Health Literacy, eHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19 Symptoms Among Health Care Workers During Lockdown: Online Survey

Validation of the extended e-health literacy scale: structural validity, construct validity and measurement invariance

BACKGROUND

Given the rapid proliferation and use of online health resources, many of which may be of dubious quality, there is an increasing need to develop electronic health literacy (e-health literacy) skills among the population of internet users. E-health literacy encompasses the skills and abilities needed to access, understand, validate, evaluate, interpret, and apply online health-related information. Measuring e-health literacy has become crucial for developing targeted interventions, assessing their impact, and producing high-quality research findings that can inform health policy and clinical practice, which can lead to improved health outcomes and potentially reducing health inequalities. The scales need to be valid and reliable so that decisions are based on high-quality data. In this regard, the issue of the measurement invariance of scales across different demographic groups has been neglected. This is critical, as assessments should be valid across different sociodemographic groups to avoid bias when comparing them. The aim of this study was to validate the Extended e-health literacy scale (eHEALS-E) on general population and investigate its structural validity and internal consistency, construct validity in terms of convergent and discriminant validity, and examine its measurement invariance across gender, age, education and social status.

METHODS

The data were collected as a part of a national health literacy survey conducted by the Slovenian National Institute of Public Health. For this survey the initial eHEALS-E scale was revised in order to address its limitations and applicability to general population. Based on a nationally representative sample, the final sample for the analysis comprised 1,944 individuals who at least occasionally used one of the various internet services to obtain health-related information. Multiple group confirmatory factor analysis was used to examine the measurement invariance of the scale.

RESULTS

With some adjustments, the measurement model of the revised 6-dimensional eHEALS-E scale demonstrated a good fit to the data (χ2 = 2508, df = 282, RMSEA = 0.064, SRMR = 0.070, CFI = 0.90). The scale had good internal consistency (alpha = 0.89). Although evidence of the scale's convergent and discriminant validity was partially provided, the analysis revealed robust measurement invariance across sociodemographic groups.

CONCLUSIONS

With a minor limitation, the scale ensures an unbiased e-health literacy assessment across different social groups, which is crucial for interventions that aim to reduce health-related social inequalities. This ensures that the interventions derived from the assessment of reality are equally valid and effective for everyone, regardless of their sociodemographic background.

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.

A Nomogram for Predicting the Infectious Disease-specific Health Literacy of Older Adults in China

PURPOSE

To identify the predictors of infectious disease-specific health literacy (IDSHL), and establish an easy-to-apply nomogram to predict the IDSHL of older adults.

METHODS

This cross-sectional study included 380 older adults who completed the IDSHL, self-rated health, socio-demographic and other questionnaires. Logistic regression was used to identify the IDSHL predictors. Nomogram was used to construct a predictive model.

RESULTS

Up to 70.1% of older adults had limited IDSHL. Age, education, place of residence, self-rated health, and Internet access were the important influencing factors of IDSHL. The established nomogram model showed high accuracy (receiver operating characteristic curve: 0.848).

CONCLUSIONS

The IDSHL of Chinese older adults was significantly deficient. The constructed nomogram is an intuitive tool for IDSHL prediction that can not only contribute toward rapid screening of high-risk older adults with limited IDSHL but also provide guidance for healthcare providers to develop prevention strategies for infectious diseases.

eHealth literacy of migrant domestic workers in Hong Kong in the COVID-19 pandemic: A mixed methods study

BACKGROUND

Health communication in the COVID-19 pandemic can be effectively implemented if all members of the populations, including marginalized population such as migrant domestic workers (MDWs), have good eHealth literacy. Lessons learned during this critical period may help improve planning and mitigation of the impacts of future health crises.

METHODS

This study aimed to examine and explore the eHealth literacy levels of the MDWs in Hong Kong during the COVID-19 pandemic by using a convergent mixed methods research design. A total of 1156 Hong Kong MDWs participated in a paper-based survey using a multistage cluster random sampling design for the quantitative component. eHealth literacy was measured using an eHealth literacy Scale (eHEALS). For the qualitative component, a purposive sampling of 19 MDWs participated in face-to-face, semi-structured, in-depth interviews. Descriptive statistics and multiple regression analyses were used to carry out the quantitative analysis, while thematic analysis was used for the qualitative analysis. Both quantitative and qualitative data were merged and integrated for mixed-methods analysis.

RESULTS

The meta-inferences of the quantitative and qualitative results mainly confirmed that MDWs in Hong Kong had good levels of eHealth literacy. The use of Instagram, YouTube and WhatsApp as the COVID-19 information sources, in addition to having an interest in the topic of the current spread of COVID-19 together with the Hong Kong government's policies related to COVID-19, were found to be associated with eHealth literacy.

CONCLUSIONS

The eHealth literacy level of MDWs in Hong Kong was shown to be good and it was influenced by the use of popular social media platforms including Instagram, YouTube, and WhatsApp. It is realistic to suggest that such platforms should be harnessed for health communication during the pandemic. Yet, regulations to combat false information on these media are also urgently needed.

Development, piloting and evaluation of an app-supported psychosocial prevention intervention to strengthen participation in working life: a study protocol of a mixed-methods approach

INTRODUCTION

Rates of incapacity to work due to mental disorders have increased in many European countries. The consequences of persistent stress can impact individuals' physical and psychological well-being and gradually develop into chronic stress. Mental disorders or symptoms of burn-out syndrome can have severe consequences. Mental disorders leading to work incapacity significantly burden the health system. Prevention interventions can protect against burn-out, depression, anxiety and other mental health disorders. Digital health is a promising approach to increase the utilisation of effective prevention interventions. This mixed-methods study evaluates a newly developed app-supported psychosocial prevention intervention called 'RV Fit Mental Health' to strengthen participation in working life.

METHODS AND ANALYSIS

The study uses a three-stage parallel mixed-methods design. This study accompanies the development (stage 1), piloting (stage 2) and evaluation (stage 3) of the new intervention. Within the stages, there is a quantitative as well as a qualitative research strand. Employed persons with an incipient mental disorder will be included. Additionally, experts within the project or connected areas will be included. Quantitative data will be analysed using multifactorial variance analyses in a pre-post design. Qualitative data will be analysed using qualitative content analysis. The study is a comprehensive research approach to investigate the development, piloting and evaluation of an app-supported psychosocial app-based prevention intervention. The rigour of the study will be achieved through data triangulation.

ETHICS AND DISSEMINATION

All participants will receive detailed study information and give written informed consent before data collection. Ethical approval was obtained from the Technical University of Munich Ethics Committee. All data collection will follow all legislative rules regarding data protection, also following the Declaration of Helsinki. The study results will be disseminated in peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBERS

DRKS00030818 and DRKS00033080.

Prospective association of eHealth literacy and health literacy with physical activity among Chinese college students: a multiple mediation analysis

Background

The COVID-19 pandemic has decreased physical activity (PA) while increasing demand for electronic health resources. eHealth literacy (EHL) is expected to aid eHealth use and health promotion. EHL was raised on the grounds of health literacy (HL). This study explored the associations among EHL, HL, and PA in Chinese college students and identified mediating mechanisms in the EHL/HL-PA relationship.

Methods

An integrated social-cognitive model was proposed. A total of 947 Chinese college students (52.8% women, age = 19.87 ± 1.68 years) completed the three-wave data collection. Path analysis was performed.

Results

An adequate good-to-fit model was indicated. Perceived EHL (PEHL) was significantly associated with perceived HL (PHL) and HL performance (HLP); PHL was negatively related to HLP; PEHL was significantly associated with self-efficacy (SE) and social support (SS); PHL had a significant effect on SS but not SE; HLP significantly affected SS but not SE; SS and SE positively predicted intention (INT), which then predicted PA. SS mediated PEHL/PHL-INT links; SE mediated the PEHL-INT link; SS and INT jointly mediated PEHL/PHL/HLP-PA; SE and INT jointly mediated PEHL-PA.

Conclusion

Relationships among EHL, HL, and PA were explored with multiple mediating mechanisms identified. Differential SE and SS roles in EHL/HL-PA links suggest new mechanisms to inform EHL/HL intervention development.

COVID-19 and diet: efforts towards a balanced diet and sustainable nutrition among university students in Pakistan

Nutrition is an important aspect of a healthy lifestyle for all individuals, including adolescents. The objective of this cross-sectional descriptive survey study was to investigate university students' awareness of immunity enhancing foods, food nutritive values, and eating practices during the COVID-19 pandemic. A total of 839 university students from four different universities in Pakistan participated in the study from October 2021 to January 2022, 397 of which were male and 442 were female. A total of 419 students were studying in medical disciplines while 420 were non-medical students. The students had significant knowledge (p < 0.05) about COVID-19, and nutritional habits were seen in both medical and non-medical students. Results showed that medical students (n-201) were slightly more aware of immunity-enhancing foods and the nutritive values of foods compared to engineering students (n-79). However, eating practices were generally poorly adopted by all of the university students. Male and female students were not significantly different in their mean replies to questions on the nutritive value of food or in their eating habits. Healthy eating practices will aid university students in preventing illnesses connected to nutrition as well as enhancing their immune systems and nutritional well-being both during and post-pandemic. In light of these results, suggestions and implications for nutritional advice and education were explored.

