Context counts: a qualitative study on how adolescents activate social resources to develop and practice health literacy

Background: Recently, the importance of social networks and other contextual factors in shaping health literacy of adolescents has gained recognition. However, research often simply refers to context without explicitly describing it. In this qualitative study, we aimed to explore how adolescents activate their (social) resources to develop and practice health literacy within a Swiss cantonal school health service program and in their everyday lives.

Methods: This study is based on a secondary analysis of interviews from an evaluation of the school health service in the canton of Zug, focusing on the final health screening in the 7th grade (corresponding to an average age of 14 years). Semi-structured interviews were conducted with 16 students. The data was analyzed using thematic analysis and constructivist grounded theory to identify and refine key themes.

Results: Our analysis revealed that adolescents' interactions with their social networks, including family members, teachers, healthcare providers, and peers, were significant resources in their health literacy practices. Other resources included school health services, regular curricula and the internet. The activation of these resources was moderated by several factors that functioned as activators or deactivators, which we divided into three categories: relationships, health system, and pre-existing health literacy. Prominent activators in the category relationships involved good rapport and trust, whereas fear of judgment deactivated resources. In the category health system, access to resources as well as opportunities for participation in dealing with health information, challenges and services were important activators (or when missing, deactivators). Finally, participants demonstrated that pre-existing health literacy in the form of pre-existing knowledge and motivation and attitudes served as an activator of their resources to develop and practice health literacy in a 'virtuous circle'. Thus, although health literacy development and practice were dependent upon their social networks, adolescents played key roles as active agents while navigating health.

Conclusions: Our findings highlight potential (de)activators of adolescents' resources, primarily those available within their social networks, in the development and practice of health literacy. Results contribute to the literature on adolescent health literacy by shedding light on the often under-described concept of context. Explicit consideration of context provides actionable insights for educators, healthcare providers, and policymakers seeking to support adolescents in the development and practice of health literacy.