COVID-19: health literacy is an underestimated problem

Qualitative exploration of intentions, concerns and information needs of vaccine-hesitant adults initially prioritised to receive COVID-19 vaccines in Australia

OBJECTIVE

Tailored communication is necessary to address COVID-19 vaccine hesitancy and increase uptake. We aimed to understand the information needs, perceived benefits and barriers to COVID-19 vaccination of people prioritised, but hesitant to receive the vaccine.

METHOD

In this qualitative study in Victoria, Australia (February-May 2021), we purposively sampled hesitant adults who were health or aged/disability care workers (n=20), or adults aged 18-69 with comorbidities or aged ≥70 years ('prioritised adults'; n=19). We thematically analysed interviews inductively, then deductively organised themes within the World Health Organization Behavioural and Social Drivers of vaccination model. Two stakeholder workshops (n=12) explored understanding and preferences for communicating risks and benefits. We subsequently formed communication recommendations.

RESULTS

Prioritised adults and health and aged care workers had short- and long-term safety concerns specific to personal circumstances, and felt like "guinea pigs". They saw vaccination as beneficial for individual and community protection and travel. Some health and aged care workers felt insufficiently informed to recommend vaccines, or viewed this as outside their scope of practice. Workshop participants requested interactive materials and transparency from spokespeople about uncertainty. Conclusions and public health implications: Eleven recommendations address communication content, delivery and context to increase uptake and acceptance of COVID-19 vaccines.

Differences in SARS-CoV-2 infections during the first and second wave of SARS-CoV-2 between six ethnic groups in Amsterdam, the Netherlands: A population-based longitudinal serological study

BACKGROUND

Surveillance data in high-income countries have reported more frequent SARS-CoV-2 diagnoses in ethnic minority groups. We examined the cumulative incidence of SARS-CoV-2 and its determinants in six ethnic groups in Amsterdam, the Netherlands.

METHODS

We analysed participants enrolled in the population-based HELIUS cohort, who were tested for SARS-CoV-2-specific antibodies and answered COVID-19-related questions between June 24-October 9, 2020 (after the first wave) and November 23, 2020-March 31, 2021 (during the second wave). We modelled SARS-CoV-2 incidence from January 1, 2020-March 31, 2021 using Markov models adjusted for age and sex. We compared incidence between ethnic groups over time and identified determinants of incident infection within ethnic groups.

FINDINGS

2,497 participants were tested after the first wave; 2,083 (83·4%) were tested during the second wave. Median age at first visit was 54 years (interquartile range=44-61); 56·6% were female. Compared to Dutch-origin participants (15·9%), cumulative SARS-CoV-2 incidence was higher in participants of South-Asian Surinamese (25·0%; adjusted hazard ratio [aHR]=1·66; 95%CI=1·16-2·40), African Surinamese (28·9%, aHR=1·97; 95%CI=1·37-2·83), Turkish (37·0%; aHR=2·67; 95%CI=1·89-3·78), Moroccan (41·9%; aHR=3·13; 95%CI=2·22-4·42), and Ghanaian (64·6%; aHR=6·00; 95%CI=4·33-8·30) origin. Compared to those of Dutch origin, differences in incidence became wider during the second versus first wave for all ethnic minority groups (all p-values for interaction<0·05), except Ghanaians. Having household members with suspected SARS-CoV-2 infection, larger household size, and low health literacy were common determinants of SARS-CoV-2 incidence across groups.

INTERPRETATION

SARS-CoV-2 incidence was higher in the largest ethnic minority groups of Amsterdam, particularly during the second wave. Prevention measures, including vaccination, should be encouraged in these groups.

FUNDING

ZonMw, Public Health Service of Amsterdam, Dutch Heart Foundation, European Union, European Fund for the Integration of non-EU immigrants.

Risk and asset-based strategies in health: priorities in biomedical, life and environmental science literature since the early twentieth century. A rapid review

BACKGROUND

In biomedical, life or environmental science research, two different strategies exist depending on the starting point of the researchers: "what makes us ill? " or "what makes us healthy?". Indeed, a risk-based strategy (RBS) attempts to minimize risk factors increasing the likelihood of developing a disease, while an asset-based strategy (ABS) attempts to promote and strengthen the factors that support good health and wellbeing. We provided an up-to-date overview of both research strategies in peer-reviewed scientific literature, in the fields of human health, animal and plant health and ecosystem health, to fit with the One Health framework. More particularly, we focused on human health by studying publications related to the COVID-19 at the beginning of the pandemic.

DESIGN

A rapid review of research science literature was carried out to identify in the PubMed/MEDLINE database the proportion of peer-reviewed articles adopting either a RBS or an ABS, in the main global environment fields from January 01, 1900 to December 31, 2019 and, related to COVID-19, from December 1, 2019 to May 31, 2020.

RESULTS

The number of published articles resulting from our search was 1,957,905, including 91.3% with an RBS and 8.7% with an ABS. When examining each field, we found that only 10.5% of human health articles deal with ABS, 5.5% for animal health, 2.2% for ecosystem health, 1.0% for plant health and 2.7% for environmental media. We noted that articles adopting both strategies were published in all health fields. Among the articles concerning COVID-19, 5,854 (55.9%), 542 articles (5.2%) adopted RBS and ABS, respectively, while 4069 (38.9%) simultaneously presenting both strategies.

CONCLUSION

Our results have allowed us to take stock of the biomedical research strategies prioritized during the twentieth century. It seems highly likely that the two strategies we have analyzed can now be chosen in such a way as to promote a balance in public health measures, at every level to guide One Health interventions aimed at helping people, animals, and plants to lead healthier lives.

COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study

BACKGROUND

Health literacy is important for the prevention of COVID-19 transmission. Research in Japan shows that health literacy is related to skills in evaluating information and decision-making (skills that are not necessarily limited to information about health). Such basic skills are important, particularly when individuals encounter new health issues for which there is insufficient evidence.

OBJECTIVE

We aimed to determine the extent to which COVID-19 preventive behaviors were associated with health literacy and skills in evaluating information and making decisions.

METHODS

A web-based questionnaire survey was conducted using a Japanese internet research company. The measures comprised 8 items on COVID-19 preventive behaviors, health literacy items (European Health Literacy Survey Questionnaire), 5 items on information evaluation, and 4 items on decision-making process. Pearson correlations between these variables were calculated. Multivariable analyses were also conducted using the COVID-19 preventive behavior score as a dependent variable.

RESULTS

A total of 3914 valid responses were received.COVID-19 preventive behaviors were significantly correlated with health literacy (r=0.23), information evaluation (r=0.24), and decision-making process (r=0.30). Standardized regression coefficients (health literacy: β=.11; information evaluation: β=.13; decision-making: β=.18) showed that decision-making process contributed the most.

CONCLUSIONS

Although comprehensive health literacy is necessary for COVID-19 preventive behaviors, the skills to evaluate a wide range of information and to make appropriate decisions are no less important. Opportunities for people to acquire these skills should be available at all times.

Association of Fear of COVID-19 and Health Literacy Among the General Public in Saudi Arabia: A Cross-Sectional Assessment

Objective

This study aims to determine the level of fear of coronavirus disease—2019 (COVID-19) among the general public in Saudi Arabia and the association of its scores with their level of health literacy.

Methods

A descriptive cross-sectional study was conducted among the general population in Saudi Arabia from April 2020 to May 2020. A three-part online self-reported survey was used to assess the participants' demographic characteristics, fear of COVID-19 of the participants, and levels of health literacy.

Results

Of the 848 participants, 56.8% were in the age group of 25–34, 45.6% were females, and 57.1% had a bachelor's degree. The total mean score of the fear of COVID-19 scale of the participants was FCoV-19: mean ± SD = 19.60 ± 7.33 and the health literacy was HL index: mean ± SD = 27.57 ± 11.05. There was a significant difference in the scores of fear of COVID-19 scale in terms of age (F = 2.442, p = 0.050), representing that those aged 45 and above had higher mean fear scores than the younger participants. The analysis revealed that an increased level of fear of COVID-19 was associated with older age (B = 1.87; p = 0.020), being unemployed (B = 0.76; p = 0.023), with no formal education (B = 0.89; p = 0.001), and low level of health literacy (B = 0.02; p = 0.021).

