This study aimed to examine the association between health literacy and illness perception among Chinese patients with chronic disease in the community through a national cross-sectional study.

This cross-sectional study was conducted in China from June 20, 2022, to August 31, 2022, and used a multistage sampling approach to select patients with chronic diseases. The study included 5,525 participants from 15 provinces, drawn from the Psychology and Behavior Investigation of Chinese Residents in 2022. We constructed univariate analysis, smooth curve fitting, threshold saturation effect analysis, and forest plot of subgroup analysis to evaluate the association between health literacy and illness perception.

The analysis revealed an inverted J-shaped association between health literacy and illness perception (P < 0.001). Moreover, the identified inflection point was 22.22. When the health literacy score was below 22.22, illness perception exhibited a positive association with health literacy (β = 0.12, 95%CI = 0.03, 0.21, P = 0.009). When the health literacy score was higher than 22.22, illness perception decreased with the increasing health literacy (β=-0.23, 95%CI=-0.27, -0.19, P < 0.001). The significant association between health literacy and illness perception did not differ significantly across subgroups, except for the Hukou subgroup.

This study determined a threshold of health literacy that was associated with the illness perception of Chinese chronic disease patients. Additionally, an inverted J-shaped association between health literacy and illness perception was observed, suggesting that targeted health literacy intervention measures should be tailored to specific chronic disease groups rather than a uniform approach.

Not applicable.

To investigate the impact of contextual socioeconomic and demographic characteristics of residents on COVID-19 outcomes during public health measures.

Aggregated data from the NSW Notifiable Conditions Information Management System linked to Australian Census data, by periods of strict and relaxed measures, were used.

During strict measures, residents of areas of lower socioeconomic status (SES) had a higher risk of infection, with the lowest areas having greater risk compared with the highest areas ((hazard ratio (HR)) 7.15, 95% confidence interval (CI) 6.24-8.19). The risk of infection was lower for those aged 40 and over and was higher for males (HR 1.34, 95% CI 1.27-1.40); those in living in areas with larger household sizes (HR 1.56, 95% CI 36-1.78); and individuals in areas with a large proportion of residents born in South Asia (HR 1.18; 95% CI 1.07-1.29), South East Asia (HR 1.20, 95% CI 1.07-1.36) and the Middle East and North Africa (HR 1.67, 95% CI 1.47-1.90). During relaxed restrictions, the impact of variables attenuated but remained significant.

Minorities, those residing in lower SES areas and those living in larger households had worse COVID-19 outcomes during strict public health measures.

Decision-makers should tailor services to avoid inequities.

This cross-sectional, descriptive survey study aimed to identify the factors affecting emerging infectious disease prevention behaviors among young workers aged < 40 years. The factors affecting infection prevention behaviors among young workers were investigated with respect to perception of personal, inter-personal, organizational, and community responses based on ecological modeling. A total of 260 young workers residing in Jeollabuk-do region in South Korea were selected via convenience sampling. Multiple regression analysis performed to assess the factors affecting emerging infectious disease prevention behaviors. Multiple regression analysis revealed that infection prevention behaviors were significantly higher among healthy female participants compared with that in not very healthy female participants. Furthermore, infection prevention behaviors were significantly lower among those residing with family members with a confirmed diagnosis compare with that in those who did not. The infection prevention behaviors were higher among participants with higher levels of perceived susceptibility and perceived self-efficacy showed higher infection prevention behaviors. Thus, health managers should actively promote the implementation of infection prevention behaviors in the workplace by developing executable infection prevention guidelines and programs to enhance the perceived susceptibility and self-efficacy of workers in preparation for outbreaks of emerging infectious diseases.

We investigate how individuals with Limited English Proficiency (LEP) seek, access, and evaluate traditional and online sources they rely on for health information.

Retrospective cross-sectional survey analysis from the United States.

Pooled Health Information National Trends Survey surveys (2013-2019).

The sample was comprised 15,316 respondents; 236/15,316 (1.54%) completed the survey in Spanish and 1727/14,734 (11.72%) had LEP (did not speak English "very well"). The sample was nationally representative across demographic categories.

Independent and dependent variables were self-reported using validated measures.

Multivariable logistic regression models using jackknife replicate weights for population estimates.

Adults with LEP were less confident in their capacity to access health information (aOR = 0.59, CI: 0.47-0.75) and had less trust in health information from medical professionals (aOR = 0.57,CI: 0.46-0.72) than English proficient (EP) adults. Although LEP and EP adults were both most likely to use the internet as their first source of information, LEP adults were more likely than EP adults to consult health professionals, print sources like books, news or brochures, family and friends, television and radio. Spanish language survey respondents were more likely to trust health information from government agencies (aOR = 1.99, CI: 1.09-3.62) and watch health-related videos on the internet than respondents who took the survey in English (aOR = 2.51, CI: 1.23-5.12).

Our results show how language barriers may contribute to health disparities experienced by linguistic minorities. Government agencies and health care organizations need to promote health information dissemination in underserved communities and may need to embrace the use of alternative information sources such as television, radio, and the internet to reach LEP populations.

More than one-third of all diseases in the world are non-communicable diseases (NCDs), and poorer health outcomes are linked to low health literacy (HL), in which nurses have a significant role to play. Various studies have confirmed that there is an association between HL and NCDs. However, less is known about how nurses can intervene in the development of HL in patients with NCDs. This systematic review was carried out to explore, in a comprehensive way, nursing interventions that could promote HL in patients with NCDs.

A systematic review (PROSPERO registration number: CRD370625) was carried out on five databases (PubMed MEDLINE, Web of Science, Scopus, ScienceDirect and JSTOR). Sequences that provided information for our study topic were retrieved and analysed following PRISMA guidelines for systematic reviews.

In total, 1915 titles and abstracts were screened, 71 articles were assessed in full-text screening and 25 studies were included in the review. Around 23 different nurse-led intervention strategies were identified, but only 11 major ones were explored in detail. The majority of them prioritised communication (teach-back), self-management programs, counselling and education. In the majority of the trials, a significant positive outcome was discovered. Both nurses and patients needed to devote time and attention to the complex nurse-led HL interventions.

Nurses' HL interventions have shown promise in promoting HL and other health outcomes in people with NCDs, but they need to be tailored to fit specific patients. Nursing programs should include more than just patient teaching strategies.

Nurses' HL efforts hold potential for enhancing HL in NCD patients, provided they are customised to individual needs.

