Digital Health Literacy during COVID-19: gender differences from a Florentine University experience

 

Gender appears to be a strong predictor of online health information-seeking behaviour (OHISB). Gender differences in OHISB have been studied in different countries with different results, but no studies investigated gender-specific behaviour among University students during the COVID-19 pandemic, which has brought with it a consequential infodemic. We sought to investigate any gender differences in OHISB in the period between the first and the second wave of the COVID-19 pandemic. A questionnaire promoted by the COVID-HL network was administered to 2996 students of all the courses at the University of Florence. It included existing validated scales adapted to the COVID-19 pandemic and newly developed scales. Gender differences were tested using the χ2 test or the Mann-Whitney U test, where appropriate. Male students reported a higher score in DHL than females (p < 0.001). However, female students reported using more often different sources for online information seeking (p < 0.05, except for YouTube), searching more corona-related topics (p < 0.05, except for economic and social consequences) and considering ‘‘very important'’ each item in the ‘‘Importance of internet information search'’ section (p < 0.05). Furthermore, female students are more likely to be ‘‘often dissatisfied'’ or ‘‘partly satisfied'’ with information about COVID-19 (p < 0.001) and to search more often for information for themselves and other people. Our study confirmed that gender could affect the way students search for health information on the Internet. Since students, in particular females, have been affected by stress and anxiety during the pandemic, these findings could help institutions to promote gender-specific education programmes to improve students’ DHL and their mental health outcomes, as well as to provide health information that fit specific gender needs.

Key messages

• Gender influences how university students search on the Internet for health information.

• This should guide institutions to better address educational programmes to improve their Digital Health Literacy.

Predictors of delayed vaccination in infants born in Tuscany, Italy: an area based cohort study

Background

Timely vaccination is essential to protect infants from vaccine-preventable diseases. The aim of the study was to evaluate the determinants of vaccination timeliness for hexavalent (HEXA) and measles-mumps-rubella (MMR) vaccines.

Methods

The study is part of the PREHMO project funded by Tuscany Region, Italy. Data on the 2017 and 2018 full birth cohorts of Tuscany (N = 41,493) were retrieved from the Birth Registry and linked to those of the Vaccine Registry up to 24 months after birth. Sociodemographic and at birth characteristics of mothers and infants were retrieved. The primary outcome was the timeliness of HEXA 1st and 3rd doses, and MMR 1st dose. Timeliness was defined as the administration of the dose a day after the period recommended by the vaccination schedule. Multiple logistic regression models were performed.

Results

For all the vaccines considered, a significantly increased risk of delayed vaccination was observed in preterm infants and in infants born in hospital of second level of newborn care, while infants conceived by assisted reproductive technologies and first-born infants showed a significantly decreased risk for delayed vaccination. Multiple births, small for gestational age status, maternal unemployment, and rural residence were significantly associated with an increased risk of delayed HEXA-1 vaccination (OR 1.31, 95%CI 1.13-1.51; OR 1.12, 95%CI 1.03-1.22; OR 1.06, 95%CI 1.01-1.13; and OR 1.1, 95%CI 1.03-1.16). As for MMR vaccination, a low maternal education was significantly associated with high risk of delay (OR 1.12, 95%CI 1.06-1.18), while rural residence, maternal foreign nationality and female sex were significantly associated with a decreased risk of delay (OR 0.91, 95%CI 0.87-0.96; OR 0.82, 95%CI 0.78-0.87; and OR 0.95, 95%CI 0.91-0.99).

Conclusions

Several common and vaccine-specific predictors of vaccination timeliness were identified. Strategies to improve a timely vaccination should take into account these predictors.

Key messages

• Several maternal and infants factors may influence vaccination timeliness of routine immunization in childhood.

• Tailored vaccination strategies are needed to improve vaccination timeliness in infants at high-risk of delayed vaccination.

Trends of risk behaviors in adolescents: a 10-year study in a representative sample of Tuscany, Italy

Background

The aim of the study was to evaluate the trends of prevalence of several health risk behaviors (HRBs) and health conditions over a 10-years period in a representative sample of adolescents of Tuscany Region, Italy.

Methods

The study had a repeated cross-sectional design, data from the last four survey waves of EDIT surveillance (2008-2018) were used. EDIT surveillance investigates HRBs in a representative sample of students attending the upper secondary schools of Tuscany. Prevalence of 17 HRBs and health conditions were considered and analyzed by age, sex, and socioeconomic status (SES).