Topics Included in Health Literacy Studies in Asia: A Systematic Review

The study aimed to review general and specific health literacy studies in different countries in Asia to understand the progress of health literacy researches in the region. English-published studies with quantitative measurements of health literacy were collected through a systematic search in PubMed, Cochrane Library, Embase, and Web of Science, without publication dates limitation. A total of 156 articles on general health literacy, oral, mental, disease-specific health literacy, and eHealth literacy were collected. General health literacy was the most covered topic in 89 articles, followed by eHealth Literacy. Health literacy studies have been conducted in 16 countries and have been increasingly concerned in most of the countries in Asia. China had the largest number of articles, followed by Taiwan. Four studies had participants from more than one country. Education, age, health status, incomes, and living/residential area were significantly associated with health literacy levels in 156 studies, with the prevalence of 55.8%, 28.2%, 20.5%, 17.9%, and 10.9%, respectively. Lower health literacy was related to poorer health outcomes or lower quality of life in 71 studies.

Respective roles of social deprivation, health literacy, and clinical factors for COVID-19: a case-control study in hospitalized patients

Introduction

To investigate the association between social deprivation and COVID-19 among hospitalized patients in an underprivileged department of the greater Paris area.

Methods

Individuals hospitalized for COVID-19 between March 1st and October 31, 2020, were included, matched on age and sex, and compared with patients hospitalized for any other reason with negative RT-PCR for SARS-CoV-2, through a case-control study. Clinical, socio-demographic characteristics, health literacy, and social deprivation, assessed by the EPICES score, were collected. Factors associated with COVID-19 in hospitalized patients were assessed using univariate and multivariate logistic regression models.

Results

69 cases and 180 controls were included. Participants were mostly men (N = 148: 59.4%) aged 65 or older (N = 109: 44.1%). Median EPICES score was 43.2 (IQR 29.4-62.9). EPICES score > 30.17 (precariousness threshold) was not significantly associated with COVID-19 in hospitalized patients (adjusted odds ratio (aOR) = 0.46; 95% Confidence Interval (CI) [0.21-1.01]). Advanced age, higher BMI, professional activity, home area of less than 25 m2 per person, and low health literacy, were significantly associated with COVID-19 in hospitalized patients.

Discussion

This study highlights probable risk factors for specific exposition in disadvantaged area: maintenance of professional activity, smaller home area, and low health literacy.

Research into the relationship between digital health literacy and healthy lifestyle behaviors: an intergenerational comparison

Introduction

Digital health literacy wields a pivotal role in individuals' health status in terms of seeking and choosing appropriate and accurate information, and useful services from a vast array of choices. This study is aimed at assessing the validity and reliability of the Turkish version of Digital Health Literacy Instrument (DHLI) and examining the relationship between DHL and the healthy lifestyle behaviors of participants from X, Y, and Z generations.

Methods

In this study, to conduct a cross-sectional web-based survey, an online self-report questionnaire was built, and a convenience sample with a snowball approach was used. The study was conducted among 1,274 respondents aged between 18 and 64 years. Data collection tools consisted of the Personal Information Form, Lifestyle Behavior Scale II (HLBS II), and DHLI. Cultural validation and psychometric testing of DHLI, exploratory factor analysis, confirmatory factor analysis, Cronbach's alpha test, and bivariate and multivariate regression analysis were used for statistical analysis.

Results

In the study, the Turkish version of the DHLI tool consisting of six dimensions proved to be valid and reliable, and deemed appropriate for use across all age groups. The average digital health literacy of the respondents was sufficient, but the mean of healthy lifestyle behavior scores was moderate. There was a positive significant relationship between the total mean scores of DHLI and HLBS. Among the subdimensions of DHLI, while the highest mean scores were in DHLI Reliability, DHLI Privacy, and DHLI Search, DHLI Navigation and DHLI Relevance showed the lowest mean scores. DHLI Reliability, DHLI Relevance, and DHLI Adding Content were statistically significant predictors of health-related behaviors of the respondents.

Conclusion

The most important feature and novelty of this study is that, although the DHLI scale has been widely translated for use in many countries, it has been translated and adapted to Turkish for the first time herein. The study offers crucial evidence about Generation X, Y, and Z's DHL level and its positive relationships with health-related behaviors. Therefore, the community and its partners should lead the way in empowering individuals to understand and use online information in an effective, secure, and health-promoting manner, along with governments.

Association between eHealth literacy, diabetic behavior rating, and burden among caregivers of children with type 1 diabetes: Cross-sectional survey study

OBJECTIVE

The purpose of this study was to clarify the relationship between eHealth literacy, diabetic behavior rating, and caregiving burden among caregivers of children with type 1 diabetes mellitus (T1DM).

METHODS

A questionnaire-based cross-sectional study of 143 primary caregivers of T1DM was conducted. Electronic health literacy was quantified using the Chinese version of the eHealth Literacy Scale (eHEALS). Their diabetic management behavior rating and caregiving burden were measured by Diabetes Behavior Rating Scale-Parent Version (DBRS-P) and Zarit Burden Interview (ZBI), respectively. Pearson correlation analysis was used to estimate the relationship between the above variables.

RESULTS

Only 54 (37.76%) caregivers qualified by eHEALS scale, with a total score of 30.07 ± 4.54 out of 40. A positive correlation between DRBS-P scores and the scores of eHEALS (Pearson correlation coefficient r = 0.226, P = 0.007) and a negative correlation between ZBI and eHEALS scores (r = -0.166, P = 0.047) were observed.

CONCLUSIONS

The eHealth literacy level of caregivers of children with T1DM in China remains to be improved. Caregivers with higher eHealth literacy had better diabetic management behaviors and less caregiving burden.

IMPLICATIONS TO PRACTICE

This study suggests that hierarchical electronic health-based interventions should be designed according to the different levels of eHealth literacy of individuals, to enhance the ability of caregivers with different eHealth literacy levels to fully utilize eHealth resources to improve their daily disease management skills and reduce their burden when caring for T1DM children. In addition, improving eHealth literacy of caregivers for children with T1DM can be one of the important ways to enhance the effectiveness of electronic health-based programs designed for them.

Determinants and outcomes of eHealth literacy in healthy adults: A systematic review

BACKGROUND

eHealth has shown many benefits in health promotion and disease prevention. For engaging in and taking advantage of eHealth, eHealth literacy is essential. This systematic review aims to summarise and examine the existing evidence on determinants and outcomes of eHealth literacy in healthy adults.

METHODS

We searched the relevant peer-reviewed articles published in English in six databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and ProQuest. The inclusion criteria of the review were: 1) studies examining 'eHealth literacy', which refers to the ability to search, select, judge and apply online health information to address or solve health problems and to improve wellbeing; 2) the type of study included observational and experimental studies, mixed method studies or qualitative studies; 3) the participants were healthy adults; 4) the main outcomes were the determinants (i.e. influencing or associated factors) and outcomes (i.e. benefits and disadvantages) of eHealth literacy. Articles were assessed by two reviewers using the Joanna Briggs Institute critical appraisal tool. A conceptual model to map the determinants and outcomes of eHealth literacy in healthy adults into the non-modifiable, individual, social and community networks and structural layers was developed to classify the identified determinants and outcomes.

RESULTS

Forty-four studies were included in this review, of which 43 studies were cross-sectional and one was qualitative. eHealth literacy determinants included age, sex, literacy factors, socioeconomic factors and language. eHealth literacy outcomes included better general health promotion behavior, COVID-19 preventive behaviors, psychological wellbeing, social support, self-rated health and health service utilisation.

CONCLUSIONS

Our results showed that eHealth literacy has multi-layered determinants and positive outcomes. Different strategies at different policy levels are needed to improve the eHealth literacy levels of healthy adults.

Digital literacy as a new determinant of health: A scoping review

INTRODUCTION

Harnessing new digital technologies can improve access to health care but can also widen the health divide for those with poor digital literacy. This scoping review aims to assess the current situation of low digital health literacy in terms of its definition, reach, impact on health and interventions for its mitigation.

METHODS

A comprehensive literature search strategy was composed by a qualified medical librarian. Literature databases [Medline (Ovid), Embase (Ovid), Scopus, and Google Scholar] were queried using appropriate natural language and controlled vocabulary terms along with hand-searching and citation chaining. We focused on recent and highly cited references published in English. Reviews were excluded. This scoping review was conducted following the methodological framework of Arksey and O'Malley.

RESULTS

A total of 268 articles were identified (263 from the initial search and 5 more added from the references of the original papers), 53 of which were finally selected for full text analysis. Digital health literacy is the most frequently used descriptor to refer to the ability to find and use health information with the goal of addressing or solving a health problem using technology. The most utilized tool to assess digital health literacy is the eHealth literacy scale (eHEALS), a self-reported measurement tool that evaluates six core dimensions and is available in various languages. Individuals with higher digital health literacy scores have better self-management and participation in their own medical decisions, mental and psychological state and quality of life. Effective interventions addressing poor digital health literacy included education/training and social support.