Investigate whether deaf or hard of hearing (D/HH) patients with COVID-19 exhibited different hospitalisation outcomes compared with hearing patients with COVID-19.

Cohort study SETTING: Statewide Inpatient Databases for Florida, Maryland, New York and Washington, for the year 2020.

Records of patients aged 18-64 years with COVID-19 PRIMARY OUTCOMES AND MEASURES: Differences in in-hospital death, 90-day readmission, length of stay, hospitalisation cost, hospitalisation cost per day, intensive care unit (ICU) or coronary care unit (CCU) utilisation and ventilation use were evaluated. Adjustment variables included patient basic characteristics, socioeconomic factors, and clinical factors.

The analyses included 347 D/HH patients and 72 882 non-D/HH patients. Multivariable log-transformed linear regression models found an association of patients' hearing loss status with longer length of stay (adjusted mean ratio (aMR) 1.15, 95% CI 1.04 to 1.27, p<0.01), higher hospitalisation cost (aMR 0.96, 95% CI 1.00 to 1.22, p=0.049) and lower hospitalisation cost per day (aMR 0.96, 95% CI 0.92 to 1.00, p=0.04). We did not detect any significant relationships with other outcomes.

Our findings suggest that higher hospitalisation costs were attributed to prolonged stays rather than costly interventions, such as ICU care. Communication barriers between healthcare providers and D/HH patients, coupled with providers' cautious approach to discharging D/HH patients, may explain our findings.

Vaccine hesitancy among marginalized populations particularly in the Hispanic community over the course of the COVID-19 pandemic has presented as a public health issue. This study examined the relationship between political affiliation and vaccination decisions of Hispanic adults in Pima County, Arizona.

Between January and October 2022, 623 participants completed surveys in English or Spanish after completing informed consent process. Information collected included sociodemographic, political affiliation and philosophy and COVID vaccination uptake. Participants were recruited at different community events in Southern Tucson, Pima County, Arizona. Participants received five dollars for completing the surveys. Data were analyzed with Stata version 16.1.

Participants were 81.8 % Hispanic and 18.2 % non-Hispanic. On average, participants were 32.9 (SD ± 11.8) years of age with a median age of 31 (IQR: 23, 41). Participants who had a bachelor's degree or above had 2.9 times greater odds of being vaccinated compared to those who had less than a high school education (Adjusted odds ratio (aOR): 2.84; 95 % CI: 1.12, 7.22). Individuals identifying as politically liberal had 3.28 times higher odds of being vaccinated compared to those identifying as conservative (OR = 3.28; 95 % CI: 1.5, 7.16). Similarly, Democrats had 3.36 times higher odds of being vaccinated than Republicans (OR = 3.36; 95 % CI: 1.61, 7.01). People who were strongly religious had statistically significantly lower odds of recommending the vaccine to others as compared to those who self-reported as not being religious.

There was an association with Hispanic adults who aligned liberal or Democrat to express more favorable views toward vaccinations. Additionally, individuals who were more educated, less religious, and in better financial situations tended to be more favorable toward vaccinations in Arizona.

The promotion of health literacy was a key public health strategy during the COVID-19 pandemic. However, the role of social networks and relationships for support with health literacy-related tasks in the context of the COVID-19 pandemic is scarcely understood. Moving beyond traditional notions of health literacy, which focus on individual skills and knowledge, this study uses the concept of distributed health literacy to explore how individuals make meaning of and respond to health literacy and make their literacy skills available to others through their relational and socially situated and lived experiences of the COVID-19 pandemic. Drawing on 89 semi-structured interviews conducted in three European countries (Italy, Portugal, and Switzerland) between October and December 2021, we found narratives of stabilization, hybridization, and disruption that show how health literacy concerning COVID-19 is a complex social construct intertwined with emotional, cognitive, and behavioral responses distributed among individuals, communities, and institutions within socioeconomic and political contexts that affect their existence. This paper opens new empirical directions to understand the critical engagement of individuals and communities toward health information aimed at making sense of a complex and prolonged situation of uncertainty in a pandemic.

Knowledge about COVID-19 enters into many aspects of decision making, especially for older people who are at increased risk of severe disease or death. Yet little is known about the resources that supported older people's uptake of COVID-19 knowledge. Here, we hypothesized that higher pre-pandemic health and financial literacy was associated with higher COVID-19 knowledge. Participants were 434 community-based older people without dementia. COVID-19 knowledge was assessed via a 5-item measure, and health and financial literacy was assessed via a 32-item measure. In an ordinal regression model adjusted for age, gender, and education, higher literacy was associated with higher COVID-19 knowledge (p < .0001), and this association persisted after further adjusting for robust measures of global cognition or one of five specific cognitive domains (all p's ≤ .0001). These findings suggest that literacy plays a key role in supporting older people's acquisition of impactful knowledge in the real world.

Health literacy is becoming increasingly important in the field of public health as it contributes to individuals' social empowerment. During the coronavirus disease 2019 (COVID-19) pandemic, preventive measures (mask usage, physical distancing, hand washing) and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shaped the degree of infection of the population, and their acceptance was associated with a multitude of factors, health literacy included. The aim of this scoping review is to explore the impact of all health literacy dimensions (namely, understanding, access, evaluation and application of health information) on accepting preventive measures and vaccination against SARS-CoV-2 among adult European citizens.

A literature search on three different databases was conducted from July 2022 to December 2022.

A total of 154 articles were initially identified, which were rigorously assessed by two reviewers. Ten studies that met the inclusion criteria were analyzed. The results showed that health literacy played an important role in accepting preventive measures and vaccination as well as in rating health information related to the coronavirus.

Health literacy is a positive predictor of coronavirus prophylaxis and could be incorporated into public health policies to appropriately control future health crises. [HLRP: Health Literacy Research and Practice. 2025;9(1):e46-e55.].

In the context of laboratory medicine, the authors describe 3 barriers to health communication: access, health communication, and language responsiveness. These barriers are interconnected and present in millions of people in need of equitable access to health communication. Equitable access entails health communication written in plain language and languages other than English to address language and literacy barriers and increase trust by avoiding language discordance and the spread of infodemics. This review includes several options to implement multidisciplinary efforts that lead to measurable improvements in health literacy.

