Health Beliefs, Trust in Media Sources, Health Literacy, and Preventive Behaviors among High-Risk Chinese for COVID-19

How Does Disgust Affect Mpox Prevention? Examining the Underlying Mechanisms of Perceived Severity and Perceived Susceptibility Moderated by Stigma

The study aims to examine the influencing mechanism of incidental exposure to Disgusting Graphics Information (DGI) about Monkeypox (Mpox) on the intention of prevention behavior. This study first investigates the components of disgust and then examines the mechanism of disgust's influence. The study uses a cross-sectional survey design among respondents who have been incidentally exposed to DGI about Mpox (N = 368). The results showed that disgust toward Mpox is the most effective component among other proposed ones (disgust toward graphics, information sources, and patients). Disgust not only positively influences prevention intention, but also indirectly influences prevention intention through perceived severity rather than perceived susceptibility. Moreover, moderated mediation was found, indicating that stigma toward patients prevents people from adopting preventive behaviors. Both theoretical and practical implications are discussed.

The relationship between health literacy and adherence to personal protective anti-COVID-19 measures in health workers and their relatives: A mixed methods design

In the fight against the COVID-19 pandemic, the importance of health literacy in individuals' attitudes has increased. This study aimed to show whether there is a relationship between health literacy and adherence to personal protective anti-COVID-19 health behaviors in health workers and their relatives and to evaluate the barriers to adherence to personal protective anti-COVID-19 health behaviors. Designed as a cross-sectional mixed-methods study. Participants were asked to fill in an online survey form containing questions designed to determine their sociodemographic data, health literacy, adherence to protective anti-COVID-19 health behaviors, and barriers to adherence. The research results were evaluated with a confidence interval of 95% and margin of error of 0.05. Thematic content analysis was used to evaluate participants' answers to the open-ended questions. In this study, data collected from 393 participants were analyzed. In the Disease Prevention and Health Promotion Subscale, the group of participants who adhered to wearing masks "at all times" obtained a higher average score from the Turkey Health Literacy Scale than other participant groups, while the participant group that "always" complied with hand washing and social distancing obtained higher average scores from the Turkey Health Literacy Scale and its two subscales compared to other participant groups. As a result of the thematic content analysis carried out in order to determine the situations that prevent the participants from complying with personal protective anti-COVID-19 health behaviors, the main themes were determined as "forgetting/not wearing the habit of wearing a mask," "mask ergonomics" and "noncompliance with social distance." This study shows that there is a positive relationship between health literacy and adherence to protective anti-COVID-19 health behaviors among health workers and their relatives and revealed major barriers to adherence to protective anti-COVID-19 health behaviors among health workers and their relatives.

Autonomous and policy-induced behavior change during the COVID-19 pandemic: Towards understanding and modeling the interplay of behavioral adaptation

Changes in human behaviors, such as reductions of physical contacts and the adoption of preventive measures, impact the transmission of infectious diseases considerably. Behavioral adaptations may be the result of individuals aiming to protect themselves or mere responses to public containment measures, or a combination of both. What drives autonomous and policy-induced adaptation, how they are related and change over time is insufficiently understood. Here, we develop a framework for more precise analysis of behavioral adaptation, focusing on confluence, interactions and time variance of autonomous and policy-induced adaptation. We carry out an empirical analysis of Germany during the fall of 2020 and beyond. Subsequently, we discuss how behavioral adaptation processes can be better represented in behavioral-epidemiological models. We find that our framework is useful to understand the interplay of autonomous and policy-induced adaptation as a "moving target". Our empirical analysis suggests that mobility patterns in Germany changed significantly due to both autonomous and policy-induced adaption, with potentially weaker effects over time due to decreasing risk signals, diminishing risk perceptions and an erosion of trust in the government. We find that while a number of simulation and prediction models have made great efforts to represent behavioral adaptation, the interplay of autonomous and policy-induced adaption needs to be better understood to construct convincing counterfactual scenarios for policy analysis. The insights presented here are of interest to modelers and policy makers aiming to understand and account for behaviors during a pandemic response more accurately.

Liberals are Believers: Young People Assign Trust to Social Media for COVID-19 Information

The COVID-19 pandemic has challenged existing health communication strategies as more people turn to social media as a primary health information source. Although many studies have explored how young people use social media, this study examined how sociodemographic factors and political ideology are associated with use and trust in social media as a source for COVID-19 information among young adults, and how use and trust in social media as a COVID-19 information source are associated with their beliefs about COVID-19. In Spring 2021, an online survey was conducted among 2,105 18-29-year-old students at an urban university in California. Our findings show that younger, female, non-binary, Asian, and Black/African American students are most likely to obtain and trust COVID-19 information on social media. Results also suggest that liberal students are more likely to turn to social media as a source for COVID-19 information compared to conservatives. However, conservative students who use social media as a source for information were more likely to believe false health information about prevention measures and the vaccine and to have lower perceived effectiveness of COVID-19 prevention behaviors and vaccination compared to liberals.

