DOI: https://doi.org/10.14710/nmjn.v15i1.66904

Health Asset Profile and Health Literacy Among Elementary School-Aged Children

*Nunung Siti Sukaesih orcid scopus  -  Nursing Department, Universitas Pendidikan Indonesia, Indonesia
Popi Sopiah orcid  -  Nursing Department, Universitas Pendidikan Indonesia, Indonesia
Emi Lindayani orcid  -  Nursing Department, Universitas Pendidikan Indonesia, Indonesia
Hikmat Pramajati orcid  -  Nursing Department, Universitas Pendidikan Indonesia, Indonesia
Dedah Ningrum orcid  -  Nursing Department, Universitas Pendidikan Indonesia, Indonesia
Sri Wulan Lindasari orcid  -  Nursing Department, Universitas Pendidikan Indonesia, Indonesia
Open Access Copyright (c) 2025 by the Authors, Published by Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Background: Mental health issues, nutritional status, physical activity, and smoking behavior are among the most serious health problems among school-aged children, and they are closely linked to health-related behaviors. Literacy skills significantly influence these behaviors at this age; however, health literacy often receives insufficient attention from the government for this age group.

Purpose: The purpose of this study was to provide a comprehensive overview of health asset profiles and health literacy among elementary school-aged children.

Methods: This cross-sectional study involved 431 sixth-grade students from the Sumedang district, recruited through a cluster sampling method. Various research instruments were employed, including the Family Affluence Scale (FAS III),  Rosenberg Self-Esteem Scale (RSES), Health Behaviours in School-Aged Children (HBSC), European Health Literacy Scale (HLS-EU), and the Newest Vital Sign (NVS) survey. Data were self-reported by participants, and BMI measurements were also collected. The Chi-square test was employed for statistical analysis.  

Results: The results revealed notable variations across the assessed health asset profile sub-variables. Functional health literacy was significantly associated with self-esteem (p<0.001), student behavior (p=0.010), wake-up time (p<0.001), and smoking habit (p<0.001). In contrast, no significant associations were found with family affluence (p=0.868), BMI (p=0.809), physical activity (p=0.087), or bedtime (p=0.092). Gender-based comparisons revealed significant differences between boys and girls in self-esteem (p=0.042), BMI (p<0.001), physical activity (p<0.001), bedtime (p=0.004), wake-up time (p=0.005), and smoking behavior (p=0.001).  

Conclusion: This study provides a comprehensive overview of health literacy in school-aged children, highlighting variations across health-related behaviors and asset profiles. Significant gender disparities were found in self-esteem, nutritional status, physical activity, bedtime, wake-up time, and smoking behavior. These findings highlight the importance of developing gender-sensitive health promotion strategies to enhance health literacy and promote healthy behaviors from early ages. 

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Keywords: Adolescent; elementary school; health asset profile; health literacy; school-age
Funding: Universitas Pendidikan Indonesia

