Health literacy, preventive COVID 19 behaviour and adherence to chronic disease treatment during lockdown among patients registered at primary health facility in urban Jodhpur, Rajasthan

Health Literacy among Korean American Immigrant Women in the USA: Role of Social Support

Health literacy is associated with health behaviors and outcomes. Using Andersen's Behavioral Model of Health Services Use, this study examined the role of limited English proficiency (LEP) and social support for the health literacy of Korean American immigrant women, one of the most affected groups by LEP. Researchers surveyed 232 Korean American immigrant women in a metro area in a Southeastern state, U.S. Health literacy was measured by the CDC Behavioral Risk Factor Surveillance System Questionnaire and the California Health Interview Survey. Participants with better English proficiency and larger social support had higher health literacy. LEP and social support interaction was significantly associated with health literacy, illustrating social support as a buffer that mitigates the negative impact of LEP on health literacy. Community programs that enhance social support through community health advocates or peer educators may increase health literacy and reduce health disparities among Korean American immigrant women with LEP.

Evaluating knowledge, attitude, and physical activity levels related to cardiovascular disease in Egyptian adults with and without cardiovascular disease: a community-based cross-sectional study

BACKGROUND

Cardiovascular disease (CVD) represents a significant health challenge in Egypt, yet there exists limited understanding regarding the knowledge, attitudes, and physical activity levels associated with CVD. These factors play a pivotal role in developing effective prevention and management strategies. Hence, this cross-sectional study aimed to evaluate Egyptian adults' knowledge, attitudes, and physical activity (KAP) levels.

METHODS

Data were collected using a previously validated questionnaire encompassing demographic characteristics, CVD knowledge (including risk factors and symptoms), attitudes toward CVD, and self-reported physical activity levels. The survey was distributed among social media channels, and trained researchers administered the questionnaire via face-to-face interviews with adult patients with and without CVD admitted to Cairo University Hospital clinics.

RESULTS

The study involved 591 participants, of whom 21.7% had CVD. Overall, participants exhibited poor knowledge regarding CVD, with a mean score of 21 ± 7 out of 40, equivalent to 52.5%. Attitudes toward CVD were moderate, with a mean score of 66.38 ± 8.7 out of 85, approximately 78%. Physical activity levels per week were also moderate, averaging 1188 MET-min with a range of 1121-18,761. Subgroup analysis revealed that individuals with CVD had lower average knowledge, attitude, and physical activity levels than those without CVD. Working in the healthcare field was a predictor of higher knowledge score (standard error (SE) 5.89, 95% confidence interval (CI) 4.61 to 7.17, P < 0.001), while those with CVD and smokers were predictors of lower attitude score (SE -4.08, 95% CI -6.43 to -1.73, P < 0.001) and (SE -2.54, 95% CI -4.69 to -0.40, P = 0.02), respectively.

CONCLUSION

The study findings highlight a significant disparity in knowledge, attitudes, and physical activity levels related to CVD in Egypt. Targeted interventions aimed at improving awareness, fostering positive attitudes, and promoting physical activity among individuals at risk for CVD are crucial for effective prevention and management.

School-Based Pre- and Post-Intervention Tests Assessing Knowledge about Healthy Lifestyles: A National School Health Awareness Campaign on Children Aged between 3 and 12 Years Old

In response to the diverse health challenges faced by today's youth and their extensive time spent in schools, we conducted a school health awareness campaign aimed at prioritizing well-being and academic performance. This analytical longitudinal study, spanning 27 schools in Lebanon, aimed to assess the impact of the awareness campaign on the health knowledge and practices of 5-, 8-, and 11-year-old students throughout pre- and post-intervention testing focused on general health and healthy habits, employing 11, 14, and 15 questions tailored to 5, 8, and 11 year olds, respectively. The questions covered various aspects, including sleep, personal and dental hygiene, nutrition, physical activity, addiction, security measures, and bullying. Out of the 7100 students who participated, 16.11% (1144 students) were evaluated before and after the campaign. The results indicated a significant increase in health awareness post-intervention across all age groups. For instance, in 5-year-olds, limited awareness decreased from 91.6% to 36.38%, while adequate awareness rose from 8.03% to 62.3%. Improvement varied across health knowledge topics, with security-related questions showing the highest enhancement. Factors such as governorate, normal-weight status, and close supervision influenced improvement. However, no significant correlations were found with school type, size, gender, age, nationality, parental factors, or comorbidities. The study concludes that the school health awareness campaign successfully heightened children's health awareness, advocating for the integration of regular health promotions into the standard educational curriculum.

Metacognition, public health compliance, and vaccination willingness

Metacognition, our ability to reflect on our own beliefs, manifests itself in the confidence we have in these beliefs, and helps us guide our behavior in complex and uncertain environments. Here, we provide empirical tests of the importance of metacognition during the pandemic. Bayesian and frequentist analyses demonstrate that citizens with higher metacognitive sensitivity-where confidence differentiates correct from incorrect COVID-19 beliefs-reported higher willingness to vaccinate against COVID-19, and higher compliance with recommended public health measures. Notably, this benefit of accurate introspection held controlling for the accuracy of COVID-19 beliefs. By demonstrating how vaccination willingness and compliance may relate to insight into the varying accuracy of beliefs, rather than only the accuracy of the beliefs themselves, this research highlights the critical role of metacognitive ability in times of crisis. However, we do not find sufficient evidence to conclude that citizens with higher metacognitive sensitivity were more likely to comply with recommended public health measures when controlling for the absolute level of the confidence citizens had in their COVID-19 beliefs.

COVID-19 prevention and rehabilitation related knowledge and practices among Egyptian post-COVID-19 patients

BACKGROUND

Even with the mild form of COVID-19, people need to practice the proper preventive measures to achieve health, safety and control spread of infection. Few studies assessed sound disinfection and rehabilitative knowledge. This study aims to assess the self-reported, knowledge of specific disinfection measures among post-recovery COVID-19 patients and identifying the most requested knowledge items regarding the prevention and post COVID rehabilitation measures.