Negative Social Exchanges During the Pandemic, Loneliness, and the Mediating Role of Stress and Feeling Misunderstood Among People at High-Risk for COVID-19 Related Complications

The goal of this study was to investigate the links between social interactions and mental health for people who are high-risk for COVID-19 complications. Specifically, we tested the relationships between negative social exchanges during the pandemic and loneliness through two mediators: stress and feeling misunderstood about one's health status. Data were collected via Amazon's MTurk from participants (N = 271) who self-identified as being high-risk for COVID-19. The results from our model showed both a direct association between negative social interactions and loneliness, and an indirect link between these variables through stress. Overall, these results highlight the importance of understanding social interactions for people who are at high-risk for COVID-19 and their mental well-being. The results and implications are discussed.

The risk perception of COVID-19 and pandemic-related behaviors: a moderated mediation model of political trust and self-efficacy

As the pandemic continues to spread across the world, the spread of the novel coronavirus disease 2019 (COVID-19) and its recurrence pose challenges for pandemic control in all countries worldwide. The present study examines the mediating role of political trust in the relationship between risk perception and pandemic-related behaviors (preventive behaviors and hoarding behaviors), and the moderating effect of self-efficacy on this relationship. The responses of 827 Chinese residents revealed that political trust plays a mediating role in the relationship between risk perception and pandemic-related behaviors. The relationship between risk perception and political trust was significant for individuals with low self-efficacy, while it became weaker for those with high self-efficacy.

Association between cultural capital and health literacy during the COVID-19 pandemic among community residents in China: the mediating effect of social capital

Background

Health literacy is crucial for managing pandemics such as COVID-19 and maintaining the health of the population; our goal was to investigate the impact of cultural capital on health literacy during the COVID-19 pandemic among community residents and to further examine the mediating role of social capital in the relationship between cultural capital and health literacy.

Methods

A cross-sectional study was conducted among 1,600 community residents selected in Chongqing, China using a stratified random sampling method. Data were gathered through a questionnaire survey, including sociodemographic characteristics, cultural capital, social capital, and health literacy. Chi-square analysis, one-way ANOVA, t-test, and hierarchical linear regression were used to analyze the level of health literacy among community residents and the related elements; the structural equation model (SEM) was used to explore the influential mechanisms of health literacy and explore whether social capital acted as a mediator in the relationship between cultural capital and health literacy.

Results

Cultural capital, community participation, community trust, reciprocity, and cognitive social capital had a significant positive effect on health literacy. In addition, the results of SEM indicated that cultural capital not only directly influences health literacy (β = 0.383, 95% CI = 0.265-0.648), but also indirectly influences health literacy through three types of social capital (β = 0.175, 95% CI = 0.117-0.465; β = 0.191, 95% CI = 0.111-0.406; β = 0.028, 95% CI = 0.031-0.174); its mediating effect accounting for 50.7% of the overall effect.

Conclusions

Our results highlight the empirical link between cultural capital and health literacy, and suggest that social capital mediates this connection. These findings suggest that governments and communities should focus on the construction of community cultural capital and provide residents with better social capital to improve their health literacy to prepare for future pandemics.

Considering Social Identity Threat Alongside the Health Belief Model to Examine Mask-Wearing Intentions of Black, Latinx, and Asian Individuals in the U.S. During COVID-19

During the COVID-19 pandemic, U.S. public health officials have recommended various safety protocols to "stop the spread", and atop the list is wearing a mask. Individuals from particular racial groups have also contended with a surge of racial profiling and race-based discrimination that has positioned mask-wearing as a risky yet health-promoting behavior. Using the health belief model (HBM), this study considers how racism and health intersect by examining the emotions, behavioral intentions, and health outcomes of mask-wearing among Black, Latinx, and Asian individuals. Cross-sectional survey data from 521 participants from across the United States were collected and analyzed using quantitative analyses. Results did not indicate significant differences in mask-wearing intentions between racial groups as predicted by the health belief model constructs; however, group differences in experiences of racism did shape perceptions of and behaviors related to mask-wearing. Mask-wearing was also related to more positive emotional experiences, and social cues to action predicted intentions to wear a mask. Implications for encouraging health-promoting behaviors across diverse populations during public health crises are discussed.

