A thorough review of the literature reveals one previous study
of children with Type 1 diabetes, which found no relationship
between children’s literacy skill and their own health, as measured
by hemoglobin A1C [67]. In contrast, we found, in this crosssectional
sample of overweight children, that higher literacy was
significantly correlated with a lower body mass index, adjusted for
age and gender.
We believe these results raise important questions for future
research. First, the uncertainty regarding our measure of child
health literacy underscores the need to develop a reliable and valid
measure of child health literacy. This measure has to be age
appropriate, and incorporate measures of not only numeracy and
reading comprehension, but also listening and speaking skills.
Construction of a test of health literacy for use in children would
also need to take into account children’s cultural context, and the
neurocognitive, physical and psychological changes that children
encounter as they grow from the early school years through
adolescence. Second, how health literacy influences BMI needs to
be more fully explored. Future researchers looking at this
relationship may consider using the Newest Vital Sign [68], which
uses a food label to assess literacy. Also, qualitative work is needed
to explore the relationship between self-efficacy, weight, and
literacy issues within the context of both culture and family.
This study represents exploratory work in a new area, and as
such, there are important limitations that should be noted. First,
the cross-sectional design limits any inferences we can make about
cause and effect. We cannot know whether higher literacy enables
better food choices and healthier weight, or whether a more
unhealthy weight results in cognitive deficits that impact literacy