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  1. Adrian, K. (2024, November 1). Pentingnya memiliki self-esteem yang sehat [The importance of having healthy self-esteem]. Alodokter.Com. https://www.alodokter.com/pentingnya-memiliki-self-esteem-yang-sehat
  2. Bambra, C., Gibson, M., Sowden, A., Wright, K., Whitehead, M., & Petticrew, M. (2010). Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews. Journal of Epidemiology and Community Health, 64(4), 284–291. https://doi.org/10.1136/jech.2008.082743
  3. Berg, M., Lindegaard, T., Flygare, A., Sjöbrink, J., Hagvall, L., Palmebäck, S., Klemetz, H., Ludvigsson, M., & Andersson, G. (2022). Internet-based CBT for adolescents with low self-esteem: A pilot randomized controlled trial. Cognitive Behaviour Therapy, 51(5), 388–407. https://doi.org/10.1080/16506073.2022.2060856
  4. Centers for Disease Control and Prevention. (2024, October 16). Understanding Health Literacy. https://www.cdc.gov/health-literacy/php/about/understanding.html
  5. Chaput, J. P., Willumsen, J., Bull, F., Chou, R., Ekelund, U., Firth, J., Jago, R., Ortega, F. B., & Katzmarzyk, P. T. (2020). 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, 17, 141. https://doi.org/10.1186/s12966-020-01037-z
  6. Chu-Ko, F., Chong, M. L., Chung, C. J., Chang, C. C., Liu, H. Y., & Huang, L. C. (2021). Exploring the factors related to adolescent health literacy, health-promoting lifestyle profile, and health status. BMC Public Health, 21(1), 1–12. https://doi.org/10.1186/s12889-021-12239-w
  7. Corell, M., Chen, Y., Friberg, P., Petzold, M., & Löfstedt, P. (2021). Does the family affluence scale reflect actual parental earned income, level of education, and occupational status? A validation study using register data in Sweden. BMC Public Health, 21, 2196. https://doi.org/10.1186/s12889-021-11968-2
  8. Delbosq, S., Velasco, V., Vercesi, C., & Vecchio, L. P. (2022). Adolescents’ nutrition: The role of health literacy, family, and socio-demographic variables. International Journal of Environmental Research and Public Health, 19(23), 15719. https://doi.org/10.3390/ijerph192315719
  9. Dodson, S., Good, S., & Osborne, R. H. (2015). Optimizing health literacy: Improving health and reducing health inequities. A selection of information sheets from the health literacy toolkit for low- and middle-income countries. World Health Organization, Regional Office for South-East Asia. https://www.who.int/publications/i/item/9789290224747
  10. Dresp-Langley, B., & Hutt, A. (2022). Digital addiction and sleep. International Journal of Environmental Research and Public Health, 19(11), 6910. https://doi.org/10.3390/ijerph19116910
  11. Duong, T. V, Aringazina, A., Baisunova, G., Nurjanah, Pham, T. V., Pham, K. M., Truong, T. Q., Nguyen, K. T., Oo, W. M., Mohamad, E., Su, T. T., Huang, H.-L., Sørensen, K., Pelikan, J. M., Van den Broucke, S., & Chang, P. W. (2017). Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries. Journal of Epidemiology, 27(2), 80–86. https://doi.org/https://doi.org/10.1016/j.je.2016.09.005
  12. Dutil, C., Podinic, I., Sadler, C. M., Da Costa, B. G., Janssen, I., Ross-White, A., Saunders, T. J., Tomasone, J. R., & Chaput, J. P. (2022). Sleep timing and health indicators in children and adolescents: A systematic review. Health Promotion and Chronic Disease Prevention in Canada, 42(4), 150–169. https://doi.org/10.24095/hpcdp.42.4.04
  13. Guo, S., Yu, X., Davis, E., Armstrong, R., & Naccarella, L. (2022). Comparison of health literacy assessment tools among Beijing school-aged children. Children, 9(8), 1128. https://doi.org/10.3390/children9081128
  14. Indonesian Ministry of Communication and Information Technology. (2022, July 2). Bank Dunia naikkan peringkat Indonesia jadi ‘upper middle-income country’ [The World Bank upgraded Indonesia’s status to an “upper-middle-income country”]. https://www.kominfo.go.id/content/detail/27568/bank-dunia-naikkan-peringkat-indonesia-jadi-upper-middle-income-country/0/berita
  15. Jafari, A., Belin, S., Sany, T., & Peyman, N. (2021). The status of health literacy in students aged 6 to 18 old years: A systematic review study. Iranian Journal of Public Health, 50(3), 448–458. https://doi.org/https://doi.org/10.18502%2Fijph.v50i3.5584