Impact of COVID-19 on Disease Self-management Among Patients With Advanced CKD: A Qualitative Study

Rationale & Objective

Patients with advanced chronic kidney disease (CKD) and their care partners experienced decreased access to care, and worse physical and emotional health during the Coronavirus Disease-19 (COVID-19) pandemic. Few studies have explored how COVID-19-related challenges affected disease self-management among those with advanced chronic kidney disease (CKD) and their care partners. Leventhal's self-regulation model offers a comprehensive framework for understanding disease self-management through the interplay of cognitive beliefs, emotional reactions and social influences. The study aims to examine the impact of COVID-19 on self-management activities among patients with CKD and care partners.

Study Design

Qualitative study.

Setting & Participants

Adults with advanced CKD, including dialysis and transplant recipients, and their carepartners.

Analytical Approach

Thematic Analysis.

Results

Among 42 participants, 12 had stage 4 CKD, 5 had stage 5 CKD, 6 were receiving in-center hemodialysis, 5 had a kidney transplant, and 14 were care partners. We identified 4 patient-related themes with corresponding subthemes related to the impact of COVID-19 on self-management: 1) cognitive understanding that COVID-19 is an additional health threat to existing kidney disease, 2) heightened anxiety and vulnerability driven by perceived risk, 3) coping with isolation through virtual interactions with healthcare services and social circles, 4) increased protective behaviors to maximize survival. Three care partner-related themes emerged: 1) hypervigilance in family care and protection, 2) interaction with health system and adaptations to self-management, and 3) increased intensity in caregiving role to facilitate patient self-management.

Limitations

The qualitative study design limits the ability to generate generalizable data. Grouping patients with Stage 3 and 4 CKD, in-center hemodialysis, and kidney transplants together limited our ability to examine self-management challenges specific to each treatment requirement.

Conclusions

When faced with the COVID-19 pandemic, patients with CKD and their care partners experienced heightened vulnerability and thus increased cautionary activities to maximize survival. Our study provides the groundwork for future interventions to help patients and care partners live with kidney disease during future crises.

Fostering mask-wearing with virality metrics and social media literacy: evidence from the U.S. and Korea

Although social media can pose threats to the public health by spreading misinformation and causing confusion, they can also provide wider access to health information and opportunities for health surveillance. The current study investigates the ways in which preventive health behaviors and norms can be promoted on social media by analyzing data from surveys and experiments conducted in the U.S. and South Korea. Survey results suggest that the pathway from social media use for COVID-19 information to mask-wearing behavior through mask-wearing norms emerges only among individuals with strong perceived social media literacy in the U.S. Experimental findings show that wear-a-mask campaign posts on social media foster mask-wearing norms and behavioral intention when they come with large (vs. small) virality metrics (e.g., Likes, shares) in both the U.S. and South Korea. Additionally, American users are more willing to engage with posts that come with supportive (vs. mixed) comments by Liking, sharing and commenting. The results highlight the need to cultivate social media literacy and opportunities for exploiting social media virality metrics for promoting public health norms and behaviors.

COVID-19 Phobia among Korean, Chinese, and Japanese students: An international comparative study

This study aimed to identify the characteristic differences and potential contributing factors of coronavirus disease 2019 (COVID-19) phobia between undergraduate and graduate students in Korea, Japan, and China. We used the online survey tool, we retained 460 responses from Korea, 248 responses from Japan, and 788 responses from China for analysis. We performed the statistical analysis; ANOVA F-test and Multiple linear regression. We visualized the results of these calculations using GraphPad PRISM 9. The mean COVID-19 phobia score was highest in Japan at 50.5 points. Psychological fear was identically prevalent in Japan and China, at an average of 17.3 points. Psychosomatic fear was highest in Japan at 9.2 points. Further, economic fear was highest in Korea at 13 points, whereas social fear was highest in China at 13.1 points. In Korea, COVID-19 phobia scores were significantly higher among women than in men. In Japan, COVID-19 phobia scores were significantly higher in individuals who complied with social distancing mandates. In China, a lack of previous experience with self-administered testing kits was associated with significantly lower phobia scores. Individuals who were avoiding crowded places had significantly higher scores in 3 countries. This implies that the students knew that it was necessary to comply with COVID-19 preventive behaviors to prevent infections. The findings of this study could be used as a reference when establishing an approach strategy to reduce COVID-19 phobia among Chinese, Japanese, and Korean students.

