COVID-19 Vaccine Confidence Mediates the Relationship between Health Literacy and Vaccination in a Diverse Sample of Urban Adults

Abstract

We sought to analyze the relationship between health literacy, confidence in COVID-19 vaccines, and self-reported vaccination. We hypothesized that the relationship between health literacy and vaccination would be mediated by vaccine confidence. We recruited (N = 271) English- and Spanish-speaking adults in Boston and Chicago from September 2018 to September 2021. We performed a probit mediation analysis to determine if confidence in COVID-19 vaccines and health literacy predicted self-reported vaccination. We hypothesized that the relationship between health literacy and vaccination would be mediated by vaccine confidence. Participants were on average 50 years old, 65% female, 40% non-Hispanic Black, 25% Hispanic, and 30% non-Hispanic White; 231 (85%) reported at least one COVID-19 vaccination. A higher mean vaccine confidence score (t = −7.9, p < 0.001) and higher health literacy (t = −2.2, p = 0.03) were associated with vaccination, but only vaccine confidence predicted vaccination in a multivariate model. Vaccine confidence mediated the relationship between health literacy and COVID-19 vaccination (mediated effects: 0.04; 95% CI [0.02, 0.08]). We found that using a simple tool to measure vaccine confidence identified people who declined or delayed COVID-19 vaccination in a diverse sample of adults with varying levels of health literacy. Simple short survey tools can be useful to identify people who may benefit from vaccine promotion efforts and evidence-based communication strategies.

Perspectives in the Development of Tools to Assess Vaccine Literacy

“…Using an 11-item tool, including general questions about immunization, Jiang et al [56] showed that the relationship between perceived HL and COVID-19 vaccine acceptance was completely mediated by attitudes toward general vaccination and self-efficacy of the COVID-19 vaccine. The pathway from determinants to vaccine acceptance has been shown by Hurstak et al [57,58]. In a population of adults, using a functional HL tool (Touchscreen Technology-LiTT) and a vaccine confidence scale, the authors revealed that HL mediated the relationship between demographic variables and vaccine confidence, which in turn mediated the relationship between HL and COVID-19 vaccine acceptance.…”

Factors Influencing COVID-19 Vaccine Confidence and Uptake in Australian Adults

“…As such, further research is needed to develop improved healthcare communications on vaccines and support the public’s ability to identify trusted sources of information and discern when they may be receiving misinformation. A recent US study by Hurstak et al ( N = 271) found that both high vaccine confidence and high health literacy were associated with COVID-19 vaccination and that vaccine confidence mediated the relationship between the three (mediator effects: 0.04; 95% CI 0.02–0.08) [ 38 ]. There is also emerging research on theory-informed information debiasing interventions, such as debunking, that can be used to dispel misinformation [ 39 ].…”

The still unexplored mediating role of vaccine literacy

“…The path from determinants to vaccine acceptance has been illustrated by Hurstak et al 9 , 10 They have shown, in a selected population of urban adults using a functional HL tool (Touchscreen Technology – LiTT) and an adapted vaccine confidence scale, that HL mediated the relationship between some demographic variables and vaccine confidence, which in turn mediated the relationship between HL and COVID-19 vaccine acceptance. It is reasonable to assume that, similar to HL, VL can play a valuable role as mediator toward health outcomes.…”