Health Literacy among Health and Social Care University Students

Sociodemographic Determinants of Health Literacy Among University Students of Health Sciences in Kosovo

Objective

Our objective was to assess the level and sociodemographic correlates of health literacy (HL) among university students of health sciences in Kosovo.

Methods

A cross-sectional study was conducted in Kosovo during February-April 2024, including 470 students of health sciences from the universities of Prishtina and Gjakova (≈86% females; mean age: 20.7±2.7 years; response rate: 70%). The internationally standardised European Health Literacy Survey Questionnaire (HLS-EU-Q) was self-administered, along with information on sociodemographic factors. Binary logistic regression was used to assess the independent sociodemographic correlates of HL.

Results

Only 7% of the students exhibited "inadequate and/or problematic" HL, whereas about 93% of participants displayed "sufficient and/or excellent" HL. In multivariable-adjusted binary logistic regression models, "inadequate and/or problematic" HL was strongly and positively associated with the male gender only (OR=3.6, 95%CI=1.5-8.9).

Conclusions

We evidenced a relatively high general HL level among university students of health sciences in Kosovo, especially among females. Enhancing HL among future health professionals could guide policies that prioritise embedding health education and resources into higher education institutions, potentially improving students' health behaviours and health outcomes, as a major prerequisite for their future work with patients and communities.

Association between health literacy and risk of depression: A systematic review and meta-analysis of observational studies

OBJECTIVES

Depression, one of the most prevalent mental disorders, constitutes a pressing threat to global population health. In recent years, an increasing number of observational studies have explored the association between health literacy (HL) and depression risk; however, their results are inconsistent. Furthermore, no study has yet systematically synthesized this association based on findings from observational studies.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A systematic literature search was performed to identify eligible studies from five databases (PubMed, MEDLINE, EMBASE, PsycINFO, and the Cochrane Library). The overall odds ratios (ORs) with 95 % confidence intervals (CIs) were estimated to evaluate the role of HL in the development and progression of depression using random-effects models. Subgroup analyses were conducted to explore the potential sources of heterogeneity.

RESULTS

Eleven observational studies, including nine cross-sectional and two longitudinal studies, were included in the current review. Meta-analysis revealed that higher levels of HL were associated with lower risk of depression (OR = 0.90, 95 % CI: 0.86-0.94). Subgroup analysis demonstrated that studies of adolescent individuals using the Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ) to quantify HL exhibited stronger associations (OR = 0.43, 95 % CI: 0.34-0.54).

CONCLUSIONS

Our meta-analysis demonstrated a statistically significant negative association between adequate levels of HL and the likelihood of depression, especially among adolescents. More longitudinal studies with rigorous design are needed to further explore the causal relationship and long-term associations.

Health and health literacy among social work students in Germany: A cross-sectional health survey

A university is a living environment that can influence people's health. This study aims to analyze health and health literacy of Bachelor of Social Work (BSW) students in comparison with students in other study programs. A survey was conducted among all students at the University of Kassel regarding their health and health literacy. The survey evaluated general health status, disability, and health literacy. In this study, BSW students had an adverse health status compared to other students. Only 66.9% of the BSW students rated their general health as very good or good (vs. 79.7% in other study programs). BSW students are also more likely to be moderately or severely limited in daily activities due to chronic health conditions than students in other study programs. In contrast, health literacy levels differ little between BSW students and other students. This study highlights the need for health (literacy) promotion in social work studies.

Digital health literacy and sociodemographic factors among students in western Iran: a cross-sectional study

INTRODUCTION

Digital health literacy is integral to accessing reliable information, especially for students making informed health decisions. This study aims to assess the digital health literacy level as well as sociodemographic factors of students of universities in Asadabad County, Hamadan, Western Iran.

METHODS

The present research was a descriptive-cross-sectional study conducted between May to June 2024. The statistical population included 500 students from the following Iranian universities in Asadabad county: Islamic Azad University, Payame Noor University, Technical and Vocational College, and Asadabad School of Medical Sciences. The van der Vaart Digital Health Literacy Scale was used for data collection.

RESULTS

The study showed that students' digital health literacy status is moderate (47.19 ± 8.34). In the dimensions of digital health literacy, operational skills (61.84 ± 32.97) were at a desirable level, with the most significant issues related to privacy protection (23.51 ± 21.72). The mean digital health literacy score of students of Medical Sciences University was significantly higher than Azad University (P < 0.001) but lower than Technical and Vocational University (P = 0.048). There was a significant relationship between digital health literacy and the variables of the university of study (p < 0.001), gender (p = 0.049), education level (p = 0.017), nativity status (p = 0.001), and residence status (p < 0.001).

CONCLUSION

The results of the present study revealed that the digital health literacy of students in Iran was moderate, depending on sociodemographic factors. The findings from this study can be used to develop and implement interventions and strategies to improve digital health literacy.

Health literacy and influencing factors in university students across diverse educational fields in Kazakhstan

Comprehensive examinations of health literacy (HL) among students in Kazakhstan are lacking. The existing literature from adult populations in Kazakhstan suggests associations between higher HL and socioeconomic and demographic factors. The HLS19-Q12 tool was used in this study to assess the HL level of 3230 students with various backgrounds. A multivariate linear regression model was used to define determinants of HL. The mean HL score for the total sample was 85.86 ± 18.67 out of 100, which indicates "excellent" level of HL. The highest HL score was in students of Health Sciences field (88.22 ± 17.53), whereas mean HL score in students of Engineering field of study was 83.27 ± 20.07, and it was 86.13 ± 18.11 for the Humanities and Social sciences field of study. The factors negatively associated with HL were region of origin, health information searching, lack of basic life support skills, smoking, self-assessment of health as bad, and missing study days. Students who smoked and used tobacco for 6 days per week had a significantly lower HL. Interaction analysis showed positive three-way interaction for male students over 19 years studying in Engineering field. Socioeconomic factors, regional disparities, and health behaviors significantly influenced HL, with lower scores observed among students from the West region, rural areas, and those with unhealthy behaviors or low socioeconomic status. The following factors were positively associated with HL in this study: field of education, affordability of medical examination and treatment, social connections and support, age, and social status. This study will allow future research and youth health promotion programs to make decisions based on the field of study and the factors that negatively and positively influence HL.

Understanding of Health literacy among Healthcare students in Saudi Arabia: a cross-sectional study

BACKGROUND AND OBJECTIVE

Health literacy is the cognitive and social abilities that influence a person's motivation and capacity to learn, comprehend, and use information to improve and maintain good health. We aimed to investigate Healthcare Students' knowledge, attitudes, and practices regarding Health Literacy in the Riyadh Province of Saudi Arabia.

