Subjective health literacy among Polish adolescents in 2018 vs 2022 – impact of gender, age, and socio-economic factors during COVID-19

Introduction and Objective. The results of the Health Behaviour in School-aged Children (HBSC) surveys conducted in 2018 and 2022 allow for a comparison of selected health-related indicators from before the COVID-19 pandemic and from its final phase. The aim of the study is to assess the level of health literacy (HL) among Polish students aged 13–17 years. Materials and Method. The surveys were conducted with nationwide samples of students (N2018=5648 and N2022=4994, respectively). Changes in the overall HLSAC-5 index and its five dimensions were examined. Results. The findings indicate a significant decline in the average HLSAC-5 scores from 15.35±2.40 to 14.84±2.80, alongside an increase in the proportion of students with low HL from 9.85% – 23.67%. Concurrently, the percentage of students rating their health as poor rose from 3.5% to 9.1%. An increasing disparity in HL levels across schools was also observed, with the intraclass correlation coefficient (ICC) escalating from 3.4% to 6.1%. General linear model confirmed a significant influence of gender, age, place of living, family affluence, self-rated health, and eight significant 2-way or 3-way interactions between independent variables. Notably, there were five significant 3-way interactions involving the year of the survey and self-rated health, with the third factor, gender, age, family wealth, presence of a chronic disease, and place of residence, respectively. Conclusions. The study highlights the dynamic nature of HL and its evolving relationship with various socio-demographic and health factors over time. The changes in students’ HL may have been influenced by factors related to living and learning during the COVID-19 pandemic.