CONCLUSIONS

Although there is interest in the study and impact of poor digital health literacy, there is still a long way to go to improve measurement tools and find effective interventions to reduce the digital health divide.

Moderating Effect of eHealth Literacy on the Associations of Coronaphobia With Loneliness, Irritability, Depression, and Stigma in Chinese Young Adults: Bayesian Structural Equation Model Study

BACKGROUND

The COVID-19 pandemic has led to an increase in known risk factors for mental health problems. Although medical information available through the internet and smartphones has greatly expanded, people's ability to seek, eschew, and use reliable web-based medical information and services to promote their mental health remains unknown.

OBJECTIVE

This study aims to explore the associations between coronaphobia and 4 frequently reported mental health problems, loneliness, irritability, depression, and stigma, during the COVID-19 pandemic and to assess the moderating effects of eHealth literacy (eHL) on the adjustment of these relationships in Chinese young adults.

METHODS

The data used in this study were collected from a web-based survey of the general Chinese population, aged between 18 and 30 years, conducted in China between December 2022 and January 2023. A nonprobability snowball sampling method was used for data collection. A Bayesian structural equation model (BSEM) using parameter expansion was used to estimate the moderating effect of eHL on the relationship between coronaphobia and psychological problems. The posterior mean and 95% highest density intervals (HDIs) were estimated.

RESULTS

A total of 4119 participants completed the questionnaire and provided valid responses. Among them, 64.4% (n=2653) were female and 58.7% (n=2417) were rural residents. All measures showed statistically significant but minor-to-moderate associations (correlation coefficients ranged from -0.04 to 0.65). Significant heterogeneity was observed between rural and urban residents at the eHL level, and coronaphobia was observed. The BSEM results demonstrated that eHL was a significant moderator in reducing the negative effects of coronaphobia on loneliness (posterior mean -0.0016, 95% HDI -0.0022 to -0.0011), depression (posterior mean -0.006, 95% HDI -0.0079 to -0.004), stigma (posterior mean -0.0052, 95% HDI -0.0068 to -0.0036), and irritability (posterior mean -0.0037, 95% HDI -0.0052 to -0.0022). The moderating effects of eHL varied across the rural and urban subsamples.

CONCLUSIONS

Using BSEM, this study demonstrated that improving eHL can significantly mitigate the negative effects of coronaphobia on 4 COVID-19-related mental health problems in Chinese young adults. Future eHL initiatives should target rural communities to ensure equal access to information and resources that can help protect their mental health during the pandemic.

Sociodemographic determinants of digital health literacy: A systematic review and meta-analysis

INTRODUCTION

Differences in digital health literacy levels are associated with a lack of access to digital tools, usage patterns, and the ability to effectively use digital technologies. Although some studies have investigated the impact of sociodemographic factors on digital health literacy, a comprehensive evaluation of these factors has not been conducted. Therefore, this study sought to examine the sociodemographic determinants of digital health literacy by conducting a systematic review of the existing literature.

METHODS

A search of four databases was conducted. Data extraction included information on study characteristics, sociodemographic factors, and the digital health literacy scales used. Meta-analyses for age and sex were conducted using RStudio software with the metaphor package.

RESULTS

A total of 3922 articles were retrieved, of which 36 were included in this systematic review. Age had a negative effect on digital health literacy (B = -0.05, 95%CI [-0.06; -0.04]), particularly among older adults, whereas sex appeared to have no statistically significant influence among the included studies (B = - 0.17, 95%CI [-0.64; 0.30]). Educational level, higher income, and social support also appeared to have a positive influence on digital health literacy.

DISCUSSION

This review highlighted the importance of addressing the digital health literacy needs of underprivileged populations, including immigrants and individuals with low socioeconomic status. It also emphasizes the need for more research to better understand the influence of sociodemographic, economic, and cultural differences on digital health literacy.

CONCLUSIONS

Overall, this review suggests digital health literacy is dependent on sociodemographic, economic, and cultural factors, which may require tailored interventions that consider these nuances.

How level of understanding and type of used sources relate to adherence to COVID-19 public health measures in Canada

Previous studies have highlighted the importance of promoting health literacy and minimizing misinformation to encourage higher adherence to key public health measures during the COVID-19 pandemic. This study explores how one's self-reported understanding of information and types of sources used to get information regarding COVID-19 can hinder adherence to public health measures implemented by the Canadian government. Data was collected following a longitudinal design of 11 time points for April 2020 to April 2021. The sub-sample used for this study included 2659 Canadians who completed the survey for at least four time points. Using Latent Class Growth Analysis, we modelled typical trajectories of adherence to three key public health measures: staying home, social distancing and mask wearing. Overall, a lower level of understanding was associated with lower adherence trajectories to public health measures, and vice-versa. Adjusted odds ratio (AOR) showed that the higher the level of understanding, the higher were the chances of following a high adherence trajectory. The type of used sources also showed a significant statistical association with adherence trajectories for social distancing and staying home (AOR: between 1.1 and 3.4). These results are discussed considering future policy implications.

The Relationship between COVID-19 Exposure Risk and Burnout in Prehospital Emergency Medical Technicians

Introduction

Exposure to coronavirus disease 2019 (COVID-19) has caused many physical and psychological effects on front-line healthcare workers (HCWs). This study aimed to assess the relationship between the exposure risk to COVID-19 disease and burnout in prehospital emergency medical technicians (EMTs).

Methods

In this correlational study, 335 prehospital EMTs were selected by random sampling method from the 49 stations of emergency medical services in the northwest of Iran. Data were collected using a questionnaire developed by the world health organization for the risk assessment and management of exposure of health care workers to COVID-19. Moreover, Pines burnout measure was used for the assessment of participants' burnout. Data were analyzed using SPSS version 13.

Results

Results showed that 30.7 % of prehospital EMTs had a high burnout score against COVID-19 disease. The prehospital EMTs who had a high occupational exposure risk experienced a high risk of burnout (P=0.03). The results of the linear regression analysis showed that prehospital EMTs who had a low exposure risk of COVID-19 had a low burnout score (β=-9.30; P<0.001), and those who had less than 10 years of work experience showed less burnout (β=-10.54; P<0.001).

Conclusion

According to the results, the exposure risk to COVID-19 increases the prehospital EMT's burnout. As a result, reducing the exposure risk to COVID-19 by providing adequate access to personal protective equipment (PPE), development of training and following standards and protocols can be effective in controlling burnout in HCWs.

Medical Students' and Radiology Technician Trainees' eHealth Literacy and Hygiene Awareness-Asynchronous and Synchronous Digital Hand Hygiene Training in a Single-Center Trial

Next to the known nosocomial infections, the COVID-19 pandemic was an example for the need for the immediate implementation of functioning hygiene concepts and knowledge transfer. The aim of this study was to evaluate the self-assessment of ehealth literacy in terms of finding, using and critically evaluating health information and theoretical and practical hygiene awareness on a voluntary participation basis at the Jena University Hospital in 2022. The well-established and validated eHEALS and WHO questionnaire on hand hygiene (HH) knowledge for healthcare workers was completely filled by 204 participants (191 medical students; 13 healthcare trainees). In a second step, after the questionnaire, 77 participants completed additional asynchronous, digitally guided self-training using DesiCoach 2Go. In the end, a synchronous hand disinfection was carried out in the hospital using Visirub, by separating it into a group without (n = 191; with and without HH questionnaire) and a group with (n = 31; with HH questionnaire) previously completed self-training. For the eHL, the respondents tended to have a positive self-assessment of finding, using and critically evaluating health information. The voluntary participants of the practical hand disinfection who had received self-training were able to achieve significantly better results (p = 0.0047), resulting in fewer wetting gaps in a subsequent performance with Visirub than those who had not received digital self-training. The survey showed that healthcare-related participants belonging to the "digital native" generation have above-average knowledge on HH and profit by digitally guided self-training.

Digital Healthy Diet Literacy and Fear of COVID-19 as Associated with Treatment Adherence and Its Subscales among Hemodialysis Patients: A Multi-Hospital Study

Treatment adherence (TA) is a critical issue and is under-investigated in hemodialysis patients. A multi-center study was conducted from July 2020 to March 2021 on 972 hemodialysis patients in eight hospitals in Vietnam to explore the factors associated with TA during the COVID-19 pandemic. Data were collected, including socio-demographics, an End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), 12-item short-form health literacy questionnaire (HLS-SF12), 4-item digital healthy diet literacy scale (DDL), 10-item hemodialysis dietary knowledge scale (HDK), 7-item fear of COVID-19 scale (FCoV-19S), and suspected COVID-19 symptoms (S-COVID19-S). Bivariate and multivariate linear regression models were used to explore the associations. Higher DDL scores were associated with higher TA scores (regression coefficient, B, 1.35; 95% confidence interval, 95%CI, 0.59, 2.12; p = 0.001). Higher FCoV-19S scores were associated with lower TA scores (B, -1.78; 95%CI, -3.33, -0.24; p = 0.023). In addition, patients aged 60-85 (B, 24.85; 95%CI, 6.61, 43.11; p = 0.008) with "very or fairly easy" medication payment ability (B, 27.92; 95%CI, 5.89, 44.95; p = 0.013) had higher TA scores. Patients who underwent hemodialysis for ≥5 years had a lower TA score than those who received <5 years of hemodialysis (B, -52.87; 95%CI, -70.46, -35.28; p < 0.001). These findings suggested that DDL and FCoV-19S, among other factors, should be considered in future interventions to improve TA in hemodialysis patients.

