Pandemic-related health literacy: a systematic review of literature in COVID-19, SARS and MERS pandemics

  1. Jun Jie Benjamin Seng
  2. Cheng Teng Yeam
  3. Caleb Weihao Huang
  4. Ngiap Chuan Tan
  5. Lian Leng Low

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Abstract

Introduction:

Health literacy plays an essential role in one’s ability to acquire and understand critical medical information in the coronavirus disease 2019 (COVID-19) infodemic and in other pandemics. We aimed to summarise the assessment, levels and determinants of pandemic-related health literacy and its associated clinical outcomes.

Methods:

A systematic review was performed in Medline ® , Embase ® , PsycINFO ® , CINAHL ® and four major preprint servers. Observational and interventional studies that evaluated health literacy related to the novel COVID-19, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) were included. Items used in health literacy instruments were grouped under the themes of knowledge, attitudes and practices. Determinants of health literacy were grouped into five domains: sociodemographic, medical, psychological/psychiatric, health systems-related and others.

Results:

Of the 2,065 articles screened, 70 articles were included. Of these, 21, 17 and 32 studies evaluated health literacy related to COVID-19, SARS and MERS, respectively. The rates of low pandemic health literacy ranged from 4.3% to 57.9% among medical-related populations and from 4.0% to 82.5% among nonmedical populations. Knowledge about the symptoms and transmission of infection, worry about infection, and practices related to mask usage and hand hygiene were most frequently evaluated. Sociodemographic determinants of health literacy were most frequently studied, among which higher education level, older age and female gender were found to be associated with better health literacy. No studies evaluated the outcomes associated with health literacy.

Conclusion:

The level of pandemic-related health literacy is suboptimal. Healthcare administrators need to be aware of health literacy determinants when formulating policies in pandemics.

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  1. Version published to 10.4103/singaporemedj.smj-2021-026
  2. ScreenIT

    SciScore for 10.1101/2020.05.07.20094227: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Due to the relative novelty and recent nature of the COVID-19 pandemic, pre-prints from four widely used databases which included arXiv, bioRxiv, medRxiv, and Social Science Research Network (SSRN) were extracted for evaluation.
    arXiv
    suggested: (arXiv, RRID:SCR_006500)
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The results of these studies should be evaluated carefully given the following limitations. Firstly, as the recruited participants are limited to those who are keyboard literate, this may limit the generalizability of the study results.(98) Additionally, the validity of these study results may be affected as these surveys commonly suffer from poor response rates.(98) With regards to the determinants of pandemic related health-literacy, higher education levels, older age, female gender, and being employed were the most studied factors associated with higher pandemic related health literacy. Our results generally concurred with the determinants of general health literacy based on current literature. Pertaining to the role of gender, females have identified in multiple studies to have higher general health literacy levels as compared to their male counterparts. (99, 100) This difference may be related to the traditional roles that females play in caring for family members and children, which increase their need and familiarity with navigating and interacting with healthcare information and systems. (101) Employment creates opportunities for individuals to access healthcare resources..(17) Likewise, the education attainment plays an important role in health literacy through its influence on knowledge, skills and resource interpretation and utilization.(10, 102) Interestingly, while older age has been associated with poorer health literacy in the general population possibly due to...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.05.07.20094227 on medRxiv