Conclusion

The study shows an above-average level of fear of COVID-19 of the general public in Saudi Arabia and its association with a low level of functional health literacy. Timely and comprehensive health interventions should be promoted to enhance the level of health literacy and further reduce the level of fear of COVID-19 in the community.

Investigating the Impact of the External Environment and Benchmark Characteristics on the China-Pakistan Economic Corridor's Construction: A COVID-19 Perspective

The economic stability of a country, such as Pakistan is dependent on the construction of mega-projects, such as the China-Pakistan Economic Corridor (CPEC). However, certain external factors and project characteristics may delay the construction of infrastructure projects; scholars have not investigated the development of CPEC from this perspective. In addition, the COVID-19 outbreak has hindered CPEC initiatives. This analysis will examine the effect of external environment factors on CPEC, and benchmark the project's effects on economic stability through CPEC's development by incorporating 523 samples obtained from employees of various CPEC projects. Structural equation modeling was used to analyze all hypotheses proposed here on AMOS 21.0 tools. According to the findings of this study, the CPEC external environment and project benchmark characteristics have a negative effect on the construction of CPEC development. Furthermore, the development of CPEC is found to have a significant effect on economic stability. However, fear of COVID-19 has weakened the relationship between CPEC development and economic stability. Finally, we also discuss the implications and limitations of the study.

Health literacy as a social vaccine in the COVID-19 pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus in the coronavirus family, causing the coronavirus disease (COVID-19). Biomedical vaccines are key but alongside biomedical vaccines, a social vaccine can be similarly useful to prevent infection from SARS-CoV-2, if applied as a health promotion strategy. In order to slow down and control the spread of SARS-CoV-2, applying the social vaccine concept should be considered in parallel. From a health promotion perspective, a social vaccine is a process of social and political mobilization driven by governmental and non-governmental organizations aiming at populations by applying interventions such as health communication, education and mass media campaigns as well as determinant-based programs to address environmental factors influencing personal behavior and community capacities to cope with and overcome the societal burdens of COVID-19. In this context, health literacy is significant, as seen in the role it plays in empowering citizens during the COVID-19 pandemic and enabling them to deal with health information considering COVID-19. As a public health strategy, health literacy as a social vaccine will enable individuals and communities to mitigate the spread of the virus by understanding and applying information as provided through governments and health authorities. The aim of this article is to explore health literacy as a promising social vaccine and opportunity to utilize social vaccination and thus be considered as a key public health approach—both bottom-up and top-down—to support the combat of COVID-19 and future states of emergency.

Associação entre letramento em saúde, ameaça pela COVID-19 e intenção vacinal de adolescentes brasileiros

Resumo Objetivo: investigar a influência do letramento em saúde na avaliação da ameaça à saúde pela COVID-19 e sobre a intenção de não se vacinar de adolescentes brasileiros. Método: estudo transversal com 526 adolescentes brasileiros de 14 a 19 anos. Aspectos socioeconômicos, perfil saúde-doença, letramento em saúde, ameaça à saúde pela COVID-19 e intenção de não se vacinar foram analisados por associação bivariada e regressão linear múltipla com resposta Poisson. Resultados: maior pontuação de letramento em saúde (p=0,010), doença cardíaca (p=0,006), menor renda (p=0,000) e morar na região norte (p=0,007) foram fatores que contribuíram para o sentimento de maior ameaça pela COVID-19. O letramento em saúde não influenciou a intenção de não se vacinar (p=0,091), cuja prevalência foi menor entre os adolescentes do Sudeste quando comparados aos do Norte (p=0,010), entre os que cursavam o ensino superior (p=0,049) e entre aqueles com maior renda (p=0,000). Conclusão: letramento em saúde influenciou a percepção da ameaça da doença, mas não a intenção de não se vacinar. Avaliação da ameaça à saúde pela COVID-19 e a prevalência da intenção de não se vacinar foram influenciadas pela região de residência, renda e escolaridade, o que reforça a importância dos determinantes sociais da saúde nesse contexto.

Country-level and regional COVID-19 burden and determinants across OECD member states and partner countries

Background

COVID-19 pandemic is tremendously impacted by socioeconomic and health determinants worldwide. This study aimed to determine factors associated with COVID-19 fatality among member states and partner countries of the Organization for Economic Cooperation and Development (OECD).

Methods

An ecological study was conducted using COVID-19 data of 48 countries for the period between 31 December 2019–31 December 2021. The outcome variables were COVID-19 case fatality rate (CFR) and years of life lost to COVID-19 (YLLs). Countries’ sociodemographics and COVID-19-related data were extracted from OECD website, Our World in Data, John Hopkins Coronavirus Resource Center, Economist Intelligence Unit (EIU) and WHO.

Results

In the first year of the pandemic (December 2019–January 2021), highest CFR was observed in Mexico, 8.51%, followed by China, 5.17% and Bulgaria, 4.12%), and highest YLLs was observed in Mexico, 2,055 per 100,000. At regional level, highest CFR was observed in North & central America, 4.25 (3.71) %, followed by South America (2.5 (0.1) %); whereas highest YLLs was observed in South America region 1457.5 (274.8) per 100,000, followed by North & central America, 1207.3 (908.1) per 100,000. As of 31 December 2021, Mexico (7.52%) and Bulgaria (4.78%) had highest CFR; on the other hand, highest YLLs was observed in England, 26.5 per 1,000, followed by the United States, 25.9 per 1,000. At regional level, highest CFR (3.37(3.19) %) and YLLs (16.7 (13) per 1,000) were both observed in North & central America. Globally, the analysis of the 2-year cumulative data showed inverse correlation between CFR and nurse per 10,000 (R = −0.48; p < 0.05) and GDP per capita (R = −0.54; p < 0.001), whereas positive correlation was observed between YLLs and elderly population rate (R = 0.66; p < 0.05) and overweight/obese population rates (R = 0.55; p < 0.05).

Conclusion

This study provides insights on COVID-19 burden among OECD states and partner countries. GDP per capita, overweight/obesity and the rate of elderly population emerged as major social and health determinants of COVID-19 related burden and fatality. Findings suggest that a robust economy and interventions designed to promote healthy longevity and prevent weight gain in at-risk individuals might reduce COVID-19 burden and fatality among OECD states and partner countries.

Supplementary information

The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00054.

Assessing eHealth literacy among internet users in Lebanon: A cross-sectional study

Objective

Assessing the level of eHealth literacy in a population is essential to designing appropriate public health interventions. This study aimed to assess eHealth literacy among adult internet users in Lebanon, recruited through social media and printed materials. The study examined the relationship between internet use, perceived eHealth literacy, and sociodemographic characteristics.

Methods

A cross-sectional study based on a web-based questionnaire was conducted between January and May 2020. The survey assessed internet use and eHealth literacy using the homonymous scale (eHEALS) in English and Arabic. Cronbach's alpha and factor analyses were used to evaluate eHEALS’ psychometric properties. A generalized linear model was used to identify factors predicting the eHEALS.

Results

A total of 2715 respondents were recruited mostly through Facebook (78%) and printed materials (17%). Most respondents completed the survey in English (82%), were aged 30 ± 11 years, female (60%), Lebanese (84%), unmarried (62%), employed (54%), and with a graduate-level education (53%). Those who completed the eHEALS questionnaire (n = 2336) had a moderate eHealth literacy (M = 28.7, SD = 5.5). eHEALS was significantly higher among older females with a high education level, recruited from Facebook, Instagram, or ResearchGate, and perceived the Internet as a useful and important source of information.

Conclusions

Future internet-delivered public health campaigns in Lebanon should account for moderate-to-low levels of eHealth literacy and find ways to engage older males with low education levels representing neglected segments (e.g. Syrians). To be more inclusive, campaigns should reach neglected population segments through non-digital, community-based outreach activities.