The relationship between health literacy, knowledge, fear, and COVID-19 prevention behavior in different age groups: A Cross-sectional online study in Japan

BACKGROUND

Coronavirus disease (COVID-19) prevention behaviors have become part of our lives. COVID-19 prevention behaviors have been reported to be associated with health literacy, knowledge, and fear. However, COVID-19 pandemic may be characterized by different situations in each age group. Since the severity of the infection and the means of accessing information differ by age group, the relationship between health literacy, knowledge, and fear may differ. Thus, factors that promote preventive behavior may differ by age group. Clarifying the factors related to prevention behaviors by age may help us consider age-appropriate promotion.

OBJECTIVE

This study aimed to examine the association between COVID-19 prevention behaviors and health literacy, COVID-19 knowledge, and fear of COVID-19 by age group.

METHODS

A cross-sectional study was conducted with 512 participants aged 20-69 years, recruited from an online sample from November 1 to 5, 2021. An online self-administered questionnaire was used to obtain the participants' characteristics, COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19. The Kruskal-Wallis rank-sum test was used to compare the scores of each item for each age group. The relationships among COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19 were analyzed using Spearman's rank correlation analysis. Additionally, multiple regression analysis was conducted with COVID-19 prevention behaviors as the dependent variable; health literacy, COVID-19 knowledge, and fear of COVID-19 as independent variables; and sex and age as adjustment variables.

RESULTS

For all participants, correlation and multiple regression analyses revealed that prevention behaviors were significantly related to health literacy, COVID-19 knowledge, and fear of COVID-19 (p<.001). Additionally, correlation analysis revealed that fear of COVID-19 was significantly negatively correlated with COVID-19 knowledge (p<.001). There was also a significant positive correlation between health literacy and COVID-19 knowledge (p<.001). Furthermore, analysis by age revealed that the factors associated with prevention behaviors differed by age group. In the age group-20-29, 30-39, and 40-49 years, multiple factors, including health literacy, influenced COVID-19 prevention behaviors, whereas in the age group-50-59 and 60-69 years, only fear of COVID-19 had an impact.

CONCLUSIONS

The results of this study revealed that the factors associated with prevention behaviors differ by age. Age-specific approaches should be considered to prevent infection.

Asian American Vaccination, Testing, and Other Healthcare Knowledge & Behaviors during COVID-19, A Systematic Review

Novel COVID-19 variants continue to endanger global public health. Increasing COVID-19 vaccination, healthcare-related preventative behaviors, and general knowledge rates are all critical in halting COVID-19 spread. We evaluated Asian American COVID-19 healthcare-related behaviors and knowledge, due to the dearth of knowledge in this area and the unique social factor of COVID-19 related discrimination; discriminatory acts during the pandemic may play a role in COVID-19 related behavior adherence. Following PRISMA-P protocol, we conducted a systematic review. The search strategy combined synonyms of health-care behaviors and knowledge. Reviewers synthesized key themes across articles and assessed studies utilizing modified Newcastle-Ottawa criteria. Of the 2,518 articles, 32 were selected. Asian Americans reported greater COVID-19 vaccination willingness and decreased COVID-19 testing relative to other racial groups. Common COVID-19 vaccination concerns included vaccination side effects, long-term safety, and distrust of COVID-19 information sources. Asian Americans had high COVID-19 preventative behavior rates including mask-wearing, handwashing, and social isolation compared to other ethnic groups. Asian Americans, conversely, had lower COVID-19-related healthcare knowledge and telemedicine adoption levels relative to other participants. This systematic review informs public health officials and clinicians of COVID-19 related healthcare knowledge and behaviors in the Asian American population. Equipped with this knowledge, public health officials can better target messaging about vaccine safety concerns to the Asian American community and recognize the importance of tailoring COVID-19 educational materials to the heterogeneous Asian American subpopulations. This systematic review also provides insight into the unique telemedicine challenges physicians may face when engaging with Asian American patients.

Changes in Adults' Eating Behaviors During the Initial Months of the COVID-19 Pandemic: A Narrative Review

Factors such as regulations and health concerns shifted daily habits, including eating behaviors, during the early months of the coronavirus disease 2019 (COVID-19) pandemic. This comprehensive narrative review synthesizes research on eating behavior changes during the early months of the pandemic (February to June 2020), including changes in amount, rate, and timing of food consumption, types and healthfulness of foods consumed, the occurrence of other specified eating behaviors (eg, restrained eating or binging), and reasons for eating (eg, stress or cravings), among adults. A literature search using three EBSCOhost databases and Google Scholar was conducted to identify relevant articles made available in 2020. A total of 71 articles representing 250,715 individuals from more than 30 countries were reviewed. Findings show eating behaviors changed little during the early COVID-19 pandemic for most participants. Among those whose eating behaviors changed, increases in both intake and frequency of eating meals and snacks were more common than decreases. Findings on timing of eating and healthfulness of food consumed showed mixed results. However, when changes occurred in the type of food consumed, increases were more common for snacks, homemade pastries, white bread/pasta, legumes, and fruits/vegetables; decreases were more common for meats, seafood/fish, frozen foods, fast food, dark breads/grains, and dark leafy green vegetables. During the pandemic, binging, uncontrolled eating, and overeating increased, meal skipping decreased, and restrictive eating had mixed findings. Changes in factors such as emotions and mood (eg, depression), cravings, and environmental factors (eg, food insecurity) were related to changes in eating behaviors. Findings can inform clinical practitioners in efforts to mitigate disruptions to normal, healthy eating patterns among adults both in and outside of global health catastrophes.

The association among eHealth literacy, depressive symptoms and health-related quality of life among older people: A cross-section study

BACKGROUND

eHealth literacy can facilitate the uptake of benefits of health for older persons. The aim of this study was to examine the association of eHealth literacy with depression, health-related quality of life (HRQoL) among older persons.

METHODS

A survey of 6183 participants (aged 60 years and above) from 17 communities was conducted in June 2019. Participants answered questions related to basic information, eHealth literacy scale (eHEALS), geriatric depression scale and the short-form health survey (SF-36). Mediation model and a linear regression analysis were performed to explore the association between the eHEALS scores and related factors.

RESULTS

The mean score of eHEALS was 21.17 (SD = 8.25). eHEALS was significant higher in men, those with living in the city, those with high educated and stable income and those with living with children, as compared to their counterparts, respectively. Moreover, chronic diseases and depressive symptoms negatively associated with eHEALS, while actively obtaining health information and physical activity positively influenced eHEALS. Furthermore, depressive symptoms had direct and indirect effects on HRQoL, as mediated by eHealth literacy.

CONCLUSIONS

The eHEALS acts as a mediator between depressive symptoms and HRQoL. As eHealth literacy is a protector for older people, efforts to improve the older persons' eHealth literacy could help to maintain health status. Therefore, healthcare providers formulate effective programs to improve eHealth literacy for older persons, which can bring benefits for health ageing.

Cut-off value of the eHEALS score as a measure of eHealth skills among rural residents in Gansu, China

Background

In this study, our aim was to quantify eHealth literacy and determine a cut-off value for eHEALS scores that signifies adequate eHealth literacy among rural residents in Gansu, China.

Methods

This cross-sectional investigation encompassed 18 rural areas across three cities-Lanzhou, Wuwei, and Dingxi-in Gansu. A total of 451 residents were recruited and underwent evaluations for both eHealth literacy and eHealth skills, utilizing the eHEALS and self-constructed tasks, respectively. A receiving operator characteristic curve was plotted with eHealth skills as the dependent variable and eHealth literacy levels as the independent variable, aiming to determine a cut-off value for eHEALS indicating adequate eHealth literacy and evaluate its predictive capacity.

Results

Among the 451 respondents, 10.9% did not possess a personal electronic device with Internet access, while 6.4% owned but had never used them. Within the remaining 373 residents, the mean eHealth literacy score was 25.85 (SD:10.93), item scores ranged from 3.12 (SD:1.45) to 3.42 (SD:1.60). Completion rates for three eHealth skills varied from 39.1% to 59.8%. The cut-off value was 29.5 determined by the Youden index. The area under the receiver operating curve was 0.829, with a sensitivity of 86.7%, and a specificity of 66.8%.

Conclusions

Our findings emphasized that eHealth literacy among rural residents remains at a low level. Moreover, we identified a cut-off value of 29.5 for eHEALS scores that signifies adequate eHealth literacy within this demographic.

