Media Health Literacy (MHL): development
and measurement of the concept among
Diane Levin-Zamir 1 ,2 , *, Dafna Lemish3 and Rosa Gofin 4 ,5 Author Affiliations
* ↵ Correspondence to: D. Levin-Zamir. E-mail:
Received March 13, 2010.
Accepted February 3, 2011.
Increasing media use among adolescents and its significant
influence on health behavior warrants in-depth understanding of their response to media content. This study developed the concept and tested a model of Media Health Literacy (MHL),
examined its association with personal/socio-demographic
determinants and reported sources of health information,
while analyzing its role in promoting empowerment and health behavior (cigarette/water-pipe smoking, nutritional/dieting
habits, physical/sedentary activity, safety/injury behaviors and sexual behavior). The school-based study included a
representative sample of 1316 Israeli adolescents, grades 7, 9 and 11, using qualitative and quantitative instruments to
develop the new measure.
The results showed that the MHL measure is highly scalable
(0.80) includes four sequenced categories: identification/
recognition, critical evaluation of health content in media, perceived influence on adolescents and intended action/
reaction. Multivariate analysis showed that MHL was
significantly higher among girls (β = 1.25, P < 0.001),
adolescents whose mothers had higher education (β = 0.16, P = 0.04), who report more adult/interpersonal sources of
health information (β = 0.23, P < 0.01) and was positively
associated with health empowerment (β = 0.36, P < 0.0005)
and health behavior (β = 0.03, P = 0.05). The findings suggest that as a determinant of adolescent health behavior, MHL
identifies groups at risk and may provide a basis for health promotion among youth.
Adolescents are spending increasingly more time with media,
according to the World Health Organization (WHO) Health
Behavior of School Children (HBSC) study, conducted in Europe and North America [ 1]. Israeli youth rank among the highest of these countries for daily hours of screen time for all ages and ranked in the highest quartiles for reported dieting and lack of physical activity among females, cigarette smoking and reported daily intake of sweetened drinks. Intentional injuries are prevalent among Israeli youth [ 2 ].
Substantial research has shown mass media can have both
health-compromising and health-promoting effects on
adolescents' health behavior. The health-compromising
influence of mass media has been studied, among others, with regards to violence [ 3 ], sexual risk behavior [4 ], obesity [5 ], body dissatisfaction and eating disorders [ 6 ], cigarette smoking [ 7] and alcohol use [ 8]. The health-promoting influence of mass media has been attributed to its capacity to provide
health information, model health-promoting norms/lifestyles
and conduct campaigns for reducing risk behaviors [ 9]. The
ubiquitous role of mass media in everyday life and the
accumulated evidence of its significant influence on youth , warrants in-depth understanding of how its use can promote
or compromise health behavior. Definitions of existing
concepts of literacy, health literacy (HL) [11 –14] and media literacy (ML) [ 15, 16 ] offer theoretical bases upon which a partial understanding can be made regarding the association
between the health content youth are exposed to in the
media, their understanding and interpretation of the meaning of these messages and their applications of that understanding in their everyday life. HL was defined in the WHO Health
Promotion Glossary [ 13] as ‘the development of the cognitive and social skills which determine the motivation and ability of individuals to gain access to understand and use information in ways that promote and maintain good health. By improving
people's access to health information and their capacity to use it effectively, HL is...