Changes in Infectious Disease–Specific Health Literacy in the Post–COVID-19 Pandemic Period: Two-Round Cross-Sectional Survey Study
Authors: Zhao Yusui , Xu Yue , Yao Dingming , Wu Qingqing , Chen Heni , Hu Xiujing , Huang Yu , Zhang Xuehai 
Published: June 2024

Abstract

Background
Infectious disease–specific health literacy (IDSHL) is a crucial factor in the development of infectious diseases. It plays a significant role not only in mitigating the resurgence of infectious diseases but also in effectively averting the emergence of novel infections such as COVID-19. During the 3 years of the COVID-19 pandemic, China primarily adopted nonpharmaceutical interventions, advocating for people to avoid crowded places and wear masks to prevent the spread of COVID-19. Consequently, there has been a dearth of research concerning IDSHL and its corresponding focal points for health education.

Objective
This study aimed to (1) evaluate the changes in IDSHL scores between 2019 (before the COVID-19 pandemic) and 2022 (the postepidemic period of COVID-19) and (2) explore the risk factors affecting IDSHL using a multivariate logistic regression analysis.

Methods
This study used 2-round cross-sectional surveys, conducted in 2019 and 2022, respectively, in 30 counties in Zhejiang Province, China. Multiple-stage stratified random sampling was used to select households, and a Kish grid was used to identify participants. An identical standardized questionnaire consisting of 12 closed-ended questions was used to measure IDSHL scores before and after the COVID-19 pandemic (2019 and 2022). Standard descriptive statistics, chi-square tests, t tests, and multivariate logistic regression analyses were used to analyze the data.

Results
The 2-round cross-sectional surveys conducted in 2019 and 2022 yielded, out of 19,366 and 19,221 total questionnaires, 19,257 (99.44% response rate) and 18,857 (98.11% response rate) valid questionnaires, respectively. The correct response rate for the respiratory infectious diseases question “When coughing or sneezing, which of the following is correct?” increased from 29.10% in 2019 to 37.92% in 2022 (χ²1=332.625; P<.001). The correct response rate for the nonrespiratory infectious diseases question “In which of the following ways can hepatitis B be transmitted to others?” decreased from 64.28% to 59.67% (χ²1=86.059; P<.001). In terms of IDSHL scores, a comparison between 2022 and 2019 revealed notable statistical differences in the overall scores (t1=10.829; P<.001) and across the 3 dimensions of knowledge (t1=8.840; P<.001), behavior (t1=16.170; P<.001), and skills (t1=9.115; P<.001). With regard to the questions, all but 4 exhibited statistical differences (P<.001). Multivariate logistic regression analyses indicated that the 2022 year group had a higher likelihood of possessing acquired IDSHL than the 2019 group (odds ratio 1.323, 95% CI 1.264‐1.385; P<.001).

Conclusions
When conducting health education, it is imperative to enhance efforts in nonrespiratory infectious disease health education, as well as respiratory infectious diseases such as COVID-19. Health education interventions should prioritize ethnic minority populations with a poor self-health status and low education.