Fear of coronavirus and health literacy levels of older adults during the COVID-19 pandemic

This study aimed to examine the fear of coronavirus and the health literacy levels of older adults during the pandemic. The sample consisted of 304 older adults from five family health centers in Turkey between April and May 2021. The data were collected using the Fear of COVID-19 Scale and the Health Literacy Scale. The fear of COVID-19 was found to be higher in women, those with chronic diseases, and those who found the epidemic measures insufficient (p < 0.05). The health literacy level was found to be higher in those with high education level, those in the 65-74 age group, and those with not using regular medicine (p < 0.001). The health literacy of older adults was a slightly above moderate level and the fear of COVID-19 was at a moderate level. Health literacy levels of older adults may be increased with written, visual, and verbal health trainings.

Relación entre alfabetización en salud, amenaza por COVID-19 e intención de vacunación entre los adolescentes brasileños

Resumen Objetivo: investigar la influencia de la alfabetización en salud sobre la evaluación de la amenaza por COVID-19 y sobre la intención de los adolescentes brasileños de no vacunarse. Método: estudio transversal con 526 adolescentes brasileños entre 14 y 19 años. Se analizaron aspectos socioeconómicos, perfil epidemiológico, alfabetización en salud, amenaza a la salud por COVID-19 y la intención de no vacunarse mediante una relación bivariada y regresión lineal múltiple de respuesta de Poisson. Resultados: una elevada puntuación de alfabetización en salud (p=0,010), enfermedades cardiovasculares (p=0,006), menor nivel de renta (p=0,000) y vivir en la región norte (p=0,007) fueron factores que ayudaron a la sensación de mayor amenaza por COVID-19. La alfabetización en salud no influyó en la intención de no vacunarse (p=0,091), cuya prevalencia fue más baja entre los adolescentes del Sudeste en comparación con los del Norte (p=0,010), entre los que cursaban estudios superiores (p=0,049) y mayor nivel de renta (p=0,000). Conclusión: la alfabetización en salud influyó sobre la percepción de la amenaza de la enfermedad pero no en la intención de no vacunarse. La evaluación de la amenaza a la salud por COVID-19 y la prevalencia de la intención de no vacunarse fueron condicionadas por la región de residencia, nivel de renta y educación, acentuando la importancia de los determinantes sociales de la salud en este contexto.

Health Literacy, Equity, and Communication in the COVID-19 Era of Misinformation: Emergence of Health Information Professionals in Infodemic Management

The health information management (HIM) field's contribution to health care delivery is invaluable in a pandemic context where the need for accurate diagnoses will hasten responsive, evidence-based decision-making. The COVID-19 pandemic offers a unique opportunity to transform the practice of HIM and bring more awareness to the role that frontline workers play behind the scenes in safeguarding reliable, comprehensive, accurate, and timely health information. This transformation will support future research, utilization management, public health surveillance, and forecasting and enable key stakeholders to plan and ensure equitable health care resource allocation, especially for the most vulnerable populations. In this paper, we juxtapose critical health literacy, public policy, and HIM perspectives to understand the COVID-19 infodemic and new opportunities for HIM in infodemic management.

Are beliefs and attitudes about COVID-19 associated with self-perceived changes in food consumption? Results from a nationwide survey during lockdown

This study aimed to understand how beliefs and attitudes regarding COVID-19 are associated with self-perceived changes in food consumption during lockdown between March 19 and May 2, 2020. We conducted a cross-sectional study with a non-probabilistic weighted sample of the Portuguese population. Data were collected using an online survey and telephone interviews. The association between agreement with sentences about food and COVID-19 and perceived changes in food consumption were assessed by multinomial logistic regression models. Overall, 5858 citizens were included, with a mean age of 38.2 (17.3) years. Exclusive agreement with the belief "SARS-CoV-2 can be transmitted by food" (27.5%) was associated with decreased odds of perceived positive changes (e.g., increased consumption of fruit and vegetables). Agreement only with the attitudinal sentence "I started to consume foods that may protect against COVID-19" (11.9%) was associated with positive perceived consumption changes (e.g., increasing fruit and vegetables, and decreasing soft drinks and snacks). Cumulative agreement (with both sentences; 10.6%) was also associated with mostly positive food consumption changes. Specific beliefs and attitudes regarding COVID-19 and food are associated with self-perceived changes in food consumption. Longitudinal research is needed to understand how beliefs and/or attitudes about the role of food in infectious diseases act as determinants of eating behavior modification.

We shall endure: Exploring the impact of government information quality and partisanship on citizens' well-being during the COVID-19 pandemic

Based on the information-as-coping perspective, we provided a theoretical framework to understand how the quality of government information and citizens' partisanship impact citizens' wellbeing in terms of satisfaction with life and anxiety during COVID-19. With survey data from 705 respondents in Indonesia, we found that government information quality is of vital importance in helping citizens get ready to fight the pandemic, as well as lowering their anxiety. Our results show that higher information quality leads to a higher ability to respond quickly to the crisis, as well as a reduced level of information overload. While partisanship is a significant predictor of information overload, it had no significant impact on perceived quick response ability. Quick response ability and information overload, in turn, predict anxiety and citizen's satisfaction with life.

The role of motivated science reception and numeracy in the context of the COVID-19 pandemic

The successful management of the COVID-19 pandemic depends on individuals accepting the current state of research and adhering to the preventive behaviors that follow from it. However, the processing of scientific results is not always rational, but influenced by prior attitudes as well as the ability to understand statistical data. Against this background, this study investigated the role of motivated reasoning and numeracy in the context of the current pandemic. To this end, participants (N = 417; US sample) evaluated two fictitious studies, one indicating that mask mandates in schools are an effective intervention to contain the spread of SARS-CoV-2, and one indicating that mask mandates in schools are counterproductive. Participants evaluated the studies in line with their prior attitude toward mask mandates. In addition, higher numeracy was associated with decreased bias, demonstrating that the ability to reason with numbers can lead to more accurate processing of statistical information.

Association of health literacy, COVID-19 threat, and vaccination intention among Brazilian adolescents

Objective:

investigate the influence of health literacy on the assessment of COVID-19 threat to health and the intention not to be vaccinated among Brazilian adolescents.

Method:

cross-sectional study with 526 Brazilian adolescents aged 14 to 19 years. Socioeconomic aspects, health-disease profile, health literacy, health threat by COVID-19 and intention not to be vaccinated were analyzed by bivariate association and multiple linear regression with Poisson response.

Results:

higher health literacy score (p=0.010), cardiovascular disease (p=0.006), lower income (p=0.000), and living in the North region (p=0.007) were factors that contributed to feeling more threatened by COVID-19. Health literacy did not influence the intention not to be vaccinated (p=0.091), whose prevalence was lower among adolescents in the Southeast region when compared to those in the North region (p=0.010), among those who attended higher education (p=0,049) and those with higher income (p=0.000).

Conclusion:

health literacy influenced the perception of COVID-19 threat, but not the intention not to be vaccinated. Assessment of COVID-19 threat to health and prevalence of the intention not to be vaccinated were influenced by the region of residence, income, and education, which reinforces the importance of social determinants of health in this context.

Measuring citizens' engagement during emergencies: Psychometric validation of the Public Health Engagement Scale for Emergency Settings (PHEs-E)

The Covid-19 pandemic has highlighted the importance of citizens' behaviors in the containment of the virus. Individuals might change their intention to adhere to public health prescriptions depending on various personal characteristics, including their own emotional status, which has been recognized to be a crucial psychological factor in orienting people's adherence to public health recommendation during emergency settings. In particular, it is crucial to support citizens' alliance with authorities and feeling of trust: public engagement is a concept that refers to the general involvement of citizens into public affairs which is generally considered an effective approach to enhance citizens' understanding of their crucial role in public affairs. However, so far there is no agreement on the metrics and indexes that should be used to measures public engagement during a health crisis. The aim of this paper is to validate a psychometric scale (PHEs-E), which intends to measure the readiness of individuals to adhere to the prescribed behavioral change to contain the emergency. Data were collected throughout the pandemic in Italy: in particular, five independent samples were recruited starting from March 2020 to March 2021. Results showed that the proposed measure has good psychometric characteristics. A general linear model was computed to assess the differences of public engagement across the different data points and among citizens with different sociodemographic characteristics. Correlations with other psychological constructs (i.e. Anxiety, Depression and Self-Efficacy) were also tested, showing that more engaged citizens have a lower level of anxiety and depression, and a higher self-efficacy. This study's findings indicate that individuals' characteristics may differentiate citizens' motivation to engage in public health behavioral recommendation to prevent the COVID-19 contagion. However the scale could be useful to perform a psychological monitoring of psychological readiness to engage in public health strategies to face critical events and settings.

