Investigating knowledge structure and research trends in child and adolescent health literacy research through network text analysis

Published:August 08, 2022DOI:


      • Since 30 years, child and adolescent health literacy has been addressed in clinical and public health approaches.
      • School-based practices need more evidence to improve health literacy in children and adolescents.
      • Validated, reliable multidimensional health literacy assessment instruments are needed.



      This study aims to investigate the knowledge structure and research trends in child and adolescent health literacy research over the past 30 years by using network text analysis.


      The study was conducted in four steps: 1) collecting abstracts, 2) keyword extraction and preprocessing, 3) creation of co-occurrence matrix, and 4) text network analysis.


      As a result of the centrality analysis, the upper-ranked core keywords were “health care,” “health behavior,” “prevention,” “treatment,” and “health promotion.” In contrast to earlier times, “barrier,” “caregiver,” “school setting,” and “QOL” have recently emerged as core keywords.


      Over the past 30 years, child and adolescent health literacy has been importantly addressed in both clinical and public health approaches. The results of the current study provide references for future research in child and adolescent health literacy.

      Implication for practice and research

      This study suggests the need for additional research on school-based practices that can improve health literacy and for identifying validated and reliable multidimensional health literacy assessment instruments.



      ERIC (Education Resources Information Center), NTA (Network text analysis), NVS (Newest Vital Sign), QOL (Quality of life), REALM (Rapid Estimate of Adult Literacy in Medicine), WRAT (Wide Range Achievement Test)
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        • Ahmad A.
        • Sorensen K.
        Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review.
        Journal of Asthma. 2016; 53: 862-878
        • Australian Commission on Safety and Quality in Health Care
        Health literacy: Taking action to improve safety and quality.
        ACSQHC, Sydney2014 (Retrieved from)
        • Beal S.J.
        • Riddle I.K.
        • Kichler J.C.
        • Duncan A.
        • Houchen A.
        • Casnellie L.
        • Corathers S.D.
        The associations of chronic condition type and individual characteristics with transition readiness.
        Academic Pediatrics. 2016; 16: 660-667
        • Benjamin R.
        Health literacy improvement as a national priority.
        Journal of Health Communication. 2010; 15: 1-3
        • Bröder J.
        • Okan O.
        • Bauer U.
        • Bruland D.
        • Schlupp S.
        • Bollweg T.M.
        • Pinheiro P.
        Health literacy in childhood and youth: A systematic review of definitions and models.
        BMC Public Health. 2017; 17: 361
        • Chen C.
        Science mapping: A systematic review of the literature.
        Journal of Data and Information Science. 2017; 2: 1-40
        • Cyram
        NetMiner (Version 4.4.3.g).
        Cyram Inc, 2021
        • Dadaczynski K.
        • Jensen B.B.
        • Viig N.G.
        • Sormunen M.
        • Von Seelen J.
        • Kuchma V.
        • Vilaça T.
        Health, well-being and education: Building a sustainable future. The Moscow statement on health promoting schools.
        Health Education. 2020; 120: 11-19
        • Davis T.C.
        • Crouch M.A.
        • Long S.W.
        • Jackson R.H.
        • Bates P.
        • George R.B.
        • Bairnsfather L.E.
        Rapid assessment of literacy levels of adult primary care patients.
        Family Medicine. 1991; 23: 433-435
        • Dharmapuri S.
        • Best D.
        • Kind T.
        • Silber T.J.
        • Simpson P.
        • D’Angelo L.
        Health literacy and medication adherence in adolescents.
        The Journal of Pediatrics. 2015; 166: 378-382
        • Diesner J.
        • Carley K.M.
        Revealing social structure from texts: Meta-matrix text analysis as a novel method for network text analysis.
        in: Narayanan V.K. Armstrong D.J. Causal mapping for research in information technology (pp. 81–108). 2005 (IGI Global)
        • Fleary S.A.
        • Joseph P.
        • Pappagianopoulos J.E.
        Adolescent health literacy and health behaviors: A systematic review.
        Journal of Adolescence. 2018; 62: 116-127
        • Friedman H.S.
        • Martin L.R.
        • Tucker J.S.
        • Criqui M.H.
        • Kern M.L.
        • Reynolds C.A.
        Stability of physical activity across the lifespan.
        Journal of Health Psychology. 2008; 13: 1092-1104
        • Gugglberger L.
        The multifaceted relationship between health promotion and health literacy.
        Health Promotion International. 2019; 34: 887-891
        • He Q.
        Knowledge discovery through co-word analysis.
        Library Trends. 1999; 48: 131-159
        • Kim Y.M.
        • Delen D.
        Medical informatics research trend analysis: A text mining approach.
        Health Informatics Journal. 2018; 24: 432-452
        • Kutcher S.
        • Wei Y.
        • Coniglio C.
        Mental health literacy: Past, present, and future.
        The Canadian Journal of Psychiatry. 2016; 61: 154-158
        • Manganello J.A.
        Health literacy and adolescents: A framework and agenda for future research.
        Health Education Research. 2008; 23: 840-847
        • Matsuo Y.
        • Ishizuka M.
        Keyword extraction from a single document using word co-occurrence statistical information.
        International Journal on Artificial Intelligence Tools. 2004; 13: 157-169
        • Murphy D.A.
        • Lam P.
        • Naar-King S.
        • Robert Harris D.
        • Parsons J.T.
        • Muenz L.R.
        • Adolescent Medicine Trials Network for HIV/AIDS Interventions
        Health literacy and antiretroviral adherence among HIV-infected adolescents.
        Patient Education and Counseling. 2009; 79: 25-29
        • Nutbeam D.
