Development and Validation of a Tool for Measuring Health-Related Media Literacy (HRML) Among Adolescents and Adults

Articles in Press

Document Type : Original Article

Authors

1 M.Sc. in Health Education and Promotion, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran.

2 Associate Professor, Ph.D. in Biostatistics, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.

3 Professor, Ph.D. in Health Education, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran

4 Professor, Ph.D. in Health Education, Department of Health Education and Promotion, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran

5 Associate Professor, Ph.D. in Reproductive Health, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran.

6 Assistant Professor, Ph.D. in Health Education and promotion, Department of Public Health, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.

Abstract

Background and Objectives: With the proliferation of media platforms as primary sources of health information, evaluating individuals' ability to effectively use these resources is crucial. This study aimed to develop and validate a reliable and valid assessment tool for measuring HRML.

Materials and Methods: The study was conducted in 2023, which involved two phases: tool development and validation. An initial draft of the HRML assessment tool was created, encompassing items assessing four key skill domains: Search and Acquire, Understanding, Appraisal, and Applying. Face and content validity were assessed through expert review by 13 health professionals familiar with health and media literacy. Exploratory factor analysis (EFA) was used to examine the interrelationships among the four dimensions and establish item-domain relationships. Confirmatory factor analysis (CFA) evaluated model fit. Reliability was assessed by administering the questionnaire to 203 healthcare service users in Boyer-Ahmad County, and internal consistency was determined using Cronbach's alpha.  

Results: The final questionnaire comprised 28 items across four domains of skills: searching and acquiring, understanding, appraising, and applying. The average content validity ratio (CVR) was 0.889, and the average content validity index (CVI) was 0.991. All four HRML dimensions showed significant positive correlations (p < 0.01). CFA indicated acceptable model fit (CMIN/DF = 1.43, AGFI = 0.830, RMSEA = 0.040, CFI = 0.903, IFI = 0.905). Cronbach's alpha for the overall scale was 0.820.

Conclusion: Effective health communication is crucial for the success of health interventions. This validated HRML assessment tool can identify areas for improvement in individuals' media literacy skills and determine preferred media sources. This information can inform the development of targeted interventions to promote informed health decision-making in individuals and communities. The tool is suitable for use in various settings, including educational institutions, workplaces, service centers, and community spaces.

Keywords

Acknowledgements: The authors acknowledge the generous financial support of Yasuj University of Medical Sciences, Yasuj, Iran.


Availability of Data and Materials: The data set used in this study will be available based on a reasoned request.


Conflicts of interest: None declared.


Consent for publication: Not applicable. 


Ethical Approval and consent to participate: This research adhered to the ethical principles outlined in the Declaration of Helsinki for studies involving human subjects. The study involved analysis of social experiences through participant interviews, with no procedures conducted on human tissues. Informed consent was obtained from all participants prior to data collection. This study received ethical approval from the Ethics Committee of Yasuj University of Medical Sciences (ethical code: IR.YUMS.REC.1400.202).


Funding: Financial support was provided by Yasuj University of Medical Sciences, Yasuj, Iran. 


Author Contributions: Performance of data gathering: M, Sh, and K, E; Planning and supervision of the work: M, Sh; K, E; Performance of the analysis: S, P, and N, R; Manuscript draft: K, E, and M, M; and comment on the final manuscript: all authors. All authors have reviewed the final manuscript. All authors have read and accepted the published version of the manuscript. 