Effects of Vaccine Literacy, Health Beliefs, and Flu Vaccination on Perceived Physical Health Status among Under/Graduate Students

Physicians highlight that receiving the flu vaccine is critical, especially during the COVID-19 pandemic period. Younger groups' flu vaccination coverage is very low, and this tendency is potentially related to a lower level of vaccine literacy and perceptions toward vaccination. This study investigated the relationship between flu vaccine literacy, health beliefs, and flu vaccinations (benefit, barrier, severity, and susceptibility) and their impact on perceived health status controlling for socioeconomic factors. It used the Health Belief Model andHealth Literacy Skills Framework with under/graduate students (N = 382) in Ohio, U.S. Path analyses were performed to examine the causal process using SPSS and Amos 23.0. Indicators of CFI, RMSEA, SRMR, and the chi-square/df of the path models were good-acceptable. Vaccine literacy directly impacted on health beliefs and vaccination. Susceptibility belief directly influenced perceived health status. The mediation effects of health beliefs (benefit, barrier) between vaccine literacy and vaccination were confirmed. The study highlights the need for healthcare providers and governments to work together to improve flu vaccine literacy and reduce negative perceptions toward vaccination among younger populations. Educational programs and official communication channels can be used to address concerns and provide accurate information about vaccines to increase flu vaccination rates and protect public health.

Effects of social media empowerment on COVID-19 preventive behaviors in China

Purpose

During the coronavirus disease 2019 (COVID-19) pandemic, ubiquitous social media has become a primary channel for information dissemination, social interactions and recreational activities. However, it remains unclear how social media usage influences nonpharmaceutical preventive behavior of individuals in response to the pandemic. This paper aims to explore the impacts of social media on COVID-19 preventive behaviors based on the theoretical lens of empowerment.

Design/methodology/approach

In this paper, survey data has been collected from 739 social media users in China to conduct structural equation modeling (SEM) analysis.

Findings

The results indicate that social media empowers individuals in terms of knowledge seeking, knowledge sharing, socializing and entertainment to promote preventive behaviors at the individual level by increasing each person's perception of collective efficacy and social cohesion. Meanwhile, social cohesion negatively impacts the relationship between collective efficacy and individual preventive behavior.

Originality/value

This study provides insights regarding the role of social media in crisis response and examines the role of collective beliefs in the influencing mechanism of social media. The results presented herein can be used to guide government agencies seeking to control the COVID-19 pandemic.

The predictors of COVID-19 preventive health behaviors among adolescents: the role of health belief model and health literacy

Aim

The present study aimed to evaluate the predictive role of the Health Belief Model (HBM) constructs and health literacy (HL) in shaping the coronavirus disease 2019 (COVID-19) preventive health behaviors (PHBs) among adolescents.

Methods

This cross-sectional study was conducted with 503 adolescent girls and boys, randomly selected via cluster sampling. For this purpose, the data were collected online through four research tools, including the demographic-clinical characteristics information questionnaire, the COVID-19 PHB Scale based on HBM, and the Health Literacy Scale for COVID-19. The data analysis was then performed by regression analysis along with the structural equation modeling (SEM), considering the significance level of 0.05.

Results

The regression analysis results demonstrated that following the one-unit increase in the values of self-efficacy and cues to action, the COVID-19 PHBs elevated by 0.063 and 0.078 units, respectively. In addition, the COVID-19 PHBs subsided by 0.018 with the rise in the value of perceived barriers (P < 0.001). According to the path analysis, the direct path from the COVID-19-related HL to the COVID-19 PHBs (B = 0.097, β = 0.087, 95% confidence interval [CI] = 0.005 to 0.189) was significant. Furthermore, the indirect path from the COVID-19-related HL to the COVID-19 PHBs through perceived susceptibility (B = 0.017, β = 0.015, 95% CI = 0.001 to 0.032), perceived barriers (B = 0.029, β = 0.026, 95% CI = 0.004 to 0.055), self-efficacy (B = 0.094, β = 0.084, 95% CI = 0.031 to 0.156), and cues to action (B = 0.153, β = 0.137, 95% CI = 0.092 to 0.215) was significant.

Conclusion

In keeping with the study results, it is essential to take some effective measures to boost the HBM constructs and HL among adolescents to improve their PHBs during pandemics such as COVID-19.

Application of the Capability, Opportunity, Motivation and Behavior (COM-B) model to identify predictors of two self-reported hand hygiene behaviors (handwashing and hand sanitizer use) to prevent COVID-19 infection among U.S. adults, Fall 2020

BACKGROUND

Handwashing with soap and water is an important way to prevent transmission of viruses and bacteria and worldwide it is estimated handwashing can prevent 1 in 5 viral respiratory infections. Frequent handwashing is associated with a decreased risk for infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Using a hand sanitizer with at least 60% alcohol when handwashing is not feasible can also help prevent the transmission of viruses and bacteria.