        • Levin-Zamir D.
        • Rowlands G.
        Health literacy and health promotion in context.
        Global Health Promotion. 2018; 25: 3-5
        • Okan O.
        • Lopes E.
        • Bollweg T.M.
        • Bröder J.
        • Messer M.
        • Bruland D.
        • Pinheiro P.
        Generic health literacy measurement instruments for children and adolescents: A systematic review of the literature.
        BMC Public Health. 2018; 18 (166–166)
        • Paakkari L.
        • Okan O.
        COVID-19: Health literacy is an underestimated problem.
        The Lancet Public Health. 2020; 5: e249-e250
        • Paakkari L.
        • Torppa M.
        • Mazur J.
        • Boberova Z.
        • Sudeck G.
        • Kalman M.
        • Paakkari O.
        A comparative study on adolescents’ health literacy in Europe: Findings from the HBSC study.
        International Journal of Environmental Research and Public Health. 2020; 17: 3543
        • Paranyushkin D.
        Identifying the pathways for meaning circulation using text network analysis.
        Nodus Labs. 2011; 26 (Retrieved from)
        • Popping R.
        Computer-assisted text analysis.
        Sage Publications, 2000
        • Qi S.
        • Hua F.
        • Xu S.
        • Zhou Z.
        • Liu F.
        Trends of global health literacy research (1995-2020): Analysis of mapping knowledge domains based on citation data mining.
        PLoS One. 2021; 16 (e0254988)
        • Quirin A.
        • Cordón O.
        • Guerrero-Bote V.P.
        • Vargas-Quesada B.
        • Moya-Anegón F.
        A quick MST-based algorithm to obtain pathfinder networks (∞, n − 1).
        Journal of the American Society for Information Science and Technology. 2008; 59: 1912-1924
        • Ramos J.
        Using tf-idf to determine word relevance in document queries.
        Proceedings of the First Instructional Conference on Machine Learning. 2003; 242: 132-142
        • Ratzan S.C.
        Health literacy: Building upon a strong foundation.
        Journal of Health Communication. 2011; 16: 3-4
        • Schima M.
        • Ames E.E.
        The health education profession in the 21st century: Setting the stage: National commission for health education credentialing, Inc., Coalition of National Health Education Organizations, USA.
        Journal of School Health. 1996; 66: 291-298
        • Scottish Government
        Making it easy: A health literacy action plan for Scotland.
        (Retrieved from)
        • Simonds S.K.
        Health education as social policy.
        Health Education & Behavior. 1974; 2: 1-10
        • Sørensen K.
        • Pelikan J.M.
        • Röthlin F.
        • Ganahl K.
        • Slonska Z.
        • Doyle G.
        • Brand H.
        Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU).
        European Journal of Public Health. 2015; 25: 1053-1058
        • Sørensen K.
        • Van den Broucke S.
        • Fullam J.
        • Doyle G.
        • Pelikan J.M.
        • Slonska Z.
        • Brand H.
        Health literacy and public health: A systematic review and integration of definitions and models.
        BMC Public Health. 2012; 12 (80–80)
        • The WHOQOL Group
        The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization.
        Social Science & Medicine. 1995; 41: 1403-1409
        • U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion
        National action plan to improve health literacy.
        (Retrieved from)
        • UN Population Fund (UNEFPA)
        Motherhood in Childhood: Facing the challenge of adolescent pregnancy.
        (Retrieved from)
        • Valerio M.A.
        • Peterson E.L.
        • Wittich A.R.
        • Joseph C.L.
        Examining health literacy among urban African-American adolescents with asthma.
        Journal of Asthma. 2016; 53: 1041-1047
        • Van der Vinne E.
        The ultimate goal of disease management: Improved quality of life by patient centric care.
        International Journal of Integrated Care. 2009; 9
        • Wasserman S.
        • Faust K.
        Social network analysis: Methods and applications.
        Cambridge University Press, 1994
        • Weiss B.D.
        • Mays M.Z.
        • Martz W.
        • Castro K.M.
        • DeWalt D.A.
        • Pignone M.P.
        • Hale F.A.
        Quick assessment of literacy in primary care: The newest vital sign.
        The Annals of Family Medicine. 2005; 3: 514-522
        • Wiium N.
        • Breivik K.
        • Wold B.
        Growth trajectories of health behaviors from adolescence through young adulthood.
        International Journal of Environmental Research and Public Health. 2015; 12: 13711-13729
        • Wilkinson G.S.
        Wide range achievement test 3. Wide range, incorporated.
        • World Health Assembly, 64
        Youth and health risks: Report by the secretariat.
        World Health Organization, 2011 (Retrieved from)
        • World Health Organization
        Shanghai declaration on promoting health in the 2030 agenda for sustainable development.
        Health Promotion International. 2017; 32: 7-8
        • World Health Organization
        Health literacy in the context of health, well-being and learning outcomes the case of children and adolescents in schools: The case of children and adolescents in schools (no. WHO/EURO: 2021–2846–42604-59268).
        World Health Organization. Regional Office for Europe, 2021
        • Zafarani R.
        • Abbasi M.A.
        • Liu H.
        Social media mining: An introduction.
        Cambridge University Press, 2014
        • Zheng M.
        • Jin H.
        • Shi N.
        • Duan C.
        • Wang D.
        • Yu X.
        • Li X.
        The relationship between health literacy and quality of life: A systematic review and meta-analysis.
        Health and Quality of Life Outcomes. 2018; 16: 1-10
        • Zhong Y.
        • Patel N.
        • Ferris M.
        • Rak E.
        Health literacy, nutrition knowledge, and health care transition readiness in youth with chronic kidney disease or hypertension: A cross-sectional study.
        Journal of Child Health Care. 2020; 24: 246-259