25–41. doi:10.1080/15398285.2017.1402636

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