Results

A total of 21.943 students were surveyed from 2008 to 2018. Declining trends in the participation in smoking, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased during the study period. During the most recent survey males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetables consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low SES students than in high SES students.

Conclusions

In conclusion findings showed various different tendencies in adolescent participation in HRBs over the course of the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females’ risk-taking behavior on the rise require careful monitoring and intervention.

Key messages

• Distinct tendencies according to sex, socio-economic condition and specific health risk behavior were observed in adolescent participation in health risk behaviors over the course of the last decade.

• Health promotion and prevention interventions tailored on specific health risk behaviors and population groups are needed.

Health Literacy, Covid-19 and risk perception: a cross-sectional survey in Prato in the 2nd wave

 

During the Covid-19 pandemic, individual and collective public health measures were undertaken to control the spread of the virus. Their effectiveness relies on people’s abilities to understand and adopt the correct behaviors. This study aims to evaluate the role of Health Literacy (HL) in influencing the adherence to Covid-19 preventive measures and risk perception of a sample of workers employed in various activities involving close contact with the population in the province of Prato (Tuscany, Italy) in the second pandemic wave (November-December 2020). A cross-sectional survey was conducted on a sample of public workers (e.g., teachers, educators, assistants/aides, other health personnel). Data on knowledge, attitudes and practices towards (KAP) Covid-19 preventive measures and risk perception were collected. HL was measured with the HLS-EU-Q6 tool. Spearman correlation analysis was used to assess the correlation between HL and KAP and Covid-19 risk perception. Multivariate linear regression analyses were performed to evaluate the role of HL in predicting KAP and Covid-19 risk perception, adjusted for sex, age, comorbidity, educational level, country of birth. A total of 402 people participated in this study; 47.8% had a problematic HL level. The HL level was correlated with KAP and practices towards Covid-19 prevention measures; no significant associations were found with Covid-19 risk perception. In multivariate models, HL significantly and positively predicted a higher level of knowledge of Covid-19 preventive measures (B = 0.413 for problematic HL; B = 0.542 for sufficient HL). Confirming a previous study conducted in Prato in the first pandemic wave, HL did not predict adherence to Covid-19 infection control measures, probably due to fear of the disease and attention towards prevention behaviors being still higher in the second pandemic wave.

Key messages

• HL skills are linked to understanding of public health measures.

• HL skills should be improved to favor the adherence to correct behaviors.

Vaccine Literacy, Covid-19 and influenza: a cross-sectional survey in Prato in the 2nd pandemic wave

 

Covid-19 is a pandemic and an infodemic, with contrasting information regarding risk and preventive measures, including vaccination. This study aims to assess Vaccine Literacy (VL) of a sample of workers in the province of Prato (Tuscany, Italy) in the second wave of the Covid-19 pandemic (November-December 2020) and to analyze the relationship between VL and attitudes about Covid-19 and flu vaccination. A cross-sectional design was adopted. Sociodemographic characteristics, health information, vaccination behaviour for past and current flu season and intention to get vaccinated against Covid-19 were collected. A multivariate logistic regression was performed to identify predictors of getting a Covid-19/flu vaccination. The Italian Health Literacy tool on Vaccination (HLVa-IT) tool was used to measure VL. A total of 117 questionnaires were analyzed. Among them, 64.9% intended to get Covid-19 vaccine. The mean VL was 3.18 ± 0.43 (functional 2.87 ± 0.72; interactive-critical 3.36 ± 0.45) out of 4. Having more than one comorbidity was a negative predictor of intention to get Covid-19 vaccine (OR: 0.21 95%CI: 0.04 - 0.91). Regarding the flu vaccine, being vaccinated in the previous season was the only positive predictor of being vaccinated in the current season (OR = 24.25 95%CI 7.96 - 87.73). The study was conducted before the authorization of Covid-19 vaccines: little information about them may have contributed to VL not being related to the intention to get vaccination. The negative role of comorbidities could be due to fear of adverse effects on fragile health status. For flu vaccination, VL may have exerted a lower impact because of the positive experience with the flu vaccine in terms of safety and effectiveness in the previous seasons.

Key messages

• The introduction of new vaccines should be supported by effective communication.

• Better knowledge of current vaccines and not just routine administration is desirable for greater personal empowerment.