Developing Machine Learning and Statistical Tools to Evaluate the Accessibility of Public Health Advice on Infectious Diseases among Vulnerable People

Background

From Ebola, Zika, to the latest COVID-19 pandemic, outbreaks of highly infectious diseases continue to reveal severe consequences of social and health inequalities. People from low socioeconomic and educational backgrounds as well as low health literacy tend to be affected by the uncertainty, complexity, volatility, and progressiveness of public health crises and emergencies. A key lesson that governments have taken from the ongoing coronavirus pandemic is the importance of developing and disseminating highly accessible, actionable, inclusive, coherent public health advice, which represent a critical tool to help people with diverse cultural, educational backgrounds and varying abilities to effectively implement health policies at the grassroots level.

Objective

We aimed to translate the best practices of accessible, inclusive public health advice (purposefully designed for people with low socioeconomic and educational background, health literacy levels, limited English proficiency, and cognitive/functional impairments) on COVID-19 from health authorities in English-speaking multicultural countries (USA, Australia, and UK) to adaptive tools for the evaluation of the accessibility of public health advice in other languages.

Methods

We developed an optimised Bayesian classifier to produce probabilistic prediction of the accessibility of official health advice among vulnerable people including migrants and foreigners living in China. We developed an adaptive statistical formula for the rapid evaluation of the accessibility of health advice among vulnerable people in China.

Results

Our study provides needed research tools to fill in a persistent gap in Chinese public health research on accessible, inclusive communication of infectious diseases' prevention and management. For the probabilistic prediction, using the optimised Bayesian machine learning classifier (GNB), the largest positive likelihood ratio (LR+) 16.685 (95% confidence interval: 4.35, 64.04) was identified when the probability threshold was set at 0.2 (sensitivity: 0.98; specificity: 0.94).

Conclusion

Effective communication of health risks through accessible, inclusive, actionable public advice represents a powerful tool to reduce health inequalities amidst health crises and emergencies. Our study translated the best-practice public health advice developed during the pandemic into intuitive machine learning classifiers for health authorities to develop evidence-based guidelines of accessible health advice. In addition, we developed adaptive statistical tools for frontline health professionals to assess accessibility of public health advice for people from non-English speaking backgrounds.

A Framework of AI-Based Approaches to Improving eHealth Literacy and Combating Infodemic

The global COVID-19 pandemic has put everyone in an urgent need of accessing and comprehending health information online. Meanwhile, there has been vast amount of information/misinformation/disinformation generated over the Internet, particularly social media platforms, resulting in an infodemic. This public health crisis of COVID-19 pandemic has put each individual and the entire society in a test: what is the level of eHealth literacy is needed to seek accurate health information from online resources and to combat infodemic during a pandemic? This article aims to summarize the significances and challenges of improving eHealth literacy in both communicable (e.g., COVID-19) and non-communicable diseases [e.g., cancer, Alzheimer's disease, and cardiovascular diseases (CVDs)]. Also, this article will make our recommendations of a general framework of AI-based approaches to improving eHealth literacy and combating infodemic, including AI-augmented lifelong learning, AI-assisted translation, simplification, and summarization, and AI-based content filtering. This general framework of AI-based approaches to improving eHealth literacy and combating infodemic has the general advantage of matching the right online health information to the right people.

Efficient Ways to Combat Doping in a Sports Education Context!? A Systematic Review on Doping Prevention Measures Focusing on Young Age Groups

Youth is characterized by testing and crossing natural boundaries, sometimes with the help of performance-enhancing substances. In this context, doping prevention measures play a crucial role to protect individuals both within and outside the context of elite sport. Based on the PRISMA guidelines, a systematic literature search was conducted in the databases ProQuest (ERIC), Scopus, PSYNDEX/PsychInfo, PubMed, and Web of Science Core Collection to provide an overview of the impact of doping prevention measures, with particular attention to the underlying understanding of learning. As a result of the screening process, 30 of the initial 5,591 articles met the previously defined and recorded eligibility criteria. The analysis led to heterogeneous results regarding content, implementation, target group, or outcome variables considered relevant. Two-thirds of the studies related to the competitive sports context. Nevertheless, there has been a growing interest in studying doping prevention and its effects on non-elite athlete target groups in recent years. In terms of effectiveness, many measures did not achieve long-term changes or did not collect any follow-up data. This contrasts with understanding learning as sustained change and reduces the intended long-term protection of prevention measures, especially for adolescent target groups. Even young age groups from 10 years upwards benefited from doping prevention measures, and almost all doping prevention measures enabled their participants to increase their physical and health literacy. No conclusion can be drawn as to whether doping prevention measures based on constructivist ideas are superior to cognitivist approaches or a combination of both. Nevertheless, programs that actively engage their participants appear superior to lecture-based knowledge transfer. Most of the prevention measures offered a benefit-orientation so that participants can achieve added value, besides trying to initiate health-promoting change through rejection. Because of the lack of sustained changes, a further modification in doping prevention seems necessary. The review results support the value of primary prevention. Doping prevention measures should enable tailored learning and development options in the sense of more meaningful differentiation to individual needs. The implementation in a school context or an online setting is promising and sees doping as a problem for society. The review highlights the importance of accompanying evaluation measures to identify efficient prevention components that promote health and protect young people.

Risk Perception and Knowledge, Attitudes, and Practices Against COVID-19 in a Hypertensive Population From a Semi-Urban City of Ecuador

Background: In an elderly population with hypertension, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a higher incidence of mortality and a protracted course of clinical symptoms. Objective: To assess the perceived risk of infection and complications due to COVID-19 in people with hypertension living in a semi-urban city of Ecuador. Methods: A cross-sectional telephone survey of adult outpatients with a previous diagnosis of hypertension in the semi-urban community of Conocoto in Quito, Ecuador was conducted from August to December 2020. Results: A total of 260 adult outpatients, aged 34-97 years, completed telephone surveys. Of total, 71.5% (n = 186) of respondents were women and 28.5% (n = 74) of respondents were men. Overall, 18.1% believe that their risk of infection is "very high," 55.4% believe that their risk of infection is "high," 21.5% believe that their risk of infection is "low," and 5% believe that their risk of infection is "very low." The perceived risk of complications, if infected by COVID-19, revealed that 21.9% believe that their risk of complication is "very high," 65.0% believe that their risk of complication is "high," 10.4% believe that their risk of complication is "low," and 2.7% believe that their risk of complication is "very low." Conclusion: Patients with hypertension are aware of the risks posed by COVID-19 infection and its impact on their health. However, the health system must educate the population on health practices and behaviors to avoid COVID-19 infection until the majority of the population of Ecuador can be vaccinated.

Building health literacy system capacity: a framework for health literate systems

The human and social implications of poor health literacy are substantial and wide-ranging. Health literacy represents the personal competencies and organizational structures, resources and commitment that enable people to access, understand, appraise and use information and services in ways that promote and maintain good health. A large-scale societal improvement of health literacy will require political buy-in and a systematic approach to the development of health literacy capacity at all levels. This article builds the case for enhancing health literacy system capacity and presents a framework with eight action areas to accommodate the structural transformation needed at micro, meso and macro levels, including a health literate workforce, health literate organization, health literacy data governance, people-centred services and environments based on user engagement, health literacy leadership, health literacy investments and financial resources, health literacy-informed technology and innovation, and partnerships and inter-sectoral collaboration. Investment in the health literacy system capacity ensures an imperative and systemic effort and transformation which can be multiplied and sustained over time and is resilient towards external trends and events, rather than relying on organizational and individual behavioural change alone. Nevertheless, challenges still remain, e.g. to specify the economic benefits more in detail, develop and integrate data governance systems and go beyond healthcare to engage in health literacy system capacity within a wider societal context.

