Treffer: AHLS (Adolescent HL scale), the final draft.

Background Adolescent health literacy (HL) is a significant public health concern, especially in developing countries with predominantly young populations like Ethiopia, as it impacts both their immediate and long-term health outcomes, and consequently, the overall wellbeing of their societies. Since HL is influenced by socio-cultural contexts, a locally developed and validated HL scale is essential for generating quality data and designing effective interventions. However, such a context-specific, validated HL scale for this age group is currently lacking in Ethiopia. This study, therefore, aims to develop and validate an adolescent HL scale tailored to the socio-cultural context of Ethiopia, to support measurement and intervention efforts. Methods This study employed a mixed methods approach, conducted in three stages between March 09, 2023 and January 25, 2024. In the first stage, concepts, categories/dimensions, and items were generated, using in-depth interviews and focus group discussions as data collection methods, to inform scale design, and the scale was subsequently developed based on these elements. The second stage comprised evaluating the scale’s content, cognitive, and usability standards through expert reviews/evaluations, cognitive interviews, and a pilot survey, followed by modifications based on these evaluations. The third stage involved further evaluation of the validity and reliability of the scale on a larger random sample, using confirmatory factor analysis and reliability tests, respectively. Purposive, convenience, and random sampling techniques were employed to select participants. The study was conducted in Afaan Oromo and Amharic languages as per the participants’ preferences. Data analysis was conducted using Atlas.ti (version 7.5.18) and SPSS with AMOS (version 23.0). Results In the first stage of the study, an initial pool of 88 items was generated and then reduced to 40 items following a rigorous review of their coverage and uniqueness. In the second stage, evaluations for ...