Exploring health perceptions and priorities of South African youth: Understanding what matters for health literacy interventions

Document Type : Original Article


1 SA MRC-Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.

2 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK.

3 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK; MRC Lifecourse Epidemiology Centre, University of Southampton, UK.

4 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK; School of Healthcare Enterprise and Innovation, University of Southampton, UK.

5 School of Health and Human Development, University of Southampton, Southampton, UK; SA MRC-Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University


Background and Objective: Health literacy is a key factor underpinning health behaviours and effective use of health information. Optimising health literacy in adolescents and young adults (AYA) is critical as they transition from childhood to adulthood, changing health-related behaviours alongside physical, emotional, and cognitive change. In South African AYA, with unplanned pregnancy common, poor health literacy may impact multiple generations. Our aim was to explore health perceptions and priorities of South African AYA to inform contextually relevant health literacy intervention design.  

Materials and Methods: Through purposive sampling of youth registered at a youth development centre in Soweto, South Africa, AYA (n=39, 18-25y) were recruited to form an advisory Youth Health Council (YHC). Health literacy was assessed with the Health Literacy Test for Limited Literacy populations (HELT-LL). Focus group discussions were recorded for inductive thematic analysis to inform AYA health literacy needs. 

Results: Most AYA (85%) had suboptimal health literacy. Analysis showed that AYA perceived ‘health’ as a complex mix of indicators (physical, emotional, mental, spiritual) that formed a holistic view of health. However, lack of funds and factors inherent in their local environment (food systems, family hierarchy, crime, vandalism, limited healthcare services) frequently challenged beneficial health behaviours. Stress was a common feature in the lives of AYA associated with multiple health domains. 

Conclusions: Stress-focused health literacy interventions are needed for youth in challenging environments. Understanding the complex constructions and the core tenets of health that young people hold can inform contextually relevant intervention co-creation for improved health literacy as youth transition into adulthood. 


Acknowledgements: The authors thank the youth that gave their time for this research and the focus group facilitators, Mr Lethukuthula Ndwande, Ms Hazel Moraka, and Ms Delisile Kubheka.

Availability of data and materials: The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. 

Conflicts of interests: None to declare. 

Consent for publication: Not applicable


Ethical approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. Approval to conduct the study was granted by the Human Research Ethics Committee (Medical) based at the University of the Witwatersrand (M200941 and M220438). All participants gave written informed consent to participate and for the group discussions to be audio recorded prior to data collection.

Funding: This research was funded through a grant from the DSI-NRF Centre of Excellence in Human Development [OPP2021008], hosted at the University of the Witwatersrand, South Africa. KMG is supported by the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042), NIHR Southampton 1000DaysPlus Global Nutrition Research Group (17/63/154) and NIHR Southampton Biomedical Research Centre (NIHR203319)) and the European Union (Erasmus+ Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP). For the purpose of Open Access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.

Author contributions: LJW, SN, KMG, KWT, MH designed the study, LJW collected the data, KM and LJW analysed the data and wrote the manuscript, all authors contributed to manuscript revisions.

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