Health Literacy and COVID-19 preventive behaviours in during the Lock-Down Phase in Tuscany (Italy)

 

In the first COVID-19 pandemic period, when no vaccines were available, individual behaviours were essential for controlling the spread of the virus. In this context of rapidly changing guidance, emerging new evidence, fake news and misinformation, there have been new challenges for health literacy (HL). This study explored whether guidance-compliant healthy behaviours were associated with HL in individuals who have performed essential activities (public employees and volunteers of the Civil Protection) during the lock-down period in the Province of Prato, Italy. Items on knowledge, attitudes and practices (KAP) towards COVID-19 preventive measures and COVID-19 risk perception, along with the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6), were collected using a self-administered structured questionnaire. In May 2020, 751 responses were collected; respondents were mostly males (59%), younger than 65 years old (83.5%), with sufficient HL (56%), and never smokers (54.2%). Most of the items related to the KAP towards COVID-19 preventive measures were significantly correlated with the HLS-EU-Q6 score in the total sample. In the multiple linear model, HL results to be a predictor of both a better self-reported knowledge of COVID-19 preventive measures (beta 0.32 for sufficient HL, 0.11 for problematic HL, 1.00 for inadequate HL) and a higher score of attitude towards the importance of COVID-19 preventive measures (beta 0.33 for sufficient HL, 0.17 for problematic HL, 1.00 for inadequate HL), while it has no role in predicting a higher risk perception. These findings can be useful to understand the importance of HL in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

Key messages

Lower levels of Health Literacy predict poor COVID-19 related knowledge and a worse attitudes towards the importance of COVID-19 preventive measures. Health Literacy may be an important factor in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services

Background

Fear of contracting COVID-19 and the large-scale preventing measures may have influenced health service utilization. The aim of the study was to assess the indirect impact of COVID-19 pandemic on the utilization of the emergency medical services (EMS) of Tuscany Region (Italy).

Methods

The study was carried out on administrative data from the public healthcare system of Tuscany (38 general hospitals and 4 university teaching hospitals). Variations in the utilization of out-of-hospital (i.e. calls for emergency medical assistance and dispatch of mobile medical care units) and in-hospitals (emergency department(ED) visits and hospitalizations from the ED) EMS during the first pandemic wave were analyzed (February - July 2020) in relation with corresponding periods of the previous three years. Furthermore, in order to understand changes in illness severity of patients using the EMS, standardized ratios for hospitalizations requiring ICU and in-hospital mortality were analyzed.

Results

Significant decreases in the expected volumes of utilizations were observed in each of the considered EMS starting from the week in which the first case of COVID-19 was confirmed in Italy till the last week of the first wave. In particular, during the peak period of COVID-19 pandemic wave a reduction of 73,041 (-67%, 95%CI -69%; -66%) in ED admissions and of 682 (-38% 95%CI -55%; -43%) in hospitalization from ED were observed. Significant decreases in hospitalizations for life threatening medical conditions were observed. No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the COVID-19 epidemic peak period (SR 1.1 95%CI 0.72-1.90; SR 1.0 95%CI 0.83-1.23).

Conclusions

A large and generalized decrease in EMS utilization was observed during the first wave of COVID-19 pandemic. Furthermore, findings suggest that seriously ill patients avoid seeking care as less seriously ill patients did.

Key messages

The falling in the utilization of emergency medical services during pandemic could portend substantial harm to public health, and not simply the absence of real health need.

The preparedness of the healthcare delivery system should not focus solely on confronting the pandemic disease, but also on ensuring access to high quality emergency care for other diseases.

The effect of COVID-19 epidemic on the incidence of community-acquired pneumonia in the elderly

Background

Since the outbreak of COVID-19 has raged, large-scale measures for prevent disease transmission have been implemented worldwide. If effectively implemented, these measures may have led to a reduction of the spread of other respiratory infectious diseases at community level. The aim of the present study was to evaluate the indirect impact of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia (CAP) in the elderly during the first epidemic wave of COVID-19 in Tuscany, Italy.

Methods

A population based study was carried out on data from the Tuscany healthcare system. Hospitalization rate for CAP, severity of CAP hospitalizations, and outpatient consumptions of antibacterials for CAP in people aged 65 years and older were considered as outcome measures. Percentage changes in the outcome measures were calculated considering corresponding periods of the 2020 and 2017-19. 95% confidence intervals and the statistical significance of the percentage changes were calculated using the Poisson model.