METHODS

This study used prevalidated electronic questionnaires among healthcare undergraduates from colleges affiliated with Saudi University in Riyadh, Saudi Arabia, from December to April 2024. Healthcare students were asked to answer a self-designed online questionnaire sent to them through social media platforms.

RESULTS

The response rate was 560 out of 600 (93.3%); 293 of the 560 students (52.3%) were aged between 23 and 24 years (mean age was 21.29 SD = 1.852). The mean GPA among the students was 4.31(± 0.682). The average overall score for health literacy among healthcare students was 100.92 ± 11.80. The mean scores for knowledge were 24.17 ± 4.67, attitudes were 38.65 ± 4.20, and practice in health literacy was 38.09 ± 5.09. Among all healthcare students, 50.2% reported good knowledge, 54.1% had good attitudes, and 50.1% exhibited good practices in health literacy. However, students' knowledge (p = 0.019) and training (p = 0.024) in health literacy were significantly associated with smoking cigarettes. Additionally, smoking shisha was significantly associated with students' knowledge (p = 0.022), attitudes (p = 0.001), and practices (p = 0.001) in health literacy.

CONCLUSION

Our study highlights that half of the healthcare students reported limited knowledge, attitude, and practice in health literacy. Age, gender, and course of study did not show significant differences. Rather, students who did not smoke cigarettes or shisha were found to have higher knowledge, attitudes, and practice in health literacy compared to smokers. However, to improve health literacy, additional education and increased awareness are needed. Further investigation is warranted to address the factors related to poor health literacy.

Health Literacy and Health-Related Quality of Life in Older Adults with Mild Cognitive Impairment

OBJECTIVES

Health literacy is considered crucial in health status outcomes, but little is known about the association among cognitively impaired persons. This study investigated the association between health literacy and health-related quality of life (HRQoL) in older adults with mild cognitive impairment (MCI). We further examined whether the association between health literacy and HRQoL depends on age, sex, and educational attainment.

DESIGN

A cross-sectional study was conducted between January and December 2022.

SETTING AND PARTICIPANTS

The study population was 233 older adults with MCI who visited the Veterans Health Service Medical Center in Seoul, Republic of Korea.

METHODS

The diagnosis of MCI was confirmed by a physician based on clinical and neuropsychological assessments. The European Health Literacy Survey Questionnaire and EuroQol Five Dimensions Questionnaire were used to measure the health literacy and HRQoL of the participants.

RESULTS

HRQoL was significantly correlated with health literacy (R = 0.25, P ≤ .001) and its 3 subdomains (R = 0.27, P ≤ .001 for healthcare; R = 0.19, P = .004 for disease prevention; and R = 0.18, P = .005 for health promotion). After adjustment for potential covariates, older adults with higher levels of health literacy were significantly associated with better HRQoL: β = 0.02 (P = .0021) for health literacy, β = 0.07 (P = .0001) for healthcare, and β = 0.04 (P = .0443) for disease prevention. The interactions between HRQoL and health literacy with the specific variables of age, sex, and education demonstrated a statistical significance (β = 0.02 with age, β = 0.03 with sex, and β = 0.06 with education).

CONCLUSIONS AND IMPLICATIONS

There was a significant association between health literacy and HRQoL among older adults with MCI. This finding suggests that improving health literacy of older adults with MCI may enhance HRQoL. An education intervention is recommended to reduce the existing health disparities due to low health literacy.

Health literacy and its determinants among higher education students in the Alentejo region of southern Portugal-A cross-sectional survey

INTRODUCTION

The capacity of higher education students to comprehend and act on health information is a pivotal factor in attaining favourable health outcomes and well-being. Assessing the health literacy of these students is essential in order to develop targeted interventions and provide informed health support. The aim of this study was to identify the level of health literacy and to analyse its relationship with determinants such as socio-demographic variables, chronic disease, perceived health status, and perceived availability of money for expenses among higher education students in the Alentejo region of southern Portugal.

METHODOLOGY

An observational, descriptive and cross-sectional study was conducted between 22 June and 12 September 2023. An online structured questionnaire consisting of the Portuguese version of the European Health Literacy Survey Questionnaire-16 items (HLS-EU-PT-Q16), including socio-demographic data, presence of chronic diseases, perceived health status, and availability of money for expenses. Data were analysed using independent samples t-test, one-way ANOVA, post-hoc Gabriel's test, and multivariate logistic regression analyses at a significance level of 0.05. Regression models were used to investigate the relationship between health literacy and various determinants. The study protocol was approved by the Ethics Committee of the University of Évora, and all participants gave written informed consent.

RESULTS

Analysis of the HLS-EU-PT-Q16 showed that 82.3% of the 1228 students sampled had limited health literacy. The mean health literacy score was 19.3 ± 12.8 on a scale of 0 to 50, with subscores of 19.4 ± 13.9 for health care, 19.1 ± 13.1 for disease prevention, and 19.0 ± 13.7 for health promotion. Significant associations were found between health literacy and several determinants. Higher health literacy was associated with the absence of chronic diseases. Regression analysis showed that lower health literacy was associated with not attending health-related courses, not living with a health professional, perceiving limited availability of money for expenses, and having an unsatisfactory health status.

CONCLUSION

This study improves the understanding of health literacy levels among higher education students in Alentejo, Portugal, and identifies key determinants. Higher education students in this region had relatively low levels of health literacy, which may have a negative impact on their health outcomes. These findings highlight the need for interventions to improve health literacy among higher education students and to address the specific needs of high-risk subgroups in the Alentejo.

Media Health Literacy in Spanish Nursing Students: A Multicenter Cross-Sectional Study

BACKGROUND

Amidst current misinformation, media literacy is an essential competency for nursing professionals. This study aimed to analyze the level of media health literacy among Spanish undergraduate nursing students, stratifying the results by gender, region, and other associated factors.

METHODS

A cross-sectional study was conducted at five Spanish universities (N = 416) using the Spanish version of the Media Health Literacy (MeHLit-SV) Questionnaire.

RESULTS

Students presented an average media health literacy score of 48.73 points. The media health literacy level was significantly higher among students from universities in the central and northeastern regions of Spain (ANOVA Test, p = 0.0002), those who had previously studied in a city (ANOVA Test, p = 0.001), those who combined their studies with employment (ANOVA Test, p = 0.001), and those residing in communities with fewer than 500 inhabitants (ANOVA Test, p = 0.001). No differences were found based on gender.

