The Relationship Between Health Literacy, Knowledge, Fear, and COVID-19 Prevention Behavior in Different Age Groups: Cross-sectional Web-Based Study (Preprint)

Abstract

BACKGROUND Coronavirus (COVID-19) caused not only a pandemic but also an infodemic. Misinformation can increase fear and influence COVID-19 infection prevention behaviors. Health literacy is considered important in infodemics for coping with misinformation. It has been reported that infection prevention behavior, health literacy, and COVID-19 fear differ by age, and it is important to clarify the relationship by age. In addition, an association between health literacy and COVID-19 knowledge has been reported, but no paper has examined this association in Japan. OBJECTIVE The aim of this study was (1) to examine factors associated with COVID-19 infection prevention behaviors by age group and (2) to clarify relationship between health literacy and COVID-19 knowledge. METHODS A cross-sectional study was conducted with 512 participants aged 20–69 years, recruited from an online sample from November 1 to 5, 2021. An online self-administered questionnaire was used to obtain participants’ characteristics, COVID-19 infection prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19. The Kruskal-Wallis rank-sum test was used to compare the scores of each item for each age group. The relationship between COVID-19 infection prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19 was reported by Spearman-rank correlation analysis. Additionally, multiple regression analysis was conducted with COVID-19 infection prevention behaviors as the dependent variable; health literacy, COVID-19 knowledge, and fear of COVID-19 as independent variables; and sex as adjustment variable. RESULTS The results of the correlation analysis showed a significant positive correlation between infection prevention behavior and health literacy (p<.001), COVID-19 knowledge (p<.001), and fear of COVID-19 (p<.001). In addition, a multiple regression analysis was conducted to examine the factors associated with infection prevention behaviors. Health literacy, COVID-19 knowledge, and fear of COVID-19 were significantly associated with infection-prevention behaviors (p<.001). Furthermore, analysis by age revealed that the factors associated with infection-prevention behavior differed by age group. In the age group of 20-29, 30-39, and 40-49 years, multiple factors, including health literacy, influenced COVID-19 infection prevention behaviors, whereas in the age group of 50-59 and 60-69 years, only fear of COVID-19 was shown to have an impact. CONCLUSIONS The results suggest that it is important to improve health literacy and correctly inform people of the risks specific to diseases to promote infection prevention behaviors.