Associations between Depression and Self-Reported COVID-19 Symptoms among Adults: Results from Two Population-Based Seroprevalence Studies in Switzerland

(1) Mental health may modulate the perceived risk of SARS-CoV-2 infection. However, it is unclear how psychological symptoms may distort symptom perception of COVID-19 and SARS-CoV-2 infection. We assessed whether depressive symptoms predicted self-reported COVID-19 symptoms, independently of serologically confirmed SARS-CoV-2 infection. (2) Participants (aged 20-64) in the Geneva (N = 576) and Ticino (N = 581) Swiss regions completed the Patient Health Questionnaire before being tested for anti-SARS-CoV-2 IgG antibodies and recalled COVID-19-compatible symptoms on two occasions: April-July 2020 (baseline), and January-February 2021 (follow-up). We estimated prevalence ratios for COVID-19 symptoms by depression scores in interaction with serological status. (3) At baseline, in Geneva, higher depression predicted higher probability of reporting systemic, upper airways, and gastro-intestinal symptoms, and fever and/or cough; in Ticino, higher depression predicted systemic, upper airways, and gastro-intestinal symptoms, fever and/or cough, dyspnea, and headache. At follow-up, in Geneva, higher depression predicted higher probability of reporting systemic symptoms and dyspnea; in Ticino, higher depression predicted higher probability of reporting systemic and upper airways symptoms, dyspnea and headache (all p values < 0.05). (4) We found positive associations between depressive symptoms and COVID-19-compatible symptoms, independently of seropositivity. Mental wellbeing has relevant public health implications because it modulates self-reported infection symptoms that inform testing, self-medication, and containment measures, including quarantine and isolation.

Impact of the eHealth literacy, knowledge and attitudes on COVID-19 prevention behavior among residents in the second year of the COVID-19 pandemic: A cross-sectional study in Anhui Province, China

Objective

The pandemic of COVID-19 continues to challenge people's health worldwide. In the second year of the pandemic, adherence to COVID-19 preventive behavior is key to continuing efforts to overcome the epidemic. This study aims to assess the COVID-19-related knowledge, attitude, and prevention behavior (KAP) and electronic health literacy (eHealth literacy) among Anhui residents in China.

Methods

From January 30 to March 27, 2021, the cross-sectional study was performed among Anhui residents in China, including 16 cities. An online survey was adopted to assess KAP regarding COVID-19, and eHealth, involving a total of 2,122 citizens. Following informed consent, residents were recruited by convenience sampling. Frequencies and proportions were calculated. Additionally, Mann-Whitney U tests were used to analyze the variables. Independent predictors of preventive behavior of COVID-19 were ascertained using a multivariable logistic regression model.

Result

Residents demonstrated good knowledge, positive attitudes, acceptable practices, and good eHealth literacy. Online news and WeChat are the main health information resources. Citizens who had good knowledge, a positive attitude, good eHealth, and did not participate in the online lectures or training COVID-19 were more likely to take preventive measures. Those with poor health, who were male, did not have family members working in health care facilities, and did not work in a face-to-face environment were less likely to take precautions. Compared with a master's degree and above, participants with middle school education level and below took preventive behavior sometimes. Residents who browse the COVID-19 webpage <15 min weekly seldom took preventive actions.

Conclusion

The study showed that in the second year of the COVID-19 pandemic, Chinese residents had adequate knowledge of COVID-19, positive attitudes, appropriate preventive practices, and basic eHealth literacy. To prevent the rebound of the COVID-19 epidemic, the government and health agencies should inform citizens concerning which information channels or websites to use and assist the underprivileged population who lacks basic infrastructure. In addition, increasing the level of knowledge and attitude, enhancing eHealth literacy and the Health Belief Model (HBM), and implementing the Health Code were seen as ways to reinforce adherence to preventive behavior. Targeting men, implementing public awareness campaigns, community engagement strategies, and health education programs are recommended.

Health Literacy in Health Professionals Two Years into the COVID-19 Pandemic: Results From a Scoping Review

BACKGROUND

Health literacy (HL) is an important public health goal but also crucial in individuals providing medical care. During the pandemic, COVID-19-related HL of health professionals (HPs) has gained momentum; it helps to minimize the risk of self-infection, on the one hand, and to protect patients and relatives from infection, on the other. However, comprehensive information about the levels of individual pandemic-related HL in HPs is scarce.

OBJECTIVE

In this paper, we aimed at describing the extent of existing research on HL (concept) conducted in HPs (population) in the COVID-19 pandemic (context). The review intends to map the literature on HL in HPs, thereby highlighting research gaps.

METHODS

This scoping review was conducted using the methodology of Khalil et al (2016). This involved an electronic search of PubMed (MEDLINE) and PsycInfo and a hand search. The included studies were iteratively examined to find items representing the four HL dimensions of access, understand, critically appraise, and apply COVID-19-related health information.

RESULTS

The search yielded a total of 3875 references. Only 7 (1.4%) of the 489 included studies explicitly stated to have addressed HL; 2 (0.4%) studies attempted to develop an instrument measuring COVID-19-related HL in HPs; 6 (1.2%) studies included an HL measure in an observational survey design. Of the remainder, the vast majority used a cross-sectional design. The dimensions access and understand were frequently examined, but few studies looked at the dimensions critical appraisal or apply. Very few studies reported an intervention aiming to improve a COVID-19-related HL outcome.

CONCLUSIONS

High levels of COVID-19-related HL among HPs are necessary to ensure not only safe practice with necessary protection of HPs, their patients, and relatives, but also successful care delivery and subsequently improved health outcomes in the long term. To advance our understanding of how high COVID-19-related HL manifests itself in HPs, how it relates to health outcomes, and how it can be improved, more research is necessary.

TRIAL REGISTRATION

Open Science Framework dbfa5; https://osf.io/dbfa5/.

Food Delivery Drivers' Health Literacy Regarding COVID-19 Prevention and Protective Behaviors During the COVID-19 Pandemic: Cross-sectional Survey in Southern Thailand

Background

In 2019, COVID-19 spread worldwide, causing a pandemic that has posed unprecedented challenges and pressure for health systems and economies. Food delivery services have become an important medium for consumer food purchases to limit human-to-human contact. Thus, delivery drivers are at high risk of exposure to COVID-19 infection at work. To the best of our knowledge, no studies have analyzed the dimensions of health literacy (HL) regarding COVID-19 prevention in this population.

Objective

This study aims to explore the HL status toward COVID-19 prevention and its associated factors among food delivery drivers in southern Thailand.

Methods

Following a cross-sectional survey from July to August 2021, Thai food delivery drivers in the upper-south and lower-south regions of southern Thailand were recruited to participate during the compulsory COVID-19 lockdown. An online structured questionnaire was administered verbally and recorded by the interviewer. Univariate and multivariate linear regressions were used to explore independently associated factors.

Results

Of 401 drivers, 291 (72.6%) were men. The median age was 31 years (range 19-64 years). The median number of months working as a driver was 12 months, and the median number of working hours was 9 hours per day. The median number of daily food orders was 20, while the median daily income was Thai baht (THB) 600 (US $15.90). Social media (Facebook and Line) was a common source of health information. The most common information required was about the COVID-19 vaccine, medications, and treatment. Most drivers (285/401, 71.1%) had excellent HL levels regarding COVID-19 prevention. Only the practical application of information was statistically correlated with behavior (r=0.38, P<.001). Drivers in the lower south of Thailand were more likely to have excellent HL than other drivers (β=7.03, P<.001). Those who frequently accessed information through YouTube (β=–2.17, P=.01) and relatives (β=–4.19, P<.001) were less likely to have excellent HL levels.

Conclusions

Understanding HL among food delivery drivers would be useful for planning effective interventions that target this population. Conventional health education through social media alone may not be effective at educating people about COVID-19 prevention. Information literacy skills could determine individuals’ HL and drivers’ behaviors.

Fear of COVID-19, healthy eating behaviors, and health-related behavior changes as associated with anxiety and depression among medical students: An online survey

Background

Medical students' health and wellbeing are highly concerned during the COVID-19 pandemic. This study examined the impacts of fear of COVID-19 (FCoV-19S), healthy eating behavior, and health-related behavior changes on anxiety and depression.

Methods

We conducted an online survey at 8 medical universities in Vietnam from 7th April to 31st May 2020. Data of 5,765 medical students were collected regarding demographic characteristics, FCoV-19S, health-related behaviors, healthy eating score (HES), anxiety, and depression. Logistic regression analyses were used to explore associations.

Results

A lower likelihood of anxiety and depression were found in students with a higher HES score (OR = 0.98; 95%CI = 0.96, 0.99; p = 0.042; OR = 0.98; 95%CI = 0.96, 0.99; p = 0.021), and in those unchanged or more physical activities during the pandemic (OR = 0.54; 95%CI = 0.44, 0.66; p < 0.001; OR = 0.44; 95%CI = 0.37, 0.52; p < 0.001) as compared to those with none/less physical activity, respectively. A higher likelihood of anxiety and depression were reported in students with a higher FCoV-19S score (OR = 1.09; 95%CI = 1.07, 1.12; p < 0.001; OR = 1.06; 95%CI = 1.04, 1.08; p < 0.001), and those smoked unchanged/more during the pandemic (OR = 6.67; 95%CI = 4.71, 9.43; p < 0.001; OR = 6.77; 95%CI = 4.89, 9.38; p < 0.001) as compared to those stopped/less smoke, respectively. In addition, male students had a lower likelihood of anxiety (OR = 0.79; 95%CI = 0.65, 0.98; p = 0.029) compared to female ones.