CONCLUSIONS

The media health literacy level of the students was deficient and varied according to socio-economic and socio-educational factors. Understanding the literacy level of future nurses and promoting the inclusion of this competency in their education will enable them to become leaders in improving the population's health self-care.

A study on the effect of school and family environments and self-efficacy on health literacy of college students

Background

Health literacy is an important means to improve health outcomes and reduce health disparities. It plays an important role in promoting multiple health-related behaviors of individuals. Numerous studies have demonstrated a number of sociodemographic and school characteristics, and family related factors were related to health literacy among college students. However, these characteristics and factors were relatively unchangeable. Research on the relationship between factors, that can be intervened, and health literacy remains scarce. This study aims to explore the association between personal and changeable environmental factors, and the level of health literacy in college students.

Methods

A cross-sectional study, which used a stratified random sampling method, was conducted at a university in Wuhan (N = 447). The survey questionnaire included sociodemographic characteristics, the School Environment Questionnaire, the Family Environment Questionnaire, the General Self-Efficacy Scale Questionnaire, and the Health Literacy Questionnaire. We used Spearman correlation tests, and Student's tests or analyses of variance to describe the relationship among continuous variables. In addition, we employed linear regression analysis to test the mediating effect based on the bias-corrected nonparametric percentile Bootstrap method.

Results

Factors related to socioeconomic status, such as living costs (p = 0.011), residential area (p = 0.003), annual household income (p = 0.001), and parents' education level (fathers: p = 0.001; mothers: p = 0.01) and occupation type (fathers: p < 0.001; mothers: p = 0.044), had close correlations with health literacy. School and family environments and self-efficacy had a positive impact on college students' health literacy (β = 0.235, p < 0.001; β = 0.323, p < 0.001; β = 0.489, p < 0.001). Self-efficacy had a mediating effect on the relationship between school and family environments, as well as health literacy. The total, direct, and indirect effects of the school environment on health literacy were 0.235, 0.157, and 0.078, respectively. The total, direct, and indirect effects of the family environment on health literacy were 0.323, 0.189, and 0.134, respectively.

Conclusion

This study confirms that improving school and family environments could directly or indirectly increase college students' health literacy through promoting their self-efficacy. Socioeconomic status has a significant impact on their health literacy. Moreover, other factors that affect students' health literacy and relationships among self-efficacy, surrounding environments, and health literacy may need to be explored in the future.

Health literacy - study protocol for LiSa cohort study

BACKGROUND

Health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, whether at home, at the workplace, in the community, marketplace, healthcare sector, or the political arena. The main aim of this project is to measure health literacy in the adult population living in the municipality of Leiria over the next 10 years. As secondary objectives it is intended to characterize anxiety and depression, metabolic risk and health behaviors in the same population and over the same period.

METHODS

This is a prospective cohort study that collects data on HL, anxiety and depression, health characteristics, health behavior and sociodemographic data. The study population will be composed by adults (≥ 18 years old) who are non-institutionalized and living in private households in Leiria. The random sample is stratified by gender and age groups. A face-to-face interview will be conducted with the Computer Assisted Personal Interview at baseline. Follow-up will be carried out every 2 years via telephone call. The association between independent variables and health literacy is examined by means of variance analysis with measurement repetition, and taking into consideration follow-up.

DISCUSSION

The LiSa project is a population-based study, derived from a random sampling technique that will allow the analysis of health outcomes in a representative sample of the population of the municipality of Leiria. The LiSa study will be a valuable resource for epidemiological research, as it will provide fundamental information to improve public health policies regarding health literacy in Portugal.

TRIAL REGISTRATION

Clinical trials: NCT05558631 (registered on 26/09/2022).

Healthy life skills and related factors among university students: a cross-sectional study in Istanbul, Turkey

BACKGROUND

Chronic non-communicable diseases (NCDs) are the leading cause of global deaths. University students with unhealthy lifestyle constitute a high-risk group for NCDs. Evaluating and developing healthy behaviors during this period is very important for future health outcomes. This study was conducted to determine healthy life skills in university students.

METHODS

A cross-sectional study was conducted at a university, and data were collected between January and March 2023 in Istanbul. Data were collected using the healthy living skills scale in University Students and the Personal Information Form. Normal distribution conditions of the data were checked with the Kolmogorov-Smirnov test. According to data distribution, data with normal distribution were analyzed using parametric statistics including t-test, ANOVA and Chi-square tests and data with non-normal distribution were analyzed using non-parametric tests including Mann-Whitney U-test and Fisher's exact test. Logistic regression test was used to determine predictor variables.

RESULTS

The average score for healthy life skills was 63.5 out of 84. Significant differences were found in the scores based on marital status, economic income, social security insurance coverage, and educational grade (p = 0.03, p = 0.001, p = 0.004, p = 0.04, respectively). Students who reported alcohol and smoking consumption had lower scores (60.8 ± 12) out of 84.

CONCLUSION

The study revealed that university students in Istanbul possess a satisfactory level of healthy life skills. By providing social support, such as expanding the coverage of social security insurance and establishing conducive educational environments, while also paying attention to the influence of peers on students, we can contribute to the development of healthy life skills in university students.

Translation, cross-cultural adaptation, and validation of the Chinese version of the COVID-19 health literacy scale in nursing students

BACKGROUND

Effective communication is an essential component of high-quality nursing care. Health literacy, the ability to access, describe, evaluate and apply health information to make informed decisions, is an important component of effective communication in nursing. Nurses, including student nurses, with good levels of health literacy (HL) are well positioned to communicate reliable public health-related information effectively, at times like the COVID-19 global pandemic. At this time, many nursing students have been at the frontline of patient education, as such, it would be expected that they have high levels of HL. However, it has been suggested that there is the need to improve HL levels in nursing students.

AIMS

The aim of this study was to analyse the structure of item response of a back translated Chinese version of the COVID-HLS-Q22 questionnaire and to assess the coronavirus-related HLof Chinese speaking nursing students in Hong Kong using the COVID-HLS-Q22-CN.

METHODS

A cross-sectional study of 97 undergraduate nursing students was conducted using two self-reported questionnaires. The HLS-EU-16 scale, with face validity already established, was used to assess scale equivalence Using a cross-over study approach, student participants were randomly assigned in sequential order. The validation process was performed in five phases: direct translation, translation synthesis, back translation, consolidation with experts, and testing with the students. The intended outcome of this study will be a formally tested model of the Chinese version of the COVID-HLS-Q22-CN, that can be replicated in Chinese population.

