This secondary analysis was derived from a broader cross-sectional study concerning adolescent vaccination determinants. The research focused on third-year students within lower secondary schools in the Umbria region, Italy. The study involved a sample of 340 adolescents out of a total of 6,996 eligible students across 18 participating schools, representing 25.0% of the schools contacted by the Regional School Office. The data collection utilized the mandatory 29-item MOHLAA-Q (MOHLAA-Questionnaire), which had been translated by the authors for use in the Italian context. It is crucial to note that the original MOHLAA-Q was validated for adolescents aged 14–17 years, and no independent validation, back-translation, or cognitive testing was performed on the translated instrument for this specific younger age group.

The findings across the four assessed domains of health literacy provided a nuanced view of the health literacy landscape among this population. Regarding difficulties in dealing with health-related information (Scale A), the results indicated a substantial portion of the adolescents faced barriers; specifically, 53.3% reported some difficulties, and 17.6% reported many difficulties. In contrast, only 25.3% reported few difficulties, and a small fraction, 3.8%, reported barely or no difficulties, suggesting that health information processing is a widespread concern.

When examining communication and interaction skills (Scale B), the distribution showed a more favorable, albeit mixed, profile. The largest groups were classified as high (32.1%) and rather high (31.2%), totaling 63.3% who demonstrated strong communication skills. However, 28.5% were classified as moderate, and 8.2% were classified as low, indicating that while many possess high skills, a notable segment requires further support in interpersonal health exchanges.

Attitudes toward health and health information (Scale C) demonstrated that the majority of adolescents were actively engaged. Specifically, 51.2% were classified as active, while 45.9% were categorized as partly passive–partly active. Only a small minority, 2.9%, were classified as passive, suggesting a generally positive predisposition toward health engagement among the youth studied.

The most pronounced area of concern was observed in health-related knowledge (Scale D). The data revealed that 51.5% of the adolescents were classified as having low health-related knowledge. This was followed by 40.9% classified as moderate, leaving only 7.6% classified as high. This high prevalence of low knowledge strongly aligns with the reported difficulties in processing health information (Scale A).

Furthermore, exploratory ordinal analyses were conducted to identify potential associations with selected adolescent and family characteristics. These analyses identified associations between adolescent sex and Scale A (difficulties in dealing with health-related information), and between parental health literacy and Scale D (health-related knowledge). However, the researchers explicitly noted that these findings are considered hypothesis-generating, meaning they suggest areas for future investigation rather than establishing definitive causal relationships.

In conclusion, the study provides descriptive evidence regarding health-literacy domains among younger adolescents in Umbria. The findings indicate that difficulties in dealing with health-related information and low health-related knowledge were relatively common features of this sample. While communication skills and attitudes showed more favorable distributions, the overall picture necessitates caution. The researchers stressed that the study was opportunistic and non-representative of the broader population.

The authors emphasized that the results must be interpreted cautiously due to several methodological limitations. These limitations include the low individual response rate, which was only 4.9% of the eligible adolescents, the non-representative nature of the recruitment, the use of a translated version of the MOHLAA-Q that had not undergone formal validation for this specific younger age group, and the exploratory nature of the identified associations. Therefore, the authors strongly recommend that future studies employ age-appropriate, validated instruments and utilize representative samples to gain a more robust and generalizable understanding of health literacy in this demographic.

Subject of Research: Health literacy among early adolescents in Italy

Article Title: Health literacy among early adolescents in Umbria, Italy: a cross-sectional study

Article References: Bertola, C., Cerabona, V., Bronzetti, L., Paciosi, F., Pocetta, G., Valentini, I., Chiavarini, M., & de Waure, C. (2026). Health literacy among early adolescents in Umbria, Italy: a cross-sectional study. Frontiers in Public Health, 14, Article 1925432. https://doi.org/10.3389/fpubh.2026.1925432

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1925432

Keywords: Health Literacy, Adolescent Health, Public Health, Cross-sectional Study, Health Education, Italy, MOHLAA-Q, Health Knowledge, Health, literacy, early, adolescents