Health literacy has been linked to positive attitudes toward COVID-19 preventive measures among adolescents and young- or middle-aged adult populations. This study examined the relationship between health literacy and attitudes toward COVID-19 preventive measures among non-English speaking Korean American older adults and their caregivers. The study additionally investigated how sociodemographic characteristics were associated with attitudes.

COVID-19 survey data was collected from potential participants for an ongoing randomized controlled trial involving both Korean American older adults and their caregivers in the Baltimore-Washington and the New York Metropolitan areas (ClinicalTrials.gov Identifier: NCT03909347). Korean American older adults with normal cognition and their caregivers were allowed to participate in the survey. We used latent profile analysis to find unique clusters of participants with a similar pattern of responses to attitudes toward COVID-19 preventive measures. Based on the analysis, we employed multinomial logistic regression to investigate how health literacy and sociodemographic characteristics were associated with the clusters.

We found three clusters based on participant responses to COVID-19 preventive measures-Positive, Negative, or Mixed. Health literacy was not associated with COVID-19 related attitudes in the study sample. Men were 2.37 times more likely to be categorized as Mixed than having Positive Attitudes compared to women. The odds of a person living in the New York metropolitan area being categorized as having Mixed Attitudes compared to Positive Attitudes were also 2.67 times more than for a person living in the Baltimore-Washington area.

Differences in attitudes toward COVID-19 preventive measures were found among sociodemographic variables but not health literacy. Investigating what information channels or methods drive perception of public health information such as COVID-19 may help identify effective dissemination strategies for non-English speaking Korean older adults.

Background Little is known about health literacy in traumatic brain injury (TBI) survivors. The aims of this study were to compare health literacy in individuals with TBI with that of a control group; to examine the association between health literacy in individuals with TBI and demographic, injury, and cognitive factors; and compare the relationship between health literacy and physical and mental health outcomes. Methods A cross-sectional observational study design was used. Adults (≥18years) were recruited from an outpatient research centre in Victoria, Australia. There were 209 participants with a complicated mild to severe TBI at least 1year previously (up to 30years 6months) and 206 control participants. Results Individuals with TBI did not have poorer health literacy than controls (IRR=1.31, P =0.102, CI95% [0.947, 1.812]). Further analysis could not be completed due to the highly skewed Health Literacy Assessment Using Talking Touchscreen Technology - Short Form (Health LiTT-SF) data. Conclusion Health literacy performance in individuals with TBI was not significantly different to controls. Premorbid education may provide a critical cognitive reserve upon which TBI survivors can draw to aid their health literacy. These findings are specific to the Health LiTT-SF measure only and require replication using more comprehensive health literacy measures in culturally diverse samples.

In the fight against the COVID-19 pandemic, the importance of health literacy in individuals' attitudes has increased. This study aimed to show whether there is a relationship between health literacy and adherence to personal protective anti-COVID-19 health behaviors in health workers and their relatives and to evaluate the barriers to adherence to personal protective anti-COVID-19 health behaviors. Designed as a cross-sectional mixed-methods study. Participants were asked to fill in an online survey form containing questions designed to determine their sociodemographic data, health literacy, adherence to protective anti-COVID-19 health behaviors, and barriers to adherence. The research results were evaluated with a confidence interval of 95% and margin of error of 0.05. Thematic content analysis was used to evaluate participants' answers to the open-ended questions. In this study, data collected from 393 participants were analyzed. In the Disease Prevention and Health Promotion Subscale, the group of participants who adhered to wearing masks "at all times" obtained a higher average score from the Turkey Health Literacy Scale than other participant groups, while the participant group that "always" complied with hand washing and social distancing obtained higher average scores from the Turkey Health Literacy Scale and its two subscales compared to other participant groups. As a result of the thematic content analysis carried out in order to determine the situations that prevent the participants from complying with personal protective anti-COVID-19 health behaviors, the main themes were determined as "forgetting/not wearing the habit of wearing a mask," "mask ergonomics" and "noncompliance with social distance." This study shows that there is a positive relationship between health literacy and adherence to protective anti-COVID-19 health behaviors among health workers and their relatives and revealed major barriers to adherence to protective anti-COVID-19 health behaviors among health workers and their relatives.

The COVID-19 pandemic posed an unprecedented challenge, which caught many health systems widely unprepared. The aim of this research was to develop a comprehensive analytical framework on health system resilience in the context of pandemics. In addition to serving as a tool to analyse the preparedness and resilience of health systems, the framework is intended to provide guidance to decision-makers in health policy.

The analytical framework was developed based on a multitiered approach. A comprehensive review of the existing literature was conducted to identify relevant frameworks on health system resilience (published between 1 January 2000 and 30 November 2021) and determinants of resilience that emerged during the COVID-19 pandemic. Input was then gathered in several rounds of consultations with designated field experts and stakeholders, drawing on their experiences from the pandemic. Finally, the framework was empirically validated in several case studies.

The framework distinguishes between prerequisites of resilience, pertaining to precautions to be taken in 'normal' times, and response strategies in the face of shocks. Both sections are further divided into six building blocks that were adapted from the WHO health system framework: governance and leadership, information and research, financing, physical resources, human resources, and service delivery. An overarching component on contextual factors-subdivided into situational, structural, cultural and international factors-represents an important addition to the existing spectrum of resilience frameworks.

Foundations for a resilient health system must be laid in 'normal' times and in all areas of the health system. In the face of a shock, adequate response strategies need to be developed. An essential learning from the COVID-19 pandemic has been that contextual factors of societies and subgroups play a major role in the ability of health systems to overcome a shock, as they impact the implementation and effectiveness of crisis management policies.

In Australia, tixagevimab/cilgavimab 150 mg/150 mg was a government-funded pre-exposure prophylaxis for COVID-19 people with multiple sclerosis (pwMS) and other neuroimmunological conditions (pwNIc) treated with anti-CD20 antibodies or sphingosine-1-phosphate receptor modulators were eligible.

To analyse the roll-out, uptake and real-world efficacy of tixagevimab/cilgavimab in the prevention and severity of COVID-19. To assess compliance with uptake depending on the location of delivery.

We undertook a single-centre study. 440 pwMS and pwNIc were eligible. Logistic regression was used to assess predictors of COVID-19 during follow-up and to assess predictors of uptake among those who consented.

