Journal of Health Literacy

Journal of Health Literacy

Physical Literacy as a Health Literacy Domain: Levels and Gender Differences in Physical Activity among Iranian Adolescents

Articles in Press

Document Type : Original Article

Authors
Elahe laele-Monfared 1, 2
Fereshteh Najafi 3
Hadi Tehrani 1, 2
Fatemeh Ramezani Barsalani 1, 4
Fatemeh Sedghi 2, 5
1 Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Social Determinant of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Kashmar School of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
4 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
5 Department of Public Health, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/jhl.2026.92474.1890
Abstract
Background and Objectives: Physical literacy (PL) is emerging as a critical component of overall health literacy, providing the specific motivation, competence, and knowledge to maintain a physically active life. However, its levels and relationship with physical activity (PA) among Iranian adolescents remain largely unexplored. This study aimed to describe the levels of physical literacy and physical activity among high school adolescents in Northeast Iran and to examine the relationship between these two variables.

Materials and Methods: In this cross-sectional study conducted between March and June 2024, 1065 students (567 males, 498 females) aged 14-20 were recruited from public schools in Mashhad through multi-stage random sampling. Participants completed three questionnaires: 1) a demographic and lifestyle survey, 2) the Physical Activity Questionnaire for Adolescents (PAQ-A), and 3) the Adolescent Physical Literacy Questionnaire (APLQ). Data were analyzed using descriptive statistics and independent samples t-tests.

Results: The mean physical literacy score was 3.50±0.80 (on a 1-5 scale), with 25.4% of participants demonstrating inadequate levels. The mean physical activity score was 2.44±0.73, with nearly half (48.3%) classified in the low activity category. While physical literacy scores were comparable between genders, a significant gender disparity was observed in physical activity levels, with females being substantially less active than males (2.23±0.65 vs 2.62±0.75, p<0.001).

Conclusion: While adolescents in Northeast Iran demonstrate moderate physical literacy levels, these do not translate into adequate physical activity, particularly among female students. The findings suggest that enhancing physical literacy—especially its translation into actual behavior—should be a key target in adolescent health promotion strategies. School-based interventions addressing gender-specific barriers are urgently needed to bridge this gap.
Keywords
Motor Activity
Adolescents
Secondary School Students
Sex Factors
Iran

Acknowledgments: The authors would like to thank all participating students, school principals, and the education authorities in Mashhad for their cooperation.


Availability of data and materials: The data sets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.


Conflict of interest: The authors declare no competing interests.


Consent for publication: Not applicable.


Ethics approval and consent to participate: The study protocol was approved by the Ethics Committee of Mashhad University of Medical Sciences (Ethics Code: IR.MUMS.REC.1403.203). All procedures were performed in accordance with the ethical standards of the institutional research committee and the Declaration of Helsinki. Given the minimal-risk nature of the anonymous questionnaire-based study, the ethics committee approved a waiver of written informed consent. A comprehensive passive parental consent procedure was implemented: detailed information sheets describing the study's purpose, procedures, and confidentiality measures were distributed to parents through school administrators. Parents were provided a two-week period to withdraw their child by contacting the research team or school principal. Immediately before survey administration, all participating students provided verbal assent after being informed of their right to decline or withdraw at any time without consequence.


Funding: This research received no external funding.


Author contributions: F.S, ELM and F.N did the research, wrote the manuscript, F.RB contributed to data collection. H,T critically reviewed the manuscript and approved the final version, F.N did the research, analyzed the data, and critically reviewed and edited the manuscript. All authors have read and approved 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/

