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Objectives For adolescents and young adults, most health literacy research has been conducted in Western countries, but few studies have been conducted in the Eastern Mediterranean region (EMR). This review aimed to explore the existing health literacy research in the EMR in addition to the levels of health literacy and its associated factors among adolescents and young adults. Methods The search, conducted using the PubMed/MEDLINE, EBSCOhost/CINAHL plus, Web of Science and J-STAGE databases, was initially performed on 16 June 2022 and later updated on 1 October 2022. Studies that targeted 10-25 years old persons, conducted in any of the EMR countries and that used the health literacy concept and/or described its levels or predictors were included in the review. Content analysis was used for data extraction and analysis. Data related to the study methods, participants, outcome variables and health literacy were extracted. Results The review included 82 studies, most of which were conducted in Iran and Turkey and adopted a cross-sectional design. Half of the studies showed that more than half of adolescents and young adults had low or moderate health literacy. Nine studies applied university-based or school-based health education interventions to improve health literacy, which was also predicted by demographic and socioeconomic factors and internet usage. Little attention was paid to assessing the health literacy of vulnerable people, such as refugees and those with a disability and exposed to violence. Finally, various health literacy topics were investigated, including nutrition, non-communicable diseases, media and depression. Conclusion Health literacy levels were low-to-moderate in adolescents and young adults in the EMR. To promote health literacy, it is recommended to use school-based health education and attempt to reach adolescents and young adults through social media platforms. More attention should be paid to refugees, people with disabilities and those exposed to violence.

Objectives Health literacy research in Palestine is limited, and a locally validated tool for use among adolescents has been unavailable until now. Therefore, this study aimed to adapt health literacy assessment scale for adolescents (HAS-A) into Arabic language (HAS-A-AR) and Palestinian context and to investigate its psychometric properties. Design We conducted a cross-sectional household survey using a stratified random sample and household face-to-face interviews. Setting and participants We conducted 1200 interviews with sixth to ninth graders in the Ramallah and al-Bireh district of the West Bank, Palestine in 2017. Methods We translated and adapted HAS-A to be sensitive to the Palestinian context and tested its psychometric properties. We evaluated face and content validity during the back-translation process and checked for construct validity through exploratory factor analysis (EFA). We tested for internal consistency using Cronbach's alpha, MacDonald's omega test and the greatest lower bound (GLB). Furthermore, we calculated the scale's average inter-item correlation. Results EFA revealed that HAS-A-AR has a similar structure to the original HAS-A. It extracted three factors (communication, confusion and functional health literacy) whose eigenvalues were >1. Together they explained 57% of the total variance. The proportions of adolescents with high levels of communication, confusion and functional health literacy were 45%, 68% and 80%, respectively. Cronbach's alpha, MacDonald's omega and the GLB values for communication subscale were 0.87, 0.88 and 0.90, and they were 0.78, 0.77 and 0.79 for confusion subscale, while they were 0.77, 0.77 and 0.80, respectively, for functional healthy literacy subscale. The average inter-item correlation for the subscales ranged between 0.36 and 0.59. Conclusion HAS-A-AR is a valid and reliable health literacy measuring instrument with appropriate psychometric properties. HAS-A-AR is currently available for use among adolescents in Palestine and the surrounding Arab countries with similar characteristics as Palestine, including language, culture and political instability.

Background: Understanding health literacy and its predictors is fundamental for adolescents to have healthy lives. This study investigated the association between exposure to violence and other factors with health literacy levels among Palestinian middle school students. Methods: This cross-sectional study included middle school students. We used the validated Arabic version of the Health Literacy Assessment Scale for Adolescents to measure health literacy levels, and asked adolescents 11 questions to assess whether they were exposed to various forms of violence. We used binary logistic regression to identify the factors associated with each health literacy subscale. Results: Among the 816 students, 20.4%, 30.5%, and 50.5% had low functional, confusion, and communication health literacy levels, respectively. Exposure to political violence was significantly associated with lower levels of functional health literacy (OR: 2.65, 95%CI: 1.71–4.08) and low confusion health literacy (OR: 1.96, 95%CI: 1.31–2.94). Domestic and school violence were associated with low levels of confusion health literacy (OR: 1.82, 95%CI: 1.30–2.55). Conclusion: Exposure to different forms of violence predicted low levels of health literacy among Palestinian middle school students. This study identified the need for middle school students to acquire the skills required to analyse and integrate the health information they receive. Therefore, there is a need for regular interventions that target an increase in their critical health literacy.

Background The COVID-19 pandemic has triggered major changes worldwide, with repercussions on mental health and education. The present study primarily aimed to retrospectively explore undergraduate students’ risk perceptions of COVID-19 and their experiences with remote learning during the pandemic, with an emphasis on their high school years. Methods This qualitative photovoice study was conducted between 30 March and 4 May 2023. The target population of this study was first- and second-year undergraduate students who had been in high school during the pandemic. Maximum variation, snowball, and convenience sampling methods were used to recruit students. They were asked to share photos and provide comments in written or voice messages explaining their experiences during the pandemic. Voice messages were manually transcribed verbatim. A manual content analysis of these comments was performed to derive the codes and themes relevant to the study objectives. Results Forty-seven students initially agreed to participate and signed an informed consent form. However, the final sample included 16 students (nine men and seven women). The content analysis revealed four themes that were identified as the main factors contributing to high school students’ risk perceptions of COVID-19. The first theme was psychosocial factors related to the pandemic, including emotions, isolation and stress. The second focused on the mechanisms used to cope with the pandemic. The third theme included beliefs and behaviours that either increased or decreased COVID-19 risk. The final theme addressed schools’ responses to COVID-19, including factors such as maintaining connections with schools, preventive measures and the transition to remote learning. Conclusion This study highlighted the extensive impact of the pandemic on Palestinian high school students, demanding instantaneous adaptation to ensure their safety and well-being while maintaining the quality of education. Remote learning has become an important strategy with opportunities and challenges for high school students.