Of the eligible pwMS and pwNIc in our service, 52.7% (233/440) requested a consultation and were included in this study. Consultation resulted in 71.7% of people (167/233) receiving the treatment. Of these, 94.0% (157/167) had received three or more COVID-19 vaccines. Among those who received a single dose of tixagevimab/cilgavimab, 19.16% (32/167) tested positive for COVID-19 during the observational window. The majority of these were on ocrelizumab (68.8% (22/32)). None of those with COVID-19 required hospitalisation or supplemental oxygen. There was no difference in odds of COVID-19 during the observation period between those who received and did not receive tixagevimab/cilgavimab (adjusted OR, aOR 2.16 (95% CI 0.82 to 6.85), p=0.43). Uptake of tixagevimab/cilgavimab was highest when offered at the hospital infusion centre (aOR 3.09 (95% CI 1.08 to 9.94) relative to referral to the local pharmacy, p=0.04).

Tixagevimab/cilgavimab administration did not protect against subsequent COVID-19 in our cohort. Compliance with uptake was influenced by administration location.

Research indicates that the effectiveness of coronavirus disease 2019 (COVID-19) physical distancing mandates is influenced by several individual factors, including health literacy; internal health locus of control (IHLOC), the belief that physical distancing can reduce COVID-19 risk; social norms; self-efficacy; and perceptions of the benefits and barriers associated with distancing. However, further investigation is needed to understand the links between these factors and compliance intentions.

This study investigates the mechanism linking these factors with the intentions to comply with physical distancing mandates.

A total of 759 participants (Mean age = 29.13, standard deviation [SD] = 8.33; 68.5% women) were surveyed online from September 2020 to October 2020. Data were analyzed using ANOVA (analysis of variance) and structural equation modeling.

Health literacy was associated with more perceived benefits (β = .175, p = .001), greater self-efficacy (β = .193, p < .001), and less perceived barriers (β = -.391, p < .001). IHLOC was significantly associated with greater perceived benefits (β = .156, p = .007) and self-efficacy (β = .294, p < .001). Family descriptive norms were significantly associated with fewer perceived barriers (β = -.276, p < .001), while injunctive norms were associated with more perceived benefits (β = .202, p = .001) and higher self-efficacy (β = .299, p < .001). Intentions to adhere to physical distancing mandates were significantly associated with past compliance (β = .427, p < .001) and perceived barriers (β = -.205, p < .001) and benefits (β = .295, p < .001). Post-hoc mediation analyses revealed several small yet significant indirect effects, highlighting the complex pathways shaping adherence intentions.

This study identifies how health literacy, IHLOC, social norms, perceived benefits and barriers, and self-efficacy intricately shape intentions to comply with physical distancing mandates. These findings offer valuable implications for public health policy and interventions. [HLRP: Health Literacy Research and Practice. 2024;8(2):e69-e78.].

The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection. The determinants of mortality on a global scale cannot be fully understood due to lack of information.

To identify key factors that may explain the variability in case lethality across countries.

We identified 21 Potential risk factors for coronavirus disease 2019 (COVID-19) case fatality rate for all the countries with available data. We examined univariate relationships of each variable with case fatality rate (CFR), and all independent variables to identify candidate variables for our final multiple model. Multiple regression analysis technique was used to assess the strength of relationship.

The mean of COVID-19 mortality was 1.52 ± 1.72%. There was a statistically significant inverse correlation between health expenditure, and number of computed tomography scanners per 1 million with CFR, and significant direct correlation was found between literacy, and air pollution with CFR. This final model can predict approximately 97% of the changes in CFR.

The current study recommends some new predictors explaining affect mortality rate. Thus, it could help decision-makers develop health policies to fight COVID-19.

People from culturally and linguistically diverse (CaLD) backgrounds in Australia generally experience poorer health outcomes, explained in part by low levels of health literacy. We conducted a systematic review to examine the development and evaluation of health education resources designed for CaLD populations. Five electronic databases were searched for English language, peer-reviewed studies published between 1980 and 2020. Thirty-four studies met the inclusion criteria. Twenty-four different health education resources were described and broadly categorized into four types: media campaigns (n = 10), text-based materials (n = 5), films (n = 8) and radio (n = 1). Studies were assessed against domains adapted from a health literacy guideline incorporating: need, collaboration, audience, health literacy, theory, test and process and impact evaluation. All but one study met the majority of the domains. All studies reported positive evaluation outcomes; this may be due to studies involving community early in resource design and including health literacy considerations in their design. Reporting resource design and evaluation against standard practice controls is recommended to build a more robust evidence base for developing effective health education resources for use by audiences from CaLD backgrounds.

Most health information does not meet the health literacy needs of our communities. Writing health information in plain language is time-consuming but the release of tools like ChatGPT may make it easier to produce reliable plain language health information.

To investigate the capacity for ChatGPT to produce plain language versions of health texts.

Observational study of 26 health texts from reputable websites.

ChatGPT was prompted to 'rewrite the text for people with low literacy'. Researchers captured three revised versions of each original text.

Objective health literacy assessment, including Simple Measure of Gobbledygook (SMOG), proportion of the text that contains complex language (%), number of instances of passive voice and subjective ratings of key messages retained (%).

On average, original texts were written at grade 12.8 (SD = 2.2) and revised to grade 11.0 (SD = 1.2), p < 0.001. Original texts were on average 22.8% complex (SD = 7.5%) compared to 14.4% (SD = 5.6%) in revised texts, p < 0.001. Original texts had on average 4.7 instances (SD = 3.2) of passive text compared to 1.7 (SD = 1.2) in revised texts, p < 0.001. On average 80% of key messages were retained (SD = 15.0). The more complex original texts showed more improvements than less complex original texts. For example, when original texts were ≥ grade 13, revised versions improved by an average 3.3 grades (SD = 2.2), p < 0.001. Simpler original texts (< grade 11) improved by an average 0.5 grades (SD = 1.4), p < 0.001.

This study used multiple objective assessments of health literacy to demonstrate that ChatGPT can simplify health information while retaining most key messages. However, the revised texts typically did not meet health literacy targets for grade reading score, and improvements were marginal for texts that were already relatively simple.

