Introduction

Currently, young people are a priority in many research studies, especially in the field of health. This group is considered vulnerable to acquire diseases ¹, many of them have health problems or disabilities. Furthermore, in various cases they carry out risky activities that can cause health problems such as accidents ², violence ^3,4, complications related to pregnancy ^5,6 and preventable or treatable diseases ^7-9. A high number of serious diseases of adulthood begin in adolescence, which can cause premature death, for example those related to alcohol and tobacco consumption ^10-13, sexually transmitted infections and HIV/AIDS ^14,15, in addition to inadequate eating and exercise habits ^16,17.

Young people frequently find themselves searching for emotions and needing to live new experiences that allow them to achieve independence in adult life, but they frequently make decisions based on impulses, that is, they act without the right thinking ¹⁸. According to this, decision making is a result of their experience, ability to learn and cognitive abilities ^19,20.

In recent years, a concept closely related to the cognitive processes of young people is consciousness, which is a process that involves, first of all, the knowledge of the situation and being aware of what is happening in the environment to understand how the information and one's own actions will impact on the goals and objectives. For awareness to exist, three levels have to be carried out, i.e., perception, comprehension and projection ²¹. In perception, the person knows the problem; in comprehension, the person interprets the information; and in the projection of the situation, the person projects into the future the situations that may occur due to their actions. Therefore, a factor that may be conditioning the health of young people is awareness.

For this reason, the tools to measure awareness as a cognitive process composed of perception, comprehension and projection of the situation can be fundamental items of the process of awareness of young people regarding their health status.

For nursing is essential to have tools that allow measuring events of interest to the most vulnerable population, in order to establish assertive strategies to contribute to the promotion of health. To this end, the research question is the following: What instruments exist to measure health awareness (perception, comprehension and projection) in young people? Therefore, the objective of this study was to identify through a systematic literature search, reliability and validity of measurement instruments based on consciousness as a cognitive process (perception, comprehension, and projection) in young people.

Methodology

A systematic literature review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the publication of systematic reviews. The search was established with Population (P), Intervention (I), Results or Outcome (O), the question being: P= Young people, I= Instruments, O= Consciousness.

In selection criteria, all those who developed instruments for measuring consciousness and its levels (perception, comprehension, and projection) in young people in the health area were considered. The search was not limited by years of publication; the aim was to search for any instrument that measured the concept, and Spanish and English studies were considered. The search was performed ranging from June to September 2022.

In information resources, the search strategy involved reviewing studies published in Pubmed, Scopus, Web of Science (Science Citation Index and Social Sciences Citation Index) and Ovid. Using words or symbols used as links between search terms with the aim of establishing a certain conceptual relationship between them. Various search terms were used, as well as the Boolean operators AND and OR, (Table 1).

Once the studies were selected by title and abstract, a full-text analysis was carried out. According to the selection criteria, all methodological articles that addressed the variable were included. The strategy was designed to be extensive, minimize bias, and maximize accuracy. It was accomplished by using a large number of words with an exhaustive search to identify the greatest number of studies. The result was complemented with articles by contacting the author. Finally, the referenced lists of articles were useful to validate the search strategy.

For study selection, an independent reviewer screened references at title and abstract level using established inclusion criteria. Those that met the items were reviewed in full text (Figure 1). It was used to filter quotations, upload references, and document reasons for the inclusion of articles that had the purpose of creating instruments for measuring the awareness variable or, failing that, excluding those that did not have a clear or convincing methodology on the topic of interest.

Source: Own-depelopment

Figure 1 PRISMA 2020, Flowchart. 2022 

For the data collection process, data extraction from the research articles (instruments) was carried out independently by the main researcher, first those corresponding to the study characteristics. The study characteristics were subsequently reviewed for accuracy. These included the study design, sample size, population characteristics, researcher’s area of interest (health), purpose of the measure, and conceptual definitions. Data related to the results of the studies that consisted of psychometric testing of the measures that included reliability and validity tests were also analyzed. To organize the information, Critical Reading Files (FLC: acronym in Spanish) were used to extract the data that allowed the characteristics of the studies to be identified more clearly. The modifications that were made were based on the Cochrane guidelines on conducting systematic reviews. The synthesis of results presents in a narrative manner the evidence of reliability and validity of the results (reliability coefficients, and the other tests that were used to test the effectiveness of an empirical indicator). These elements helped to better understand the psychometric scope of the measures. In total, there were 10 methodological articles included in the review out of a total of 50 that had been previously chosen.

