# Comparison of Health Literacy on Physical Activity and Nutrition Between Children and Adolescents with Congenital Heart Disease and Healthy Controls

## TL;DR

Children with congenital heart disease have lower health literacy and physical activity levels compared to healthy peers.

## Contribution

First study comparing health literacy in physical activity and nutrition between children with congenital heart disease and healthy controls.

## Key findings

- Children with congenital heart disease had significantly lower PAHL-C and NHL-C scores than healthy controls.
- Patients with congenital heart disease reported less physical activity compared to controls.
- Boys had higher physical activity levels and PAHL-C scores than girls.

## Abstract

Background: Health literacy can be defined as the ability to access, understand, evaluate, and apply health information in order to make informed health decisions in daily life. Despite its importance, little is known about health literacy in the domains of physical activity and nutrition among children with congenital heart disease. The aim of this study was to examine differences in health literacy related to physical activity and nutrition between children and adolescents with congenital heart disease and a healthy control group (Control). Methods: A total of 244 children and adolescents (age 8–18 years; mean age 13.4 ± 3.1 years, 53.3% girls) were enrolled, comprising 122 patients with congenital heart disease and 122 age- and sex-matched healthy controls. Patients were recruited during routine medical examinations at the German Heart Center, while controls were recruited from Munich schools. The Physical Activity Health Literacy Scale for Children (PAHL-C) and the Nutrition Health Literacy Scale for Children (NHL-C) were used to assess health literacy in the domains of physical activity and nutrition. Scores for both scales were calculated as additive sum scores and converted to a scale from 0 to 100, where higher scores indicate better health literacy. Physical activity levels were measured via self-reported frequency of days per week in which children engaged in at least one hour of physical activity. Results: Children with congenital heart disease showed lower PAHL-C scores (Patients: 65.9 ± 18.0 vs. Control: 72.9 ± 14.9, p = 0.001) and lower NHL-C scores (Patients: 63.6 ± 19.0 vs. Control: 69.3 ± 14.8, p = 0.009) than healthy controls. Boys reported significantly higher self-reported physical activity levels (p = 0.001) and had significantly higher PAHL-C scores than girls (p < 0.001). Patients with congenital heart disease reported significantly less physical activity compared to controls (Patients: 4.2 ± 1.7 days/week vs. Control: 5.2 ± 1.8 days/week, p < 0.001). Conclusions: Children with congenital heart disease demonstrate lower health literacy in the domains of physical activity and nutrition than their healthy counterparts and report being less active. This highlights the need for targeted interventions to address both physical activity and health literacy in children with congenital heart disease.