  16. Knisel, E., Rupprich, H., Wunram, A., Bremer, M., & Desaive, C. (2020). Promotion of elementary school students’ health literacy. International Journal of Environmental Research and Public Health, 17(24), 9560. https://doi.org/10.3390/ijerph17249560
  17. Kohoutek, J., Maráček, M., Ng, K., & Hamrik, Z. (2022). Test–retest reliability of selected HBSC items in Vietnam: Well-being, physical and sedentary activities, and eating behaviours. BMC Medical Research Methodology, 22, 135. https://doi.org/10.1186/s12874-022-01624-7
  18. Linnebur, L. A., & Linnebur, S. A. (2018). Self-administered assessment of health literacy in adolescents using the Newest Vital Sign. Health Promotion Practice, 19(1), 119–124. https://doi.org/10.1177/1524839916677729
  19. Liu, Y., Wang, M., Villberg, J., Torsheim, T., Tynjälä, J., Lv, Y., & Kannas, L. (2012). Reliability and validity of Family Affluence Scale (FAS) among adolescents in Beijing, China. Child Indicators Research, 5(2), 235–251. https://doi.org/10.1007/s12187-011-9131-5
  20. Loer, A. K. M., Domanska, O. M., Stock, C., & Jordan, S. (2022). Correction: Loer et al. Subjective generic health literacy and its associated factors among adolescents: Results of a population-based online survey in Germany. International Journal of Environmental Research and Public Health, 19(3), 1848. https://doi.org/10.3390/ijerph19031848
  21. Mao, Y., Xie, T., & Zhang, N. (2020). Chinese students’ health literacy level and its associated factors: A meta‐analysis. International Journal of Environmental Research and Public Health, 18(1), 204. https://doi.org/10.3390/ijerph18010204
  22. Ministry of Health Republic of Indonesia. (2024). Profil kesehatan Indonesia 2022 [Indonesia health profile 2022]. https://kemkes.go.id/id/profil-kesehatan-indonesia-2023
  23. Muslih, M., & Chung, M.-H. (2024). Structural validity of the Rosenberg self-esteem scale in patients with schizophrenia in Indonesia. PLoS ONE, 19(5), e0300184. https://doi.org/10.1371/journal.pone.0300184
  24. Ngo, H., VanderLaan, D. P., & Aitken, M. (2020). Self-esteem, symptom severity, and treatment response in adolescents with internalizing problems. Journal of Affective Disorders, 273, 183–191. https://doi.org/10.1016/j.jad.2020.04.045
  25. Nutbeam, D. (2015). Defining, measuring, and improving health literacy. Health Evaluation and Promotion, 42(4), 16–22. https://doi.org/https://doi.org/10.7143/jhep.42.450
  26. Paakkari, L., Torppa, M., Välimaa, R., Villberg, J., Ojala, K., & Tynjälä, J. (2019). Health asset profiles and health indicators among 13- and 15-year-old adolescents. International Journal of Public Health, 64(9), 1301–1311. https://doi.org/10.1007/s00038-019-01280-7
  27. Palenzuela-Luis, N., Duarte-Clíments, G., Gómez-Salgado, J., Rodríguez-Gómez, J. Á., & Sánchez-Gómez, M. B. (2022). International comparison of self-concept, self-perception, and lifestyle in adolescents: A systematic review. International Journal of Public Health, 67, 1604954. https://doi.org/10.3389/ijph.2022.1604954
  28. Parandeh, A.P., Keshavarz, F., Salehi, M., Fakhri Moghadam, R., Khajoui, E., Nazari, F., & Dehghan, M. (2020). Health literacy and media literacy: Is there any relation? International Quarterly of Community Health Education, 42(2), 195–201. https://doi.org/10.1177/0272684X20972642
  29. Parizadeh, D., Momenan, A. A., Amouzegar, A., Azizi, F., & Hadaegh, F. (2018). Tobacco smoking: Findings from 20 years of the Tehran lipid and glucose study. International Journal of Endocrinology and Metabolism, 16(4), 1–9. https://doi.org/10.5812/ijem.84738
  30. Park, A., Eckert, T. L., Zaso, M. J., Scott-Sheldon, L. A. J., Vanable, P. A., Carey, K. B., Ewart, C. K., & Carey, M. P. (2017). Associations between health literacy and health behaviors among urban high school students. Journal of School Health, 87(12), 885–893. https://doi.org/10.1111/josh.12567
