Study On The Relationship Between Residents’ Health Literacy And COVID-19 Protection Knowledge And Behavior Based On Structural Equation Model

Objective:To understand the health literacy level of residents in Jiangxi Province,and the status quo of cognition and behavior of COVID-19 prevention,clarify the relationship between residents’ health literacy and COVID-19 prevention cognition and behavior,and provide scientific basis for comprehensively improving residents’ health literacy level and their ability to respond to public health emergencies such as the COVID-19 epidemic.Methods:A cross-sectional survey was conducted among permanent residents aged 15-69 years in Jiangxi Province by using the National Residents’ Health Literacy Monitoring Questionnaire and COVID-19 Cognitive Level and Protective Behavior Questionnaire.Linear correlation was used for correlation analysis,logistic regression was used for multifactor analysis,and Amos24.0 was used to construct a structural equation model to explore the relationship between social demographic characteristics,health literacy,COVID-19 protection knowledge and COVID-19 protection behavior.Results: A total of 2882 valid questionnaires were collected in this study,and the effective recovery rate was 99.24%.The concrete results are as follows:(1)Health literacy,cognition level of COVID-19 and current status of protective behaviors: In 2021,the health literacy rate of residents in Jiangxi Province was15.37%.Among the three aspects of health literacy,the highest rate of basic knowledge and conceptual literacy was 25.19%;followed by healthy lifestyle and behavioral literacy,with a possession rate of 18.08%;while the lowest rate of basic skill literacy was 14.43%;The literacy rate of six types of health issues,from high to low,is: safety and first aid literacy(40.08%),scientific health concept literacy(38.03%),health information literacy(25.29%),chronic disease prevention literacy(20.61%),infectious disease prevention literacy(19.40%),and basic medical literacy(16.07%).In 2021,the qualified rate of COVID-19 cognition and protective behavior of residents in Jiangxi Province was 42.68% and 53.12%,respectively.(2)The single factor analysis of health literacy level suggests that the health literacy level of low age group,higher education level,higher annual household income,medical personnel,civil servants,and students is relatively high(P<0.05);The health literacy level of local registered residence people is lower than that of non-local registered residence people,and the health literacy level of family population of 3～5 people is higher than that of family population of 1～2 people and more than 6 people(P<0.05);The gender distribution suggests that men have higher levels of basic knowledge and conceptual literacy(P=0.014),safety and first aid(P=0.035),and health information(P=0.047)in three types of health issues compared to women.(3)The univariate analysis of COVID-19 cognition level and protective behavior showed that the eligible rate of COVID-19 cognition level and protective behavior was relatively high among low age group,with high education level,high annual household income,medical staff,civil servants,non-local registered residence,and family population of 3～5(P<0.05);In addition,the gender distribution suggested that women had higher protective behaviors against COVID-19 than men(P<0.05).(4)The structural equation model fitting among social demographic characteristics,health literacy,COVID-19 knowledge and protective behavior was acceptable(RMSEA=0.064<0.080,GFI=0.951,AGFI=0.925,TLI=0.936,CFI=0.950).Social demographic characteristics have a direct impact on health literacy,and its path coefficient is 0.757;The total effect on the protection knowledge of COVID-19 was 0.508(direct effect: 0.194,indirect effect: 0.314).The path coefficient of health literacy to COVID-19 protection knowledge was 0.415;The total effect of health literacy on protective behavior of COVID-19 was 0.652(direct effect was 0.630,indirect effect was 0.022).The path coefficient of COVID-19 protection knowledge to COVID-19 protection behavior is 0.052.This study had not yet observed the direct or indirect influence of social demographic characteristics on COVID-19 protection behavior.Conclusions:(1)The health literacy rate of residents in Jiangxi Province is relatively low,among which the basic skills rate is the lowest,followed by healthy lifestyle and behavior.From the six kinds of health problems,residents in Jiangxi Province mainly face four kinds of health problems: basic medical care,prevention and treatment of infectious diseases,prevention and treatment of chronic diseases and health information.(2)The qualified rate of cognition and protective behavior of COVID-19 among residents in Jiangxi province is at a low level,so the measures of popularization of science,education and normalization of prevention and control of COVID-19 epidemic among residents need to be further implemented.(3)Social demographic characteristics not only have a direct impact on COVID-19 protection knowledge,but also have an indirect impact on COVID-19 protection knowledge through health literacy,and health literacy has a greater indirect impact on COVID-19 protection knowledge.In addition,health literacy not only has a direct impact on COVID-19 protection behavior,but also has an indirect impact on COVID-19 protective behavior through COVID-19 protection knowledge,but the direct impact of health literacy is even greater.Improving residents’ health literacy level can enhance residents’ COVID-19 protection knowledge and behavior ability.