Health Literacy among Older Adults during COVID-19 Pandemic: A Cross-Sectional Study in an Urban Community in Thailand

BACKGROUND

This study assessed health literacy (HL) and its associated factors among older adults during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This cross-sectional study included older adults in urban communities in Thailand. We randomly selected a total of 421 older adults and performed multiple logistic regression analyses.

RESULTS

The average age of the respondents was 70.0±7.1 years. Most respondents were female, married, had a low education level (primary school or lower), were unemployed, and had sufficient income. We observed nonproficient and proficient HL levels in 56.1% and 43.9% of respondents, respectively. The factors influencing HL included attending healthcare services at a tertiary hospital, good accessibility to COVID-19 prevention materials and health information, and provision of a high level of social support from neighbors and health personnel.

CONCLUSION

The results of our study provide important information on the outcome of accessibility and social support among older adults in an urban community during the COVID-19 pandemic. In addition, access to health services, prevention equipment, and information was important for people at risk of HL and helped promote good behaviors.

Digital Technology Application for Improved Responses to Health Care Challenges: Lessons Learned From COVID-19

While COVID-19 is still ongoing and associated with more than 5 million deaths, the scope and speed of advances over the past year in terms of scientific discovery, data dissemination, and technology have been staggering. It is not a matter of “if” but “when” we will face the next pandemic, and how we leverage technology and data management effectively to create flexible ecosystems that facilitate collaboration, equitable care, and innovation will determine its severity and scale. The aim of this review is to address emerging challenges that came to light during the pandemic in health care and innovations that enabled us to adapt and continue to care for patients. The pandemic highlighted the need for seismic shifts in care paradigms and technology with considerations related to the digital divide and health literacy for digital health interventions to reach full potential and improve health outcomes. We discuss advances in telemedicine, remote patient monitoring, and emerging wearable technologies. Despite the promise of digital health, we emphasise the importance of addressing its limitations, including interpretation challenges, accuracy of findings, and artificial intelligence–driven algorithms. We summarise the most recent recommendation of the Virtual Care Task Force to scaling virtual medical services in Canada. Finally, we propose a model for optimal implementation of health digital innovations with 5 tenets including data management, data security, digital biomarkers, useful artificial intelligence, and clinical integration.

Declines in health literacy and health-related quality of life during the COVID-19 pandemic: a longitudinal study of the Japanese general population

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, the importance of health literacy (HL) was addressed by public health researchers. We longitudinally examined the changes in general HL and health-related quality of life (HRQOL) between immediately before the COVID-19 outbreak and 1 year later, and how general HL before the outbreak was related to changes in HRQOL in the Japanese general population.

METHODS

Among the Japanese residents aged 20-79 years who participated in our previous study in 2017, 826 were followed-up via self-administered questionnaires in January 2020 and February 2021, for the purposes of this study. The HRQOL was measured using the SF-8, a short version of the SF-36 Health Survey, and general HL was measured using the short form of the European Health Literacy Survey Questionnaire (HL-SF12) in the 2020 and 2021 surveys.

RESULTS

The physical and mental dimensions of HRQOL as well as general HL declined significantly from immediately before the COVID-19 outbreak to 1 year later (p = .010, p < .001 and p < .001, respectively). The decline in HRQOL, especially the mental dimension, was more significant among women. A lower economic status was also related to a greater decline in HRQOL (p = .026 for the physical dimension and p = .012 for the mental dimension). Higher general HL before the COVID-19 outbreak was associated with a lesser decline in HRQOL in both the physical and mental dimensions (p = .040 and p < .001, respectively) after controlling for possible confounding variables such as gender and economic status.

CONCLUSIONS

Healthcare support is crucial for vulnerable populations during and after the pandemic. General HL may be important for attenuating the decline in HRQOL, by enabling effective use of health information and adaptive behaviors toward health threats. Further studies are needed to better understand the association between HL and HRQOL.

Health literacy and e-health literacy among Arabic-speaking migrants in Sweden: a cross-sectional study

Background

Health inequities arise when the public cannot access and understand health information in an easy, accessible, and understandable way. Evidence supports that health literacy (HL) is a determinant for health outcomes, and when HL is limited this may have a major impact on morbidity as well as mortality. Migrants are known to have limited HL. Therefore, this study aimed to explore comprehensive health literacy (CHL) and electronic health literacy (eHL) among Arabic-speaking migrants in Sweden.

Methods

This was a cross-sectional observational study conducted in Sweden. A total of 703 persons were invited to participate between February and September 2019. Two questionnaires – the Health Literacy Survey European Questionnaire (HLS-EU-Q16) and the eHealth Literacy Scale (eHEALS) – and questions about self-perceived health and Internet use were distributed in Swedish and Arabic. Various statistical analyses were performed to determine the associations for limited CHL and eHL.

Results

A total of 681 respondents were included in the analysis. Of these, 334 (49%) were native Arabic-speaking migrants and 347 (51%) were native Swedish-speaking residents. CHL and eHL differed between the groups. The Arabic speakers had significantly lower mean sum scores in eHL 28.1 (SD 6.1) vs 29.3 (6.2), p = 0.012 and lower proportion of sufficient CHL 125 (38.9%) vs 239 (71.3%), p < 0.001 compared to Swedish speakers. Multiple regression analysis showed on associations between limited CHL and eHL and being Arabic speaking, less Internet use, and not finding the Internet to be important or useful. Furthermore, longer time spent in Sweden was associated with higher levels of CHL among the Arabic speakers, (OR 0.94, 95% CI 0.91–0.98, p < 0.01).

Conclusions

CHL and eHL differ between Arabic-speaking migrants and native Swedish speakers, but also between Arabic speakers who have lived different lengths of time in Sweden. Though it seems that the eHealth literacy is less affected by language spoken, the Internet is suggested to be an appropriate channel for disseminating health information to Arabic-speaking migrants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12187-5.

Predictors of intention to get COVID-19 vaccine: A cross-sectional study

BACKGROUND

People around the world look hesitant to get the coronavirus disease-2019 (COVID-19) vaccine. Identifying factors behind people's hesitancy is of great importance.

AIM

This paper aimed at examining the predictors of the intention to get the COVID-19 vaccine in a sample of 281 Jordanians.

METHODS

A cross-sectional online survey was employed to collect data on the intention to vaccination, knowledge and attitudes toward COVID-19, the perception of measures taken by the government to control COVID-19, self-rated health, and perceived susceptibility and severity of COVID-19.

RESULTS

The subjects were hesitant to get the vaccine. Intention to get the vaccine was predicted by being male, working in the education field, and having a poor perception of health, better perception of the adequacy of governmental measures, positive attitudes towards COVID-19, and higher levels of perceived susceptibility to the disease. These predictor variables accounted for 25.5% of the total variance.

CONCLUSION

This study demonstrated that this sample of Jordanian people had some hesitancy to take the COVID-19 vaccine; variables in the study partially explained that. Several implications have been discussed, including further research is needed to fully understand the relationships between different variables and the intention to get the vaccine.

Covid-19 Literacy Scale: Turkish Validity and Reliability Study

The current study was planned to test the validity and reliability of the Turkish version of the COVID-19 Literacy Scale. The sample of the study was taken from 473 individuals. In this study, language validity, content validity and construct validity were examined to determine the validity of the scale. Its reliability was evaluated by internal consistency, split-half reliability, and test-retest reliability method. It was defined that the scale has a two-factor structure as a result of EFA and its factor loadings are in the appropriate range (0.852-0.324). According to the CFA result, it was determined that the model-data fit was at a good level. The Cronbach values for the whole scale and subscales were .92, .90, and .87, respectively. It was observed that the test-retest value was .95. It was concluded that the Turkish form of the COVID-19 Literacy Scale is a reliable and valid tool.