METHODS

This is an exploratory cross-sectional study using an electronically open survey. A pre-tested e-questionnaire was employed for data assembling. The sample size was calculated and a total of 417 people completed the questionnaire. Knowledge score was calculated for preventive and disinfection measures during and after COVID 19 infection. It comprised three sections: socio-demographics, study participants' knowledge regarding precautions, disinfection, and rehabilitation measures, as well as sources of knowledge about COVID-19.

RESULTS

All participants infected with COVID-19 (82%) reported self-isolation for ten days after confirming the infection, with only 18% required hospitalization. Regarding the information needed by the participants, the highest requests were for the rehabilitation information after COVID-19 and preventive measures. Females under 30 years old and those with a college education or higher were significantly more likely to request rehabilitation information after COVID-19 (P-value 0.05). Nevertheless, males were significantly more interested in information regarding preventive measures; They were over 30 years old and had education below university (P-value 0.05). Participants (above 30 years old) had significantly higher knowledge of preventive and disinfection measures during and after COVID-19 infection (P = 0.030).

CONCLUSION

After the COVID-19 experience, most participants demonstrated a great desire for rehabilitation information and proper preventive measures. This paves the way for delivering self-management and rehabilitation knowledge and emphasizing the significance of various prevention modalities.

How does the COVID-19 pandemic impact medication adherence of patients with chronic disease?: A systematic review

OBJECTIVE

To determine how the COVID-19 pandemic impacts patients with chronic disease medication adherence.

METHODS

Four electronic databases, PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text, were searched for literature between 2019 and 2021. Abstracts and later full texts were independently screened by the authors of this review using inclusion and exclusion criteria to determine relevance to our study. Joanna Briggs Institute (JBI) critical appraisal tools were used to assess the quality of included texts. Relevant information and data from the included texts were extracted into tables for data synthesis and analysis.

RESULTS

Ten studies met the study criteria, the most popular study design was cross-sectional design (n = 9, 90.0%), others were case series (n = 1, 10.0%). Barriers to medication adherence and facilitators of medication adherence were the major two themes that participants reported regarding the impact of COVID-19 on medication adherence. Moreover, these two main themes have been organized in sub-themes that are dealt with in-depth.

DISCUSSION

Our results could heighten healthcare providers, stakeholders, and policy leaders' awareness of providing appropriate support for chronic disease patients, especially regarding medication adherence. Future research incorporating programs that support patients' needs is recommended.

The impact of health literacy on COVID-19 immunization

The COVID-19 pandemic can be controlled by vaccination in addition to public health measures. This study investigate the impact of Health Literacy (HL) on vaccination and COVID-19. 334 patients and patient's relatives aged 18 to 65 years who were followed up at the Infectious Diseases Clinic between March and July 2022 for reasons other than COVID-19 disease were included in the study. The COVID-19 vaccination status of each participant was queried and the preferred vaccination was recorded on the case form. The mean age was 40.9 years, and 52.4% (n:175) of participants were women. It was found that 82.3% (n:275) of participants had received at least one dose of the vaccine COVID-19. It was found that 17.6% of participants had not been COVID-19 vaccinated. It was found that 60.7% (n:203) of participants received ≥ 2 doses of the mRNA-based viral vaccine. Vaccination rates were found to be significantly lower in patients with 'inadequate' HL (p = .047). In addition, the vaccination rate was lower in people aged 39 years and younger and in the presence of one or more chronic diseases. When chronic diseases are present, COVID-19 becomes more severe. On the other hand, the disease shows a moderate clinical picture and plays a significant role in transmission to risk groups in the young population, where vaccination rates are low. This situation in the context of COVID-19 demonstrates once again the importance of informing at-risk groups and the healthy young population about vaccine-preventable diseases.

Disparities in the level of COVID-19 health literacy and the associated factors among employees in long-term care facilities in Taiwan

BACKGROUND

Coronavirus disease 2019 (COVID-19) poses a significant threat to the safety of residents in long-term care facilities, and the staff of long-term care facilities are essential in the care and prevention of major infectious diseases and therefore require good health literacy to ensure the health of residents. The main objective of this study was to examine the health literacy of staff in long-term care facilities and analyze the factors associated with their COVID-19 health literacy in Taiwan to provide a basis for the response mechanism to emerging infectious diseases.

METHODS

A cross-sectional survey with a structured questionnaire by a convenience sample method and to assess the COVID-19 health literacy of caregivers working in long-term care facilities in this study. The COVID-19 health literacy scale was a self-administered scale designed to combine the concept of "health literacy" with the 3 levels and 5 stages of preventive medicine. A total of 385 workers from 10 long-term care facilities were surveyed as the study sample, and the validated questionnaires were statistically analyzed using SPSS version 22.0 statistical software. A multivariate logistic regression model was used to establish the associated factors of the COVID-19 health literacy level.

RESULTS

Overall, the mean COVID-19 health literacy score was 88.7 ± 10.4 (range: 58-105). Using a quartile scale, 92 (23.9%) of the study participants had low health literacy (health literacy score < 82), 190 (49.3%) had average health literacy (health literacy score 82-98), and the remaining 103 (26.8%) had good health literacy (health literacy score 99-105). Statistical analysis revealed significant differences (p < 0.05) in the COVID-19 health literacy score by demographic variables (education, job category, number of daily service users, and training related to infectious disease prevention and control) of the study population. The logistic regression analysis of the COVID-19 health literacy level (> 82 vs. ≤82) showed a significant difference in the study sample by gender (male vs. female, OR = 2.46, 95% CI = 1.15-5.26), job category (nurse practitioner vs. caregiver, OR = 7.25, 95% CI = 2.46-21.44), monthly service hours (> 160 h vs. 40-79 h, OR = 0.044, 95% CI = 0.07-0.97), experience caring for confirmed COVID-19 patients (yes vs. no, OR = 0.13, 95% CI = 0.02-0.98), and training related to infectious disease prevention and control (yes vs. no, OR = 2.8, 95% CI = 1.52-5.15).

CONCLUSIONS

This study recommends that facilities provide immediate updated COVID-19 information to staff, especially frontline caregivers, and specifically enhance COVID-19 infection control education training for all facility staff to eliminate health literacy disparities.

