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Background Health literacy (HL) is closely associated with leading health indicators. Parents represent a critical subgroup among the adult population since they are not only responsible for their own health but also for the health of their children. Previous research suggests that parents with low HL are less likely to meet the preventive and health care needs of their children but the relationship between parental HL and child health is not yet well understood. Methods A cross-sectional survey was implemented in 2017 in 28 public schools in Germany. The parent questionnaire was completed by 4217 caregivers and included the short form of the HLS-EU-Q16. The child questionnaire examined health knowledge, behaviors and outcomes. For children under 11 years, the caregiver reported on behalf of their children (N = 1518). In all other cases, the children completed the questionnaires (N = 2776). Bivariate and multivariate analyses were carried out. Results Among the interviewed parents, 45.8% showed a problematic or inadequate HL. Parents with higher HL reported a better subjective health and quality of life, and they judged their children as being healthier. The major determinant of high parental HL was socio-economic status (r=.088***). High parental HL was associated with positive health behaviors in children including higher consumption of fruits and vegetables, fewer sweetened beverages, regular tooth brushing and more physical activity. The relationships between parental HL and smoking, alcohol consumption, sexual activity among children and children’s weight were not significant. Conclusions The results confirm a relationship between low parental HL, SES and some problematic health behaviors in children. Strengthening the HL of vulnerable parents may contribute to improved health outcomes particularly in the areas of children’s nutrition, exercise and dental health, and parents should be integrated in school-based activities of health promotion and prevention. Key messages There is a strong statistical relationship between parental health literacy and socio-economic status. Parental health literacy is associated with child health behaviors (e.g., nutrition, exercise).

Parental health literacy and health behaviors in children: a 2017 cross-sectional survey in Germany