Promoting Navigation Health Literacy at the Intersection of Schools and Communities. Development of the Game-Based Intervention Nebolus

Emerging empirical evidence indicates a limited health literacy for a substantial proportion of children and adolescents. Although it is generally agreed upon promoting health literacy as early as possible in the lifespan, there is a lack of interventions addressing children and adolescents and their primary living environments. This article describes the development of Nebolus, a game-based intervention aiming to promote navigation health literacy at the intersection of schools and communities. Its intervention foundation lies in a socio-ecological understanding of health as well as in the Entertainment Education approach. Following an extensive literature search on health-related location-based games, a co-creation process was initiated that involved adolescents, community stakeholders, and design/IT professionals in all phases of the intervention development. The final Nebolus intervention includes three core activities: (1) a Nebolus rally app for adolescents aged 12 to 16 years, (2) an online planning tool allowing local health service providers/professionals to set up own Nebolus rallies, and (3) accompanying teaching material on health literacy in the school setting to be used before and after the Nebolus rallies. This article provides an overview of the intervention layout and discusses strengths and challenges of its development and implementation.

Measuring COVID-19 Related Health Literacy in Healthcare Professionals-Psychometric Evaluation of the HL-COV-HP Instrument

BACKGROUND

Thus far, there is no instrument available measuring COVID-19 related health literacy of healthcare professionals. Therefore, the aim of this study was to develop an instrument assessing COVID-19 related health literacy in healthcare professionals (HL-COV-HP) and evaluate its psychometric properties.

METHODS

An exploratory factor analysis, a confirmatory factor analysis, and descriptive analyses were conducted using data from n = 965 healthcare professionals. Health literacy related to COVID-19 was measured with 12 items, which were adapted from the validated HLS-EU-Q16 instrument measuring general health literacy.

RESULTS

Exploratory factor analysis demonstrated that 12 items loaded on one component. After removing one item due to its high standardized residual covariance, the confirmatory factor analysis of a one-factor model with 11 items showed satisfactory model fit (χ² = 199.340, df = 41, χ²/df = 4.862, p < 0.001, RMSEA = 0.063, CFI = 0.963 and TLI = 0.951). The HL-COV-HP instrument showed good internal consistency (Cronbach's alpha 0.87) and acceptable construct reliability.

CONCLUSIONS

The HL-COV-HP is a reliable, valid, and feasible instrument to assess the COVID-19 related health literacy in healthcare professionals. It can be used in hospitals or other healt hcare settings to assess the motivation and ability of healthcare professionals to find, understand, evaluate, and use COVID-19 information.

Older People's Lived Perspectives of Social Isolation during the First Wave of the COVID-19 Pandemic in Italy

The aim of the present study is to understand the experiences of isolation and strategies used to cope with it among older people living at home during the first wave of the COVID-19 pandemic. More specifically, the roles of media and online technologies were also explored. Semistructured interviews were conducted via telephone between March and April 2020 with 30 people aged 72-94 years old living in Northern Italy. The thematic analysis identified six thematic areas: changes in daily life, emotions, social networks, exploited resources and strategies, use of media, and view of the future. Older people faced the emergency in heterogeneous ways; some were able to take advantage of their own residual resources and of social support, whereas in other cases, isolation exacerbated existing weaknesses. Technology and media were useful for reducing loneliness and fostering social contacts, but people with age-related impairments or low digital literacy presented many difficulties in approaching new technologies. Moreover, the overabundance of information could also increase anxiety and feelings of threat. Given the impact of social isolation on older people's well-being, it is critical to identify and strengthen personal resources and social support strategies that may help older people cope with the restrictions imposed by the COVID-19 pandemic.

Community socioeconomic deprivation and SARS-CoV-2 infection risk: findings from Portugal

Background

Socioeconomic differences have been observed in the risk of acquiring infectious diseases, but evidence regarding SARS-CoV-2 remains sparse. Hence, this study aimed to investigate the association between SARS-CoV-2 infection risk and socioeconomic deprivation, exploring whether this association varied according to different phases of the national pandemic response.

Methods

A cross-sectional study was conducted. Data routinely collected for patients with a laboratorial result recorded in SINAVE^®, between 2 March and 14 June 2020, were analysed. Socioeconomic deprivation was assessed using quintiles of the European Deprivation Index (Q1-least deprived to Q5-most deprived). Response phases were defined as before, during and after the national State of Emergency. Associations were estimated using multilevel analyses.

Results

The study included 223 333 individuals (14.7% were SARS-CoV-2 positive cases). SARS-CoV-2 infection prevalence ratio increased with deprivation [PR(Q1)=Ref; PR(Q2)=1.37 (95% CI 1.19–1.58), PR(Q3)=1.48 (95% CI 1.26–1.73), PR(Q4)=1.73 (95% CI 1.47–2.04), PR(Q5)=2.24 (95% CI 1.83–2.75)]. This was observed during the State of Emergency [PR(Q5)=2.09 (95% CI 1.67–2.62)] and more pronounced after the State of Emergency [PR(Q5)= 3.43 (95% CI 2.66–4.44)].

Conclusion

The effect of socioeconomic deprivation in the SARS-CoV-2 infection risk emerged after the implementation of the first State of Emergency in Portugal, and became more pronounced as social distancing policies eased. Decision-makers should consider these results when deliberating future mitigation measures.

Mental health, quality of life and optimism during the covid-19 pandemic: a comparison between Brazil and Portugal

PURPOSE

Although there have been numerous studies investigating the mental health of individuals during the pandemic, a comparison between countries is still scarce in the literature. To explore this gap, the present study aimed to compare the mental health (i.e., anxiety and depression), quality of life (QoL), and optimism/pessimism among individuals from Brazil and Portugal during the COVID-19 pandemic and the associated factors.

METHOD

A cross-sectional population-based study was conducted during the COVID-19 pandemic in Brazil and Portugal. Data collection was carried out between May and June 2020, using an online form which was sent through social networks. A total of 2069 participants (1156 from Brazil and 913 from Portugal) were included. Depressive symptoms (PHQ-9), Anxiety (GAD-7), optimism/pessimism (Revised Life Orientation Test - LOT), QoL (WHOQOL-Bref), and sociodemographic, health, and social distancing variables were assessed. Data was analyzed using univariate and multivariate models.

RESULTS

There were remarkable differences between Brazil and Portugal in all outcomes during the COVID-19 pandemic, including higher levels of depressive symptoms, anxiety, and optimism for the Brazilian individuals and higher levels of QoL and pessimism for the Portuguese individuals. The following factors were associated with the mental health and QoL in both Brazilian and Portuguese populations: gender, age, being a healthcare professional, and days in social distancing.

CONCLUSION

Despite the fact that Brazilians were more optimistic during the COVID-19 pandemic, they had lower levels of mental health and QoL as compared to the Portuguese individuals.

The causes, impacts and countermeasures of COVID-19 "Infodemic": A systematic review using narrative synthesis

An unprecedented infodemic has been witnessed to create massive damage to human society. However, it was not thoroughly investigated. This systematic review aims to (1) synthesize the existing literature on the causes and impacts of COVID-19 infodemic; (2) summarize the proposed strategies to fight with COVID-19 infodemic; and (3) identify the directions for future research. A systematic literature search following the PRISMA guideline covering 12 scholarly databases was conducted to retrieve various types of peer-reviewed articles that reported causes, impacts, or countermeasures of the infodemic. Empirical studies were assessed for risk of bias using the Mixed-Methods Appraisal Tool. A coding theme was iteratively developed to categorize the causes, impacts, and countermeasures found from the included studies. Social media usage, low level of health/eHealth literacy, and fast publication process and preprint service are identified as the major causes of the infodemic. Besides, the vicious circle of human rumor-spreading behavior and the psychological issues from the public (e.g., anxiety, distress, fear) emerges as the characteristic of the infodemic. Comprehensive lists of countermeasures are summarized from different perspectives, among which risk communication and consumer health information need/seeking are of particular importance. Theoretical and practical implications are discussed and future research directions are suggested.