Despite vaccination and various prevention policies, the coronavirus (COVID-19) pandemic maintains its negative effects globally. Therefore, people must be adequately informed and put this knowledge into practice in order to take the necessary precautions. This can be achieved with adequate health literacy. In this context, this study was conducted to determine the relationship between health literacy, COVID-19 knowledge and adherence to preventive measures. The sample of this descriptive cross-sectional online survey consisted of 1086 people. Data were collected using a demographics questionnaire, the European Health Literacy Scale, the COVID-19 Knowledge Assessment Questionnaire and the COVID-19 Adherence Assessment Questionnaire. Participants' health literacy index had a median score of 30.9, with 67.5% having inadequate or problematic health literacy. Gender, age, education, marital status, region of residence, employment status and economic status were associated with health literacy (p < 0.05). Participants' median knowledge and adherence scores were 40 and 54, respectively. There were significant positive correlations between health literacy index, knowledge and adherence scores (p < 0.001). This study demonstrated that health literacy, COVID-19 knowledge and adherence were associated with each other. As a result, strategies aimed at improving health literacy may be beneficial in terms of having better knowledge and demonstrating high adherence to measures, thus, eradicating the COVID-19 pandemic, reducing COVID-19-related conditions and promoting public health.

The SARS-CoV-2 pandemic has hit minorities more profoundly than the majority society. We evaluated the interplay between ethnic minority identity, gender, and COVID-19-related attitudes and behaviours.

Using data from a survey carried out among both members of ethnic minorities in Poland and Mexico and the majority outgroups, we assessed the perception of the pandemic as a grave threat to the self and to the world, as well as compliance with the protective measures to stop the spread of COVID-19. We tested the effects of gender and minority versus majority status on protective compliance, and of the pandemic as a threat to the self and the world.

A two-way ANOVA test with gender and ethnicity factors revealed significant effects of gender, ethnicity, and gender × ethnicity interaction. The effect of gender was significant for compliance with protective behaviours, threat to the self, and threat to the world. Women had higher mean levels of protective behaviours, perceptions of threat to the self, and perceptions of threat to the world than men. The effect of Indigenous ethnicity was significant for protective behaviours and threat to the world. The mean level of protective behaviours and threat to the world was higher for ethnic minority groups than for non-minority groups.

Maladaptive gender differences in COVID-19-related attitudes and behaviour are less prominent among people self-identifying as ethnic minority members.

Ethnic minorities, such as Pasifika, residing in high-income countries were at higher risk of COVID-19 infection during the pandemic. To understand the experiences of Pasifika, including message dissemination and barriers to tailored public health messaging during the pandemic, a qualitative study was undertaken, underpinned by Laswell's Model of Communication and Bandura's social cognitive theory with data collected using Pasifika methods. Pasifika adults (n = 65) were recruited across Sydney from July 2020 to March 2022. Health care professionals (HCP) (n = 17) employed by four local health districts (LHDs) and Pasifika community-based organizations delivering multicultural COVID-19-related work within the study catchment, were also recruited. Five themes were constructed from the data of: (i) prevailing fear and uncertainty over COVID-19 infection and losing employment; (ii) limited knowledge of government perpetuating distrust in Government as a benevolent source of information; (iii) faith and trust as priorities for health decision-making; (iv) 'Coconut wireless'-the role of family, friends and community in disseminating public health messages through word of mouth; and (v) limited health literacy affecting compliance with public health orders. Community members identified important messages and resources had not been sufficiently distributed. Most HCPs understood the necessity of grassroots-level engagement but reported existing approaches were inadequate to navigate challenges. These findings highlight the need for public health promotion and communication strategies that consider both the social and cultural determinants of health. We propose a 7-point checklist as a cultural appropriateness lens to assist the development and rating of existing or new health promotion messaging and resources.

Longitudinal studies can provide timely and accurate information to evaluate and inform COVID-19 control and mitigation strategies and future pandemic preparedness. The Optimise Study is a multidisciplinary research platform established in the Australian state of Victoria in September 2020 to collect epidemiological, social, psychological and behavioural data from priority populations. It aims to understand changing public attitudes, behaviours and experiences of COVID-19 and inform epidemic modelling and support responsive government policy.

This protocol paper describes the data collection procedures for the Optimise Study, an ongoing longitudinal cohort of ~1000 Victorian adults and their social networks. Participants are recruited using snowball sampling with a set of seeds and two waves of snowball recruitment. Seeds are purposively selected from priority groups, including recent COVID-19 cases and close contacts and people at heightened risk of infection and/or adverse outcomes of COVID-19 infection and/or public health measures. Participants complete a schedule of monthly quantitative surveys and daily diaries for up to 24 months, plus additional surveys annually for up to 48 months. Cohort participants are recruited for qualitative interviews at key time points to enable in-depth exploration of people's lived experiences. Separately, community representatives are invited to participate in community engagement groups, which review and interpret research findings to inform policy and practice recommendations.

The Optimise longitudinal cohort and qualitative interviews are approved by the Alfred Hospital Human Research Ethics Committee (# 333/20). The Optimise Study CEG is approved by the La Trobe University Human Ethics Committee (# HEC20532). All participants provide informed verbal consent to enter the cohort, with additional consent provided prior to any of the sub studies. Study findings will be disseminated through public website (https://optimisecovid.com.au/study-findings/) and through peer-reviewed publications.

NCT05323799.

Conflicting messages and misleading information related to the coronavirus (COVID-19) pandemic (SARS-CoV-2) have hindered mitigation efforts. It is important that trust in evidence-based public health information be maintained to effectively continue pandemic mitigation strategies. Officials, researchers, and the public can benefit from exploring how people receive information they believe and trust, and how their beliefs influence their behaviors.

To gain insight and inform effective evidence-based public health messaging, we distributed an anonymous online cross-sectional survey from May to July, 2020 to Virginia residents, 18 years of age or older. Participants were surveyed about their perceptions of COVID-19, risk mitigation behaviors, messages and events they felt influenced their beliefs and behaviors, and where they obtained information that they trust. The survey also collected socio-demographic information, including gender, age, race, ethnicity, level of education, income, employment status, occupation, changes in employment due to the pandemic, political affiliation, sexual orientation, and zip code. Analyses included specific focus on the most effective behavioral measures: wearing a face mask and distancing in public.

Among 3,488 respondents, systematic differences were observed in information sources that people trust, events that impacted beliefs and behaviors, and how behaviors changed by socio-demographics, political identity, and geography within Virginia. Characteristics significantly associated (p < 0.025) with not wearing a mask in public included identifying as non-Hispanic white, male, Republican political identity, younger age, lower income, not trusting national science and health organizations, believing one or more non-evidence-based messages, and residing in Southwest Virginia in logistic regression. Similar, lesser in magnitude correlations, were observed for distancing in public.