OBJECTIVE

Since early 2020, the public has been encouraged to handwash frequently with soap and water and use alcohol-based hand sanitizer when soap and water are not available to reduce COVID-19 transmission. This study's objectives were to assess U.S. adults' perceptions of components of the Capability, Opportunity, Motivation and Behavior (COM-B) Model in relation to these two hand hygiene behaviors and to identify relationships between these components and hand hygiene behaviors.

METHODS

Items assessing capability, opportunity, motivation, and hand hygiene behaviors were included in FallStyles, a survey completed by 3,625 adults in the fall of 2020 through an online panel representative of the U.S.

POPULATION

We calculated composite capability, opportunity, and motivation measures and descriptive statistics for all measures. Finally, we conducted multiple logistic regressions to identify predictors of handwashing and hand sanitizer use.

RESULTS

Most respondents reported frequently washing hands with soap and water (89%) and using alcohol-based hand sanitizer (72%) to prevent coronavirus. For capability, over 90% of respondents said that neither behavior takes a lot of effort, but fewer agreed that they knew when, or how, they should engage in handwashing (67%; 74%) and hand sanitizer use (62%; 64%). For opportunity, over 95% of respondents said lack of time didn't make it hard to engage in either behavior; fewer said visual cues reminded them to engage in the behaviors (handwashing: 30%; sanitizer use: 48%). For motivation, the majority believed the two behaviors were good ways to prevent coronavirus illness (handwashing: 76%; sanitizer use: 59%). Regressions indicated that capability, opportunity, and particularly motivation were positively associated with both hand hygiene behaviors.

CONCLUSIONS

The COM-B model was a helpful framework for increasing understanding of hand hygiene behavior; it identified capability, opportunity, and motivation as predictors of both handwashing and hand sanitizer use.

The Influence of Stereotypes on Trust in Doctors from Patients' Perspective: The Mediating Role of Communication

Purpose

To investigate the relationship among patients' stereotypes of doctors, effectiveness of doctors' communication skills evaluated by patients, and patients' trust in doctors.

Patients and Methods

A cross-sectional survey with a total of 3289 patients from 103 hospitals in eastern, central and western China was conducted.

Results

There were strong correlations among patients' stereotypes, patients' evaluation on doctors' communication skills, and patients' trust (r = 0.50-0.67, p < 0.01 for all). Patients' trust was predicted by patients' stereotypes directly (β = 0.32, 95% CI: 0.27-0.37) and indirectly (β = 0.19, 95% CI: 0.16-0.23) through patients' evaluation on doctors' communication skills.

Conclusion

Both patients' stereotypes and patients' evaluation on doctors' communication skills have predictive effects on patients' trust. Patients' stereotypes are not only a direct predictor of patients' trust but also an indirect predictor via doctors' communication skills as a mediator. This national survey underlines the significance of patients' stereotypes, and emphasizes the importance of developing doctors' communication skills on patients' trust. In order to build a more trustful doctor-patient relationship, there should be a joint effort at social and individual level to reinforce positive impression and suppress negative stereotypes of doctors. As far as communication skills are concerned, doctors are encouraged to use helpful verbal and nonverbal techniques that benefit their profession impression management.

Meaning in life and health behavior habits during the COVID-19 pandemic: Mediating role of health values and moderating role of conscientiousness

An increasing number of studies have explored health behavior changes since the COVID-19 outbreak, however, the potential mechanism leading to the acquisition of COVID-19-related health behavior habits remains largely underexplored. The current study aimed to investigate how meaning in life contributed to the Chinese general public's acquisition of COVID-19-related health behavior habits, and whether health values would play a mediating role and conscientiousness would play a further moderating role in this relation. A total of 1024 Chinese participants (age range = 17-63 years; 67.29% females) were recruited by posting flyers on an open-access web forum. All participants voluntarily completed a series of online anonymous questionnaires assessing conscientiousness, meaning in life, health values and health behavior habits. Results showed that (1) the majority of the respondents reported the acquisition of COVID-19-related health behavior habits, and meaning in life positively predicted COVID-19-related health behavior habits; (2) health values mediated the link between meaning in life and health behavior habits; and (3) conscientiousness moderated the indirect effect, such that the indirect effect was stronger among individuals with low conscientiousness. These findings have important implications for revealing the reconstruction of the Chinese public's health behavior habits and its potential mechanism that meaning in life influences health behavior habits through health values during the COVID-19 pandemic, particularly for individuals with low conscientiousness.