RESULTS

Factorial equivalence was present across language versions in both questionnaires. Internal consistency was excellent for COVID-HLS-Q22-CN (coefficient alpha for Chinese version of questionnaire, 0.957 and English version, 0.953). This suggested that the four subscale are stable across the two questionnaires.

CONCLUSION

The COVID-HLS-Q22-CN has proven to be a feasible and reliable tool in the assessment of Hong Kong based Chinese speaking nursing students. The emergence of issues around COVID-related HL further highlights the need to include the teaching of critical health literacy skills within nurse education, preparing the healthcare professionals of the future for public health emergencies.

Factors related with nursing students' health literacy: a cross sectional study

Background

Nursing professionals have a crucial role in promoting health literacy in health services, so it is necessary to ensure health literacy skills in future health professionals.

Objective

The objective of the study was to examine the health literacy of nursing students and its associated factors.

Methods

A cross-sectional descriptive study was carried out on 460 nursing students. For data collection, a semi-structured questionnaire was obtained on sociodemographic characteristics, perception and health care, use of the health system and lifestyles. In addition, health literacy was assessed using the European Health Literacy Questionnaire.

Results

6.1% of the participants had an inadequate level of health literacy and 36.5% problematic. The probability of having sufficient health literacy is directly associated with age; and inversely with smoking, prolonged screen time and living alone (p < 0.05).

Conclusion

A large percentage of nursing students need to improve their health literacy skills. It is necessary to integrate a greater number of contents in health literacy in the curriculum of nursing students.

Health Literacy Among University Students in Shaanxi Province of China: A Cross-Sectional Study

Background

An adequate level of health literacy will help university students to better respond to public health emergencies and reduce unintended harm caused by public health events. The objective of this study was to assess the health literacy levels of students from Universities of Shaanxi province of China, in order to provide a basis for the development of health literacy promotion plan for university students.

Methods

An online cross-sectional questionnaire survey was conducted at five universities in Shaanxi Province of China on the Wen-Juan-Xing online platform. A purposive sampling method was used to 1578 students via self-administered questionnaire. Comparisons of means were made using the t-test and ANOVA, and comparisons of ratios or composition ratios were made using the χ² test.

Results

The mean score for health literacy was (105.33±10.14) out of 135, and the mean scores for the three dimensions of health knowledge, attitudes and practices were (36.093±4.192), (34.178±4.227) and (35.059±4.515) respectively. Of the total sample, 39.2% were classified as sufficient in health literacy. Female students had higher health literacy level than male students (t=4.064, p=0.044), lower grade students scored higher than higher grade (F=3.194, p=0.013), students from urban cities scored higher than those who came from rural areas (t=16.376, p<0.001), and university students with health education experience scored higher than those without (t=24.389, p<0.001).

Conclusion

University students' health literacy is closely related to their gender, grades, family location and health education experience.

Electronic health literacy and its association with lifestyle behavior among undergraduate students: A cross-sectional survey

Background

This study aims to assess healthy lifestyle behaviors among undergraduate students and determine the association between electronic health literacy with lifestyle behavior among undergraduate Jordanian university students.

Methods

A descriptive cross-sectional design was used. The study recruited 404 participants utilizing undergraduate students from public and private universities. The e-Health literacy scale was used to assess the level of health information literacy among university students.

Results

Data were collected from 404 participants who reported very good health status, the majority of the participants were female 57.2% with an average age of 19.3 years. The results showed that participants had good health behavior in terms of exercise, taking breakfast, smoking status, and sleeping status. The results have shown an inadequate level of e-Health literacy 16.61 (SD = 4.10) out of 40. The vast majority of students, in terms of their attitudes toward the Internet, thought that Internet health information was very useful/useful (95.8%). Also, they thought that online health information was very important /important (97.3%). The results showed that students who were attending public universities had higher e-Health literacy scores rather than those who were attending private universities, t (402) = 1.81, p = .014. The mean e-Health literacy score for nonmedical students was higher than those for medical students (p = .022).

Conclusion

The study's findings provide important insights into the health behaviors and electronic health literacy of undergraduate students in Jordanian universities, and offer valuable guidance for future health education programs and policies aimed at promoting healthy lifestyles in this population.

[Health Literacy Among German Health Professionals-To-Be - Exploratory Pilot Study]

OBJECTIVE

Health literacy is defined as the ability to collect, understand, evaluate and use health information. Previous studies have shown that the German population has only an average level of health literacy. Health professionals such as nurses, doctors or midwives need to be health literate themselves to promote patients' health literacy, as well as to protect and promote their own health. So far, there is a lack of research about health literacy among health professionals in Germany. The objective of this study was to assess the health literacy of health professionals.

METHOD

The study involved 583 participants from the final year classes of the DHBW Stuttgart and dual cooperation partners (vocational schools and academic teaching hospitals). These included graduates of nursing, midwifery and therapy (physiotherapy/logo-/occupational therapy), as well as management in health care and medical students in their practical year. The questionnaire HLS-EU-Q16 was used to record health literacy. By means of 16 questions, the participants rated on a 4-point scale how easy or difficult it was for them to find, understand, assess and implement health-related information.

RESULTS

The study showed that only 30.1% of the participants had sufficient health literacy; 48.9% of the participants showed problematic health literacy, 21.0% inadequate health literacy. The analysis of the individual questions showed that, in almost all areas, paticipants reported more problems in finding, understanding, assessing and implementing health-related information than respondents in other European countries.

CONCLUSIONS

The present study shows that young health professionals have limited health literacy. Further research is needed to obtain a more comprehensive and differentiated picture of health literacy among health professionals. Health literacy skills and competencies should be systematically introduced in health professions-related study curricula, as well as in bedside training.

Online health information seeking and digital health literacy among information and learning resources undergraduate students

Background

During the COVID-19 pandemic, students have trouble coping with the available health information regarding the coronavirus in their daily lives because of misinformation.

Objectives

The aim of this study was to evaluate online health information seeking and digital health literacy among information and learning resources undergraduate students at Taibah University during the COVID-19 pandemic.

Methods

To investigate the primary goal, this study used a simultaneous exploratory mixed methods design. Seventeen students participated in phone interviews, and 306 were invited to complete an online survey.

Analysis

The collected data was analyzed using both quantitative (SPSS) and qualitative (NVivo 10) methods.