Communication inequalities and health disparities among vulnerable groups during the COVID-19 pandemic - a scoping review of qualitative and quantitative evidence

BACKGROUND

The COVID-19 pandemic has exacerbated health disparities in vulnerable groups (e.g., increased infection, hospitalization, and mortality rates in people with lower income, lower education, or ethnic minorities). Communication inequalities can act as mediating factors in this relationship. Understanding this link is vital to prevent communication inequalities and health disparities in public health crises. This study aims to map and summarize the current literature on communication inequalities linked with health disparities (CIHD) in vulnerable groups during the COVID-19 pandemic and to identify research gaps.

METHODS

A scoping review of quantitative and qualitative evidence was conducted. The literature search followed the guidelines of PRISMA extension for scoping reviews and was performed on PubMed and PsycInfo. Findings were summarized using a conceptual framework based on the Structural Influence Model by Viswanath et al. RESULTS: The search yielded 92 studies, mainly assessing low education as a social determinant and knowledge as an indicator for communication inequalities. CIHD in vulnerable groups were identified in 45 studies. The association of low education with insufficient knowledge and inadequate preventive behavior was the most frequently observed. Other studies only found part of the link: communication inequalities (n = 25) or health disparities (n = 5). In 17 studies, neither inequalities nor disparities were found.

CONCLUSIONS

This review supports the findings of studies on past public health crises. Public health institutions should specifically target their communication to people with low education to reduce communication inequalities. More research about CIHD is needed on groups with migrant status, financial hardship, not speaking the language in the country of residence, sexual minorities, and living in deprived neighborhoods. Future research should also assess communication input factors to derive specific communication strategies for public health institutions to overcome CIHD in public health crises.

The Determinants of Adherence to Public Health and Social Measures Against COVID-19 Among the General Population in South Korea: National Survey Study

BACKGROUND

The COVID-19 pandemic has created devastating health, social, economic, and political effects that will have long-lasting impacts. Public health efforts to reduce the spread of COVID-19 are the priority of national policies for responding to the pandemic globally. Public health and social measures (PHSMs) have been shown to be effective when used alone or in combination with other measures, reducing the risk of spreading COVID-19. However, there is insufficient evidence on the status of compliance with PHSMs in the general population for the prevention of COVID-19 in public areas, including Korea.

OBJECTIVE

The aim of this study was to assess levels of compliance with the recommended PHSMs against SARS-CoV-2 infection and their predictors among the general population by using national data.

METHODS

This study was a secondary data analysis of the National Survey of Infectious Disease Preventive Behaviors in Community, which was conducted by the Korea Centers for Disease Control and Prevention Agency (KDCA) between October 12 and October 30, 2020. The primary study was cross-sectional, using stratified sampling via an adjusted proportional allocation method to select representative samples and ensure the stability of samples. The data were collected through phone interviews conducted by trained enumerators using a structured questionnaire. PHSM adherence was measured using a 10-item comprehensive infectious disease prevention behavior (CIDPB) scale, and each sociocognitive factor, including perceived susceptibility to SARS-CoV-2 infection, perceived severity of SARS-CoV-2 infection, perceived confidence in performing preventive behaviors related to COVID-19, information comprehension ability, and trust in information from the KDCA, was measured. A total of 4003 participants were included in the final analysis. Tobit regression and a decision tree analysis were performed to identify the predictors of preventive measures and the target groups for intervention.

RESULTS

We discovered that women scored 1.34 points higher on the CIDPB scale than men (P<.001). Compared to the group aged 19 to 29 years, those aged 50 to 59 years and those older than 60 years scored 1.89 and 2.48 points higher on the CIDPB scale (P<.001), respectively. The perceived severity of infection, confidence in preventive behaviors, information comprehension ability, and trust in information from the KDCA were significant positive determinants of CIDPBs (P<.001). The perceived susceptibility to infection showed a significant negative relationship with CIDPBs (P<.001).

CONCLUSIONS

Female sex, older age, lower income, and sociocognitive factors were found to be significant determinants of adhering to PHSMs. The findings suggest the need for tailored interventions for target groups; specifically, the age group that was the most active at work indicated the highest potential to spread infection. Adequate public health education and health communication for promoting adherence to PHSMs should be emphasized, and behavior change strategies for those with low perceived confidence in performing PHSMs should be prioritized.

Political Psychological and Sociocultural Determinants of Compliance with COVID-19 Emergency Measures Among Waste Pickers in an Iranian Sub-urban Slum Community

In the context of the coronavirus disease 2019 (COVID-19) pandemic, compliance with government regulations is a tremendous challenge in the effort to curb the viral transmission. The fact that specific communities and people across the world continue to ignore government regulations of COVID-19 is a crucial issue to address. Researchers sought to examine the political psychological and sociocultural determinants of adherence to COVID-19-related law and policy measures among waste pickers in a sub-urban slum community in Iran. A cross-sectional survey of 362 waste pickers from two municipalities in the countryside of Tehran, Iran, was conducted between January and May 2022. Multiple regression analysis was used to predict the significant difference between the direct or indirect effects of political psychological and sociocultural variables on compliance with COVID-19 emergency measures. Confidence intervals were estimated using the bootstrap method. The findings supported the proposed model. The results indicated that political ideology (β = - 0.13, 95% CI - 0.29 to 0.02), individualism worldview (β = - 0.14, 95% CI - 0.32 to 0.07), fatalism (β = - 0.18, 95% CI - 0.40 to 0.04), health literacy (β = 0.16, 95%CI - 0.05 to 0.37) and prosociality (β = 0.09, 95%CI 0.03-0.13) exert an indirect effect on compliance with the COVID-19 emergency measures through both trust in government and trust in science and scientific community. This study has implications for authorities in ensuring adherence to governmental orders for COVID-19 outbreak. A democracy-based and human rights-based approach and a flexible framework for proceeding more equitable COVID-19 legal and government regulations is critical to an effective and acceptable health response to COVID-19. Instituting slum emergency planning committees, incorporating the informal providers into all pandemic response plans in every urban informal settlement and providing an immediate guarantee of payments to waste packers will be indispensable.

Relationship between health literacy and COVID-19 knowledge: A cross-sectional study

Background

Health literacy (HL) is a protective factor for some chronic diseases. However, its role in the Coronavirus Disease 2019 (COVID-19) pandemic has not been clarified. This study aims to explore the association between HL and COVID-19 knowledge among residents in Ningbo.