Effects of Health Literacy in the Fight Against the COVID-19 Infodemic: The Case of Japan

This study quantitatively examines whether health literacy can reduce belief in COVID-19 misinformation and conspiracy theories. Conducting path and cluster analyses on survey data collected from 1,488 adults in Japan in 2021, we found that while health literacy reduces people's belief about COVID-19 and vaccination misinformation, it has no direct effect on their belief in COVID-19 conspiracy theories. That said, the results also highlighted the importance of health literacy. It is found that even though high health literacy does not guarantee a low degree of conspiracy beliefs, low health literacy is associated with high susceptibility to both misinformation and conspiracy theories. Moreover, people who relied more on social media than mass media for COVID-19 news and reported on having been more severely affected by the pandemic were found to be more likely to have lower health literacy and higher belief in misinformation and conspiracy theories. Based on the findings, we discussed ways to enhance health literacy research and promotion in Japan.

COVID-19 related information seeking: The impact of media on parental concerns

The expansion of information sources and their use has accelerated since the beginning of the COVID-19 pandemic, sometimes provoking significant concern in the daily lives of parents. The objective of this study was to investigate the association between COVID-19 related information sources and the level of concern about COVID-19 among parents of school-aged children. Using factor analysis and hierarchical ascending classification, we constructed groups according to the information sources they used. We performed ANOVA analysis and then binomial logistic regression to compare concern levels among the groups created. Overall, the 3,459 participants were mainly women (79.2%) and 59.5% reported being between 35 and 44 years old. The mean concern score in our sample was 9.5/15 (s.d. = 3.87). The whole sample fell into three groups: (1) Traditional Media (n = 1,610), who mainly used newspapers; (2) Online Social Networks and Entourage (n = 776), who mostly consulted online social media as well as friends and family; and (3) the Unplugged (n = 1,073), who consulted few or no information sources. Compared to the Unplugged, individuals in the other two groups had a higher risk of being concerned (Traditional Media, OR = 2.2; p < 0.001; Social Networks and Entourage, OR = 3.1; p < 0.001). Communication about pandemic risk should be conveyed based on reliable information and at moderate intervals to safeguard the mental health of individuals.

Revisit the Effects of Health Literacy on Health Behaviors in the Context of COVID-19: The Mediation Pathways Based on the Health Belief Model

Background

Emerging research has identified health literacy as an important resource for individual health care and disease prevention. In the context of COVID-19, People with limited HL are less likely to follow preventive measures such as wearing masks, social isolation, or taking the vaccination. However, the pathways of how health literacy affects decision-making have remained unclear.

Methods

With a cross-sectional study, a total of 613 responses (mean age is 25.64 ± 6.46 years) were collected. The relationship between health literacy and health behaviors under COVID-19 was examined, and the potential mediation pathways were assessed based on the health belief model.

Results

With linear regression, it was found that health literacy has a direct effect on health behaviors and three constructs in the health belief model, i.e., perceived susceptibility, perceived severity, perceived barriers, as well as an indirect effect on health behaviors via increasing perceived barriers related with COVID-19 preventive measures. The results showed that health literacy only goes through the pathway of perceived barriers to influence health behaviors, and the indirect effects via other pathways were not significant.

Conclusions

The research addressed the mediation model underlying the effects of health literacy on health behaviors and identified a partial mediation role of perceived barriers. Health literacy could promote individual health behavior by reducing the perceived barriers to forming a healthy lifestyle and making health decisions. Future health promotion interventions increasing people's health literacy should be advocated to promote health initiatives in the whole population.

The Roles of Health and e-Health Literacy, Conspiracy Beliefs and Political Sympathy in the Adherence to Preventive Measures Recommended during the Pandemic

Adherence to preventive measures is of the utmost importance for limiting the spreading of the coronavirus. Many predictors of adopting preventive behaviors have been analyzed in different countries during the COVID-19 pandemic. Objectives: The study’s main aim was to assess the roles of health (HL) and e-health literacy (eHL), conspiracy beliefs, political sympathy, and religious practices in the adherence to COVID-19 preventive measures after adjusting for sociodemographic factors. The analysis was based on the data obtained from a survey conducted among 2410 adult Internet users in Poland in October 2020. The survey was performed with a computer-assisted web-based interviewing technique. Survey data were analyzed through uni- and multivariable linear regression models. The multivariable regression model revealed that after adjusting for sociodemographic variables, the preventive measures score (PMS) was significantly associated with HL (B = 0.04, p < 0.001), eHL (B = 0.03, p < 0.001) and the COVID-19-related conspiracy beliefs score (C19CBS) (B = −0.24, p < 0.001). There was also a significant statistical relationship between PMS and political sympathies and religious practices. HL and eHL are key factors eligible for modification through appropriate interventions and showing positive effects in compliance with preventive measures. Conspiracy beliefs, political sympathy and religious beliefs are independently associated with the adherence.