Results

Search engines, social media, and YouTube were most often used by the respondents as sources to search for COVID-19-related information. COVID-19 symptoms, restrictions, and the current spread of COVID-19 were the most searched topics by the respondents. Significant and relevant differences emerged for the digital health literacy subscales “information search” and “adding self-generated content”. However, there were no significant differences in the digital health literacy subscale “determining relevance”.

Conclusion

Using the internet to provide health information tailored to the needs and interests of students to seek health information online and thereby improve their health literacy.

COVID-digital health literacy and subjective well-being of students in Ghana: Mediation-moderation analyses

Background

Previous research has established a strong association between COVID-19 digital health literacy (DHL) and subjective well-being among several populations, including students. With the growing misinformation and heightened fear of COVID-19 among persons with an underlying medical condition, several scholars have questioned the direct relationship between DHL and well-being. This study assessed the moderating roles of information accuracy concerns and the existence of an underlying medical condition among students.

Methods

Using a cross-sectional design, a multi-stage sampling approach was used to select 1392 students from senior high schools in Northern Ghana who completed a questionnaire containing information on DHL, information accuracy, subjective well-being, and underlying health condition, with reported internal consistency coefficients above 0.70. The data which was processed with SPSS version 25, was analyzed using correlation (Pearson and biserial), and Hayes' PROCESS for the moderation and mediation analyses.

Results

A significant positive relationship was found between (a) DHL and subjective well-being, (b) DHL and information accuracy concerns, and (c) information accuracy concerns and subjective well-being. However, the prevalence of underlying health condition was negatively associated with information accuracy, DHL, and subjective well-being. Information accuracy concerns and the existence of an underlying medical condition significantly regulated the relationship between DHL and subjective well-being.

Conclusions

Demonstrating satisfactory levels of DHL does not necessarily result in improved subjective well-being. However, emphasis should be placed on whether individuals attach much importance to the accuracy of information retrieved as well as having or not an underlying health condition.

Understanding Health Literacy among University Health Science Students of Different Nationalities

An adequate level of health literacy is essential for clear communication between patients and health care workers. The internationalization of universities is increasing in the field of health care. The aims of our research were to measure (1) the level of health literacy and its correlation among university students and (2) the relationship between the different instruments measuring health literacy. A cross-sectional study was conducted in the 2020/2021 academic year. The questionnaire included questions on sociodemographic status, study data, health status, and health literacy level. According to the HLS-EU-Q16 health literacy questionnaire, more than half of the students had a limited HL level in disease prevention (52.4%) and health promotion (58.4%) subindexes. Nationality was found to be an influencing factor (p < 0.001). According to the NVS, 80.1% of the students had an adequate HL level. A significant correlation was found between the results and nationality (p = 0.005). None of the Chew questions demonstrated a correlation with nationality (q1 p = 0.269, q2 p = 0.368, q3 p = 0.528). Nationality is a key factor in the level of subjective and functional health literacy. We need to measure both types of levels to see the real results.

Health Literacy and Its Associations with Understanding and Perception of Front-of-Package Nutrition Labels among Higher Education Students

(1) Background: Nutrition labels on the front of food packages have increasingly become the focus of research. However, too few studies have placed special emphasis on nutritionally at-risk subpopulations, such as young adults or those with low literacy/numeracy skills. The present study aimed to assess both the perception and objective understanding of three front-of-package labeling (FOPL) formats currently in use on the Belgian market, i.e., the Nutri-Score, Reference Intakes, and Multiple Traffic Lights, among students of varying health literacy (HL) levels. (2) Methods: A web-based survey was carried out among 2295 students of tertiary education in the province of Liège, Belgium. The questionnaire included questions related to general characteristics, objective understanding, and perception in response to the assigned FOPL format and level of HL. (3) Results: With respect to objective understanding, the Nutri-Score outperformed all other labels across all HL levels, and it was similarly understood in students of varying HL levels. Several students' characteristics appeared to be associated with each cluster of perception, with the Nutri-Score cluster having the highest percentages of disadvantaged students, i.e., those with inadequate HL, from non-university institutions, with low self-estimated nutrition knowledge, and with low self-estimated diet quality. (4) Conclusion: Overall, the findings supported the Nutri-Score as particularly effective in guiding students in their food choices. Of particular importance is the fact that the summarized and graded color-coded nutritional label would be a useful strategy for those disadvantaged by limited HL.

Impact of Limited E-Health Literacy on the Overall Survival of Patients With Cancer

PURPOSE

Digitalization of the health care system is transforming cancer patient care. Although many studies have investigated the determinants of a limited digital health literacy, the association between frailty factors and overall survival (OS) of these patients has never been assessed.

METHODS

A retrospective noninterventional study included 15,244 adult patients with cancer diagnosed between January 1, 2015, and December 31, 2017, and treated at the Centre Léon Bérard. Limited e-health literacy was defined as the absence of an e-mail address in the electronic patient record. An Inverse Probability of Treatment-Weighted Kaplan-Meier estimate and a multivariate Cox proportional hazards model including interaction terms were used to adjust for confounding on measured covariates.

RESULTS

In total, 15,244 adults with cancer were included: 55% women, with a median age of 62 years (19-103), and 35.5% had a metastatic disease. More than half (n = 8,771, 57.5%) had entered their e-mail address in their electronic patient record, and 4,020 (26.4%) opened their own patient portal. The median follow-up was 3.6 years (range: 0-6.8). Inverse Probability of Treatment-weighted Kaplan-Meier estimates showed a significantly better OS for patients with an e-mail address (P < .001). In multivariate analysis integrating interaction terms, male gender (hazard ratio [HR] = 1.27; 95% CI, 1.15 to 1.41; P < .001), older age (HR = 1.02; 95% CI, 1.02 to 1.03; P < .001), de novo metastatic setting (HR = 2.63; 95% CI, 2.47 to 2.79; P < .001), and no e-mail address (HR = 1.63; 95% CI, 1.33 to 2.00; P < .001) were significantly associated with worse OS.

CONCLUSION

Our results support a strong association between the limited level of literacy and OS. A more in-depth study integrating variables such as socioeconomic level and location of residence would enrich these results.

A Visualized and Scientometric Analysis of Health Literacy Research

PURPOSE

The health literacy concerned by numerous policy and advocacy organizations is springing up rapidly and has evolved substantially over the past few decades. During the period of COVID-19, people who are in the absence of effective treatment and limited availability of vaccination need a higher health literacy to protective themselves. In order to provide a summary of the health literacy research, a visualized and Scientometric analysis is applied in this study.

METHODS

Based on a scientific review of 3,670 data on health literacy from Web of Science, this research uses Citespace software to systematically and objectively describe health literacy to determine the knowledge evolution structure between articles and investigate research trends.