Conclusions

During the pandemic, FCoV-19S and cigarette smoking had adverse impacts on medical students' psychological health. Conversely, staying physically active and having healthy eating behaviors could potentially prevent medical students from anxiety and depressive symptoms.

Lockdown support, trust and COVID-19 conspiracy beliefs: Insights from the second national lockdown in France

Due to the COVID-19 pandemic, restrictive sanitary measures such as lockdowns have been implemented all around the world. Based on a representative sample of the population collected through an online cross-sectional survey, the goal of the study was to investigate the factors associated with lockdown agreement in France during the second general lockdown of fall 2020. More specifically, we aimed to investigate how trust in the government and COVID-19 conspiracy beliefs influenced lockdown agreement. Trust in the authorities and low adherence to conspiracy beliefs appeared as strong predictors of lockdown acceptance among our sample. Using a mediation analysis, we highlighted a significant indirect effect of trust in the authorities on lockdown agreement through the adherence to conspiracy beliefs: low level of trust translated into higher odds to believe in COVID-19 misinformation which in turn decreased lockdown support. The double effect of trust on lockdown agreement, both directly and indirectly, underlines the importance of careful communication from the government around decisions related to COVID-19 mitigation measures in order not to deteriorate even more the low level of trust in the health action of the government. The fight against false information also appears of the utmost importance to increase the population adherence to public authorities’ recommendations.

Body mass index, body fat percentage, and visceral fat as mediators in the association between health literacy and hypertension among residents living in rural and suburban areas

Background

Hypertension is a major cause of death and disability worldwide. Enhancing health literacy (HL) may help to alleviate the risk of hypertension and its burden. However, evidence on the association between HL and hypertension and potential mechanisms remain to be explored.

Objectives

This study examined the association between HL and hypertension; and explored whether body mass index (BMI), body fat percentage (PBF), and visceral fat (VF) were mediators of this association in people who resided in rural and suburban areas in Vietnam.

Methods

A cross-sectional survey was conducted from 1st July to 31st December 2019, involving 1655 residents and exploring participants' sociodemographic characteristics, HL, health-related behaviors, comorbidities, body composition, and blood pressure (BP). People with systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or using antihypertensive medication were classified as having hypertension. Multiple logistic regression and mediation analyses were used to explore associations.

Results

The hypertension prevalence was 41.9% (694/1,655). In adjusted models, a higher HL score was associated with a lower hypertension likelihood (OR = 0.96; 95%CI = 0.95–0.97; p < 0.001). Factors associated with a higher odd of hypertension were overweight/obese (OR = 1.69; 95%CI = 1.24–2.29; p = 0.001), high PBF (OR = 2.35; 95%CI = 1.85–2.99; p < 0.001), and high VF (OR = 2.27; 95%CI = 1.63–3.16; p < 0.001). Notably, PBF significantly mediated the association between HL and hypertension (indirect effect, OR = 0.99; 95%CI = 0.98–0.99; p = 0.009; percent mediated = 8.56%). The mediating roles of BMI and VF were not found.

Conclusion

The prevalence of hypertension was relatively high. People with better HL were less likely to have hypertension. The association between HL and hypertension was partially explained by PBF. Strategic approaches are required to improve people's HL and body fat which further help to manage hypertension in rural and suburban areas.

Digital Health Competencies Among Health Care Professionals: Systematic Review

Background

Digitalization is not fully implemented in clinical practice, and several factors have been identified as possible barriers, including the competencies of health care professionals. However, no summary of the available evidence has been provided to date to depict digital health competencies that have been investigated among health care professionals, the tools used in assessing such competencies, and the effective interventions to improve them.

Objective

This review aims to summarize digital health competencies investigated to date and the tools used to assess them among health care professionals.

Methods

A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was performed. The MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Scopus databases were accessed up to September 4, 2021. Studies assessing digital health competencies with quantitative designs, targeting health care professionals, and written in English were included. The methodological quality of included studies was evaluated using the Joanna Briggs Institute tools.

Results

A total of 26 studies, published from 1999 to 2021, met the inclusion criteria, and the majority were cross sectional in design, while only 2 were experimental study designs. Most studies were assessed with moderate to low methodological quality; 4 categories and 9 subcategories of investigated digital health competencies have been identified. The most investigated category was “Self-rated competencies,” followed by “Psychological and emotional aspects toward digital technologies,” “Use of digital technologies,” and “Knowledge about digital technologies.” In 35% (9/26) of the studies, a previously validated tool was used to measure the competencies assessed, while others developed ad hoc questionnaires.

Conclusions

Mainly descriptive studies with issues regarding methodology quality have been produced to date investigating 4 main categories of digital health competencies mostly with nonvalidated tools. Competencies investigated might be considered while designing curricula for undergraduate, postgraduate, and continuing education processes, whereas the methodological lacks detected might be addressed with future research. There is a need to expand research on psychological and emotional elements and the ability to use digital technology to self-learn and teach others.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42021282775; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282775

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.

eHealth Literacy and its Associated Factors Among Health Professionals During the COVID-19 Pandemic in Resource-Limited Settings: Cross-sectional Study

Background

The COVID-19 pandemic has wreaked havoc on health care systems and governments worldwide. Although eHealth literacy is acknowledged as a critical component of public health, it was overlooked during the pandemic. To assist patients and their families, health professionals should be knowledgeable about online health information resources and capable of evaluating relevant online information. In a resource-constrained situation, the level of eHealth literacy among health professionals is not well documented.

Objective

The aim of this study was to assess the eHealth literacy level and its associated factors among health professionals working in Amhara regional state teaching hospitals, Ethiopia.

Methods

A self-administered questionnaire was used in an institutional-based cross-sectional study design. Descriptive statistics were calculated to describe eHealth literacy statements and key variables using SPSS v.24. Bivariable and multivariable logistic regression models were fit to identify factors related to eHealth literacy. Variables with P<.05 were declared to be statistically significant predictors.

Results

A total of 383 participants completed and returned the questionnaire with a response rate of 90.5%. Health professionals demonstrated a moderate level of eHealth literacy (mean 29.21). Most of the professionals were aware of the available health resources located on the internet, and know how to search and locate these resources. However, they lack the ability to distinguish high-quality health resources from low-quality resources. Factors that were significantly associated with eHealth literacy were computer access, computer knowledge, perceived ease of use, and perceived usefulness of eHealth information resources.

Conclusions

It is crucial to provide training and support to health care workers on how to find, interpret, and, most importantly, evaluate the quality of health information found on the internet to improve their eHealth literacy level. Further research is needed to explore the role of eHealth literacy in mitigating pandemics in developing countries.

Association between health literacy and COVID-19 prevention behaviors among pregnant and postpartum women

OBJECTIVE

To investigate the association between health literacy and COVID-19 prevention behaviors among pregnant and postpartum women in Japan.

METHODS

In this cross-sectional, web-based, self-reported questionnaire survey, we investigated the association between health literacy and COVID-19 prevention behaviors among pregnant and postpartum women in Japan. A multivariable logistic regression analysis was performed to evaluate the association with adjustment for socioeconomic characteristics.

RESULTS

There were 926 respondents, comprising 368 pregnant and 558 postpartum women. Women with high health literacy scores accounted for 42% of the respondents. This group had a significantly higher proportion of actively adopting preventive behaviors than the low health literacy group (33.5 vs. 25.4%, p = .008). The multivariable logistic regression analysis showed high health literacy was significantly associated with high preventive behaviors scores compared to low health literacy (adjusted odds ratio, 1.66; 95% confidence interval, 1.22-2.27).

CONCLUSION

Higher health literacy was significantly associated with a higher proportion of COVID-19 prevention behaviors among women who are pregnant or postpartum.

Exploring the Online Health Information-Seeking Behavior in a Sample of Italian Women: The "SEI Donna" Study

There is much discussion about the skills of people in understanding and managing online health information. The Italian survey “SEI Donna” aimed to investigate perceptions and use of the web in women regarding health issues considering their health literacy (HL) and healthcare skills. We used an online questionnaire to explore different aspects of online health-related information-seeking behavior. The study participants (n = 7027) were categorized into healthcare workers (HW), healthcare students (HS), and non-healthcare women (non-HW). Half the sample (52%) searched online for a second opinion after the medical examination without statistical difference among HW, HS, and non-HW. Women in the age range of 26−40 years (OR = 1.28, p < 0.001), having chronic illness (OR = 1.48; p < 0.001), and being moderately (OR = 1.58; p < 0.001) or not satisfied (OR = 2.04; p < 0.001) with healthcare professionals were more likely to use the Internet to seek medical insight. Overall, 34% of women had a functional HL, the same being higher in HW (64%) and in HS (43%) than the rest of the women (18%) (p < 0.0001). The suboptimal HL suggests the need to improve HL in the general population to be skilled in surfing the web and, at the same time, to reorganize health training to improve the HL of healthcare professionals, also enriching their communication skills.