Methods

A total of 6,336 residents aged 15-69 years in Ningbo were selected by multi-stage stratified random sampling method. The "Health Literacy Questionnaire of Chinese Citizens (2020)" was used to evaluate the relationship between COVID-19 knowledge and HL. Chi-square test, Mann-Whitney U test and logistic regression were used to analyze the data.

Results

The HL and COVID-19 knowledge levels of Ningbo residents were 24.8% and 15.7%, respectively. After adjusting for confounding factors, people with adequate HL were the more likely to have adequate COVID-19 knowledge compared with those with limited HL (OR = 3.473, 95% CI = 2.974-4.057, P <0.001). Compared with the limited HL group, the adequate HL group had a higher rate of COVID-19 knowledge, a more positive attitude, and a more active behavior.

Conclusion

COVID-19 knowledge is significantly associated with HL. Improving HL may influence people's knowledge about COVID-19, thereby changing people's behaviors, and finally combating the pandemic.

Burden of COVID-19 infection and lockdown measures on individuals with chronic diseases in Saudi Arabia: A national population-based study

BACKGROUND

The recent COVID-19 crisis has placed a huge strain on the global health and economy. The toll of the damage on the human society exceeds the morbidity and mortality of the pandemic and the associated burden, considering the multidimensional impact on all aspects of life.

OBJECTIVES

The present study assessed the specific impact of COVID-19 on individuals with chronic diseases including the Years Lost for Disability (YLD) burden of COVID-19 infection, and multidimensional impact on the disease management, adaptive lifestyle, and socioeconomic dimensions.

METHOD

A national, population-based cross-sectional study was conducted among adult Saudi population. An internet-based questionnaire was used to collect sociodemographic characteristics, medical history, impact of COVID-19 lockdown on the management of the chronic disease, adaptive lifestyle, and impact of COVID-19 on family members. Additionally, data regarding eventual COVID-19 infection, severity and management were collected. YLD was estimated and normalized per 100,000 persons.

RESULT

Having a chronic disease was not associated with a greater risk of COVID-19 (relative risk [RR]=0.83, p = 0.153); however, it was associated with higher risk of declined physical activity (RR=1.30, p < 0.0001), deteriorated eating habit (RR=1.20, p = 0.002), sleep quality (RR=1.25, p < 0.0001), and overall health perception (RR=1.61, p < 0.0001), loss of family members due to COVID-19 (RR=1.96, p = 0.0001), and impacted household income (RR=1.11, p = 0.010). In case of COVID-19 infection, having a chronic disease was associated with increased risk of hospitalization (RR=5.04, p = 0.005) and having a moderate-to-severe form of COVID-19 (RR=6.00, p = 0.013). The overall YLD was estimated to be 17.7 per 100,000 individuals, and there was no significant difference between individuals with chronic diseases and those without.

CONCLUSION

COVID-19 entailed a substantial burden on the Saudi society in 2020, and individuals with preexisting chronic diseases suffered more important multidimensional impact, which need further research to assess the real impact of the pandemic and draw the pertinent lessons from the experience for future possible epidemics.

Health Literacy, Misinformation, Self-Perceived Risk and Fear, and Preventive Measures Related to COVID-19 in Spanish University Students

The "infodemic" is one of the main obstacles in the fight against the COVID-19 pandemic. In order to face it, health literacy (HL) is essential since it allows for knowledge about COVID-19 and the practice of preventive measures to be fostered. This is especially relevant in university students due to their idiosyncrasy. This study aims to evaluate the level of HL related to COVID-19 (HLC), risk perception, misinformation, and the attitudes and behaviors adopted to prevent the spread of coronavirus in Spanish university students. An online questionnaire was administered to 499 Spanish university students. The HLC index presented a mean of 33.89 out of 50; a total of 63.8% had an inadequate level of HLC. They practiced a mean of 7.54 out of 9 preventive behaviors, and the mean knowledge score was 10.40 out of 13. The HLC showed significantly different scores for the degree, the practice of preventive measures, and some sources of information. The level of HL correlates with the adoption of preventive measures. The higher the severity and perceived susceptibility, the more preventive measures are taken by the students. Therefore, there is a need to strengthen the HL skills of university students and address the dissemination of misinformation. Although caution should be taken when generalizing these results due to the limitations inherent within a cross-sectional study and the convenience sampling, our results can guide the establishment of health education strategies and policies for the management of the infodemic in pandemic situations, according to this target population.

Präventive Verhaltensweisen zum Schutz vor einer Infektion mit SARS-CoV-2 bei Menschen mit gesundheitlicher Vulnerabilität

Hintergrund

Trotz gesundheitlicher Risiken, die für alle Menschen von SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) ausgehen, weisen Bevölkerungsgruppen mit gesundheitlicher Vulnerabilität ein erhöhtes Gefährdungsprofil auf. Zu den Risikogruppen für schwere COVID-19-Verläufe („coronavirus disease 2019“) gehören Personen ab 50 Jahren, Raucher*innen, adipöse Personen sowie Menschen mit bestimmten Vorerkrankungen. Gerade für diese Bevölkerungsgruppe ergibt sich ein erhöhter Schutzbedarf. Inwiefern sich das Schutzverhalten von Personen mit hoher im Vergleich zu Personen mit geringer gesundheitlicher Vulnerabilität unterscheidet, ist bislang wenig untersucht.

Methode

Es wurde eine onlinebezogene Querschnittstudie mit einem „convenience sample“ von n = 210 in Deutschland lebenden Personen im Alter ab 18 Jahren realisiert. Es wurden subjektive Selbsteinschätzungen zur Anwendung von Infektionsschutzmaßnahmen sowie der eigenen Informationssuche und -zufriedenheit bezüglich der Pandemie und der COVID-19-bezogenen Gesundheitskompetenz (GK) erfasst. Die Analyse erfolgte uni-, bi- sowie multivariat, wobei für alle Analysen ein Signifikanzlevel von p < 0,05 festgelegt wurde.