ABC Epatite Web App: raising health awareness in a mobile world

BACKGROUND

This paper presents the case study of a health campaign for mobile devices launched in Italy in 2019 aimed at raising viral hepatitis awareness. The research project "ABC epatite. Sviluppo di una app per la prevenzione delle epatiti virali e per la consapevolezza dei comportamenti a rischio", winner of the 2018 Digital Health Program of Gilead Italia, was carried out by the Italian National Research Council.

METHODS

The project entailed the development of a free Italian language Progressive Web App (PWA) providing current and scientifically validated information on viral hepatitis (A, B and C).

RESULTS

A mobile first PWA health awareness app was implemented (https://epatite.web.app) together with an Android app version. Diversified landing pages cater to two target audiences: general public and schools. An initial campaign was directed toward engaging schools in nine Italian regions.

CONCLUSIONS

Preliminary results based on the campaign directed toward Italian schools in just under half of its regions have shown promise on the feasibility of reaching large audiences and encouraging engagement on viral hepatitis prevention. A mobile first approach to health communication is a cost-effective way to help reaching the goal of eradicating viral hepatitis by reducing infections and deaths.

Education as a Predictor Factor for Knowledge of COVID-19 in Portugal

Introduction/Objective: Pandemic of COVID-19 is a major public health problem. At the time of development of this study, no specific medication/vaccine for this disease was approved. Therefore, preventive measures were the main key to control this pandemic. Health literacy (HL) is the ability to obtain, understand and use the information to make free and informed decisions about the health of an individual and to promote community empowerment. Thus, the HL of COVID-19 is important for community empowerment and the adoption of preventive measures. This article aims to understand possible predictors of HL of COVID-19, functional domain.

Material and Methods: A cross-sectional study was designed, applying the Questionnaire of COVID-19 (previously designed and submitted to a preliminary pilot testing) through an online platform from April 23 to June 23, 2020. An Index of Health Knowledge of COVID-19 Questionnaire (IHK-COV19) was constructed. Associations between independent variables (“Gender,” “Age,” “Education,” and “Risk Factor” for COVID-19 codified by ICPC-2) and HL were assessed using multivariate analyses (mixed effects models). The level of significance was set at p < 0.05.

Results: Our sample includes 864 subjects (median age, 44.33 years), mostly women (n = 619; 71.76%), undergraduate (n = 392; 45.37%) and with at least one risk factor for COVID-19 (n = 266; 30.79%). Univariate and multivariate analyses demonstrated “Age” as a negative predictor of IHK-COV19 and “Education” and “Risk Factor” as positive predictors of IHK-COV19.

Conclusions: Health knowledge regarding COVID-19 is associated with the level of education. Future interventions should consider including HL mechanisms in interventions designed to improve communication.

The Impact of the Online COVID-19 Infodemic on French Red Cross Actors' Field Engagement and Protective Behaviors: Mixed Methods Study

Background

The COVID-19 pandemic has been widely described as an infodemic, an excess of rapidly circulating information in social and traditional media in which some information may be erroneous, contradictory, or inaccurate. One key theme cutting across many infodemic analyses is that it stymies users’ capacities to identify appropriate information and guidelines, encourages them to take inappropriate or even harmful actions, and should be managed through multiple transdisciplinary approaches. Yet, investigations demonstrating how the COVID-19 information ecosystem influences complex public decision making and behavior offline are relatively few.

Objective

The aim of this study was to investigate whether information reported through the social media channel Twitter, linked articles and websites, and selected traditional media affected the risk perception, engagement in field activities, and protective behaviors of French Red Cross (FRC) volunteers and health workers in the Paris region of France from June to October 2020.

Methods

We used a hybrid approach that blended online and offline data. We tracked daily Twitter discussions and selected traditional media in France for 7 months, qualitatively evaluating COVID-19 claims and debates about nonpharmaceutical protective measures. We conducted 24 semistructured interviews with FRC workers and volunteers.

Results

Social and traditional media debates about viral risks and nonpharmaceutical interventions fanned anxieties among FRC volunteers and workers. Decisions to continue conducting FRC field activities and daily protective practices were also influenced by other factors unrelated to the infodemic: familial and social obligations, gender expectations, financial pressures, FRC rules and communications, state regulations, and relationships with coworkers. Some respondents developed strategies for “tuning out” social and traditional media.

Conclusions

This study suggests that during the COVID-19 pandemic, the information ecosystem may be just one among multiple influences on one group’s offline perceptions and behavior. Measures to address users who have disengaged from online sources of health information and who rely on social relationships to obtain information are needed. Tuning out can potentially lead to less informed decision making, leading to worse health outcomes.

Learning from each other in the COVID-19 pandemic

The increase in cases of coronavirus disease 2019 (COVID-19) worldwide has been paralleled by increasing information, and misinformation. Accurate public health messaging is essential to counter this, but education may also have a role. Early in the outbreak, The London School of Hygiene & Tropical Medicine partnered with FutureLearn to develop a massive open online course (MOOC) on COVID-19. Our approach was grounded in social constructivism, supporting participation, sharing uncertainties, and encouraging discussion. The first run of the course included over 200,000 participants from 184 countries, with over 88,000 comments at the end of the three-week run. Many participants supported each other's learning in their responses and further questions. Our experience suggests that open education can complement traditional messaging, potentially providing a sustainable approach to countering the spread of misinformation in public health.

No one asked us: Understanding the lived experiences of midwives providing care in the north west suburbs of Melbourne during the COVID-19 pandemic: An interpretive phenomenology

Problem

Within the Victorian healthcare system, a rapid response to the COVID-19 pandemic has necessitated frequent and ongoing changes to midwifery practice.

Background

Midwives are a vital workforce at risk of burnout, attrition, and trauma. Emotional consequences of the pandemic for midwives remain largely unknown.

Aim

To understand the lived experiences of midwives providing care in the north west suburbs of Melbourne, Victoria during the pandemic.

Methods

Purposive and snowball sampling facilitated the recruitment of eight midwives in the north west suburbs of Melbourne, Victoria. Semi-structured interviews were audio recorded and transcribed, occurring via telephone or video between September and October 2020. Interpretive phenomenology was the methodology used, informed by the writings of Heidegger and Gadamer.

Findings

Insights gleaned from the data embody a range of understandings. The unknown cost of change and adaptation; waves of the virus; balancing risk; telehealth; personal protective equipment; stripping away support; the privilege of abiding by the restrictions; separation, distress, uncertainty; and, professional strength.

Discussion

Experiences of midwives during the pandemic are characterised by sensations of voicelessness and professional invisibility. Distinctive differences in personal wellbeing and professional satisfaction exist between midwives working with and without continuity of care.

Conclusion

This paper voices the lived experiences of Victorian midwives, in the midst of an extended lockdown, during the COVID-19 pandemic. Knowledge obtained from this research provides important understandings for leaders, policymakers, and healthcare systems, in planning a long-term response to the pandemic that supports the wellbeing and longevity of a vital workforce.

Health Literate Hawai'i: A Blueprint to Empower Health and Wellbeing

Recent studies have identified high rates of chronic disease in Hawai'i's adults and youth. As the state responds to the COVID-19 pandemic and looks beyond it, the prevention and management of chronic diseases are critical for community health and wellbeing. Low health literacy is more common in rural populations, Filipinos, and Pacific Islanders in Hawai'I, older adults, and many other groups with high rates of chronic disease. Promoting health literacy can reduce chronic disease burdens for individuals, families, and communities. Using the framework of the social-ecological model, which is important for visioning effective chronic disease management and prevention, this article provides a blueprint of layers of influence for building a health literate Hawai'I generally and around chronic disease specifically. The article will close with a call to action informed by the National Action Plan to Improve Health Literacy for stakeholders and providers to address health literacy in the state of Hawai'I in organizations, systems, and policy. These actions should address root causes of disease and help build more equitable health outcomes across the state now and in the future.

Association Between Mood Disorders and Risk of COVID-19 Infection, Hospitalization, and Death: A Systematic Review and Meta-analysis

IMPORTANCE

Preexisting noncommunicable diseases (eg, diabetes) increase the risk of COVID-19 infection, hospitalization, and death. Mood disorders are associated with impaired immune function and social determinants that increase the risk of COVID-19. Determining whether preexisting mood disorders represent a risk of COVID-19 would inform public health priorities.