Improving Health Literacy: Analysis of the Relationship between Residents' Usage of Information Channels and Health Literacy in Shanghai, China

Background: This study aimed to examine the relationship between residents’ health literacy (HL) and their use of and trust in information channels. Methods: A community-based cross-sectional health survey utilizing a cluster sampling design was conducted in January 2022. The sample consisted of 1067 residents in Shanghai, China. Those who correctly answered over 80% of the questions were regarded as qualified. The differences in residents’ HL and the dimensions of knowledge HL, lifestyle HL, and skills HL were analyzed based on their use of and trust in traditional media, the internet, and offline activities. Logistic regression was conducted to examine the effects of the usage of these channels on all four types of HL. Results: A total of 27.65% of participants were qualified for HL. The use of traditional media (OR = 1.405, p < 0.05) and engagement in offline activities (OR = 1.951, p < 0.05) were significantly related to HL. Disbelief in traditional media was related to being qualified in knowledge HL (OR = 1.262; p < 0.05), whereas disbelief in offline activities had an adverse effect on knowledge HL and skills HL (OR = 0.700, 0.807; p < 0.05). Conclusion: Effort should be made to improve the efficiency of offline health education, and ensure the reliability and quality of health-related information from mass media and the internet to improve residents’ HL.

Do Chinese netizens cross-verify the accuracy of unofficial social media information before changing health behaviors during COVID-19? A Web-based study in China

Background

As social media platforms have become significant sources of information during the pandemic, a significant volume of both factual and inaccurate information related to the prevention of COVID-19 has been disseminated through social media. Thus, disparities in COVID-19 information verification across populations have the potential to promote the dissemination of misinformation among clustered groups of people with similar characteristics.

Objective

This study aimed to identify the characteristics of social media users who obtained COVID-19 information through unofficial social media accounts and were (1) most likely to change their health behaviors according to web-based information and (2) least likely to actively verify the accuracy of COVID-19 information, as these individuals may be susceptible to inaccurate prevention measures and may exacerbate transmission.

Methods

An online questionnaire consisting of 17 questions was disseminated by West China Hospital via its official online platforms, between May 18, 2020, and May 31, 2020. The questionnaire collected the sociodemographic information of 14,509 adults, and included questions surveying Chinese netizens’ knowledge about COVID-19, personal social media use, health behavioral change tendencies, and cross-verification behaviors for web-based information during the pandemic. Multiple stepwise regression models were used to examine the relationships between social media use, behavior changes, and information cross-verification.

Results

Respondents who were most likely to change their health behaviors after obtaining web-based COVID-19 information from celebrity sources had the following characteristics: female sex (P=.004), age ≥50 years (P=.009), higher COVID-19 knowledge and health literacy (P=.045 and P=.03, respectively), non–health care professional (P=.02), higher frequency of searching on social media (P<.001), better health conditions (P<.001), and a trust rating score of more than 3 for information released by celebrities on social media (P=.005). Furthermore, among participants who were most likely to change their health behaviors according to social media information released by celebrities, female sex (P<.001), living in a rural residence rather than first-tier city (P<.001), self-reported medium health status and lower health care literacy (P=.007 and P<.001, respectively), less frequent search for COVID-19 information on social media (P<.001), and greater level of trust toward celebrities’ social media accounts with a trust rating score greater than 1 (P≤.04) were associated with a lack of cross-verification of information.

Conclusions

The findings suggest that governments, health care agencies, celebrities, and technicians should combine their efforts to decrease the risk in vulnerable groups that are inclined to change health behaviors according to web-based information but do not perform any fact-check verification of the accuracy of the unofficial information. Specifically, it is necessary to correct the false information related to COVID-19 on social media, appropriately apply celebrities’ star power, and increase Chinese netizens’ awareness of information cross-verification and eHealth literacy for evaluating the veracity of web-based information.