Ergebnisse

Über alle erhobenen Schutzverhaltensweisen hinweg weisen die Befragten eine insgesamt hohe Compliance (84 %) auf. Während das Tragen einer Maske (96 %) und das Vermeiden von privaten Reisen und Händeschütteln (95 %) die höchste Zustimmung erhielten, berührten 47 % der Befragten ihr Gesicht häufig mit ungewaschenen Händen. Jüngere (35 % bis 29 Jahre) sowie Personen mit eingeschränkter Gesundheitskompetenz (28 %) zeigen sowohl in den bivariaten und multivariaten Analyse signifikant häufiger ein weniger ausgeprägtes Schutzverhalten. Hingegen ließen sich differenziert nach Anzahl gesundheitlicher Risikofaktoren keine Unterschiede im präventiven Schutzverhalten feststellen

Schlussfolgerung

Es konnte ein hohes Niveau der Anwendung von präventiven Schutzmaßnahmen bei Befragten dieser Studie ermittelt werden. Sowohl in den uni- als auch bi- und multivariaten Analysen ist die gesundheitliche Vulnerabilität nicht mit einem stärker ausgeprägten Schutzverhalten assoziiert. Insbesondere für Personen mit eingeschränkter coronaspezifischer Gesundheitskompetenz sind Defizite im Infektionsschutz erkennbar, weshalb die zielgruppenspezifische Aufklärung weiter priorisiert werden muss.

Health knowledge and livelihood experiences with COVID-19 amongst Arizona residents

The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing public health concern that is rapidly evolving and has impacted individuals and communities differently. We analyzed deidentified survey datasets to evaluate the perceptions, experiences, and impacts of COVID-19 among Arizona residents. The survey included 1,472 eligible Spanish-speaking participants in Southern (Pima, Santa Cruz, Cochise, Yuma County) and Central Arizona (Maricopa County). Eighteen questions which included participants' health and socio-economic status, source of information on COVID-19, preventive measures, the impact of COVID-19 on household income, and vaccination status were administered to the survey respondents. The analyzed data showed an unequal proportion of the reported source of COVID-19 information between Southern and Central Arizona participants. More male respondents (n = 833, 57%) participated in the study than did the female respondents (n = 638, 43%). Of the 1,472 total participants in both regions, 1,011 (68.7%) participants represented Southern Arizona while 461 (31.3%) participants represented Central Arizona. Of the 461 participants in Central Arizona, the majority reported television (56%) and social media (20%) as their primary source of information. Whereas, of the 1,011 participants in Southern Arizona, the majority reported social media (37%) and television (32%) as their major source of information on COVID-19. Overall, 82% of the participants were vaccinated, with a statistically significant difference between the proportion of vaccinated individuals in the Southern and Central Arizona (chi-square p-value of 0.00139). More individuals in Southern Arizona participated in the survey than in Central Arizona across both genders, with 58% of women reporting loss of jobs due to COVID-19. This study demonstrated that the COVID-19 pandemic profoundly had a more socio-economic impact on women than men, particularly Hispanic women in this subset.

Association between Mental Health and Hand Hygiene Practices in Adults with Hypertension and Diabetes during the COVID-19 Pandemic: The 2020 Korea Community Health Survey

The preventive measures against the spread of COVID-19 have negatively impacted the mental health of people with chronic diseases. This cross-sectional study investigated the association between mental health and hand hygiene practices in patients with hypertension (HTN) and diabetes mellitus (DM) (n = 74,296) during the COVID-19 pandemic. Their anxiety about contracting COVID-19 and death, depression, and hand hygiene practices were compared to that of controls. Multiple logistic regression analysis showed that the patients had higher anxiety and depression and poorer hand hygiene practices than controls. Anxiety about contracting COVID-19 was associated with increased handwashing before eating (aOR = 1.59), after using the restroom (aOR = 1.61), after returning from outdoors (aOR = 1.69), for at least 30 s (aOR = 1.45), and with soap or hand sanitizer (aOR = 1.43). However, depression was associated with decreased handwashing before eating (aOR = 0.50), after using the restroom (aOR = 0.51), after returning from outdoors (aOR = 0.51), for at least 30 s (aOR = 0.73), and with soap or hand sanitizer (aOR = 0.63). Anxiety about death showed similar results. Psychological support for people with chronic diseases in crisis situations may promote self-care activities such as hand hygiene for infection control.

Measuring COVID-19 health literacy: validation of the COVID-19 HL questionnaire in Spain

Background

The COVID-19 pandemic has highlighted the importance of health literacy to make informed preventive decisions. A specific COVID-19 health literacy questionnaire (CHL-Q) is included in the COVID-19 Snapshot Monitoring WHO initiative to conduct behavioral insights studies related to COVID-19. The objective was to assess the psychometric properties of a Spanish version of the COVID-19 Health Literacy Questionnaire (CHL-Q).

Methods

Data quality, acceptability, internal consistency, and construct and structural validity were analyzed. A Rasch analysis was also performed. This cross-sectional, observational study was conducted on the Spanish general population after the first wave of the pandemic and after the end of the general lockdown by an online survey agency. 1033 participants (inclusion criteria were being 18 years or older and living in Spain), was extracted from a panel of approximately 982,000 participants. The sampling was stratified matching the Spanish general population in terms of age, gender, and area of residence. The CHL-Q includes 9 items and assesses people's knowledge, motivation and competencies to access, understand, evaluate, and apply information about COVID-19 in order to make informed decisions.

Results

CHL-Q index presented a mean of 33.89 (SD = 9.4), and good fit to the Rasch model (χ2(32) = 34.672, p = 0.342, person separation index = 0.77), with ordered thresholds, unidimensionality, item local independence, and no item bias by sex, age or education level. The CHL-Q showed significant different scores by level of education, experience of infection, confusion related to COVID-19 information and adherence to preventive measures. We found a statistically significant correlation between the CHL-Q index and the total number of preventive measures adopted, COVID-19 knowledge, and information seeking behaviour. The Cronbach´s alpha was 0.87 and the item total corrected correlation, 0.49–0.68.

Conclusions

The Spanish version of CHL-Q is a short, adequate, and reliable instrument to measure COVID-19 related health literacy in the Spanish general population. Measuring the CHL in the population can be useful to evaluate whether public authorities, media and the medical and scientific community have been able to reach the population to offer the information in the terms they need it.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-02050-5.

