gms | German Medical Science

Background: Health literacy plays a key role during the COVID-19 pandemic, by helping people to make personal risk assessments and distinguish between trustworthy health messages and misinformation. Health literacy also empowers people and enables them to access information sources, broaden their knowledge about the coronavirus, and to understand and apply behavioral recommendations.

Objectives: The aim of this study was to assess corona-specific health literacy (from hereafter: HL) of the German population 16+ years, to assess changes in HL over time, and to describe how HL is related to different covariates that are relevant during the pandemic.

Methods: A longitudinal trend study was conducted as an online survey. The sample is representative of internet users regarding age, sex, education and residence. Data was collected at three measurement points in 2020: t0 (N=1037; Mar/Apr), t1 (N=1021; Sep/Oct), t2 (N=1036; Nov/Dec). The focus was to describe trends in HL, using descriptive statistics and bivariate analyses.

Results: The amount of people with low HL has decreased from 50.4% to 35.5% between t0 and t1. This improvement has been stable until t2, although we could observe a non-significant increase to 38.2% with low HL at t2. The greatest challenge (t0–t2) is appraising reliability of health information. At t2, it is hardest for people to judge if media information on COVID-19 is trustworthy (37.4% difficult or very difficult). Low HL is related to various significant adverse outcomes. People with low HL

1.

feel less-informed about COVID-19,

2.

are more likely to be confused by the amount of information available,

3.

are less likely to engage in physical distancing, handwashing and mask-wearing,

4.

more often doubt the effectiveness of preventive behaviors, and

5.

more often have negative attitudes towards vaccination, lower vaccination readiness and higher vaccine hesitancy.

Discussion: During 2020 significant improvements in population HL were observed. We attribute this improvement mainly to effective communication strategies during the pandemic, with key recommendations on risks and preventive measures being easy-to-understand and easy-to-apply. However, more than 1/3 of the population has low HL. This is a critical as low HL is associated with numerous negative health outcomes.

Practical implications: It will be important to provide targeted information that meets the needs of different populations, to strengthen their HL, and to reinforce positive behaviours that can be implemented by all. In particular, critical thinking in relation to health information on the internet and further media sources needs to be strengthened. HL must also be addressed on the systems-level, in policymakers and within organizations, such as media, internet and tech as well as healthcare organizations.

Take away message: Health literacy is an important tool in the public health emergency toolbox during the COVID-19 pandemic and despite significant improvements of population health literacy since the beginning of the pandemic, more than 30% of the German population have limited corona-specific health literacy, which is associated with numerous adverse outcomes.