A Systematic Review of the Impact of the First Year of COVID-19 on Obesity Risk Factors: A Pandemic Fueling a Pandemic?

Obesity is increasingly prevalent worldwide. Associated risk factors, including depression, socioeconomic stress, poor diet, and lack of physical activity, have all been impacted by the coronavirus disease 2019 (COVID-19) pandemic. This systematic review aims to explore the indirect effects of the first year of COVID-19 on obesity and its risk factors. A literature search of PubMed and EMBASE was performed from 1 January 2020 to 31 December 2020 to identify relevant studies pertaining to the first year of the COVID-19 pandemic (PROSPERO; CRD42020219433). All English-language studies on weight change and key obesity risk factors (psychosocial and socioeconomic health) during the COVID-19 pandemic were considered for inclusion. Of 805 full-text articles that were reviewed, 87 were included for analysis. The included studies observed increased food and alcohol consumption, increased sedentary time, worsening depressive symptoms, and increased financial stress. Overall, these results suggest that COVID-19 has exacerbated the current risk factors for obesity and is likely to worsen obesity rates in the near future. Future studies, and policy makers, will need to carefully consider their interdependency to develop effective interventions able to mitigate the obesity pandemic.

How to improve the COVID-19 health education strategy in impoverished regions: a pilot study

Background

It is of great challenge to raise the public coronavirus disease 2019 (COVID-19) related health literacy (CRHL) in impoverished regions due to the limits of poor infrastructure, large proportion of vulnerable groups, etc. However, those limits cannot be solved in the short term. Therefore, this study chose Liangshan Yi Autonomous Prefecture, one of the poorest areas in China, as a pilot, to reveal the quantitative relationships among different dimensions under the COVID-19 health education framework, clarify the key points for health promotion, and provide specific suggestions for COVID-19 health education strategy in impoverished regions.

Methods

A cross-sectional questionnaire survey was conducted in five regions of Liangshan Yi Autonomous Prefecture in 2020. There were 2,100 individuals sampled by multi-stage method. This survey mainly measured the four dimensions: CRHL, COVID-19 related tense psychological reactions (CRTPR), COVID-19 related information report acquisition (CRIRA), and general health literacy (GHL). The multivariate logistic regression was used to explore the influence of demographic characteristics on each dimension. Furthermore, to quantify the relationships among different dimensions, this study employed the structural equation model (SEM), and analyzed the mediating effects of CRHL and CRIRA as well as the moderating effects of regional characteristic variables.

Results

The CRHL played an important role in promoting COVID-19 health education, reaching 52.5% in Liangshan Yi Autonomous Prefecture. The GHL (β = 0.336) and age (β = 0.136) had statistically positive impacts on CRHL. The CRHL affected CRTPR negatively (β = − 0.198) and CRIRA positively (β = 0.052). The CRHL played significant mediating roles among the four dimensions (P < 0.05). Effectiveness of government prevention and control as well as the ethnicity moderated not only the relationships between CRHL and other dimensions, but also the mediating effect of CRHL (P < 0.05). People with lower income and education levels had lower GHL (β = 0.286, 1.292). The youth were more likely to show CRTPR (β = − 0.080).

Conclusions

By proposing and verifying the theoretical framework, this study put forward specific suggestions on how to improve COVID-19 health education strategies in impoverished regions via implementation methods, key groups and effect evaluation, which also provided references about future public health emergencies for other impoverished regions of the world.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-022-00963-3.

Predictors of eHealth Literacy and Its Associations with Preventive Behaviors, Fear of COVID-19, Anxiety, and Depression among Undergraduate Nursing Students: A Cross-Sectional Survey

Background: The infodemic has been co-existing with the COVID-19 pandemic with an influx of misinformation and conspiracy theories. These affect people’s psychological health and adherence to preventive measures. eHealth literacy (eHEALS) may help with alleviating the negative effects of the infodemic. As nursing students are future healthcare professionals, having adequate eHEALS skills is critically important in their clinical practice, safety, and health. This study aimed to (1) explore the eHEALS level and its associated factors, and (2) examine the associations of eHEALS with preventive behaviors, fear of COVID-19 (FCV-19S), anxiety, and depression among nursing students. Methods: We surveyed 1851 nursing students from 7 April to 31 May 2020 from eight universities across Vietnam. Data were collected, including demographic characteristics, eHEALS, adherence to preventive behaviors (handwashing, mask-wearing, physical distancing), FCV-19S, anxiety, and depression. Linear and logistic regression analyses were performed appropriately to examine associations. Results: The mean score of eHEALS was 31.4 ± 4.4. The eHEALS score was significantly higher in males (unstandardized regression coefficient, B, 0.94; 95% confidence interval, 95% CI, 0.15 to 1.73; p = 0.019), and students with a better ability to pay for medication (B, 0.79; 95% CI, 0.39 to 1.19; p < 0.001), as compared to their counterparts. Nursing students with a higher eHEALS score had a higher likelihood of adhering to hand-washing (odds ratio, OR, 1.18; 95% CI, 1.15 to 1.22; p < 0.001), mask-wearing (OR, 1.15; 95% CI, 1.12 to 1.19; p < 0.001), keeping a safe physical distance (OR, 1.20; 95% CI, 1.15 to 1.25; p < 0.001), and had a lower anxiety likelihood (OR, 0.95; 95% CI, 0.92 to 0.99; p = 0.011). Conclusions: Nursing students who were men and with better ability to pay for medication had higher eHEALS scores. Those with higher eHEALS scores had better adherence to preventive measures, and better psychological health. The development of strategies to improve eHEALS of nursing students may contribute to COVID-19 containment and improve their psychological health.

Readability of Korean-Language COVID-19 Information from the South Korean National COVID-19 Portal Intended for the General Public: Cross-sectional Infodemiology Study

BACKGROUND

The coronavirus pandemic has increased reliance on the internet as a tool for disseminating information; however, information is useful only when it can be understood. Prior research has shown that web-based health information is not always easy to understand. It is not yet known whether the Korean-language COVID-19 information from the internet is easy for the general public to understand.

OBJECTIVE

We aimed to evaluate the readability of Korean-language COVID-19 information intended for the general public from the national COVID-19 portal of South Korea.

METHODS

A total of 122 publicly available COVID-19 information documents written in Korean were obtained from the South Korean national COVID-19 portal. We determined the level of readability (at or below ninth grade, 10th to 12th grade, college, or professional) of each document using a readability tool for Korean-language text. We measured the reading time, character count, word count, sentence count, and paragraph count for each document. We also evaluated the characteristics of difficult-to-read documents to modify the readability from difficult to easy.

RESULTS

The median readability level was at a professional level; 90.2% (110/122) of the information was difficult to read. In all 4 topics, few documents were easy to read (overview: 5/12, 41.7%; prevention: 6/97, 6.2%; test: 0/5, 0%; treatment: 1/8, 12.5%; P=.006), with a median 11th-grade readability level for overview, a median professional readability level for prevention, and median college readability levels for test and treatment. Difficult-to-read information had the following characteristics in common: literacy style, medical jargon, and unnecessary detail.

CONCLUSIONS

In all 4 topics, most of the Korean-language COVID-19 web-based information intended for the general public provided by the national COVID-19 portal of South Korea was difficult to read; the median readability levels exceeded the recommended ninth-grade level. Readability should be a key consideration in developing public health documents, which play an important role in disease prevention and health promotion.

How do Vaccinators Experience the Pandemic? Lifestyle Behaviors in a Sample of Italian Public Health Workers during the COVID-19 Era

Public health workers (PHWs) have experienced substantial workload changes because of their role in managing measures to limit the spread of COVID-19. The study’s aim was to assess lifestyle changes in Italian PHWs during the pandemic. PHWs attending an annual meeting completed an anonymous questionnaire assessing their sociodemographic and behavioral characteristics and lifestyle changes during the pandemic. A total of 1000 questionnaires were completed. Most participants (63.5% women, mean age 40 ± 13.1 years) were of normal weight (61.5%), non-smokers (81.9%), had a total screen time of ≥5 h/day (83.1%), and slept at least 6 h/night (88.7%). Approximately one-third consumed sweet foods every day (30%) and did not engage in physical activity (34.6%). Current sweet food consumption, physical activity, and sleep were associated with changes in these behaviors in the last 2 years (Tau-b = 0.155; Tau-b = −0.175; Tau-b = −0.276, respectively, p < 0.001). An increase in remote working was associated with worse sleep (odds ratio (OR) 2.065, 95% confidence interval (CI) 1.482–2.877) and diet (OR 1.982, 95% CI 1.385–2.838), and increased tablet/PC use (OR 3.314, 95% CI 2.358–4.656). Health promotion measures are needed to support the adoption of healthy lifestyles in this population during the current pandemic.