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/

References

  1. Solhi M, Jormand H, Gohari MR. Media literacy and attitudes towards weight loss supplements in students of Iran University of Medical Sciences, Iran. Military Caring Sciences. 2015;2(4):221-8. https://doi.org/10.18869/acadpub.mcs.2.4.221
  2. Zokaei MS, Vedadhir A, Khashei R. Factors Influencing the Health Lifestyles in Tehran, with a Focus on the Media Consumption. Global Media Journal-Persian Edition. 2016;11(1):47-65.
  3. Moorhead SA, Hazlett DE, Harrison L, Carroll JK, Irwin A, Hoving C. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. Journal of medical Internet research. 2013;15(4):e1933. https://doi.org/10.2196/jmir.1933 PMid:23615206 PMCid:PMC3636326
  4. Brown JD. Media literacy has potential to improve adolescents' health. Journal of Adolescent Health. 2006;39(4):459-60. https://doi.org/10.1016/j.jadohealth.2006.07.014 PMid:16982377
  5. Ashrafi-Rizi H, Khorasgani ZG, Zarmehr F, Kazempour Z. A survey on rate of media literacy among Isfahan University of Medical Sciences' students using Iranian media literacy questionnaire. Journal of education and health promotion. 2014;3(1). https://doi.org/10.4103/2277-9531.131939
  6. Tehrani H. Media health literacy. Journal of Health Literacy. 2016;1(3):141-6.
  7. Bergsma LJ, Carney ME. Effectiveness of health-promoting media literacy education: a systematic review. Health education research. 2008;23(3):522-42. https://doi.org/10.1093/her/cym084 PMid:18203680
  8. Levin-Zamir D, Lemish D, Gofin R. Media Health Literacy (MHL): development and measurement of the concept among adolescents. Health education research. 2011;26(2):323-35. https://doi.org/10.1093/her/cyr007 PMid:21422003
  9. Hindmarsh CS, Jones SC, Kervin L. Effectiveness of alcohol media literacy programmes: a systematic literature review. Health education research. 2015;30(3):449-65. https://doi.org/10.1093/her/cyv015 PMid:25840435
  10. Riesmeyer C, Hauswald J, Mergen M. (Un) healthy behavior? The relationship between media literacy, nutritional behavior, and self-representation on Instagram. Media and Communication. 2019;7(2):160-8. https://doi.org/10.17645/mac.v7i2.1871
  11. Paek H-J, Reber BH, Lariscy RW. Roles of interpersonal and media socialization agents in adolescent self-reported health literacy: a health socialization perspective. Health education research. 2011;26(1):131-49. https://doi.org/10.1093/her/cyq082 PMid:21248025
  12. Truman E, Bischoff M, Elliott C. Which literacy for health promotion: health, food, nutrition or media? Health promotion international. 2020;35(2):432-44. https://doi.org/10.1093/heapro/daz007 PMid:30793740
  13. Akbarinejad F, Soleymani MR, Shahrzadi L. The relationship between media literacy and health literacy among pregnant women in health centers of Isfahan. Journal of education and health promotion. 2017;6(1):17. https://doi.org/10.4103/2277-9531.204749 PMid:28546982 PMCid:PMC5433646
  14. Primack BA, Gold MA, Land SR, Fine MJ. Association of cigarette smoking and media literacy about smoking among adolescents. Journal of Adolescent Health. 2006;39(4):465-72. https://doi.org/10.1016/j.jadohealth.2006.05.011 PMid:16982379 PMCid:PMC3008629
  15. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health promotion international. 2000;15(3):259-67. https://doi.org/10.1093/heapro/15.3.259
  16. Potter WJ. Theory of media literacy: A cognitive approach: Sage Publications; 2004. https://doi.org/10.4135/9781483328881
  17. Aufderheide P. Media literacy: From a report of the national leadership conference on media literacy. Media literacy around the world: Routledge; 2018. p. 79-86. https://doi.org/10.4324/9781351292924-4
  18. Suárez‐Perdomo A, Garcés‐Delgado Y, Arvelo‐Rosales CN. Systematic review on adolescents' construction of media literacy in educational settings. Review of Education. 2025;13(1):e70048. https://doi.org/10.1002/rev3.70048
  19. Scull TM, Kupersmidt JB, Parker AE, Elmore KC, Benson JW. Adolescents' media-related cognitions and substance use in the context of parental and peer influences. Journal of youth and adolescence. 2010;39(9):981-98. https://doi.org/10.1007/s10964-009-9455-3 PMid:19795197 PMCid:PMC3678372
  20. Levin-Zamir D, Bertschi I. Media health literacy, eHealth literacy and health behaviour across the lifespan: Current progress and future challenges. International handbook of health literacy. 2019:275-90. https://doi.org/10.56687/9781447344520-021
  21. Chinn D. Critical health literacy: A review and critical analysis. Social science & medicine. 2011;73(1):60-7. https://doi.org/10.1016/j.socscimed.2011.04.004 PMid:21640456
  22. Levin-Zamir D, Bertschi I. Media health literacy, eHealth literacy, and the role of the social environment in context. International journal of environmental research and public health. 2018;15(8):1643. https://doi.org/10.3390/ijerph15081643 PMid:30081465 PMCid:PMC6121358
  23. Primack BA, Gold MA, Switzer GE, Hobbs R, Land SR, Fine MJ. Development and validation of a smoking media literacy scale for adolescents. Archives of pediatrics & adolescent medicine. 2006;160(4):369-74. https://doi.org/10.1001/archpedi.160.4.369 PMid:16585481 PMCid:PMC3001232
  24. Austin EW, Pinkleton BE, Austin BW, Van de Vord R. The relationships of information efficacy and media literacy skills to knowledge and self-efficacy for health-related decision making. Journal of American college health. 2012;60(8):548-54. https://doi.org/10.1080/07448481.2012.726302 PMid:23157196
  25. Zhou M, Ramírez AS, Ha S, Chittamuru D, Yan Y. Development and validation of a critical health literacy scale: Exploring media literacy, social determinants, and empowerment. Critical Public Health. 2025;35(1):2498034. https://doi.org/10.1080/09581596.2025.2498034
  26. Higgins JW, Begoray D. Exploring the Borderlands between Media and Health: Conceptualizing" Critical Media Health Literacy". Journal of Media Literacy Education. 2012;4(2):136-48. https://doi.org/10.23860/jmle-4-2-4
  27. Cheung C, Yin W. Assessing network media literacy in China: The development and validation of a comprehensive assessment instrument. International Journal of Media and Information Literacy. 2018;3(2):53-65. https://doi.org/10.13187/ijmil.2018.2.53
Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 23 December 2025

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