1. Mayordomo-Pinilla N, Sánchez-Miguel PA, Galán-Arroyo C, Castillo-Paredes A, Rojo-Ramos J. Physical literacy in school aged children: a preliminary analysis relating health factors. Frontiers in Public Health. 2025;13:1424027. https://doi.org/10.3389/fpubh.2025.1424027 PMid:40241958 PMCid:PMC12000050
2. Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1· 6 million participants. The lancet child & adolescent health. 2020;4(1):23-35. https://doi.org/10.1016/S2352-4642(19)30323-2 PMid:31761562 PMCid:PMC6919336
3. Chaput J-P, Willumsen J, Bull F, Chou R, Ekelund U, Firth J, et al. 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: summary of the evidence. International Journal of Behavioral Nutrition and Physical Activity. 2020;17(1):141. https://doi.org/10.1186/s12966-020-01037-z PMid:33239009 PMCid:PMC7691077
4. Chen W, Zhou B, Wang X, Li L. Research on the relationship between physical literacy and demographic variables and interpersonal support for physical exercise among adolescents in China. Plos one. 2024;19(10):e0311793. https://doi.org/10.1371/journal.pone.0311793 PMid:39466803 PMCid:PMC11516006
5. Alipour-Anbarani M, Ghaffari M, Montazeri A, Kavousi A, Ramezankhani A. Development and Psychometric of a Physical Literacy Questionnaire for Young Adolescents (16-18 Years of Age): A Mixed-Method Study. Shiraz E-Medical Journal. 2023;24(9). https://doi.org/10.5812/semj-138738
6. Latif RA, Nawi NF, Khamis MH, Basar A. EVALUATING MALAYSIA'S PHYSICAL EDUCATION PROGRAM IN LIGHT OF UNESCO'S QUALITY PHYSICAL EDUCATION GUIDELINES. Journal of Issue In Education. 2024;47:63-78. https://doi.org/10.22452/jiie.vol47.5
7. Young L, O'Connor J, Alfrey L. Physical literacy: a concept analysis. Sport, Education and Society. 2020;25(8):946-59. https://doi.org/10.1080/13573322.2019.1677586
8. Clark HJ, Dudley D, Barratt J, Cairney J. Physical literacy predicts the physical activity and sedentary behaviours of youth. Journal of Science and Medicine in Sport. 2022;25(9):750-4. https://doi.org/10.1016/j.jsams.2022.04.008 PMid:35934659  
9. 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/15.3.183 https://doi.org/10.1093/heapro/15.3.259
10. Urstad KH, Andersen MH, Larsen MH, Borge CR, Helseth S, Wahl AK. Definitions and measurement of health literacy in health and medicine research: a systematic review. BMJ open. 2022;12(2):e056294. https://doi.org/10.1136/bmjopen-2021-056294 PMid:35165112 PMCid:PMC8845180
11. Mohammadi M, Mahmoud S, Hoomanian D, Gharayagh Zandi H, Hamidi M. Relationship between Physical Activity Level and Physical Literacy in Iranian Ethnic Children: A Cross-Cultural Study. Journal of Applied Psychological Research. 2024;15(4):109-28.
12. Ranaei A, Tavakoly Sany SB, Vahedian Shahroodi M, Sabahi A, Tehrani H, Khajavi A. School-based peer education intervention on physical activity in Iranian adolescent girls: an application of the theory of planned behavior. Frontiers in Public Health. 2025;13:1558210. https://doi.org/10.3389/fpubh.2025.1558210 PMid:40406080 PMCid:PMC12096170
13. Hsu S-H, Kim D, Ok G. From vision to action: the development of physical education in UN, UNESCO, South Korea, and Taiwan, 1945-2024. Sport, Education and Society. 2025:1-16. https://doi.org/10.1080/13573322.2025.2550508
14. Öztürk Ö, Aydoğdu O, Kutlutürk Yıkılmaz S, Feyzioğlu Ö, Pişirici P. Physical literacy as a determinant of physical activity level among late adolescents. Plos one. 2023;18(4):e0285032. https://doi.org/10.1371/journal.pone.0285032 PMid:37115768 PMCid:PMC10146507
15. Ying Y, Jiabin L, Shanshan Z, Kaixin Y, Xiaomei L, Shengyu W, et al. The relationship between physical literacy and physical activity: A systematic review and meta‐analysis. Applied Psychology: Health and Well‐Being. 2025;17(4):e70062. https://doi.org/10.1111/aphw.70062 PMid:40760865  
16. Mohammadi Moghaddam A, Jalilvand M, Yari S. Effectiveness of traditional and virtual reality exercises with physical literacy approach on motivation and acquisition of motor skills: a modern educational approach. The Neuroscience Journal of Shefaye Khatam. 2024:0-. https://doi.org/10.61186/shefa.12.3.33
17. Moghaddam AM, Jalilvand M, Yari S. Comparing Traditional and Virtual Reality Exercises with a Physical Literacy Approach: Impact on Motivation and Motor Skill Acquisition. 2024.
18. Qian H, Ren X, Wang H, Zou Y. Global Insights and Key Trends in Physical Literacy Research: A Bibliometric Analysis and Literature Review from 2007 to 2024. Journal of Multidisciplinary Healthcare. 2025:2039-55. https://doi.org/10.2147/JMDH.S515715 PMid:40242081 PMCid:PMC12002333
19. Mohammadzadeh M, Sheikh M, Hominian Sharif Abadi D. Development of norm for Adolescent Physical Literacy Questionnaire (APLQ) in Tehran. Sport Sciences and Health Research. 2020;12(2):207-16.
20. Alipour-Anbarani M, Montazeri A, Kavousi A, Ghaffari M, Ramezankhani A. The Relationship between Physical Literacy of Adolescents and the Socioeconomic Status of Families. Health Providers. 2022;2(1):1-11.
21. Faghihimani Z, Nourian M, Nikkar AH, Farajzadegan Z, Khavariyan N, Ghatrehsamani S, et al. Validation of the Child and Adolescent International physical activity questionnaires in Iranian children and adolescents. ARYA Atherosclerosis Journal. 2010;5(4).
