Background The COVID-19 pandemic has imposed a heavy burden on health care systems and governments. Health literacy (HL) and eHealth literacy (as measured by the eHealth Literacy Scale [eHEALS]) are recognized as strategic public health elements but they have been underestimated during the pandemic. HL, eHEALS score, practices, lifestyles, and the health status of health care workers (HCWs) play crucial roles in containing the COVID-19 pandemic. Objective The aim of this study is to evaluate the psychometric properties of the eHEALS and examine associations of HL and eHEALS scores with adherence to infection prevention and control (IPC) procedures, lifestyle changes, and suspected COVID-19 symptoms among HCWs during lockdown. Methods We conducted an online survey of 5209 HCWs from 15 hospitals and health centers across Vietnam from April 6 to April 19, 2020. Participants answered questions related to sociodemographics, HL, eHEALS, adherence to IPC procedures, behavior changes in eating, smoking, drinking, and physical activity, and suspected COVID-19 symptoms. Principal component analysis, correlation analysis, and bivariate and multivariate linear and logistic regression models were used to validate the eHEALS and examine associations. Results The eHEALS had a satisfactory construct validity with 8 items highly loaded on one component, with factor loadings ranked from 0.78 to 0.92 explaining 76.34% of variance; satisfactory criterion validity as correlated with HL (ρ=0.42); satisfactory convergent validity with high item-scale correlations (ρ=0.80-0.84); and high internal consistency (Cronbach α=.95). HL and eHEALS scores were significantly higher in men (unstandardized coefficient [B]=1.01, 95% CI 0.57-1.45, P<.001; B=0.72, 95% CI 0.43-1.00, P<.001), those with a better ability to pay for medication (B=1.65, 95% CI 1.25-2.05, P<.001; B=0.60, 95% CI 0.34-0.86, P<.001), doctors (B=1.29, 95% CI 0.73-1.84, P<.001; B 0.56, 95% CI 0.20-0.93, P=.003), and those with epidemic containment experience (B=1.96, 95% CI 1.56-2.37, P<.001; B=0.64, 95% CI 0.38-0.91, P<.001), as compared to their counterparts, respectively. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures (B=0.13, 95% CI 0.10-0.15, P<.001; B=0.22, 95% CI 0.19-0.26, P<.001), had a higher likelihood of healthy eating (odds ratio [OR] 1.04, 95% CI 1.01-1.06, P=.001; OR 1.04, 95% CI 1.02-1.07, P=.002), were more physically active (OR 1.03, 95% CI 1.02-1.03, P<.001; OR 1.04, 95% CI 1.03-1.05, P<.001), and had a lower likelihood of suspected COVID-19 symptoms (OR 0.97, 95% CI 0.96-0.98, P<.001; OR 0.96, 95% CI 0.95-0.98, P<.001), respectively. Conclusions The eHEALS is a valid and reliable survey tool. Gender, ability to pay for medication, profession, and epidemic containment experience were independent predictors of HL and eHEALS scores. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures, healthier lifestyles, and a lower likelihood of suspected COVID-19 symptoms. Efforts to improve HCWs’ HL and eHEALS scores can help to contain the COVID-19 pandemic and minimize its consequences.

ObjectivesWe examined impacts and interactions of COVID-19 response involvement, health-related behaviours and health literacy (HL) on anxiety, depression, and health-related quality of life (HRQoL) among healthcare workers (HCWs).DesignA cross-sectional study was conducted. Data were collected 6 April to 19 April 2020 using online-based, self-administered questionnaires.Setting19 hospitals and health centres in Vietnam.Participants7 124 HCWs aged 21–60 years.ResultsThe COVID-19 response-involved HCWs had higher anxiety likelihood (OR (95% CI)=4.41 (3.53 to 5.51)), higher depression likelihood (OR(95% CI)=3.31 (2.71 to 4.05)) and lower HRQoL score (coefficient, b(95% CI)=−2.14 (−2.89 to −1.38)), compared with uninvolved HCWs. Overall, HCWs who smoked or drank at unchanged/increased levels had higher likelihood of anxiety, depression and lower HRQoL scores; those with unchanged/healthier eating, unchanged/more physical activity and higher HL scores had lower likelihood of anxiety, depression and higher HRQoL scores. In comparison to uninvolved HCWs who smoked or drank at never/stopped/reduced levels, involved HCWs with unchanged/increased smoking or drinking had lower anxiety likelihood (OR(95% CI)=0.34 (0.14 to 0.83)) or (OR(95% CI)=0.26 (0.11 to 0.60)), and lower depression likelihood (OR(95% CI)=0.33 (0.15 to 0.74)) or (OR(95% CI)=0.24 (0.11 to 0.53)), respectively. In comparison with uninvolved HCWs who exercised at never/stopped/reduced levels, or with those in the lowest HL quartile, involved HCWs with unchanged/increased exercise or with one-quartile HL increment reported lower anxiety likelihood (OR(95% CI)=0.50 (0.31 to 0.81)) or (OR(95% CI)=0.57 (0.45 to 0.71)), lower depression likelihood (OR(95% CI)=0.40 (0.27 to 0.61)) or (OR(95% CI)=0.63 (0.52 to 0.76)), and higher HRQoL scores (b(95% CI)=2.08 (0.58 to 3.58)), or (b(95% CI)=1.10 (0.42 to 1.78)), respectively.ConclusionsPhysical activity and higher HL were found to protect against anxiety and depression and were associated with higher HRQoL. Unexpectedly, smoking and drinking were also found to be coping behaviours. It is important to have strategic approaches that protect HCWs’ mental health and HRQoL.