Associations of COVID-19 Risk Perception, eHealth Literacy, and Protective Behaviors Among Chinese College Students Following Vaccination: A Cross-Sectional Study

Background

In spite of strict regulation of coronavirus disease 2019 (COVID-19) preventive measures and containment in China, there are still confirmed cases sporadically occurring in many cities. College students live in groups and have active social activities so that it will trigger a serious public health event once an infection event occurs. Thus, identifying the status and related factors of protective behaviors among them after receiving vaccination will be crucial for epidemic control. This study aimed to gather information on the protective behaviors and to identify the associations of COVID-19 risk perception, eHealth literacy, and protective behaviors for Chinese college students following vaccination.

Methods

A cross-sectional survey of college students engaged in protective behaviors post vaccination was conducted using the COVID-19 risk perception scale, eHealth literacy scale, and protective behaviors following vaccination questionnaire in one of the groups. Multiple linear regression analysis was used to confirm the correlation among the COVID-19 risk perception, eHealth literacy, and protective behaviors for Chinese college students.

Results

A total of 5,641 Chinese college students were included. Male students comprised 59.01% with an average age of (21.39 ± 2.75) years and most students rating their health as very good (44.85%) or pretty good (46.98%). A smaller percentage (13.76%) believed that they would likely or most likely be infected with COVID-19 after getting vaccinated. In addition, more than 1 in 10 (10.35%) college students had ever suspected to suffer from post-vaccination reactions following the COVID-19 vaccination. The mean score of protective behaviors was 26.06 ± 3.97. Approximately one-third (30.42%) of the students always or often did not wear a mask when going out. Some college students (29.25%) did not maintain distance of at least 1 m from others in social situations. Older female college students who were in good health and perceived as being at a low risk of getting infected with COVID-19, and those never suspected to suffer from post-vaccination reactions expected to engage in post-vaccination protective measures. Those with a higher level of perceived risk, severe risk perception and eHealth literacy, and a lower level of unknown risk perception were more likely to engage in further protective behaviors after getting vaccinated.

Conclusions

Overall, the level of protective behaviors among the Chinese college students following vaccination could be improved, especially for male, younger college students in poor health. This study revealed the predictive effects of risk perception and eHealth literacy on protective behaviors, recommending that the negative and positive effects of risk perception should be balanced in epidemic risk management, and eHealth literacy promotion should also be emphasized for public health and social measures.

Association between Covid-19 preventive behaviors and health literacy, information-evaluation, and decision-making skills in Japanese adults

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.

The Role of Health Literacy in COVID-19 Preventive Behaviors and Infection Risk Perception: Evidence from a Population-Based Sample of Essential Frontline Workers during the Lockdown in the Province of Prato (Tuscany, Italy)

Background: The effectiveness of pandemic control measures requires a broad understanding from the population. This study aimed to evaluate the role played by health literacy (HL) in influencing the adherence to COVID-19 preventive measures and risk perception of essential frontline workers during the lockdown period. Methods: A cross-sectional survey was conducted on a population-based sample of frontline workers from Prato Province (Italy). Data on knowledge, attitudes and practices towards COVID-19 preventive measures and risk perception were collected. HL was measured with the HLS-EU-Q6 tool. Multivariate linear regression analyses were performed. Results: A total of 751 people participated in this study, and 56% of the sample showed a sufficient level of HL. In the multivariate models, HL resulted in being positively correlated with both knowledge (beta 0.32 for sufficient HL, 0.11 for problematic HL) and attitudes (beta 0.33 for sufficient HL, 0.17 for problematic HL) towards the importance of COVID-19 preventive measures. The HL level was not associated with the adoption of preventive behaviors and COVID-19 risk perception. Conclusions: HL may play a key role in maintaining a high adherence to infection prevention behaviors and may be a factor to take into account in the implementation of public health interventions in pandemic times.

Role of factors in eHealth literacy in period of COVID-19: a study of Turkey

Purpose

This study aims to understand the eHealth literacy skills of chronic patients and to explore the relations, patterns between eHealth literacy skills and different factors such as demographics, search strategies and health information sources and to explain their effects on eHealth literacy in Turkey in Izmir in COVID-19 outbreak.

Design/methodology/approach

A quantitative method was used in the study including a questionnaire. A total of 604 chronic patients responded to the questionnaire who applied the five popularly identified hospitals in Izmir in Turkey. CHAID analysis method was implemented to explore the strongest correlation between eHealth literacy and independent variables.

Findings

Using different social media types were correlated with patients’ eHealth literacy scores. Using Facebook, Twitter were the supportive predictors for the eHealth literacy scores. However, digital literacy was highly important for eHealth literacy.

Originality/value

This study shows that the social media channels which provides much more information such as Facebook and Twitter for the chronic patient. This could be beneficial for the eHealth tools and social media content developers in terms of the supply of health information. Moreover, the study gives ideas about the effect of digital literacy and the importance of health information provided.

Negative Impacts of COVID-19 Induced Lockdown on Changes in Eating Behavior, Physical Activity, and Mental Health as Modified by Digital Healthy Diet Literacy and eHealth Literacy

Background: The COVID-19-induced lockdown has been implemented in many countries, which may cause unfavorable changes in lifestyles and psychological health. People's health literacy, healthy diet, and lifestyles play important roles in mitigating the negative impacts of the pandemic. Therefore, we aimed to examine associations of COVID-19 lockdown with changes in eating behavior, physical activity, and mental health; and the modification effects by digital healthy diet literacy (DDL) and eHealth literacy (eHEALS) on the associations.

Methods: We conducted an observational study on 4,348 outpatients from 7th April to 31st May 2020. Data from 11 hospitals in Vietnam included demographic characteristics, DDL, eHEALS, eating behavior, physical activity, and mental health changes. Multiple logistic regression and interaction models were performed to examine associations.

Results: Patients under lockdown had a lower likelihood of having “unchanged or healthier” eating behavior (odds ratio, OR, 0.38; 95% confidence interval, 95%CI, 0.29 to 0.51; p < 0.001), “unchanged or more” physical activity (OR, 0.79; 95% CI, 0.69 to 0.90; p < 0.001), and “stable or better” mental health (OR, 0.77; 95% CI, 0.67 to 0.89; p < 0.001), as compared to those after lockdown. In interaction models, as compared to patients after lockdown and with the lowest DDL score, those under lockdown and with a one-score increment of DDL had a higher likelihood of having “unchanged or healthier” eating behavior (OR, 1.05; 95% CI, 1.02 to 1.07; p < 0.001), and “stable or better” mental health (OR, 1.02; 95% CI, 1.01 to 1.04; p < 0.001). Similarly, as compared to patients after lockdown and with the lowest eHEALS score, those under lockdown and with a one-score increment of eHEALS had a higher likelihood of having an “unchanged or more” physical activity (OR, 1.03; 95% CI, 1.01 to 1.05; p < 0.001).

Conclusion: The COVID-19 lockdown measure could negatively affect eating behavior, physical activity, and mental health among outpatients. Better DDL and eHEALS were found to mitigate the negative impacts of the lockdown, which may empower outpatients to maintain healthy lifestyles and protect mental health. However, this study holds several limitations that may undermine the certainty of reported findings.

Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization's conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.

Fear, anxiety and depression among pregnant women during COVID-19 pandemic: impacts of healthy eating behaviour and health literacy

INTRODUCTION

The COVID-19 pandemic has been influencing people's psychological health, especially in pregnant women. We aimed to examine associated factors of fear of COVID-19, anxiety and depression among pregnant women during the pandemic where the impacts of healthy eating behaviour (HES) and health literacy (HL) were emphasized.

METHODS

A cross-sectional study was conducted between 14 February 2020 and 31 May 2020 in 18 health centres and hospitals across Vietnam. Data of 518 pregnant women were analysed, including socio-demographics, pregnant-related factors, HES, HL, health-related behaviours, fear of COVID-19 scale (FCoV-19S), anxiety (using the generalized anxiety disorder (GAD-7)) and depression (using the patient health questionnaire with 9 items (PHQ-9)). Regression analysis was utilized to explore the associations.

RESULTS

Pregnant women with higher scores of HES and HL had lower likelihood of anxiety (odds ratio, OR, 0.79; 95% confidence interval (95%CI), 0.73, 0.87; p < .001; and OR, 0.94; 95%CI, 0.90, 0.99; p = .018) and depression (OR, 0.84; 95%CI, 0.78, 0.91; p < .001; and OR, 0.96; 95%CI, 0.91, 0.99; p = .044), respectively. Pregnant women being employed had a lower FCoV-19S score (regression coefficient, B, -1.46; 95%CI, -2.51, -0.40; p = .007). Besides, other significant predictors of anxiety were eating healthier during the pandemic, unchanged or more physical activity, elevated gestational age and smoking. Other significant predictors of depression were eating healthier during the pandemic, elevated gestational age and smoking.

CONCLUSIONS

Among others, HES and HL had positive impacts on protecting pregnant women against anxiety and depression. Improving HES and HL should be addressed as a strategic approach to improve reproductive health during the pandemic.KEY MESSAGEThe COVID-19 pandemic influences antenatal mental disorders with the higher level as opposed to that before the pandemic.Healthy eating behaviour and better health literacy (HL) had critical roles in lowering prenatal anxiety and depression during the COVID-19 crisis.Strategic approaches for improving healthy eating and HL should be recommended for protecting pregnant women from mental health problems during the pandemic.