  31. Prihanto, J. B., Nurhayati, F., Wahjuni, E. S., Matsuyama, R., Tsunematsu, M., & Kakehashi, M. (2021). Health literacy and health behavior: Associated factors in Surabaya high school students, Indonesia. International Journal of Environmental Research and Public Health, 18(15), 8111. https://doi.org/10.3390/ijerph18158111
  32. Rohman, A., & Nurhayati, F. S. (2021). Hubungan literasi kesehatan dengan pola hidup sehat siswa SMP di masa pandemi COVID-19 [The relationship between health literacy and healthy lifestyle among junior high school students during the COVID-19 pandemic]. Jurnal Pendidikan Olahraga dan Kesehatan, 9(1), 101–106
  33. Sarhan, M. B. A., Fujiya, R., Kiriya, J., Htay, Z. W., Nakajima, K., Fuse, R., Wakabayashi, N., & Jimba, M. (2023). Health literacy among adolescents and young adults in the Eastern Mediterranean region: A scoping review. BMJ Open, 13(6), e072787. https://doi.org/10.1136/bmjopen-2023-072787
  34. Sopamena, Y., Pongtambing, Y. S., Andriani, W. O. A. S., Fitriani, Y., & Anshari, D. (2022). Adaptasi alat ukur literasi gizi pada mahasiswa angkatan pertama program sarjana di Universitas Pattimura, Maluku [Adaptation of a nutrition literacy measurement tool for first-year undergraduate students at Pattimura University, Maluku]. Jurnal Gizi Masyarakat Indonesia, 9(2), 83–92. https://doi.org/10.30597/jgmi.v9i2.18946
  35. Sørensen, K., Van Den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12, 80. https://doi.org/10.1186/1471-2458-12-80
  36. Suni, E., & Singh, A. (2023, September 8). How much sleep do you need? How sleep works. https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need
  37. Tavousi, M., Mohammadi, S., Sadighi, J., Zarei, F., Kermani, R. M., Rostami, R., & Montazeri, A. (2022). Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS ONE, 17(7), e0271524. https://doi.org/10.1371/journal.pone.0271524
  38. Van Bortel, T., Wickramasinghe, N. D., Morgan, A., & Martin, S. (2019). Health assets in a global context: A systematic review of the literature. BMJ Open, 9, e023810. https://doi.org/10.1136/bmjopen-2018-023810
  39. van Sluijs, E. M. F., Ekelund, U., Crochemore-Silva, I., Guthold, R., Ha, A., Lubans, D., Oyeyemi, A. L., Ding, D., & Katzmarzyk, P. T. (2021). Physical activity behaviours in adolescence: Current evidence and opportunities for intervention. The Lancet, 398(10298), 429–442. https://doi.org/10.1016/S0140-6736(21)01259-9
  40. Vasli, P., Shekarian-Asl, Z., Zarmehrparirouy, M., & Hosseini, M. (2024). The predictors of COVID-19 preventive health behaviors among adolescents: The role of health belief model and health literacy. Journal of Public Health, 32, 157-166. https://doi.org/10.1007/s10389-022-01808-x
  41. Vereecken, C. A., & Maes, L. (2003). A Belgian study on the reliability and relative validity of the health behaviour in school-aged children food-frequency questionnaire. Public Health Nutrition, 6(6), 581–588. https://doi.org/10.1079/PHN2003466
  42. World Health Organization. (2019). Accelerated Action for the Health of Adolescents (AA-HA!) A manual to facilitate the process of developing national adolescent health strategies and plans. https://www.who.int/publications/i/item/9789241517058
  43. World Health Organization. (2020). WHO guidelines on physical activity and sedentary behaviour. https://www.who.int/publications/i/item/9789240015128
  44. World Health Organization. (2022, August 10). Adolescent and young adult health. https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions
  45. World Health Organization. (2023a). Regional consultation on parent support for early childhood development and adolescent health in South-East Asia. https://apps.who.int/iris/bitstream/handle/10665/367021/SEA-CAH-44-eng.pdf?sequence=1&isAllowed=y
  46. World Health Organization. (2023b, July 31). Tobacco. Fact sheet. https://www.who.int/news-room/fact-sheets/detail/tobacco
  47. Zhang, L., Zhang, D., Fang, J., Wan, Y., Tao, F., & Sun, Y. (2020). Assessment of mental health of Chinese primary school students before and after school closing and opening during the COVID-19 pandemic. JAMA Network Open, 3(9), e2021482. https://doi.org/10.1001/jamanetworkopen.2020.21482

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