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Background: We aimed to examine the impacts of digital healthy diet literacy (DDL) and healthy eating behaviors (HES) on fear of COVID-19, changes in mental health, and health-related quality of life (HRQoL) among front-line healthcare workers (HCWs). Methods: An online survey was conducted at 15 hospitals and health centers from 6–19 April 2020. Data of 2299 front-line HCWs were analyzed—including socio-demographics, symptoms like COVID-19, health literacy, eHealth literacy, DDL, HES, fear of COVID-19, changes in mental health, and HRQoL. Regression models were used to examine the associations. Results: HCWs with higher scores of DDL and HES had lower scores of FCoV-19S (regression coefficient, B, −0.04; 95% confidence interval, 95% CI, −0.07, −0.02; p = 0.001; and B, −0.10; 95% CI, −0.15, −0.06; p < 0.001); had a higher likelihood of stable or better mental health status (odds ratio, OR, 1.02; 95% CI, 1.00, 1.05; p = 0.029; and OR, 1.04; 95% CI, 1.00, 1.07; p = 0.043); and HRQoL (OR, 1.02; 95% CI, 1.01, 1.03; p = 0.006; and OR, 1.04; 95% CI, 1.02, 1.06; p = 0.001), respectively. Conclusions: DDL and HES were found as independent predictors of fear of COVID−19, changes in mental health status, and HRQoL in front-line HCWs. Improving DDL and HES should be considered as a strategic approach for hospitals and healthcare systems.

BACKGROUND Coronavirus disease (COVID-19) pandemic creates a heavy burden on healthcare systems and governments. Health literacy (HL) and eHealth literacy (eHEAL) are recognized as strategic public health elements but underestimated during the pandemic. HL, eHEAL, practices, lifestyles, and health status of health care workers (HCWs) play crucial roles in containing the COVID-19 pandemic. OBJECTIVE To evaluate psychometric properties of the eHEAL scale, and examine associations of HL and eHEAL with adherence to infection prevention and control procedures (AIPC), lifestyle changes, and suspected COVID symptoms (S-COVID-19-S) among HCWs during the lockdown. METHODS We conducted an online survey on 5209 HCWs from 15 hospitals and health centers across Vietnam from 6th to 19th April 2020. HCWs were asked about their socio-demographics; HL; eHEAL; AIPC; changes in dietary intake, smoking, drinking, physical activity; and S-COVID-19-S. Principal component analysis, correlation analysis, bivariate, and multivariate linear and logistic regression models were utilized to validate eHEAL scale and examine the associations. RESULTS The eHEAL was found with a good construct validity with eight items highly loaded on one component with factor loadings rank from .78 to .92, explained 76.34% of variance; satisfactory criterion validity as correlated with HL (rho=.42); good convergent validity with high item-scale correlations (rho=.80-.84); high internal consistency (Cronbach α=.95). HL and eHEAL were significantly higher in men (unstandardized coefficient, B 1.01, 95% confidence interval, 95% CI 0.57 to 1.45, P<.001; B 0.72, 95% CI 0.43 to 1.00, P<.001), better ability to pay for medication (B 1.65, 95%CI 1.25 to 2.05, P<.001; B 0.60, 95%CI 0.34 to 0.86, P<.001), being doctors (B 1.29, 95%CI 0.73 to 1.84, P < .001; B 0.56, 95%CI 0.20 to 0.93, P=.003), having epidemic containment experiences (B 1.96, 95%CI 1.56 to 2.37, P<.001; B 0.64, 95%CI 0.38 to 0.91, P<.001), as compared to their counterpart, respectively. HCWs with higher HL score, or higher eHEAL score had better AIPC (B 0.13, 95%CI 0.10 to 0.15, P<.001; or B 0.22, 95%CI 0.19 to 0.26, P<.001), higher likelihood of healthy eating (odds ratio, OR 1.04, 95%CI 1.01-1.06, P=.001; or OR 1.04, 95%CI 1.02-1.07, P=.002), and doing more physical activity (OR 1.03, 95%CI 1.02-1.03, P<.001; or OR 1.04, 95%CI 1.03-1.05, P<.001), and lower likelihood of having S-COVID-19-S (OR 0.97, 95%CI 0.96-0.98, P<.001, or OR 0.96, 95%CI 0.95-0.98, P<.001), respectively. CONCLUSIONS The eHEAL is a valid and reliable survey tool. Gender, ability to pay for medication, type of healthcare personnel, and epidemic containment experience are independent predictors of HL and eHEAL. HCWs with higher HL score or eHEAL score had better AIPC, healthier lifestyles, and lower S-COVID-19-S likelihood. Efforts to improve HCWs’ HL and eHEAL can help to contain the COVID-19 pandemic and its consequences.