Results

It was found that 60 % of the studies were carried out in the United States of America, 30 % in Turkey, and only 10 % in Mexico. Within the findings, of the levels of consciousness, perception is the level that has mostly been addressed as an instrument for health issues. In which measurement instruments were developed that help understand the perception of young people and adults in relation to health issues, these studies are specifically focused on the perception based on contraceptives and condom use, having an Alpha reliability of Cronbach that ranged from 0.70 to 0.90, they also carried out the procedures to know the validity of the instruments specifically content, construct and criterion validity ^22-24.

Other authors created instruments for health perception which included a broader vision of the concept of perception. The health perception scale focuses not only on knowing the perception of individuals about a specific disease or problem, because it can be used for any condition related to health ²⁵. Moreover, an adaptation of the health perception scale was found in the Turkish population ²⁶, obtaining validity and reliability similar to those found by Diamond, author of the original scale.

In a health awareness scale that served to form the dimensions based on previous findings, the instrument focused on integration of behaviors, responsibility and motivations that lead to developing certain conducts, reliability and validity were acceptable in the pilot test ²⁷. Another study aimed to evaluate the psychometric characteristics of the translation and cultural adaptation of the health awareness scale, focused on sexual awareness, which had similar reliability to the original scale ²⁸.

Among the methodological studies found, the three-dimensional scale (awareness, attitude and stigma of addiction) which was carried out in young people and obtained an acceptable reliability of Cronbach’s Alpha of 0.089 in a sample of 317 individuals ²⁹. A self-determined questionnaire was also found, the sexual awareness scale to measure tendencies, as well as dispositions associated with attention to sexual processes. Two studies were carried out on young people to validate the scale, similar results of validity and reliability were obtained in both studies, obtaining favorable results for the use of the instrument ³⁰. Finally, an instrument was included which measures the perception of obesity in the young population, with acceptable Cronbach’s Alpha of 0.63 to 0.70 ³¹.

Discussion

Based on the objective of identifying, through a systematic bibliographic search, the reliability and validity of measurement instruments based on consciousness seen as a cognitive process (perception, comprehension, and projection in young people), it could be seen that, from the methodological studies of consciousness in this population, perception is the level of consciousness that has been used the most. This may be due to the fact that this variable alone is the subject of many studies in this population group ^32-35. Regarding the search in which 10 methodological studies were obtained, it can be said that, although they generally presented acceptable psychometric properties ³⁶, it is important to mention that no one was found that allows evaluating the concept of consciousness with a comprehensive approach, i.e., seen as a cognitive process that comprises a series of steps (levels). This can be attributed to the fact that the approach in most cases is based on knowing very superficial aspects such as the perception of the health status of young people. In this regard, a researcher ²¹ states that consciousness is a concept that must be reflected on, defined as a systematic process that consists of three levels, first the situation is perceived, it is understood and subsequently it is projected into the future. Finally, currently there is no instrument that meets these characteristics, those analyzed address consciousness in a very general way or taking into account only the first level (perception).

It can be seen that, although some psychometric characteristics are presented in most of the studies, they were not used to the same extent by the researchers. This may be because the authors used different criteria to evaluate their instruments. However, in this sense it is important to consider that the different statistical tests of reliability and validity in the construction of instruments can provide greater certainty in their use ³⁷. To the best of our knowledge, this systematic review is the first to be carried out in the Mexican context to analyze instruments on health awareness in the young population. Some limitations were seen, such as the search strategy used excluded studies on children and part of adolescence population that may be closely related to young people because they are part of their transition stage. Finally, although a considerable number of databases were reviewed to include all instruments without restricting the search by years, it is necessary to consult other sources of information such as grey literature. It is recommended in the future to create measurement instruments based on consciousness from a comprehensive approach, i.e., considering the process that leads to making decisions based on health.

Conclusions

It is evident that there are some tools to measure consciousness. However, these do not measure the concept comprehensively, that is, they do not address the three levels of consciousness. Substantive elements or parts in young people's decision-making based on their health. There is a need to have tools that can measure consciousness with its three levels. Likewise, they allow us to visualize the entire decision-making process of young people based on their health and with these results to be able to identify the weakest part of the consciousness process and, thus, establish more accurate interventions in the future that help to promote these weaknesses in the process in this population in health matters. This systematic review allows us to identify existing tools that can serve as a basis for studies that aim to measure awareness in the area of health. Nursing plays an important role in the search for tools that allow identifying the current health status of different vulnerable population groups.

Conflict of interests

The authors stated that there is no conflict of interest.

Financing

The authors stated that they did not receive any financing of any kind.