This study describes how information sources considered trustworthy vary across different populations and identities, and how these differentially correspond to beliefs and behaviors. This study can assist decision makers and the public to improve and effectively target public health messaging related to the ongoing COVID-19 pandemic and future public health challenges in Virginia and similar jurisdictions.

To address vaccine hesitancy, specific self-rated tools have been developed to assess vaccine literacy (VL) related to COVID-19, including additional variables, such as beliefs, behavior, and willingness to be vaccinated. To explore the recent literature a search was performed selecting articles published between January 2020 and October 2022: 26 papers were identified using these tools in the context of COVID-19. Descriptive analysis showed that the levels of VL observed in the studies were generally in agreement, with functional VL score often lower than the interactive-critical dimension, as if the latter was stimulated by the COVID-19-related infodemic. Factors associated with VL included vaccination status, age, educational level, and, possibly, gender. Effective communication based on VL when promoting vaccination is critical to sustaining immunization against COVID-19 and other communicable diseases. The VL scales developed to date have shown good consistency. However, further research is needed to improve these tools and develop new ones.

To evaluate the impact of research design on the perceived medical treatment effectiveness among researchers, healthcare workers (HCWs) and consumers in Croatia.

A cross-sectional study was conducted from November 2021 to February 2022 using an online survey. The participants were researchers, HCWs and consumers from Croatia. The survey had six scenarios about the same medical treatment presented within different study designs and in random order. Participants were asked to assess on a scale from 1 to 10 if the descriptions presented a sufficient level of evidence to conclude that the treatment was effective.

For researchers (n = 97), as the number of participants and degree of variable control in the study design increased, the perceived level of sufficient evidence also increased significantly. Among consumers (n = 286) and HCWs (n = 201), no significant differences in scores were observed between the cross-sectional study, cohort study, RCT, and systematic review.

There is a need to implement educational courses on basic research methodology in lower levels of education and as part of Continuing Medical Education for all stakeholders in the healthcare system. Trial registration: this study has been registered on the Open Science Framework prior to study commencement (https://osf.io/t7xmf).

To validate the 10-item Consumer Health Activation Index (CHAI), developed in the United States, as an activation measure for interventions targeted at the Australian older general population.

The study was a cross sectional design. Exploratory factor analysis (EFA) was conducted on survey data from a community sample of participants (n = 250), aged 55-75 years. Confirmatory factor analysis (CFA) was used to evaluate dimensionality among a second sample of participants randomly sampled from the electoral roll (n = 571), aged 50-75 years. Associations between the CHAI and self-reported health behaviours were examined.

EFA revealed a 7-item, two-factor structure ('Health self-management' and 'Patient-provider engagement'). CFA indicated optimum model fit was obtained with this structure. Subscale reliability and validity were confirmed, with significant correlation to age, functional health literacy and health screening.

In contrast to the original structure, optimum model fit was obtained with a two-factor solution and retention of seven items. The subscales have utility as a measure of health activation for tailoring of information in this group.

A freely-available, unidimensional health activation measure has demonstrated an underlying two-scale structure that will enable tailored approaches toward the enhancement and maintenance of self- and externally-managed health behaviours in an Australian population.

To compare the associations of COVID-19 preventive behaviours and depressive and anxiety symptoms with eHealth literacy and COVID-19 knowledge among Korean adults.

A cross-sectional online survey was conducted in April 2020.

Seoul metropolitan area in South Korea.

1057 Korean adults were recruited.

Associations between eHealth literacy, COVID-19 knowledge, COVID-19 preventive behaviours and psychological distress were computed using Pearson's correlation and logistic regression analyses. eHealth literacy, COVID-19 knowledge, COVID-19 preventive behaviours and psychological distress were weighted by sex and age distribution of the general population in Seoul Metropolitan area.

68.40% (n=723) perceived high eHealth literacy level (eHEALS ≥26), while 57.43% (n=605) had high levels of COVID-19 knowledge (score ≥25). No significant association between eHealth literacy and COVID-19 knowledge was identified (r=0.05, p=0.09). eHealth literacy and COVID-19 knowledge were significantly associated with COVID-19 preventive behaviours (aOR=1.99, 95% CI 1.51 to 2.62 L; aOR=1.81, 95% CI 1.40 to 2.34, respectively). High eHealth literacy was significantly associated with anxiety symptom (aOR=1.71, 95% CI 1.18 to 2.47) and depressive symptom (aOR=1.69, 95% CI 1.24 to 2.30). COVID-19 knowledge had negative and no associations with the symptoms (aOR=0.62, 95% CI 0.46 to 0.86; aOR=0.79, 95% CI 0.60 to 1.03, respectively). High eHealth literacy with low COVID-19 knowledge was positively and significantly associated with COVID-19 preventive behaviours (aOR=2.30, 95% CI 1.52 to 3.43), and anxiety (aOR=1.81, 95% CI 1.09 to 3.01) and depressive symptoms (aOR=2.24, 95% CI 1.41 to 3.55). High eHealth literacy with high COVID-19 knowledge were significantly associated with more preventive behaviours (aOR=3.66, 95% CI 2.47 to 5.42) but no significant associations with anxiety and depressive symptoms.

We identified that eHealth literacy and COVID-19 knowledge were not associated each other, and differently associated with individuals' COVID-19 preventive behaviours and psychological well-being. Public health strategies should pay attention to enhancing both eHealth literacy and COVID-19 knowledge levels in the public to maximise their COVID-19 preventive behaviours and mitigate their psychological distress during COVID-19 pandemic.

The impact of the Covid-19 pandemic has been widely documented. While deaths are now in the millions and many more have been impacted in other ways, the impact of Covid-19 has not been felt equally, with it exacerbating existing inequalities and disproportionately impacting a number of populations. With this Covid-19 has created unprecedented challenges in relation to health communication, with the need to reach disadvantaged populations. This systematic scoping review sought to 1) synthesize the existing research regarding communication inequalities in the response to the Covid-19 pandemic, and 2) analyze the recommendations that emerge from this body of evidence on how to best address these inequalities. This review includes 40 studies that fell into three broad groups (1) those revealing a disadvantage or inequality in studies of general population; (2) those focussing on communication with sub-groups disproportionately affected by the pandemic; and (3) those reporting and evaluating practical attempts to address inequalities. The results largely corroborate those found in past pandemics, highlighting the role of sociodemographic, cultural/religious, and economic factors in facilitating/jeopardizing the public's capacity to access and act upon public health messaging. In a number of studies it was encouraging to see recommendations from the literature - particularly, lessons learnt on the importance of community partnerships, trusted messengers and the co-creation of health and risk messages - being applied, however many challenges remain unmet. Covid-19 has also highlighted the need to actively tackle misinformation, something which was recognized, but largely unaddressed.