RESULTS

The results show that the annual outputs of publications have grown rapidly since 2003. The USA and Australia make larger contributions compared with other countries in terms of quantity of publications and worldwide collaboration relationship between them. The "Soc Sci Med," "J Health Commun." "Patient Educ Couns" and "J Gen Intern Med" pay more attention to health literacy research. The leading authors with influence and authority are Wolf MS, Osborne RH, and Paasche-Orlow MK. Health literacy research in this field focuses on care, knowledge, and education, and so on. An emerging trend of health literacy with Covid-19, online tools, nursing, and obesity will spread across the globe.

CONCLUSION

Compared with simply reviewing existing articles, the major contribution in this study is a comprehensive review of yearly scientific output, journals, countries, institutions, contributors, highly cited papers, and keywords for health literacy research. The review also provides valuable and seminal guidelines for interested researchers on health literacy research.

Do health literacy levels of nursing students change throughout the study programme? A cross-sectional study

OBJECTIVES

The aim of this research was to analyse if the level of health literacy (HL) of nursing students changes throughout the study programme.

DESIGN

A cross-sectional study with anonymous self-reporting was conducted.

PARTICIPANTS/SETTING

329 public university nursing students in Seville, Spain; 243 of the first year and 86 of the fourth.

INTERVENTIONS

The short Spanish version of the Health Literacy Survey Questionnaire-European Union was used to evaluate HL.

PRIMARY AND SECONDARY OUTCOME MEASURES

The proportions of the limited level of HL were compared between academic years and the crude and corrected OR were calculated with the Mantel-Haenszel test to evaluate the effect of confusion of the sex variable on the HL level and academic year relationship. A logistic regression model with step-by-step analysis was run, including the independent variables sex, age, marital status, academic year and HL level (limited/sufficient) as the dependent variable.

RESULTS

62.1% of the participants of the first year versus 47.7% of the fourth year had a limited literacy level for a crude OR of 1.5 (95% CI 1.10 to 2.21; p=0.014) and a corrected by sex OR of 1.8 (95% CI 1.10 to 2.96; p=0.026). Only the strata in women had a statistically significant relationship. The logistic regression model ratified that the HL was a function exclusive to the academic year.

CONCLUSION

The HL level of nursing students increases from the first to the fourth academic year, even when controlling for sex. Although the HL level in the fourth academic year was greater than that of the first, both groups had inadequate HL levels. It is hence recommended to implement intervention strategies, which reinforce in the curriculum the knowledge and experiences related with health communication and education to ensure that future professionals improve their HL. Achieving adequate HL is crucial to be able to provide care to patients, their families and the community.

Nursing students' understanding of health literacy and health practices: a cross-sectional study at a university in Namibia

Background

A poor understanding of health literacy and inadequate health practices among nurses can be detrimental to a population’s health. The starting point of solving this problem is through the provision of methodical health literacy and health practice education in the nursing curriculum. This study explored nursing students’ understanding of the concept of ‘health literacy’ and their health practices at a university in Namibia.

Methods

A descriptive cross-sectional study was carried out among 205 nursing students. A simple stratified sampling method was used and data were collected using a self-reporting Understanding of Health Literacy (UHL) questionnaire. Pearson correlation, independent t-test and One-way ANOVA were used to analyse the data.

Results

The overall mean Understanding of Health Literacy score was 13.04 ± 1.52. The majority (n = 157; 76.5%) of the students were found to have adequate health literacy scores, 21.5% had moderate health literacy scores, and only 2% had inadequate health literacy scores. The overall mean health practice score was 32.4 ± 5.50. Most (n = 106; 51.7%) of the students were found to have poor health practices, 44.4% had average health practices, and just 3.9% had good health practices. There was no significant relationship between the health literacy levels and health practices of the students (p = 0.63).

Conclusions

Nursing students have a good understanding of the concept of health literacy, but more effort can be made to translate this understanding into health literacy skills. There is a need to investigate the contributing factors to poor health practices, as well as develop strategies that can support good health practices among nursing students. These health literacy skills could then be transferred into the students' professional careers as nurses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00776-z.

Investigation of perceived fear of COVID-19 and vaccine hesitancy in nursing students

This study aims to investigate the perceived fear of COVID-19 and vaccine hesitancy in nursing students. This study was conducted as a cross-sectional study with the participation of 1167 nursing students. Personal Information Form, Vaccine Hesitancy Scale and Fear of COVID-19 Scale were used for data collection. The reasons for the vaccine hesitancy of the students were listed as follows: 57.6% of them stated that it had side effects, 17.7% stated there was no conclusive evidence that the vaccine was effective, and 12.6% stated it was not reliable. A positive correlation was found between fear of COVID-19 and vaccine hesitancy.

The Impact of Information Sources on COVID-19-Related Knowledge, Attitudes, and Practices (KAP) among University Students: A Nationwide Cross-Sectional Study

COVID-19 is an emerging respiratory disease caused by a novel coronavirus accompanied by a tsunami of misinformation and fake news. This can weaken the public health responses by affecting the COVID-19-related knowledge, attitudes, and practices (KAP) of the public. Therefore, this cross-sectional study was designed during the early stage of the pandemic to evaluate the KAP of Palestinian university students and their commonly used information sources. We found that the most trusted information source among students was the World Health Organization (WHO), followed by the Palestinian Ministry of Health (MoH) briefings and healthcare workers, whereas social media was the most frequently used source of information. The participants exhibited a high level of COVID-19-related knowledge, having an average score of 8.65 (range: 0–10). In total, 76% avoided going to crowded places, and only 33% wore a mask while being outdoors. The vast majority (93%) checked the accuracy of COVID-19-related information before publishing it, 56% used the WHO and MoH briefings for fact-checking, and only 8% relied on healthcare workers. This was particularly the case for those who lived in refugee camps. This study provides an insight into the information sources used by Palestinian university students, the sources they trust, and the information formats they prefer. These results may help public health authorities to locate the information sources through which university students should be targeted. Efforts should be made to recommend healthcare workers as credible information sources. In this way, they will be able to prevent the spread of misleading information and provide high-quality information, especially within unconventional settings such as refugee camps.

