Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy

Abstract

Objectives: To explore the variation in understanding, attitudes and uptake of COVID-19 health advice during the 2020 pandemic lockdown by health literacy. Study design: National cross sectional community survey. Setting: Australian general public. Participants: Adults aged over 18 years (n=4362). Main outcome measures: Knowledge, attitudes and behaviours related to COVID-19; health literacy and socio-demographic factors. Results: People with inadequate health literacy had poorer understanding of COVID-19 symptoms (49% vs 68%; p<0.001), were less able to identify behaviours to prevent infection (59% vs 72%; p<0.001), and experienced more difficulty finding information and understanding government messaging about COVID-19 than people with adequate health literacy. They were less likely to rate social distancing as important (6.1 vs 6.5, p<0.001) and reported more difficulty remembering/accessing medication since lockdown (3.6 vs 2.7, p<0.001). Importantly there was higher endorsement of misinformation beliefs related to COVID-19 and vaccination in people with lower health literacy. Similar results were observed among people who primarily speak a language other than English at home. Conclusion: Our findings show important disparities by health literacy and language in COVID-19 related knowledge, attitudes and behaviours that have the potential to undermine efforts to reduce viral transmission and may lead to social inequalities in health outcomes in Australia. Those with the greatest burden of chronic disease are most disadvantaged, and most likely to experience severe disease and die from COVID-19. Addressing the health literacy needs of the community in public health messaging about COVID-19 must now be a priority in Australia.

The Association between Future Anxiety, Health Literacy and the Perception of the COVID-19 Pandemic: A Cross-Sectional Study

“…This finding is in line with the results of studies carried out in other countries. According to McCaffery et al, using the STAI questionnaire on a sample of adult Australians, an inadequate level of HL was associated with a lower perceived seriousness of threat, but a higher level of anxiety [90]. Wolf et al also found a greater degree of anxiety in patients living in the USA suffering from chronic diseases who also had low HL [48].…”

Impact of COVID-19 Restrictions on People with Hypertension

“…Baseline data were collected from all states/territories in April 2020 during COVID-19 lockdown, with a subsample followed-up in June 2020 when restrictions eased. Of 4362 baseline participants, those reporting high blood pressure with no other chronic conditions (n=466) were randomly matched to individual healthy controls based on age (+/-3 years), gender, education and health literacy adequacy (given baseline survey differences(McCaffery et al, 2020)). The initial match rate was 95.7%, with constraints relaxed until all cases were paired.…”

Examining Australian’s beliefs, misconceptions, and sources of information for COVID-19: A national online survey

“…Public health messaging not only should ensure translation of messages but also understand the cultural differences that may interfere with practicing preventive behaviours. Unlike other Australian surveys [5,8], our survey looked beyond quantifying knowledge and attitudes to include qualitative content analyses to identify specific reasons for participants' misconceptions.…”

“…Misinformation about prevention, transmission, and treatment of COVID-19 has the potential to derail these efforts. International and Australian-focused online surveys suggest 71% -93% of participants [5,6] could identify preventive behaviours (e.g., hand hygiene, physical distancing), but the proportion of individuals who self-report practicing these behaviours were fewer, ranging from a low of 45% in a survey of UK participants [7] to 85% in an Australian sample [8]. The difference between the high proportion of people knowing appropriate prevention behaviours and the lower proportion of those reporting to practice the behaviour, suggests that knowledge alone is insufficient to change behaviour.…”

“…This constitutes a knowledgepractice gap. Varying demographic differences have been reported to predict practicing preventive behaviours including low socio-economic status [7], low health literacy [5], anxiety [5,8], and those with high compared with low engagement and perceptions of risk [8,9].…”