Many of the groups in the Australian population who are at the greatest risk from COVID-19 – including those with chronic disease – are also the least likely to understand the public health messages aimed at keeping them and the broader community safe from the pandemic.
That’s the concerning finding from the first Australian research to look at what impact people’s health literacy has on their knowledge, attitudes, beliefs and behaviours in relation to COVID-19.
The study, published in the Sax Institute journal Public Health Research & Practice, should ring alarm bells for those developing public health information aimed at reducing the spread of the virus, say the authors.
They are calling for action to ensure public health messages are better tailored to meet the needs of our diverse population, especially those who may be most vulnerable to COVID-19.
In the article below, lead author Professor Kirsten McCaffery of the University of Sydney outlines the study findings.
Kirsten McCaffery writes:
One of the keys to Australia’s success in controlling COVID-19 so far has been the public’s response to health information about the disease – adopting social distancing, following lockdown directives and heeding the advice to get tested at the onset of any symptoms.
But what if people don’t understand or trust the messages that are being disseminated?
We know that Australians have varying levels of health literacy – the ability to understand, access and act on health advice and to make informed health decisions.
As detailed previously on Croakey, using performance based metrics, 59 percent of the Australian population has inadequate health literacy, with older Australians, those from non-English speaking backgrounds, those with less formal education and groups with poorer health more likely to struggle to understand health advice.
We also know that many of the most socially disadvantaged groups in our population – such as those with chronic disease – are more susceptible to COVID-19 and experience a more severe response to the virus.
In order to explore what this means, we surveyed 4,326 Australians aged over 18 years in April – during the first COVID-19 lockdown period. We asked about their knowledge, attitudes and behaviours related to COVID-19, as well as looking at their level of health literacy and sociodemographic factors.
The Australia-first data on health literacy and COVID-19, published in Public Health Research & Practice, raises serious concerns.
Among the survey sample, 13 percent of people were found to have inadequate health literacy, as assessed by a literacy screening tool which identifies people with very low health literacy.
Disparities in knowledge
Only about half (49 percent) of those with inadequate health literacy had knowledge of three key COVID-19 symptoms, compared to about two-thirds of those with adequate health literacy.
Those with inadequate health literacy were less able to identify three government-recommended behaviours to prevent infection (59 percent versus 72 percent) and they experienced more difficulty finding information and understanding government messaging about COVID-19 than people with adequate health literacy.
We found that older people (aged 59–90 years) rated the seriousness of the threat of COVID-19 as higher than younger participants, but also reported being less nervous and having lower anxiety, and a greater proportion believed that they were not likely to get sick than in the younger age groups.
In terms of how COVID-19 had impacted on people’s behaviour, the vast majority of respondents (92 percent) reported that they had changed their plans due to COVID-19.
However, people with inadequate health literacy were less likely to report social distancing as important and were more likely to feel personally unprepared for a widespread outbreak than those with adequate health literacy.
Among those taking regular medications, people with inadequate health literacy were also more likely to say they had difficulty remembering or accessing their medicines during lockdown.
Misinformation about COVID-19
We also asked the respondents about whether they believed some widely circulated misinformation about both COVID-19, and about vaccination in general.
People with lower health literacy were more likely to endorse misinformation, including the statements: “Data about the effectiveness of vaccines if often made up”, and “the threat of COVID-19 is greatly exaggerated”, compared with those with adequate health literacy.
While only a small proportion of respondents (6 percent) spoke a language other than English (LOTE) at home, we found the same pattern of results among that group as among those with inadequate health literacy. They rated the threat of COVID-19 as lower, with a greater proportion indicating that they were not likely to get sick, compared with those who primarily spoke English at home.
While our findings may not be all that surprising, the implications cannot be ignored.
There are clearly important disparities in Australians’ knowledge, attitudes and behaviour around COVID-19, which are associated with how well they can understand public health messaging about the pandemic.
These disparities not only have the potential to undermine efforts to reduce the spread of the virus, but have the potential to lead to greater social inequalities in health outcomes in Australia.
The findings support our previous concerns about the low level of attention paid to health literacy, and cultural and linguistic diversity (CALD) in COVID-19 public health messaging in the early phases of the pandemic response when good communication and adherence to behavioural advice was crucially important.
Understand, trust and act on advice
Until an effective vaccine becomes available, changing people’s behaviour remains our primary defence against the spread of the virus.
This means our diverse communities and patient groups must be able to understand, trust and act on evolving health advice.
People with the greatest burden of chronic diseases are most disadvantaged, and these are the people who are also most likely to experience severe disease and die from COVID-19.
By ensuring that health messages are tailored to meet the needs of those with lower levels of health literacy within our community, we can help to protect them and reduce the risk of COVID-19 for all Australians.
It must now be a priority for governments and all institutions charged with developing public health messaging about COVID-19 to address the health literacy, language and cultural needs of our whole community.
Professor Kirsten McCaffery, from the Sydney Health Literacy Lab, School of Public Heath, University of Sydney, is the lead author of the study on COVID-19 and health literacy published in Public Health Research & Practice.