OBJECTIVE

To assess whether preexisting mood disorders are associated with a higher risk of COVID-19 susceptibility, hospitalization, severe complications, and death.

DATA SOURCES

Systematic searches were conducted for studies reporting data on COVID-19 outcomes in populations with and without mood disorders on PubMed/MEDLINE, The Cochrane Library, PsycInfo, Embase, Web of Science, Google/Google Scholar, LitCovid, and select reference lists. The search timeline was from database inception to February 1, 2021.

STUDY SELECTION

Primary research articles that reported quantitative COVID-19 outcome data in persons with mood disorders vs persons without mood disorders of any age, sex, and nationality were selected. Of 1950 articles identified through this search strategy, 21 studies were included in the analysis.

DATA EXTRACTION AND SYNTHESIS

The modified Newcastle-Ottawa Scale was used to assess methodological quality and risk of bias of component studies. Reported adjusted odds ratios (ORs) were pooled with unadjusted ORs calculated from summary data to generate 4 random-effects summary ORs, each corresponding to a primary outcome.

MAIN OUTCOMES AND MEASURES

The 4 a priori primary outcomes were COVID-19 susceptibility, COVID-19 hospitalization, COVID-19 severe events, and COVID-19 death. The hypothesis was formulated before study search. Outcome measures between individuals with and without mood disorders were compared.

RESULTS

This review included 21 studies that involved more than 91 million individuals. Significantly higher odds of COVID-19 hospitalization (OR, 1.31; 95% CI, 1.12-1.53; P = .001; n = 26 554 397) and death (OR, 1.51; 95% CI, 1.34-1.69; P < .001; n = 25 808 660) were found in persons with preexisting mood disorders compared with those without mood disorders. There was no association between mood disorders and COVID-19 susceptibility (OR, 1.27; 95% CI, 0.73-2.19; n = 65 514 469) or severe events (OR, 0.94; 95% CI, 0.87-1.03; n = 83 240). Visual inspection of the composite funnel plot for asymmetry indicated the presence of publication bias; however, the Egger regression intercept test result was not statistically significant.

CONCLUSIONS AND RELEVANCE

The results of this systematic review and meta-analysis examining the association between preexisting mood disorders and COVID-19 outcomes suggest that individuals with preexisting mood disorders are at higher risk of COVID-19 hospitalization and death and should be categorized as an at-risk group on the basis of a preexisting condition.

The Relation between Perceived and Actual Understanding and Adherence: Results from a National Survey on COVID-19 Measures in Belgium

To reduce the spread of COVID-19 among the population, Belgium has implemented various infection prevention and control measures over time. This study investigated the extent to which understanding of the COVID-19 measures contributed to adherence, and which personal characteristics were considered risk factors for lower adherence. It consisted of a large online survey among a sample of the population (n = 2008), representative of citizens of Belgium in terms of gender, age, province and socio-economic status. The survey was conducted in September 2020, and included questions on perceived and actual understanding of COVID-19 protective measures in place during that time, as well as past and future adherence to those measures. The results showed that both perceived and actual understanding contributed significantly to past as well as future adherence. Risk factors for perceived understanding included being male and belonging to a younger age group, while risk factors for actual understanding were speaking French (versus Dutch) and belonging to a lower socio-economic level. Communication about COVID-19 measures should put more focus on trying to improve the understanding of the measures, instead of only making them known, particularly for those who are less health literate and as such at risk of poor understanding.

Research on Influencing Factors and Dimensions of Health Literacy in Different Age Groups: Before and After the COVID-19 Era in Chongqing, China

Background: Understanding the levels of health literacy among different groups is essential for better public health interventions targeting specific subgroups of the population. Additionally, this article explores the prevalence and influencing factors of the health literacy levels of different age groups during the COVID-19 epidemic. Methods: Multistage stratified cluster random sampling and the Probability Proportion to Size (PPS) method were used to select permanent residents aged 15-69 in Chongqing (54,706) for the questionnaire survey. The survey period is from July 2019 and July 2020. Single-factor analysis and logistic regression models were used to study the relationship between demographics, socioeconomic factors, other independent covariates, and health literacy. Results: The health literacy levels of residents declined with age, and there were significant differences in health literacy levels between age groups (χ² = 3332.884, P < 0.05). As far as the factors affecting health literacy level are concerned, high education and high income are the protective factors for health literacy level for residents of all ages. For adolescents (OR = 1.383, 95% CI: 1.217-1.571), young adults (OR = 1.232, 95% CI = 1.117-1.358), and middle-aged people (OR = 1.096, 95% CI = 1.017-1.182), residence in rural areas was a protective factor. In terms of the dimensions of health literacy, in particular, elderly health literacy in 2020 in Scientific Health Concepts, Safety and First Aid, Basic Medical Care decreased significantly compared with 2019. Conclusions: For adolescents, young adults, middle-aged people, to solve the problem of urban and rural health quality gap, we should not only use the geographical division, but also consider the social population and socio-economic differences. For the elderly, the following four dimensions of health literacy need to be paid more attention than those of other age: Basic Knowledge and Concepts, Scientific Health Concepts, Safety and First Aid, and Basic Medical Care. A lack of knowledge on the prevention and treatment of chronic diseases is the main reason for the recent decline in health literacy. And the health literacy among residents in major public health emergencies is needed.

Health Literacy Levels among Italian Students: Monitoring and Promotion at School

Health literacy was identified as an important determinant of health, particularly for adolescents. However, more efforts are needed to monitor this construct and provide inputs for policy development. This study aims to: (a) Assess the validity and reliability of the Italian version of the Health Literacy for School-Aged Children (HLSAC-I); (b) Identify the health literacy levels among Italian students and compare them with other countries’ levels; and (c) Identify the associations between health literacy and multiple social determinants (social stratifiers, family, and school connectedness). Data came from the Health Behaviour School-Aged Children survey, carried out in the Lombardy region in northern Italy in 2018. A representative sample of 2,287 13- and 15-year-old Lombardian students was involved. The results support the validity and reliability of the HLSAC-I. A total of 18.7% of the sample reported low levels, and only 6.8% reported high levels. Italian students reported the lowest levels of health literacy compared with other countries. School connectedness and educational approach are the most relevant associated factors. This study confirms a school’s role in reducing inequalities and promoting health. It highlights the importance of monitoring health literacy and implementing health promotion policies at school through a whole-school approach.

COVID-19: repercussions of nursing, structuring and resolutivity of national health systems

AIM

To analyze the repercussions of Nursing, the structuring and resolution of National Health Systems in facing the new coronavirus (SARS-CoV-2) in selected countries.

METHOD

Reflection article on the confrontation of COVID-19 by the National Health Systems of China, United States of America, Italy, United Kingdom, Portugal, Cuba and Brazil, from information disseminated in different media and in the literature.

RESULTS

The response of health systems depended more on political decisions than on their structuring and organization. Nursing, being the front line, was the profession most affected in number of cases and deaths.

FINAL CONSIDERATIONS

The reflection shows that the countries' economic and political issues interfered in the response to COVID-19 and what the role played by Nursing is essential in the front line to face the pandemic.

Social Bonding and Public Trust/Distrust in COVID-19 Vaccines

COVID-19 vaccine hesitancy has been a growing concern. The pandemic has proved to be very complicated with the mutated virus. The Delta variant is contributing to a surge of cases across the globe. Vaccine hesitancy can be socially contagious, requiring more stringent efforts from policy makers and health professionals in promoting vaccine uptake. Some evidence shows that vaccine acceptance appears to have played an integral role in successfully controlling the pandemic. Vaccination acceptance, however, demands that the public has a good understanding of the vaccine’s benefits in promoting healthier societies and people’s quality of life. Unclear COVID-19 vaccine information can lead to distrust in vaccines and vaccine hesitancy. It is of paramount importance to communicate clear and unbiased vaccine information to the public to encourage vaccine uptake. Word of mouth communication remains important to further promote COVID-19 vaccine uptake in the community. This short paper discusses the role of social bonds and public trust/distrust and word of mouth communication in vaccine decision making.