College of Nursing and Health, Kongju National University, 56 Gongjudaehak-Ro, 32588, Gongju-Si, Chungcheongnam-do, Republic of Korea.
BMC Public Health. 2023 Feb 6;23(1):255. doi: 10.1186/s12889-023-15182-0.
Poor health literacy is associated with lower utilization of preventable services. However, the relationship between health literacy and COVID-19 vaccine hesitancy remains controvertible.
This study used data from 229,242 individuals who completed the Community Health Survey in Korea from August 16 to October 31 in 2021. To operationalize COVID-19 vaccine hesitancy, we measured vaccine refusal, which is defined as not having been vaccinated and not intending to get vaccinated against COVID-19. Health literacy is operationalized in two dimensions; the ability to understand spoken directions from health professionals and the ability to understand written information regarding health. Covariates include sex, age, educational level, marital status, employment status, basic living security pension status, and subjective health status. Two multivariable logistic regression models were run to determine factors associated with COVID-19 vaccine refusal. Model 1 included sociodemographic characteristics and subjective health status. Model 2 added two health literacy variables. Odds ratio (OR) and 95% confidence intervals (CI) were calculated.
Only 3.9% of the Korean adult population were estimated to refuse COVID-19 vaccine. The most commonly cited reasons for COVID-19 vaccine refusal were concerns about vaccine adverse events (47.6%), followed by the assessment of one's own health status (29.5%). Individuals who found spoken directions very difficult to understand were more likely to refuse COVID-19 vaccine than those who found spoken directions very easy (OR = 1.55, 95% CI: 1.28-1.87, p < 0.001). People who did not pay attention to written information were more likely to refuse COVID-19 vaccine than those who reported it to be very easy to understand (OR = 1.28, 95% CI: 1.13-1.45, p < 0.001). People in all other categories of the literacy spectrum for either spoken or written information did not have an increased risk of COVID-19 vaccine refusal.
Health literacy was significantly associated with COVID-19 vaccine refusal. Health literacy programs could be beneficial to reduce vaccine refusal, particularly for the people who find spoken directions from health professionals very difficult to understand and those who do not pay attention to written information.
健康素养较差与预防服务利用率较低有关。然而，健康素养与 COVID-19 疫苗犹豫之间的关系仍存在争议。
本研究使用了 2021 年 8 月 16 日至 10 月 31 日在韩国进行的社区健康调查中 229242 名完成调查的个体的数据。为了操作化 COVID-19 疫苗犹豫，我们测量了疫苗拒绝，即尚未接种且不打算接种 COVID-19 疫苗的情况。健康素养在两个维度上进行操作化；理解来自卫生专业人员的口头指示的能力和理解与健康相关的书面信息的能力。协变量包括性别、年龄、教育程度、婚姻状况、就业状况、基本生活保障养老金状况和主观健康状况。进行了两项多变量逻辑回归模型，以确定与 COVID-19 疫苗拒绝相关的因素。模型 1 包括社会人口统计学特征和主观健康状况。模型 2 添加了两个健康素养变量。计算了比值比（OR）和 95%置信区间（CI）。
韩国成年人口中只有 3.9%的人估计会拒绝 COVID-19 疫苗。拒绝 COVID-19 疫苗的最常见原因是对疫苗不良事件的担忧（47.6%），其次是对自身健康状况的评估（29.5%）。认为口头指示很难理解的人比认为口头指示很容易理解的人更有可能拒绝 COVID-19 疫苗（OR=1.55，95%CI：1.28-1.87，p<0.001）。不关注书面信息的人比报告很容易理解书面信息的人更有可能拒绝 COVID-19 疫苗（OR=1.28，95%CI：1.13-1.45，p<0.001）。在口头或书面信息的任何其他类别的读写能力范围内的人，其 COVID-19 疫苗拒绝的风险没有增加。
健康素养与 COVID-19 疫苗拒绝显著相关。健康素养计划可能有助于减少疫苗拒绝，特别是对于那些认为来自卫生专业人员的口头指示非常难以理解以及不关注书面信息的人。
