Determinants of Health Literacy among Iranian Children Aged 9–12: A Qualitative Study

Articles in Press

Document Type : Original Article

Authors

1 School of Public Health, Department of Health Education & Health promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Research Center for Cancer Screening and Epidemiology, Public Health Department, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran.

3 Center for Health Services Research, The University of Queensland, Brisbane, Australia

Abstract

Background and Objective: Health literacy critically shapes health outcomes across the lifespan. However, determinants influencing its development during childhood remain inadequately understood, particularly within culturally diverse populations. Iranian children face distinctive socio-cultural challenges that may impact health literacy formation, though empirical research on contributing factors is limited.To investigate multifactorial determinants influencing health literacy development among Iranian children aged 9–12 years, drawing on perspectives of children, mothers, and educators.

Materials and Methods: This exploratory qualitative study employed conventional content analysis following Graneheim and Lundman's methodology. Conducted in Isfahan Province, Iran (February 2023–May 2024), purposive sampling using maximum variation recruited 21 participants: children aged 9–12 years (n=14), mothers (n=3), and elementary school educators (n=4). Semi-structured interviews averaged 34 minutes, yielding 760 minutes of recorded material. Data analysis used MAXQDA 2022 software with independent verification.

Results: Content analysis of 1,077 initial codes yielded four overarching categories encompassing 15 subcategories: 1) Child-level determinants: health knowledge and understanding, mental and emotional well-being, health skills and self-management; 2) Family and home environment determinants: family health literacy and awareness, maternal roles and practices, family structure and dynamics; 3) Educational and institutional determinants: school environment and policies, curriculum and learning content, teaching methodologies, educator competence; 4) Socio-cultural and systemic determinants: economic status, cultural and religious context, information environment, policy and governance, environmental quality.

Conclusion: This study identified four interconnected categories of determinants influencing health literacy development among Iranian children aged 9-12 years. Findings revealed children's capacity for health reasoning and the central role of family environments, particularly maternal influences. Educational approaches emphasizing interactive learning methods and educator competence emerged as important factors. Economic constraints, cultural values, and environmental conditions represented significant systemic determinants, providing evidence for developing culturally responsive, multi-level interventions.

Keywords

Acknowledgements: We would like to express our sincere gratitude to all individuals who contributed to the completion of this study. We also acknowledge the use of Claude for assistance with English translation and manuscript editing.


Availability of data and materials: The all data was included in the article.


Conflicts of interest: The authors state that there is no conflict of interest in the present study.


Consent for publication: Not applicable.


Ethics 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 conducting interviews. For child participants, both informed consent and parental permission were obtained, along with approval from school officials. This study received ethical approval from the Ethics Committee of Shahid Sadoughi University of Medical Sciences (ethical code: IR.SSU.SPH.REC.1401.131).


Funding: No financial support.


Authors' contributions: Concept and designed the study: Zohreh Rahaie Collection of data: Sara Zamani Bakhtiarvand and Armin Zareiyan Analysis and interpretation of data: Hossein Ali Sadeghian and Farhad Fatehi, Drafting and reviewing the manuscript: Sara Zamani Bakhtiarvand. All authors reviewed and approved the final 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 licence, visit https://creativecommons.org/licenses/by/4.0/

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