Knowledge, Attitude, and Practice Toward Cardiovascular Diseases in the Lebanese Population

Background & Objective:

Cardiovascular diseases (CVD) are the leading cause of death globally. Assessing CVD knowledge, attitude, and practice (KAP) is necessary to spread awareness about CVD in Lebanon, their corresponding risk factors, and behaviors in which individuals can avoid or minimize the possibility of developing a CVD.

Subjects & Methods:

This was a case-control analytical study that targeted 921 CVD and non-CVD subjects. A questionnaire form was used to collect data related to patients’ demographics, socioeconomic status, habits, medical and family history, KAP towards CVD, and source of information. Data was analyzed using SPSS v.25.

Results:

Data from 921 participants were distributed over the CVD group (52.6% males aged 58.3 ± 13.7 years [n = 460]) and the non-CVD group (47.7% males aged 36.3 ± 15.4 years [n = 461]). CVD patients were significantly older than non-CVD subjects (p < 0.001). All three KAP scores of both groups were of poor to fair levels. Both CVD knowledge and attitude mean scores in CVD patients (26.6 ± 5.2 over 40 [66.50%] and 63.3 ± 10.2 over 85 [74.47%], respectively) were significantly higher than the ones of non-CVD subjects (23.5 ± 7.9 over 40 [58.75%] and 61.4 ± 12.4 over 85 [72.74%], respectively, p < 0.001). However, the CVD mean practice score was significantly lower in CVD patients (6.0 ± 1.7 over 9 [66.67%]) than the one of non-CVD subjects (6.3 ± 2.2 over 9 [70.00%] p < 0.001). Mostly, educational level (p < 0.001), governorate (p < 0.01), and smoking (p < 0.001) were predictors of KAP CVD in both groups.

Conclusion:

With an overall limited knowledge, attitude, and practice toward CVDs, the Lebanese population (with CVD or non-CVD) needs targeted national campaigns about CVD according to the identified predictors of CVD KAP to prevent and to alleviate the complications due to CVDs.

Impact of COVID-19 response on public health literacy and communication

With unaddressed challenges of pandemic with re-emergence of coronavirus disease 2019 (COVID-19) waves, public health literacy and communication have proved to be a prerequisite for effective communication as part of the control strategy. Hence this article addressed the impact of COVID-19 response policies on public health literacy. Considering the rapid transmission of COVID-19, taking lives needs urgent attention from the population›s perspective to be more vigilant about health information and incorporate that into their daily routines. To be responsible and resilient globally, governments and states are formulating different health policies and related plans to prevent and control the spread of the pandemic. This article has recommended short-term measures, including smart focused IEC targeted on vaccination and motivational sessions for health care workers and front line workers. Targeted Long-term measures included healthcare system reforms inclusive of resources, workforce, capacity building with particular focus on lifestyle measures addressing non-communicable disease prevention.

COVID-19 Lockdown in Patients with Chronic Diseases: A Cross-Sectional Study

Background: We aimed to investigate the impact of the first COVID-19 lockdown on medication adherence, physician access, lifestyle behaviours, and mental health in patients with chronic conditions. Methods: A cross-sectional phone survey was conducted in 1274 housebound adults recruited from 8 regional chronic disease cohorts (CLEO CD study: NCT04390126). Results: Medication adherence was 97%; 305 (41%) patients declared that at least one scheduled visit with a physician was missed during the first lockdown. The main changes in lifestyle behaviours were deterioration in sleep time (duration and/or quality; 71%), increase in screen time (46%), and decrease in physical activity (46%). Nineteen percent experienced psychological distress (Kessler-6 score ≥ 5). An urban living place (OR, 1.76 vs. rural; 95% CI, 1.32−2.33; p = 10−4), worse self-reported mental health (OR, 1.62 vs. about the same or better; 95% CI, 1.17−2.25; p = 0.003), and a K6 score ≥ 5 (OR, 1.52 vs. <5; 95% CI, 1.05−2.21; p = 0.03) were independent factors associated with at least one unhealthy behaviour. Conclusions: Encouraging results were observed in terms of medication adherence. Caution is needed in chronic disease patients living in urban places as well as those presenting psychological distress and worse self-reported mental health to reduce unhealthy behaviours.

Enhancement in medication adherence amidst COVID-19 using active reminders

The aim of this study is to enhance medication adherence amidst COVID-19 with the help of active reminders. Effect of: patients' perception of side effect, importance of physicians' instructions, and their beliefs, on medication adherence were measured. Sample size was 583. The study was conducted in the state of Sikkim in India. Responses were analyzed and a structural equation model was framed to test the paths. It was found that reminders had a significant impact on patients' perception about importance given to physician instruction ( β = 0.433 ) and their beliefs ( β = 0.224 ). These mediators helped to increase the adherence rate of patients.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1140/epjs/s11734-022-00532-7.

Predictors of COVID-19 preventive behaviours in a sample of the Turkish population

AIM

This research aimed to determine predictors of COVID-19 preventive behaviours in a sample of the Turkish population.

METHODS

The study was conducted with 575 individuals. COVID-19 preventive behaviours were evaluated with a 19-item scale scored from 19 to 95. Knowledge on COVID-19 was evaluated with a 22-item scale scored from 0 to 22. General health literacy was evaluated with the Turkey Health Literacy Scale (THLS), which was scored from 0 to 50.

RESULTS

The average COVID-19 preventive behaviours score was moderately high in this sample of the Turkish population. Being female, having a higher level of education, better economic status, being a non-smoker, having a higher level of COVID-19 knowledge and better general health literacy score were significant predictors of COVID-19 preventive behaviours (P < 0.05).

CONCLUSION

Sociodemographic characteristics, knowledge of COVID-19 and general health literacy are crucial in preventing COVID-19 infections in a sample of the Turkish population.