Results

A total of 3,346 new CAP hospitalizations occurred in people aged 65 years and older in the whole study time-frame. Significant reductions in the weekly hospitalization rates for CAP were observed starting from the week in which the national containment measures were imposed, this negative deviation continued even after the lift of the national lock-down until the end of the first wave of COVID-19 in July (maximum weekly decrease of 46%). All the antibacterial classes for CAP showed a significant decrease in their outpatient consumptions during the COVID-19 epidemic period.

Conclusions

The implementation of large-scale COVID-19 containment measures likely reduced the incidence of CAP in the elderly during the first wave of COVID-19 pandemic. Furthermore, findings suggests that individual prevention measures that remained mandatory after the lift of the national lock-down also had a relevant role in the reducing CAP incidence.

Key messages

The potential benefits of pandemic containment measures can extend beyond the prevention of COVID-19 to include the reduction of the burden of respiratory infectious diseases

Taking into account the indirect impact of pandemic containment measures on respiratory tract infections may improve the planning of health services during a pandemic.

Patterns of risky driving behaviors among Tuscan adolescent drivers: a cluster analysis

Background

Adolescents have a high risk of road traffic accident (RTA) because of their high engagement in risky driving behaviors (RDBs); to date, very few studies have investigated the patterns of RDBs. The aim of the study is to identify distinctive RDBs patterns and to examine their associations with RTAs in a sample of adolescent drivers

Methods

The EDIT project is a cross-sectional survey carried out in a representative sample (6.824) of Tuscany Region students aged 14-19 years. The study analyses a subsample of students who reported to drive/ride at least once a week (2764). Self-reported frequency in the last year of the following RDBs was determined: talking on phone; texting; using GPS; talking to passengers; smoking; eating; listening to loud music; fatigued driving; speeding; and driving under the influence (DUI) of alcohol or drugs. A cluster analysis was conducted to identify RDBs patterns. A multivariate model was used to evaluate the difference in the risk of RTA across clusters; ANOVA and post-hoc pairwise comparisons were used to further characterize cluster membership

Results

Four distinct RDBs clusters were identified: “safe”(45.6%), “average”(21.8%), “careless but not DUI”(21.5%) and “reckless and DUI”(11.2%) drivers. When compared with “safe” drivers, “careless but not DUI” and “reckless and DUI” drivers showed a significantly higher risk of RTA (respectively, OR 1.68, 95%CI 1.29-2.18, p &lt; 0.001; OR 2.88; 95%CI 2.10-3.95, p &lt; 0.001). Clusters were characterized by several significant differences in sociodemographic variables, cell-phone use, quality of the relationships with parents, school performances, mental health and well-being, health behaviors, gaming, bullying and risky sexual behaviors

Conclusions

RDBs evidently occur in typical patterns that are linked with different RTA risks. Several domains of adolescent life seem to be involved in cluster membership. An awareness of this clustering enables to better targeting adolescents at higher risk of RTA

Key messages

RDBs occur in patterns in adolescents, and indicators of risky behaviors and of mental and social well-being may help to identify RDBs clusters at high risk of road traffic accidents. Multimodal prevention approaches in risky driving behaviors are likely to be more successful than targeting a single behavior in adolescents.

Measuring Health Literacy in Tuscany through the Italian risk factor surveillance system (PASSI)

Background

Health literacy (HL) can be defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. A module to measure HL has been implemented in Tuscany since 2017 within the Italian risk factor surveillance system (PASSI). Here, we aimed to assess HL levels and their relations with social determinants and health behaviours.

Methods

During 2017-2018, a representative sample (N &gt; 7000, aged 18 to 69 years) of the Tuscan population was interviewed in PASSI. HL was measured using the Italian version of the short-short form (HLS-EU-Q6) of the HLS-EU-Q47. Multivariate analysis was performed to investigate associations between HL, social determinants and selected health behaviours (diet and physical activity).

Results

61% of the interviewees had an adequate HL level, 30% problematic and 9% inadequate. In the multivariate analysis, the odds of inadequate HL level increased for all social determinants except gender and loneliness. The strongest association was observed for foreign citizenship (OR 3.38, 95% CI 2.63-4.34) followed by financial problems (OR 2.10, 95% CI 1.73-2.55), low education (OR 1.91, 95% CI 1.58-2.32), being aged 50-69 years (OR 1.51, 95% CI 1.18-1.94) and unemployment (OR 1.42, 95% CI 1.17-1.72). With regard to health behaviours, subjects with inadequate HL level had the lowest odds of engaging in regular physical activity (OR 0.59, 95% CI 0.49-0.71) and one of the lowest odds of eating at least three portions of fruit and vegetables (OR 0.79, 95% CI 0.65-0.95).