To investigate the association between social deprivation and COVID-19 among hospitalized patients in an underprivileged department of the greater Paris area.

Individuals hospitalized for COVID-19 between March 1st and October 31, 2020, were included, matched on age and sex, and compared with patients hospitalized for any other reason with negative RT-PCR for SARS-CoV-2, through a case-control study. Clinical, socio-demographic characteristics, health literacy, and social deprivation, assessed by the EPICES score, were collected. Factors associated with COVID-19 in hospitalized patients were assessed using univariate and multivariate logistic regression models.

69 cases and 180 controls were included. Participants were mostly men (N = 148: 59.4%) aged 65 or older (N = 109: 44.1%). Median EPICES score was 43.2 (IQR 29.4-62.9). EPICES score > 30.17 (precariousness threshold) was not significantly associated with COVID-19 in hospitalized patients (adjusted odds ratio (aOR) = 0.46; 95% Confidence Interval (CI) [0.21-1.01]). Advanced age, higher BMI, professional activity, home area of less than 25 m2 per person, and low health literacy, were significantly associated with COVID-19 in hospitalized patients.

This study highlights probable risk factors for specific exposition in disadvantaged area: maintenance of professional activity, smaller home area, and low health literacy.

This study investigates the intricate relationship between exposure to information sources, trust in these sources, conspiracy and misinformation beliefs, and COVID-19 anxiety among 509 Omani citizens aged 11 to 50, representing 11 governorates. Employing structural equation modeling, we not only examine these associations but also explore how trust and COVID-19 anxiety act as moderating variables in this context. Additionally, we delve into demographic factors such as age group, educational level, gender, and place of residence (governorate) to discern potential variations.Our findings reveal that trust in health experts is inversely related to belief in conspiracy theories, while trust in health experts negatively correlates with exposure to conspiracy and misinformation. Intriguingly, trust in health experts exhibits divergent effects across governorates: it diminishes conspiracy and misinformation beliefs in some regions but not in others. Exposure to personal contacts and digital media, on the other hand, is associated with heightened beliefs in misinformation and conspiracy theories, respectively, in select governorates. These distinctions may be attributed to proximity to Muscat, the capital city of Oman, where various media outlets and policy-making institutions are situated. Furthermore, lower educational attainment is linked to greater belief in conspiracy and misinformation. Females reported higher levels of conspiracy theory beliefs and COVID-19 anxiety while no significant differences were detected in misinformation beliefs.This study sheds light on the intricate dynamics of misinformation and conspiracy theories in the context of COVID-19 in Oman, highlighting the pivotal roles of trust and COVID-19 anxiety as moderating factors. These findings offer valuable insights into understanding and addressing the spread of misinformation and conspiracy theories during a public health crisis.

We investigated the knowledge, attitudes and practice (KAP) towards coronavirus disease 2019 (COVID-19) and its related preventive measures in Singaporeans aged ≥60 years.

This was a population-based, cross-sectional, mixed-methods study (13 May 2020-9 June 2020) of participants aged ≥ 60 years. Self-reported KAP about ten symptoms and six government-endorsed preventive measures related to COVID-19 were evaluated. Multivariable regression models were used to identify sociodemographic and health-related factors associated with KAP in our sample. Associations between knowledge/attitude scores and practice categories were determined using logistic regression. Seventy-eight participants were interviewed qualitatively about the practice of additional preventive measures and data were analysed thematically.

Mean awareness score of COVID-19 symptoms was 7.2/10. The most known symptom was fever (93.0%) and the least known was diarrhoea (33.5%). Most participants knew all six preventive measures (90.4%), perceived them as effective (78.7%) and practised 'wear a mask' (97.2%). Indians, Malays and participants living in smaller housing had poorer mean scores for knowledge of COVID-19 symptoms. Older participants had poorer attitudes towards preventive measures. Compared to Chinese, Indians had lower odds of practising three out of six recommendations. A one-point increase in score for knowledge and attitudes regarding preventive measures resulted in higher odds of always practising three of six and two of six measures, respectively. Qualitative interviews revealed use of other preventive measures, for example, maintaining a healthy lifestyle.

Elderly Singaporeans displayed high levels of KAP about COVID-19 and its related preventive measures, with a positive association between levels of knowledge/attitude and practice. However, important ethnic and socioeconomic disparities were evident, indicating that key vulnerabilities remain, which require immediate attention.

The study assessed the moderation modelling of digital health literacy and sense of coherence across subjective social class and age among university students in Ghana during the COVID-19 pandemic.

A total of 1160 students were conveniently sampled from two universities namely, the University of Education, Winneba and University of Cape Coast, using the descriptive cross-sectional survey design. Preliminary analysis was performed using descriptive statistics, whilst multivariate multiple regression and moderation analyses (Haye's Model) were employed to analyze the main data.

The study revealed that COVID-19 digital health literacy is directly and positively associated with sense of coherence among university students. Further, higher subjective social class positively and strongly moderated the relationship between COVID-19 digital health literacy and sense of coherence among university students. Additionally, the relationship between COVID-19 digital health literacy and sense of coherence was indirectly prominent among relatively older university students than younger ones.

The findings have implications for university management/authorities and public health agencies to organize effective orientation and self-management training programmes for university students.

Excessive worry is an invisible disruptive force that has adverse health outcomes and may advance to other forms of disorder, such as anxiety or depression. Addressing worry and its influences is challenging yet crucial for informing public health policy.

We examined parents' worries, influences, and variability before and during COVID-19 pandemic and across geography. Parents (n = 340) and their primary school-aged children from five Australian states completed an anonymous online survey in mid-2020. After literature review, we conceptualised the influences and performed a series of regression analyses.

Worry levels and the variables contributing to parents' worry varied before to during the pandemic. The proportion of parents who were "very worried all the time" increased by 14.6% in the early days of the pandemic. During the pandemic, ethnic background modified parents' worry and parents' history of daily distress symptoms was a significant contributor (p < 0.05). Excessive exposure to news remained significant both before and during the pandemic. The primary predictor of parents' worry before COVID-19 was perceived neighbourhood safety, while the main predictor during COVID-19 was financial risk due to income change. Some variable such as neighbourhood safety and financial risk varied in their contribution to worry across geographical regions. The proportion of worried children was higher among distraught parents.