Generalized Anxiety among Swiss Health Professions and Non-Health Professions Students: An Open Cohort Study over 14 Months in the COVID-19 Pandemic

To date, little is known about the long-term trajectory of generalized anxiety disorder (GAD) symptoms in health professions (HP) students over the course of the pandemic. Like health professionals in general, HP students may have a significantly greater susceptibility to GAD symptoms due to their involvement in the health care system and the associated specific stressors and risks during the COVID-19 pandemic. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate the long-term course of GAD symptoms with eight measurement points over 14 months in 9380 HP and non-HP students in Switzerland between March 2020 and June 2021. We employed logistic regression models with clustered sandwich standard errors to estimate unadjusted and adjusted prevalence of GAD symptoms. In the full model, we adjusted for age, gender, nationality, social status, social support, self-efficacy, and COVID-19 symptoms in the past 4 weeks. At baseline, the estimated adjusted GAD symptom prevalence was 17.6% (95% CI = 14.4–20.7) in HP students and 24.4% (95% CI = 22.3–26.5) in their peers. With the peak of the second SARS-CoV-2 infection wave in October/November 2020, GAD symptom prevalence substantially increased and then remained stable over time, despite changes in the epidemiological situation and its associated containment measures. At the last follow-up in June 2021, GAD symptom prevalence in HP and non-HP students was 22.9% (95% CI = 16.3–29.5) and 36.9% (95% CI = 32.9–40.9), respectively. Absolute differences in GAD symptom prevalence between student groups over all eight measurement points ranged from 6.2% to 14.9% (all p < 0.05). Non-HP students are identified as a specifically vulnerable group. Accordingly, target group-specific public health campaigns and interventions should be developed with the aim to strengthen their resources, reducing GAD symptoms, and preventing chronification.

Universal Predictors of Dental Students' Attitudes towards COVID-19 Vaccination: Machine Learning-Based Approach

BACKGROUND

young adults represent a critical target for mass-vaccination strategies of COVID-19 that aim to achieve herd immunity. Healthcare students, including dental students, are perceived as the upper echelon of health literacy; therefore, their health-related beliefs, attitudes and behaviors influence their peers and communities. The main aim of this study was to synthesize a data-driven model for the predictors of COVID-19 vaccine willingness among dental students.

METHODS

a secondary analysis of data extracted from a recently conducted multi-center and multi-national cross-sectional study of dental students' attitudes towards COVID-19 vaccination in 22 countries was carried out utilizing decision tree and regression analyses. Based on previous literature, a proposed conceptual model was developed and tested through a machine learning approach to elicit factors related to dental students' willingness to get the COVID-19 vaccine.

RESULTS

machine learning analysis suggested five important predictors of COVID-19 vaccination willingness among dental students globally, i.e., the economic level of the country where the student lives and studies, the individual's trust of the pharmaceutical industry, the individual's misconception of natural immunity, the individual's belief of vaccines risk-benefit-ratio, and the individual's attitudes toward novel vaccines.

CONCLUSIONS

according to the socio-ecological theory, the country's economic level was the only contextual predictor, while the rest were individual predictors. Future research is recommended to be designed in a longitudinal fashion to facilitate evaluating the proposed model. The interventions of controlling vaccine hesitancy among the youth population may benefit from improving their views of the risk-benefit ratio of COVID-19 vaccines. Moreover, healthcare students, including dental students, will likely benefit from increasing their awareness of immunization and infectious diseases through curricular amendments.

Prevalence and Drivers of COVID-19 Vaccine Hesitancy among Czech University Students: National Cross-Sectional Study

Background: university students are believed to retain the highest levels of health literacy. They are perceived as the opinion leaders within their communities; therefore, their health-related beliefs and attitudes are deemed important for public health campaigns. This study aimed to investigate the COVID-19 vaccine hesitancy drivers among university students in the Czech Republic. Methods: a cross-sectional study using a self-administered questionnaire was carried out in the weeks before the unrestricted vaccine deployment to Czech adults. The questionnaire had 21 multiple-choice items stratified in 4 categories; demographic characteristics, COVID-19-related anamnesis and influenza vaccine experience, attitudes towards COVID-19 vaccination, and the possible drivers of COVID-19 vaccine hesitancy suggested by the WHO-SAGE. Results: out of the 1351 included students, 66.8% were females, 84.5% were Czech nationals, and 40.6% enrolled in healthcare programs. The overall COVID-19 vaccine acceptance level was 73.3%, 19.3% of participants were vaccine-resistant, and only 7.4% were vaccine-hesitant. Trust in the pharmaceutical industry, trust in healthcare providers, and perceived knowledge sufficiency predicted higher odds of vaccine acceptance. In contrast, media and social media, personal beliefs, immunity misconception, previous COVID-19 infection, and suspicions about novel vaccines and the local availability predicted higher odds of vaccine hesitancy. Conclusions: The findings of this study predict a fair probability to achieve community immunity (herd immunity) among the target population group. The primary prevention strategies in the Czech Republic need to be culturally sensitive and inclusive for foreign nationals. As one-quarter of the participating students are dependent on vaccine safety data, this study findings support the call for independent studies evaluating the side effects of COVID-19 vaccines.

Facing the Growing COVID-19 Infodemic: Digital Health Literacy and Information-Seeking Behaviour of University Students in Slovenia

The entire world is faced with the COVID-19 pandemic, which is also accompanied by an infodemic. This refers to the rapid spread of (accurate and false) information, mainly through internet usage increasing. Digital health literacy (DHL) is therefore important for addressing challenges related to online health information and services, as well as for navigation through the complex information landscape with huge amounts of different (and conflicting) information about COVID-19. The aim of this study is to examine the level of DHL in relation to COVID-19 in Slovenian university students and to determine online information-seeking behaviour in order to plan and prepare effective communication interventions for this sub-population. A cross-sectional survey, administered by an online questionnaire, was conducted to collect data on DHL. A total of 3621 students participated, of whom 70% were female and the average age was 22.65 years (SD = 4.65). Bivariate analyses were performed to assess the association of key characteristics with DHL. Overall, the results show that the level of DHL among students is sufficient. Most difficulties were reported in assessing the reliability of information (n = 1484, 49.3%). Approximately one third of the students (n = 847, 27.9%) reported having problems in finding information of their interest, and somewhat more (n = 900, 29.6%) reported difficulties in making a selection among all the information found. Students with a sufficient level of DHL are more likely to seek information through search engines and websites of official institutions, while students with a limited level of DHL more frequently reported using social media for health information searches. It is necessary to establish interventions for a systematic lift of the DHL and health literacy (HL) of all population groups.

Association between health literacy and mortality: a systematic review and meta-analysis

BACKGROUND

To identify the relationship between health literacy (HL) and mortality based on a systematic review and meta-analysis.