What Is the Flag We Rally Around? Trust in Information Sources at the Outset of the COVID-19 Pandemic in Latvia

Trust in information sources about COVID-19 may influence the public attitude toward the disease and the imposed restrictions, thus determining the course of the COVID-19 pandemic in a given country. Acknowledging an increase in trust in the government or the so-called rally ‘round the flag’ effect around the world at the beginning of the COVID-19 pandemic, this study explores possible determinants of this effect in Latvia, looking at such variables as the perceived disease risk, gender, age, education, income, and language spoken in the family. Presuming that risk perception may be amplified by trust in various information sources, we investigate a spill-over of the rally ‘round the flag’ effect on healthcare professionals, media, and interpersonal networks. Studying data from a nationally representative sociological survey conducted in September 2020, we confirm a positive relationship between trust in all information sources, except friends, relatives, and colleagues, and perceived disease risk. Correlations are also strong regarding trust in almost all information sources and the measured socio-demographic variables, except gender. Interpersonal trust seems to be relatively stable, and in most cases the correlations are statistically insignificant. With this study we suggest that increase in trust in government institutions as well as other information sources, even in crisis situations, does not depend on any single element, but instead presents a more complex phenomenon.

To Be (Vaccinated) or Not to Be: The Effect of Media Exposure, Institutional Trust, and Incentives on Attitudes toward COVID-19 Vaccination

The COVID-19 vaccine has become a strategic vehicle for reducing the spread of the pandemic. However, the uptake of the vaccine by the public is more complicated than simply making it available. Based on social learning theory, this study examines the role of communication sources and institutional trust as barriers and incentives as motivators of people's attitudes toward vaccination and actual vaccination. Data were collected via an online panel survey among Israelis aged 18-55 and then analyzed using structural equation modeling (SEM). Findings show that social media trust negatively mediates the effect of exposure to information on the vaccine on attitudes toward vaccination. However, mass media trust and institutional trust positively mediate this relationship. Incentives were effective motivators for forming positive attitudes and moderating the effect of institutional trust on attitude toward vaccination. This study facilitates a deeper understanding of health communication theory in pandemics and makes important recommendations for practitioners and policy makers.

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.

Health Literacy and Disparities in Knowledge, Attitude and Practice Regarding COVID-19 Among College Students During the COVID-19 Outbreak in China: A Cross-Sectional Study

Purpose

This study aimed to assess the knowledge, attitude and practice (KAP) towards COVID-19 of Chinese college students during the COVID-19 outbreak and identify the determinants considerably associated with KAP.

Methods

An online cross-sectional questionnaire survey was conducted in February 2020 in China to recruit participants on the Wen-Juan-Xing online platform. A self-made questionnaire was used to assess the KAP towards COVID-19.

Results

The average scores of COVID-19-related KAP among college students were 32.16 ± 4.09, 16.84 ± 3.18 and 15.36 ± 1.83, respectively. The average correct response rate of COVID-19-related knowledge was 84.62%. 94.59% of the respondents believed China could control and conquer the pandemic; 98.92% of the respondents wore a mask when they went out. The multiple linear regression showed that the female students had higher scores of COVID-19-related knowledge than male students (β = 0.79, P = 0.01), and the students from 985 or 211 universities (β = -2.22, P < 0.01) were significantly associated with higher knowledge scores. Furthermore, a significantly positive correlation was found between the scores of COVID-19-related KAP among students.

Conclusion

The college students had a good KAP towards the COVID-19 pandemic. The present study was able to access the COVID-19-related KAP among college students during the pandemic and identify their weaknesses in pandemic prevention. Consequently, the results of this study provide theoretical basis for implementing precision health education among college students and reference for campuses to conduct scientific prevention and control during a pandemic. Results also provide beneficial experience to curb similar major public health emergencies in the future.

What Explains Natives and Sojourners Preventive Health Behavior in a Pandemic: Role of Media and Scientific Self-Efficacy

The COVID-19 pandemic triggered a severe global public health emergency. The current research investigated and compared "Natives and Sojourners" health-protective behavior in Mainland China during the pandemic. We adopted a unified view to propose our theoretical model by adapting the Health Belief Model (HBM) and Institutional Theory (IT). The data obtained through an online survey questionnaire from 435 respondents during the second and third quarters of were analyzed. Structural equation modeling (SEM) was used to empirically analyze the proposed model. The media self-efficacy (MSE), scientific self-efficacy (SSE), perceived health risks (PHRs), and the perceived benefits of being protected have positive and significant effects on the definition of health-protective behavioral intentions among natives and sojourners in mainland China. Media and SSE can play a strategic role in formulating public health-protective behavior. The current research recommends an effective communication with sojourners during crisis for them to be a part of the national crisis management plan (i.e., infectious disease).