Conclusions

Our findings suggest that HL is strongly associated with social determinants and has major influence on health behaviours. Our study is still ongoing, with the next step being to build a conceptual model to depicting the effect of HL as a mediator of the association between social determinants and health behaviours.

Key messages

Health Literacy is strongly associated with social determinants. Health Literacy has major influence on health behaviours.

Effect of a health education intervention on intestinal parasitic infections in Bolivian children

Backgrounds

Intestinal parasitic infections (IPI) are a major health issue for children of low- and middle-income countries. Water, sanitation and hygiene (WASH) practices are crucial for preventing IPI. The aim of the study was to evaluate the effects of a school-based health education intervention on handwashing behavior and IPI prevalence in children

Methods

This is a randomized intervention trial in 8 primary schools in rural communities over the course of 3 school years; preliminary results from the first two years of the trial are here presented. Schools were randomly selected and assigned in a 1:1 ratio to intervention or control (no intervention) groups. For each school year, the intervention included 14 school-based educational sessions and 2 skit events, involving children aged 8-12 years. Knowledge, attitude and practice questionnaire and handwashing at key events was assessed at the beginning and end of each school year. IPI prevalence was assessed with repeated cross-sectional parasitology surveys 12 months apart, involving a minimum of 50 children for each school

Results

At baseline, no significant differences between intervention and control schools were present in the proportion of children who washed their hands at key events (7.2% vs 9.3%, p = 0.28), in IPI (79.4% vs 75.3%, p = 0.3) and multiple parasitic infections (MPI) prevalences (47.6 vs. 38.6; p = 0.051). At the end of the second year, the percentage of children who washed their hands at key events was significantly higher in the intervention schools (75.4% vs 12.1%, p &lt; 0.001), and the prevalence of IPI and MPI in the intervention schools were respectively about 25% and 15% lower than in the control schools (respectively, 42.9% vs 67.8%, p &lt; 0.001; 16.1% vs 31.6%, p &lt; 0.001)

Conclusions

A school-based health education intervention could achieve significant changes in hand-washing behaviors and reduction in the prevalence of IPI in children. The third year survey results are needed to confirm these findings

Key messages

An health education intervention on water, sanitation and hygiene (WASH) practices can reduce the risk of IPI infection in children. An health education intervention on water, sanitation and hygiene (WASH) practices could be configured as a sustainable long-term approach to intestinal parasitic infections control in children.

Measuring health literacy: performance-based versus perception-based measures

Background

Many performance-based or perception-based measurement tools of health literacy (HL) have been developed. The aim of this study is to compare the results of performance-based versus perception-based measures of HL in a population-based sample in Florence (Italy).

Methods

223 subjects were interviewed. To measure HL, HLS-EU-Q16 (perception-based measure of general HL) and NVS (performance-based measure of functional HL) were used. Sociodemographic characteristics were collected.

Results

The majority of the subjects had high school (36%) or university (44%) degree and gets to the end of the month quite or very easily with financial resources available (69%). Considering age classes, 22% was 18-45, 26% 46-55, 34% 56-65, 18% 66-70 year-old. According to HLS-EU-Q16, 11.8% had inadequate, 55.5% problematic and 33% sufficient HL; considering NVS, 11.7% had high likelihood of limited HL, 28.7% possibility of limited HL, 59.6% adequate HL.

The percentage of people with low HL was higher for HLS-EU-Q16 than for NVS in each category of age class, educational level, and financial resources. For both measures, the percentage of people with low HL increased with age, becoming more similar for older people: for HLS-EU-Q16, from 59.2% for 18-45 to 78.4% for &gt;65 years old; for NVS, from 20% for 18-45 to 67.5% for &gt;65 years old. Similar results were observed for educational level and financial resources: for both tests, the percentage of people with low HL increased with the decreasing of educational level or financial resources; for the worst situations (less than high school diploma or having not enough financial resources), the percentage of people with low HL become similar comparing the two tests.

Conclusions

Perception-based measure of general HL and performance-based measure of functional HL investigate different aspects, but in the worst situations (older people, low educational level and not enough financial resources) they tend to produce the same result.

Key messages

Perception-based measure of general HL and performance-based measure of functional HL investigate different aspects. In the worst situations (older people, low educational level and not enough financial resources) they tend to produce the same result.