METHODS

Literature published from database inception until July 2020 was searched using the PubMed and Web of Science databases, using relevant keywords and clear inclusion and exclusion criteria. The search was limited to English language articles. Two reviewers independently selected studies and extracted data. Pooled correlation coefficients and their 95% confidence intervals (CI) between HL and mortality were estimated using Stata 15.0 software. Potential sources of heterogeneity were explored using subgroup analysis, sensitivity analysis, and meta-regression. Quality of the original studies that were included in the meta-analysis was evaluated using the Newcastle-Ottawa Scale. A funnel plot and Egger's test were used to determine whether significant publication bias was present.

RESULTS

Overall, 19 articles were included, reporting on a total of 41,149 subjects. Eleven were prospective cohort studies, and all articles were considered "good" quality. The most used screening instruments were the short Test of Functional Health Literacy (S-TOFHLA) in Adults and the Brief Health Literacy Screen (BHLS). Among 39,423 subjects (two articles did not report the number of patients with low HL), approximately 9202 (23%) had inadequate or marginal HL. The correlation coefficient between HL and mortality was 1.25 (95%CI = 0.25-0.44).

CONCLUSION

Lower HL was associated with an increased risk of death. This finding should be considered carefully and confirmed by further research.

COVID-19 and Health Information Seeking Behavior: Digital Health Literacy Survey amongst University Students in Pakistan

Amid the COVID-19 pandemic, digital health literacy (DHL) has become a significant public health concern. This research aims to assess information seeking behavior, as well as the ability to find relevant information and deal with DHL among university students in Pakistan. An online-based cross-sectional survey, using a web-based interviewing technique, was conducted to collect data on DHL. Simple bivariate and multivariate linear regression was performed to assess the association of key characteristics with DHL. The results show a high DHL related to COVID-19 in 54.3% of students. Most of the Pakistani students demonstrated ~50% DHL in all dimensions, except for reliability. Multivariate findings showed that gender, sense of coherence and importance of information were found to be significantly associated with DHL. However, a negative association was observed with students' satisfaction with information. This led to the conclusion that critical operational and navigations skills are essential to achieve COVID-19 DHL and cope with stress, particularly to promote both personal and community health. Focused interventions and strategies should be designed to enhance DHL amongst university students to combat the pandemic.

Is health literacy associated with antibiotic use, knowledge and awareness of antimicrobial resistance among non-medical university students in Egypt? A cross-sectional study

OBJECTIVES

Antibiotic resistance is a global public health concern, especially in developing countries, where antibiotic misuse is widespread. However, studies investigating relevant factors, particularly in youth, are limited. This study examined the levels of health literacy (HL) and their association with antibiotic use, knowledge of antibiotics and awareness of antibiotic resistance among university students in Egypt.

DESIGN

A cross-sectional study was conducted using self-administered questionnaires during 2018. The Health Literacy Survey (HLS-EU-Q16) and the WHO Antibiotic resistance: Multi-Country Public Awareness Survey were used. Bivariate and multivariable analyses were used to compare responses on use and knowledge of antibiotics, and awareness of antibiotic resistance between the three levels of students' HL.

SETTING

University, Cairo, Egypt.

PARTICIPANTS

508 non-medical university students.

OUTCOMES

Students' HL scores were categorised into sufficient, problematic and inadequate. Students' knowledge of antibiotics was categorised into good and poor. Students' awareness of antibiotic resistance was categorised into high, average and poor.

RESULTS

35.1% of students had sufficient HL. 79.7% of students had poor knowledge of antibiotics. 39.9% of students reported having used antibiotics in the past month without a prescription. 92.2% had limited awareness of antibiotic resistance and 30.6% of students heard about the term 'antimicrobial resistance'. Background characteristics did not significantly differ by HL levels or knowledge scores, except for students' year of study. Sufficient HL was independently associated with students' high awareness of antibiotic resistance (adjusted OR=2.8; 95% CI: 1.3 to 5.9).

CONCLUSIONS

HL was insufficient in this sample of non-medical Egyptian university students. Across all levels of HL, knowledge of antibiotics and awareness of antibiotic resistance were limited, reflecting deficiency in relevant education programmes. Findings suggest that sufficient HL supports high awareness of antibiotic resistance. Incorporating HL and rational antibiotic use awareness raising programmes in university curricula is an urgent necessity to curb antibiotic resistance.

The evaluation of chatbot as a tool for health literacy education among undergraduate students

This study discussed and evaluated the usefulness, performance, and technology acceptance of a chatbot developed to educate users and provide health literacy. A semi-structured interview and analytic sessions were provided on Google Analytics dashboard, and the users' acceptance toward the technology was measured using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2). A total of 75 undergraduate students were involved over a total period of two months. Each respondent explored the health chatbot actively to get advice from it with a phrase that matched the chatbot's intents via mobile devices. The evaluation results showed that 73.3% of the respondents found that the chatbot can help understand several health issues and provide a good conversation. The performance evaluation also showed that the chatbot contributed a low percentage of exit, where less than 37% of users exited the application. The overall assessment showed that the developed chatbot has a significant potential to be used as a conversational agent to increase health literacy, especially among students and young adults. However, more research should be done before the technology can replace humans in a real setting.

Interdisciplinary Perspectives on Health Literacy Research Around the World: More Important Than Ever in a Time of COVID-19

As we write our editorial for a health literacy special issue in the midst of the international COVID-19 crisis, we take this opportunity to highlight the importance of individual, community, and population health literacy. We are not only in a "pandemic" but also an "infodemic". Health literacy is more important than ever in the face of these global health threats, which have impacted outcomes across the levels of the socio-ecological model (SEM), including individual health behaviors, family relationships, organizational behavior, state policy-making, national mortality statistics, and the international economy in the span of weeks. Our special issue sought to pull together interdisciplinary threads guided by two principles. The first was defining health literacy as essential skills and situational resources needed for people to find, understand, evaluate, communicate, and use information and services in a variety of forms across various settings throughout their life course to promote health and wellbeing. The second was the idea that enhancing health literacy in populations and systems is critical to achieving health equity. In this time of public health need across traditional borders, the inter-sectoral and international perspectives of special issue articles are more urgent than ever. A greater understanding, appreciation, and application of health literacy can support policy action on multiple levels to address major public health challenges. Health literacy should be built deliberately as a population-level resource and community asset. We have summarized the set of articles in this special issue across the levels of the SEM, hoping their thoughtful considerations and interesting findings will help to support global health and wellness and inspire future research, policy, and practice in this global public health emergency and beyond.