Knowledge, Attitude, and Practice (KAP) toward COVID-19 Pandemic among the Public in Taiwan: A Cross-Sectional Study

Purpose: Knowledge, attitude, and practice (KAP) models are often used by researchers in the field of public health to explore people’s healthy behaviors. Therefore, this study mainly explored the relationships among participants’ sociodemographic status, COVID-19 knowledge, affective attitudes, and preventive behaviors. Method: This study adopted an online survey, involving a total of 136 males and 204 females, and used a cross-sectional study to investigate the relationships between variables including gender, age, COVID-19 knowledge, positive affective attitudes (emotional wellbeing, psychological wellbeing, and social wellbeing), negative affective attitudes (negative self-perception and negative perceptions of life), and preventive behaviors (hygiene habits, reducing public activities, and helping others to prevent the epidemic). Results: The majority of participants in the study were knowledgeable about COVID-19. The mean COVID-19 knowledge score was 12.86 (SD = 1.34, range: 7−15 with a full score of 15), indicating a high level of knowledge. However, the key to decide whether participants adopt COVID-19 preventive behaviors was mainly their affective attitudes, especially positive affective attitudes (β = 0.18−0.25, p< 0.01), rather than COVID-19 disease knowledge (β = −0.01−0.08, p > 0.05). In addition, the sociodemographic status of the participants revealed obvious differences in the preventive behaviors; females had better preventive behaviors than males such as cooperating with the epidemic prevention hygiene habits (t = −5.08, p< 0.01), reducing public activities (t = −3.00, p< 0.01), and helping others to prevent the epidemic (t = −1.97, p< 0.05), while the older participants were more inclined to adopt preventive behaviors including epidemic prevention hygiene habits (β = 0.18, p = 0.001, R2 = 0.03), reducing public activities (β = 0.35, p< 0.001, R2 = 0.13), and helping others to prevent the epidemic (β = 0.27, p< 0.001, R2 = 0.07). Conclusions: Having adequate COVID-19 knowledge was not linked to higher involvement in precautionary behaviors. Attitudes toward COVID-19 may play a more critical function in prompting individuals to undertake preventive behaviors, and different positive affective attitudes had different predictive relationships with preventive behaviors.

Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic

Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations.

Experience of adherence to treatment among patients with coronary artery disease during the COVID-19 pandemic: A qualitative study

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused patients with chronic diseases to face various challenges. The present qualitative study aimed to explore adherence to treatment in patients with coronary artery disease (CAD) during the COVID-19 pandemic. Methods: This qualitative content analysis was conducted from September 2020 to February 2021. Online in-depth interviews were conducted with 15 patients with CAD after discharge from Nemazi and Al-Zahra heart hospitals, Shiraz, Iran. Data management was done via MAXQDA 12 software using conventional content analysis based on the method proposed by Graneheim and Lundman. Results: The results revealed three main categories, nine subcategories, and 431 primary codes. The first category was 'improved self-care in the shadow of COVID-19' (Improving self-care due to fear of COVID-19, 'utilization of alternative strategies, and reinforcement of self-care beliefs). The second category was 'redefinition of support systems' (need for a support system, seeking for alternative support systems, and changes in social interactions). The last category was 'barriers to treatment adherence' (shortage of financial resources, need to adjust with working conditions, and mental conflicts). Conclusion: The results indicated that the COVID-19 threats encouraged the patients with CAD to adhere to their care principles. Nonetheless, the restrictions resulting from the pandemic caused problems in adherence to treatment. Thus, redefinition of the support systems in accordance with the present conditions are recommended.

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.

Effect of COVID-19 driven lockdown on social contact pattern in Puducherry, India: A longitudinal study

Objective

This study was undertaken to assess the change in social contact and transmission dynamics among adults in the Puducherry district during the different phases of country-wide lockdown.

Methods

Adults aged 18-69 years in Puducherry were assessed for frequency and duration of contacts in the following time points: prior to lockdown (March 2020), during lockdown, immediate post-lockdown (April, June 2020), and seven months post-lockdown (February 2021). Adjusted incidence rate ratios (aIRR) were obtained using a generalized estimating equation. We also assessed the exponential trajectory of the time-varying reproduction number (R_t) during and after lockdown.

Results

Compared to pre-lockdown phase, frequency of social contacts during 1^st week, 4^th week of lockdown, and immediate post-lockdown were reduced by 89% (aIRR = 0.11; 95% CI: 0.09-0.13), 40% (aIRR = 0.60; 95% CI: 0.52-0.69) and 91% (aIRR = 0.09; 95% CI: 0.07-0.10) respectively. However, the decline was not statistically significant at seven months post-lockdown. Correspondingly, we observed an initial spike in R_t during the lockdown phase followed by a gradual decline during the immediate post-lockdown phase. However, seven months post-lockdown, R_t has increased again.

Conclusion

The study showed high compliance to the lockdown measures in Puducherry during the lockdown and immediate post-lockdown periods. However, as the lockdown measures were relaxed, the contact rate returned to the pre-lockdown state.

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.

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.

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.

Effect of Lockdown on Diabetes Care During the COVID-19 Pandemic: Result of a Telephone-Based Survey Among Patients Attending a Diabetic Clinic in Northern India

Background

The coronavirus disease 2019 (COVID-19) pandemic has aggravated the demand for diabetes care due to restrictive measures like the lockdown affecting access to healthcare services. The current study was conducted to assess the changes in medication compliance, dietary pattern, and glucose monitoring during the lockdown period as compared to the pre-lockdown period among patients living with type 2 diabetes mellitus (T2DM) attending a diabetes clinic in northern India.

Methods

This cross-sectional study was conducted between May and July 2020. Information regarding the sociodemographic and clinical profiles of the patients like age, sex, income, qualification, family history of diabetes, history of smoking and alcohol, type of treatment, co-morbidities, drug adherence for T2DM, changes in the pattern of diet, physical activity, blood glucose monitoring, and drug usage during and before the lockdown was collected through telephonic interviews using a structured tool. Descriptive analysis was performed, and the chi-square and Wilcoxon sign ranks tests were used to see the association between variables.

Results

A total of 260 patients were enrolled in the study. A higher proportion of males reported a decrease in the consumption of cereals (13.9%), eggs (56.5%), and meat and fish (92.7%) and an increase in water intake (25.8%) while a higher proportion of females reported no change in physical activity levels (77.2%) during the lockdown against pre-COVID times. There was a significant improvement in medication adherence and glycemic control during the lockdown period as compared to the pre-lockdown times.

Conclusion

More time for self-care, adequate counseling about glycemic goals, and knowledge of self-monitoring of blood glucose levels helped the majority of patients in adopting a healthy lifestyle and achieve better glycemic control during the COVID-19 lockdown.