22. Mohammadi M, Elahipanah F, Amani-Shalamzari S. The role of the cultural environment in the development of physical literacy and physical activity of Iranian children. BMC pediatrics. 2023;23(1):477. https://doi.org/10.1186/s12887-023-04297-3
23. Amiri P, Naseri P, Vahedi-Notash G, Jalali-Farahani S, Mehrabi Y, Hamzavi-Zarghani N, et al. Trends of low physical activity among Iranian adolescents across urban and rural areas during 2006-2011. Scientific reports. 2020;10(1):21318. https://doi.org/10.1038/s41598-020-78048-0 PMid:33288806 PMCid:PMC7721745
24. Nejadghaderi SA, Ahmadi N, Rashidi M-M, Ghanbari A, Noori M, Abbasi-Kangevari M, et al. Physical activity pattern in Iran: findings from STEPS 2021. Frontiers in public health. 2023;10:1036219. https://doi.org/10.3389/fpubh.2022.1036219 PMid:36684955 PMCid:PMC9846211
25. Pastor-Cisneros R, López-Gil JF, Carl J, Adsuar JC, Mendoza-Muñoz M. Exploring the associations of perceived physical literacy with depression, anxiety, and stress among Spanish adolescents. Complementary Therapies in Clinical Practice. 2025;59:101948. https://doi.org/10.1016/j.ctcp.2025.101948 PMid:39827701  
26. Mendoza-Muņoz M, López-Gil JF, Pereira-Payo D, Pastor-Cisneros R. Sociodemographic correlates of perceived physical literacy in Spanish adolescents: results from the EHDLA study. Frontiers in Sports and Active Living. 2025;7:1601852. https://doi.org/10.3389/fspor.2025.1601852 PMid:40778311 PMCid:PMC12328388
27. Kırılmaz NP. The relationship between perceived physical literacy and physical self perception of the high school students: Middle East Technical University; 2025.
28. Hartman MA. The Relationship of Physical Literacy, Motivation, Cognitive Function, and Academic Performance Among Elementary School Children. 2025.
29. Choi SM, Sum RKW, Leung EFL, Ng RSK. Relationship between perceived physical literacy and physical activity levels among Hong Kong adolescents. PLoS One. 2018;13(8):e0203105. https://doi.org/10.1371/journal.pone.0203105 PMid:30148876 PMCid:PMC6110504
30. Long B, Chen S, Long Y, Liu Y, Li Y, Wang Y, et al. The predictive relationship between parents' perceptions of physical activity and children's physical literacy. Scientific Reports. 2025;15(1):24207. https://doi.org/10.1038/s41598-025-09369-1 PMid:40624220 PMCid:PMC12234739
31. Domínguez-Martín G, Tárraga-López PJ, López-Gil JF. Relationship between perceived physical literacy and obesity-related outcomes in adolescents: the EHDLA study. Frontiers in Public Health. 2024;12:1321361. https://doi.org/10.3389/fpubh.2024.1321361 PMid:38694986 PMCid:PMC11062133
32. Yin H, Omar Dev RD, Soh KG, Zhang Y, Tan Z, Lian M. The relationship between school physical activity policy environment and physical literacy among primary school students: Evidence from Henan Province, China. PloS one. 2025;20(10):e0330991. https://doi.org/10.1371/journal.pone.0330991 PMid:41134756 PMCid:PMC12551888
33. Moemeni S. Investigation the level of physical activity in elementary students of Hamadan province, Iran. International journal of school health. 2022;9(2):99-105.
34. Strain T, Flaxman S, Guthold R, Semenova E, Cowan M, Riley LM, et al. National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5· 7 million participants. The Lancet Global Health. 2024;12(8):e1232-e43.
35. Samarkandi OA. Prevalence of physical activity among healthcare students in King Saud University, Riyadh, Saudi Arabia. An observational study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 2022;59:00469580221100157. https://doi.org/10.1177/00469580221100157 PMid:35574590 PMCid:PMC9121456
36. Who. Physical activity fact sheet. World Health Organization Geneva, Switzerland; 2021.
37. Guthold R, Willumsen J, Bull FC. What is driving gender inequalities in physical activity among adolescents? Journal of Sport and Health Science. 2022;11(4):424-6. https://doi.org/10.1016/j.jshs.2022.02.003 PMid:35217213 PMCid:PMC9338329
38. Saller FV, Khaled SM. Potential psychosocial influences on gender differences in physical activity among Qatari adolescents: a first insight through descriptive observation. International Journal of Adolescence and Youth. 2019;24(2):234-51. https://doi.org/10.1080/02673843.2018.1515087
39. Ricardo LIC, Wendt A, dos Santos Costa C, Mielke GI, Brazo-Sayavera J, Khan A, et al. Gender inequalities in physical activity among adolescents from 64 Global South countries. Journal of Sport and Health Science. 2022;11(4):509-20. https://doi.org/10.1016/j.jshs.2022.01.007PMid:35074485 PMCid:PMC9338337
40. Araujo RH, Werneck AO, Martins CL, Barboza LL, Tassitano RM, Aguilar-Farias N, et al. Global prevalence and gender inequalities in at least 60 min of self-reported moderate-to-vigorous physical activity 1 or more days per week: an analysis with 707,616 adolescents. Journal of Sport and Health Science. 2024;13(5):709-16. https://doi.org/10.1016/j.jshs.2023.10.011 PMid:37923057 PMCid:PMC11282350
Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 22 August 2026