Objective: Palestinians are exposed to chronic violence, which has a negative impact on health status. Health literacy is increasingly employed to increase people’s control over their health. This qualitative research explored adolescents’, parents’ and teachers’ views regarding important health-related issues to Palestinian adolescents, as a preliminary step to develop a health literacy tool sensitive to the Palestinian social context.Methods: We conducted 22 semi-structured interviews with adolescents, teachers and parents in the Ramallah Governorate between January and February 2017. Sex and locality variations were taken into consideration. Conventional content analysis was used to analyze interviews and retrieve the main categories of health-related issues that are important to adolescents.Results: Palestinian adolescents need to access information covering a wider range of health issues including reproductive health, lifestyle, personal hygiene, environmental health and mental health. Some of the adolescents linked violence to health status. Many of the participants identified adolescents’ willingness to search for health information as a challenge and interviews revealed various health information sources for adolescents. The main sources of health information were mothers, friends, school and the internet among others.Conclusion: Needs are high for Palestinian adolescents to improve their health literacy. Empowering them with health literacy competencies may be vital for alleviating the negative health impact of chronic exposure to violence. A context sensitive health literacy instrument can help conduct new research for understanding predictors of Palestinian adolescent health literacy.

Objective To examine the moderating role of health literacy in the association between direct exposure to violence and weight status among Palestinian adolescents. Design A household cross-sectional study conducted in 2017. Setting A Palestinian district of the West Bank. Participants Palestinian adolescents aged 11-16 years. Results After excluding underweight adolescents from the 1200 who were initially recruited, the data of 1173 adolescents were analysed. A high proportion (62%) of adolescents were directly exposed to violence. The prevalence of obesity and overweight was 6.5% and 17.1%, respectively. The odds of obesity and overweight were 2.8 and 1.8 times higher among adolescents who were not exposed to domestic and school violence when they had low health literacy in the communication subscale. The odds of obesity were 62% and 57% lower among adolescents with high functional health literacy when exposed to domestic and school violence and to any form of violence, respectively. Among adolescents who were not exposed to any form of violence, those who had high health literacy in the communication subscale were 72% less likely to be obese compared with those who had low health literacy. Conclusions Health literacy moderated the association between direct exposure to violence and weight status. When health literacy levels were higher, lower obesity rates were observed among adolescents who were directly exposed to any form of violence or exposed either to political violence only or domestic and school violence only. The results warrant further investigation of the role of health literacy in adolescent health. It is recommended that policy-makers integrate the health literacy concept into both education and health systems.

Health literacy plays an important role in personal and community health. Since university is a turning point when young adults begin to take responsibility for their own health, understanding university students health literacy levels is crucial. To this end, we aimed to explore health literacy and its associated factors among Palestinian university students. We conducted a cross-sectional study at Birzeit University in the Ramallah district. We recruited 472 students using convenience sampling at six oncampus cafeterias. The 44-item Arabic version of the Health Literacy Questionnaire was used to measure students health literacy levels, while a locally developed distress scale was used to measure students distress levels. We stratified the multiple regression model for the health literacy score by gender. Students average total health literacy score was 135.3 (SD 20.9), with male students scoring significantly higher than female students. A higher health literacy score was significantly associated with having a father with a higher level of education, a higher frequency of medical checkups, higher self-reported health status, and consulting a higher number of sources for health-related information. High distress levels were associated with lower levels of health literacy, especially among female students. This study provides the first evidence on Palestinian university students health literacy levels. Tailored health education and promotion are required for students with low parental education and moderate to high distress. Future research is required to explain the gender differences in health literacy and distress among university students.

The Millennium Development Goals (MDGs) were adopted at the United Nations Millennium Summit in year 2000. The specific goal was set to reduce Under-5 Mortality Rate (U5MR) to 1/3 of the 1990 level in 2015. As international cooperation in the health sector has progressed, the U5MR has dropped to less than half of the world. The results were evaluated as great achievements. In 2015, Sustainable Development Goals (SDGs) were launched, and the one of the targets was set to reduce the U5MR to 25 or less per 1000 births in 2030. For countries that have not been achieved at the target of the 2015 SDGs, we examine the relationship between U5MR and income levels and income inequality, and consider future measures.【Methods】We obtained and analyzed the data of Under-5 Mortality Rate, Gross National Income per capita and GINI Index from the World Bank Open Database.【Findings】The countries which the U5MR did not drop below half in 1990-2015 tended to be higher and lower income countries and larger income inequality.【 Discussion】To achieve the SDGs goal of reducing U5MR to 25/1000 births or less in all countries / regions, middle-income countries with large income inequality in addition to low-income countries where U5MR is currently at a high level. It was suggested that comprehensive policies and measures based on the SDGs philosophy are necessary.