Exploring health perceptions and priorities of South African youth: Understanding what matters for health literacy interventions

Health literacy is a key factor underpinning health behaviours and effective use of health information. Optimising health literacy in adolescents and young adults (AYA) is critical as they transition from childhood to adulthood, changing health-related behaviours alongside physical, emotional, and cognitive change. In South African AYA, with unplanned pregnancy common, poor health literacy may impact multiple generations. Our aim was to explore health perceptions and priorities of South African AYA to inform contextually relevant health literacy intervention design.   Through purposive sampling of youth registered at a youth development centre in Soweto, South Africa, AYA (n=39, 18-25y) were recruited to form an advisory Youth Health Council (YHC). Health literacy was assessed with the Health Literacy Test for Limited Literacy populations (HELT-LL). Focus group discussions were recorded for inductive thematic analysis to inform AYA health literacy needs.  Most AYA (85%) had suboptimal health literacy. Analysis showed that AYA perceived ‘health’ as a complex mix of indicators (physical, emotional, mental, spiritual) that formed a holistic view of health. However, lack of funds and factors inherent in their local environment (food systems, family hierarchy, crime, vandalism, limited healthcare services) frequently challenged beneficial health behaviours. Stress was a common feature in the lives of AYA associated with multiple health domains.  Stress-focused health literacy interventions are needed for youth in challenging environments. Understanding the complex constructions and the core tenets of health that young people hold can inform contextually relevant intervention co-creation for improved health literacy as youth transition into adulthood.