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.

Coronavirus-related health literacy and perceived restrictiveness of protective measures among community-dwelling older persons in Finland

BACKGROUND

Older people with limited health literacy may encounter difficulties in finding relevant information on COVID-19, understanding its relevance, and complying with recommended protective measures. Complying with such recommendations has required older as well as younger persons to change their daily lives in ways that have reduced their opportunities for engaging in many activities meaningful to them.

AIMS

To find out from what sources older people have obtained information on protective measures, the level of their coronavirus-related health literacy (CHL), and whether CHL is associated with their perceptions of the restrictiveness of coronavirus-related protective measures.

METHODS

696 Finnish men and women aged over 77 answered a mailed questionnaire on their CHL, sources of information and perceptions of the restrictiveness of the recommended protective measures. The association of CHL with perceived restrictiveness was studied using multinomial logistic regression analysis.

RESULTS

Television and newspapers were the most frequently reported sources of information. Reporting high confidence in the ability to assess how one's behavior influences coronavirus infection risk was associated with higher odds of perceiving the protective measures to be highly restrictive, when controlling for age, gender, and difficulty in using digital devices (OR 3.21, 95% CI 1.09, 9.46).

DISCUSSION

Participants who reported being highly confident about their ability to appraise the influence of their behavior on their susceptibility to coronavirus infection were more likely to perceive that the recommended protective measures had restricted their daily lives.

CONCLUSIONS

Health literacy plays a role in complying with recommended restrictions.

Verbal memory is associated with adherence to COVID-19 protective behaviors in community dwelling older adults

Background

Adherence to protective behaviors is central to limiting the spread of COVID-19 and associated risk of serious illness and mortality in older populations. Whether cognition predicts adherence to protective behaviors has not been examined in older adults.

Aims

To examine whether specific cognitive abilities predict adherence to COVID-19 protective behaviors in older adults, independent of other relevant factors.

Methods

Data from 431 older adults (i.e., ≥ 65 years) who took part in the COVID-19 module of the Health and Retirement Study were included in the present study. Separate binary logistic regression models were used to examine whether performance on measures of immediate and delayed recall and working memory predicted adherence to COVID-19 protective behaviors, controlling for demographics, level of COVID-19 concern, depressive symptoms, and medical conditions.

Results

For every unit increase in immediate and delayed recall, the probability of adhering to COVID-19 protective behaviors increased by 47% and 69%, respectively. There was no association between the measure of working memory and adherence.

Discussion

It is of public interest to understand the factors that reduce adherence to protective behaviors so that we can better protect those most vulnerable and limit community spread. Our findings demonstrate that reduced memory predicts non-adherence to COVID-19 protective behaviors, independent of virus concern, and other relevant demographic and health factors.

Conclusions

Public health strategies aimed at increasing adherence to COVID-19 protective behaviors in community dwelling older adults, should account for the role of reduced cognitive function in limiting adherence.

Perception of COVID-19 Prevention Methods Efficacy and Intention to Use Among Patients with Chronic Disease in Dessie Town, Northeast Ethiopia: A Multicentered Cross-sectional Study

Background

In Ethiopia, people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been increasing dramatically. COVID-19 precaution measures are essential for highly susceptible groups. However, it was not known previously to what extent chronic disease patients were perceived to know about the efficacy of prevention measures. Hence, the aim of this study was to assess perception of patients with chronic disease toward the efficacy of COVID-19 preventive measures and their intention to carry out those measures.

Methods

A multicentered institutional-based cross-sectional study was conducted among 413 patients attended in selected hospitals of Dessie town from July 21 to August 5, 2020. Hospitals were selected using the lottery method and systematic random sampling was utilized to select study participants. An interviewer-administered structured questionnaire was used to collect the data and the tool had four dimensions which include sociodemographic, clinical profile and risk assessment, perceived efficacy of prevention measures, and patient’s intention to carry out measures. In multivariable analysis, variables were declared statistically significant at a p-value of <0.05.

Results

In this study, the mean age of participants was 48.2 years (SD ±15.8 years) and 52.1% were females. In overall, 42.1% of participants had low perception on the efficacy of prevention measures and 28.3% had low intention to carry out measures. In this study, young adults (AOR=2.48; 95%CI: 1.42–4.31), male gender (AOR=2.75; 95%CI: 1.73–4.37), low literacy (AOR=3.42; 95%CI: 1.47–7.94) and face mask nonusers (AOR=1.64; 95%CI: 1.03–2.61) were significantly associated with low perceived efficacy of COVID-19 prevention methods.

Conclusion

In this study, a significant proportion of patients had low perception about the efficacy of COVID-19 prevention measures and nearly one-third of them had low intention to carry out prevention measures. Therefore, health education programs about efficacy of preventive measures should be provided by health professionals targeting high risk groups.

The Impact of Health Literacy on Knowledge and Attitudes towards Preventive Strategies against COVID-19: A Cross-Sectional Study

The coronavirus disease 2019 (COVID-19) pandemic introduced a set of mitigation measures based on personal behavior and attitudes. In the absence of vaccination or specific treatment, it became essential to comply with these measures to reduce infection transmission. Health literacy is the basis for changing behaviors.

AIM

To characterize the impact of literacy on knowledge and attitudes towards preventive strategies against COVID-19.

METHODS

This cross-sectional study involved an online questionnaire applied to students of the University of Porto, Portugal, containing questions about knowledge and attitudes towards COVID-19 based on European guidelines. Health literacy was assessed through the Newest Vital Sign questionnaire. Logistic regression estimated the relationship between health literacy and both knowledge and attitudes.

RESULTS

We included 871 participants (76.3% female), with a median age of 22 years old. We found adequate literacy in 92% of our sample, irrespective of gender and age. In the global analysis, 78.6% of the participants had adequate knowledge, and 90.4% had adequate attitudes. We found that better literacy was significantly associated with attitudes towards COVID-19, but not with better knowledge. In a model adjusted for gender, age, and previous education in the health field, female gender and previous education in the health field were associated with better knowledge and attitudes.

CONCLUSION

Better health literacy is associated with better attitudes towards preventive strategies against COVID-19. We should invest in ways to improve health literacy, so we can improve people's attitudes and consequently reduce coronavirus' transmission.