Parents' worry during the health pandemic was not triggered by the health risks factors but by the financial risk due to income change. The study depicts inequality in the impact of COVID-19 by ethnic background. Different policies and reported virus case numbers across states may have modified the behaviour of variables contributing to the geography of parents' worry. Exposure to stressors before the COVID-19 pandemic may have helped parents develop coping strategies during stressful events. Parents are encouraged to limit their exposure to stressful news. We advocate for parents-specific tailored policies and emphasise the need for access to appropriate mental health resources for those in need. Advancing research in geographical modelling for mental health may aid in devising much-needed location-targeted interventions and prioritising resources in future events.

Health literacy (HL) can be regarded as a key element of non-pharmaceutical interventions used in emergency responses. The present study aimed to determine the associations of combinations of general HL and COVID-19-related HL with COVID-19 protective behaviors and healthy lifestyle behaviors.

A questionnaire survey was conducted from December 2020 to January 2021 among residents in Japanese metropolitan areas. Valid responses were received from 1,443 residents. The levels of HL were categorized into four groups: low level in both HLs (reference), high level in general HL only, high level in COVID-19-related HL only, and high level in both HLs. The total scores of eight COVID-19 protective behaviors were dichotomized into low and high adherence. Healthy lifestyle behaviors included healthy and balanced diet, adequate sleep, and regular exercise. Poisson regression analyses were conducted to examine the associations between the HL groups and high adherence to COVID-19 protective behaviors.

High level in COVID-19-related HL only was associated with high adherence to COVID-19 protective behaviors [prevalence ratio (PR), 1.25; 95% confidence interval (CI), 1.09-1.45], while high level in general HL only was associated with healthy and balanced diet (PR, 1.49; 95% CI, 1.04-2.13), adequate sleep (PR, 1.46; 95% CI, 1.02-2.10), and regular exercise (PR, 2.00; 95% CI, 1.29-3.13). High level in both HLs showed the highest prevalence of high adherence to COVID-19 protective behaviors and healthy lifestyle behaviors.

These findings indicate that COVID-19-related HL and general HL can both be considered to enhance protective behaviors.

In many high-income countries, COVID-19 has disproportionately impacted Culturally and Linguistically Diverse (CALD) communities. Barriers to engaging with essential health messaging has contributed to difficulties in following public health advice and exacerbated existing inequity in Australia. Research suggests that recently-arrived CALD populations are particularly vulnerable to misinformation and are more likely to experience vaccine hesitancy. The aim of this study was to explore the barriers and enablers to COVID-19 vaccination among recently-arrived CALD communities in Melbourne's outer north and identify strategies to reduce hesitancy in this population.

Semi-structured interviews were conducted with representatives from community organisations working with recently-arrived CALD communities in Melbourne's north. This included a mix of peer (from the community) and health care workers.

Fifteen participants from community organisations participated in interviews. Thematic analysis identified four themes; (1) trusted sources, (2) accurate and culturally sensitive information, (3) supported pathways and (4) enablers to vaccination.

Participants reported a perceived lack of accurate, culturally sensitive health information and service provision as key barriers to vaccination in recently-arrived CALD communities. Participants identified a range of perceived enablers to increasing vaccination uptake in the communities they work with, including utilising established channels of communication and harnessing the communities' strong sense of collective responsibility. Specific strategies to reduce vaccine hesitancy included identifying and utilising trusted sources (e.g. faith leaders) to disseminate information, tailoring health messages to address cultural differences, providing opportunities to contextualise information, and modifying service delivery to enhance cultural sensitivity. There is an urgent need for increased efforts from health and government agencies to build sustainable, collaborative relationships with CALD communities.

Although the number of identified coronavirus disease 2019 (COVID-19) cases and deaths has decreased, the repetitive crest-trough pattern of the spread of COVID-19 has yet to cease. The current situation may affect the mental health status of university students who are distracted in their academic and daily lives by the pandemic. This cross-sectional study aimed to identify the determinant factors of the mental health status of Japanese university students before and in the middle of the 7th wave of the pandemic, one of the largest waves to be experienced in Japan.

A survey was administered to two groups of students during the recession period between the 6th and 7th waves (n = 156) and during the 7th wave of the pandemic (n = 97).

T-tests showed no statistically significant differences between the two groups in Perceived Stress Scale (PSS) scores, while the COVID-19 anxiety scores (p < 0.001) and General Health Questionnaire (GHQ) scores were significantly higher in the Pandemic period group (p = 0.011). The multiple regression model indicated that PSS scores were the only determinant of GHQ scores in the Pandemic period group.

The results indicate that stressful life events, such as the COVID-19 pandemic and daily hassles, which are measured by the PSS, affect students' mental health differently. Therefore, the author submits that school counselors should provide counseling to students to reduce anxiety caused by daily hassles, during recession and pandemic periods. Students also require assistance with the reduction of stress and anxiety caused by daily hassles, regardless of the pandemic situation.

The COVID-19 pandemic can be controlled by vaccination in addition to public health measures. This study investigate the impact of Health Literacy (HL) on vaccination and COVID-19. 334 patients and patient's relatives aged 18 to 65 years who were followed up at the Infectious Diseases Clinic between March and July 2022 for reasons other than COVID-19 disease were included in the study. The COVID-19 vaccination status of each participant was queried and the preferred vaccination was recorded on the case form. The mean age was 40.9 years, and 52.4% (n:175) of participants were women. It was found that 82.3% (n:275) of participants had received at least one dose of the vaccine COVID-19. It was found that 17.6% of participants had not been COVID-19 vaccinated. It was found that 60.7% (n:203) of participants received ≥ 2 doses of the mRNA-based viral vaccine. Vaccination rates were found to be significantly lower in patients with 'inadequate' HL (p = .047). In addition, the vaccination rate was lower in people aged 39 years and younger and in the presence of one or more chronic diseases. When chronic diseases are present, COVID-19 becomes more severe. On the other hand, the disease shows a moderate clinical picture and plays a significant role in transmission to risk groups in the young population, where vaccination rates are low. This situation in the context of COVID-19 demonstrates once again the importance of informing at-risk groups and the healthy young population about vaccine-preventable diseases.