The realtionship between health litercy and Covid 19 fear: a cross sectional study from Turkey

Document Type : Original Article


1 Department of Public Health Nursing, Nursing Faculty, Ataturk University, Erzurum, Turkey

2 Department of Nursing Fundamentals, Nursing Faculty, Ataturk University, Erzurum, Turkey

3 Department of Psycatric Nursing, Nursing Faculty, Ataturk University, Erzurum, Turkey



Bacground and Objectives: Health literacy is an important concept in the Covid-19 pandemic and has positive effects on fear. This purpose has been realized to determine the impact of concept of health literacy, which improves awareness in relation to health services on the Covid fear.

Materials and Methods: This study is a cross-sectional study that was conducted on 1060 people in Turkey who filled out the study instruments in January 2021.  Online tools were used to collect data due to social distance restrictions. The research data were collected using “Personal information form” created as based on literature and observations, “Turkish Health Literacy Scale -32 (HLS-TR), and COVID-19 Fear Scale (FCV-19S). To analyzes of data, average, t test, ANOVA, regression test were used.

Results: Average total score of Turkish Health literacy was 30.36±8.88. According to regression analysis, health literacy has significantly affect Covid fear and higher health literacy was associated with lower FCoV-19S scores (r=-0.760, p<0.001).

Conclusion: Adequate level of health literacy can reduce the negative effects of fear of COVID-19 during the pandemic in Turkey.


1. Xiang YT, Yang Y. Li W, Zhang L. Zhang Q. Cheung, T. et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020; 7, 228-229.
2. World Health Organisation. Coronavirus Disease (COVID-2019) Situation Reports; WHO: Geneva, Switzerland, 2020; Available online: (accessed on 01.12.2020).  
3. T.C. Health Ministry, (accessed on 01.12.2020).  
4- Patel MP, Kute VB, Agarwal SK, behalf of COVID O. "Infodemic" COVID 19: More Pandemic than the Virus. Indian journal of nephrology. 2020;30(3):188.  
5. Brooks S.K, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N. et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet, 2020; 395, 912-920.  
6. Galea S, Merchant RM, Lurie N. The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention. JAMA Internal Medicine, 2020; E1-E2.
7. Jafari Y, Tehrani H, Esmaily H, Shariati M, Vahedian‐shahroodi M. Family‐centred empowerment program for health literacy and self‐efficacy in family caregivers of patients with multiple sclerosis. Scandinavian journal of caring sciences. 2020;34(4):956-63.
8. Okan O, Bollweg TM, Berens E, Hurrelmann K, Bauer U, Schaeffer D. Coronavirus-related health literacy: A cross-sectional study in adults during the COVID-19 infodemic in Germany. International journal of environmental research and public health, 2020; 17(15), 5503.
PMid:32751484 PMCid:PMC7432052  
9. Izadi L, Taghdisi MH, Ghadami M, Delavar A, Sarokhani B. Identification of Effective Factors Decision Making in Crisis in Media rganization: A Systematic Review with Emphasis on Media literacy in Health Crisis (Corona Pandemic). Iranian Journal of Health Education and Health Promotion. 2020;8(4):390-406.  
10. Torales J, O'Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-coronavirus and its impact on global mental health. International Journal of Social Psychiatry, 2020; 1-4.
11. Nguyen HC, Nguyen MH, Do BN, Tran CQ, Nguyen TTP, Pham KM, et al. People with Suspected COVID-19 Symptoms Were More Likely Depressed and Had Lower Health-Related Quality of Life: The Potential Benefit of Health Literacy. J. Clin. Med. 2020; 9, 965.
PMid:32244415 PMCid:PMC7231234  
12. Yılmaz M, Tiraki Z. What is the Health Literacy? How Assessment? Dokuz Eylul University E-Journal of Nursing Faculty, 2016; 9(4), 142-147.  
13. Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc. Health 2020; 4, e10-e11.  
14. Goyal K, Chauhan P, Chhikara K, Gupta P, Singh MP. Fear of COVID 2019: First suicidal case in India Asian J. Psychiatr. 2020; 49, 101989.
PMid:32143142 PMCid:PMC7130010  
15. Xiang Y, Yang Y, Li W, Zhang L, Zhang Q, Cheung, T. et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020; 7, 228-229.  
16. Duan L, Zhu G. Psychological interventions for people a ected by the COVID-19 epidemic. Lancet Psychiatry 2020; 7, 300-302.  
17. Okyay P, Abacıgil F. Turkey Health Literacy Scale Reliability and Validity. Turkish Adaptation of the European Health Literacy Scale (ASOY-TR). Health Ministry 2016.  
18. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: development and initial validation. International journal of mental health and addiction. 2020; 1-9  
19. Satici B, Gocet-Tekin E, Deniz ME, Satici SA. Adaptation of the Fear of COVID-19 Scale: Its association with psychological distress and life satisfaction in Turkey. International Journal of Mental Health and Addiction, 2020; 1-9
PMid:32395095 PMCid:PMC7207987  
20. Muslu L, Çiftçi Ş, Aktaş EN. Health Lıteracy Levels Of Students Of Guıdance And Psychologıcal Counselıng Department. Journal of Research in Education and Teaching, 2017; 6(3): 277-285.  
21. Duman A. Determining General Health Literacy Levels of Parents and Affecting Factors in Primary School First Grade Vaccination in Fatih District. Specialty Thesis in Medicine. İstanbul Unıversity, 2017.  
22. Özdemir H, Alper Z, Uncu Y, Bilgel N. Health Literacy Among Adults: A Study from Turkey. Health Education Research 2010; 25(3): 464-477.
23. Lee HY, Rhee TG, Kim NK, Ahluwalia JS. Health Literacy As A Social Determinant of Health in Asian American Immigrants: Findings From A Population-Based Survey in California. Journal Of General Internal Medicine 2015; 30(8): 1118-1124.
PMid:25715993 PMCid:PMC4510223  
24. Morrison AK, Brousseau DC, Brazauskas R, Levas MN. Health literacy affects likelihood of radiology testing in the pediatric emergency department. The Journal of pediatrics 2015; 166(4): 1037-1041.
PMid:25596100 PMCid:PMC4380861  
25. Haun JN, Patel NR, French DD, Campbell RR, Bradham DD, Lapcevic WA. Association Between Health Literacy and Medical Care Costs in An Integrated Healthcare System: A Regional Population Based Study. BMC Health Services Research 2015; 15(1): 249-259.
PMid:26113118 PMCid:PMC4482196  
26. Nakayama K, Osaka W, Togari T, Ishikawa H, Yonekura Y, Sekido A, Matsumoto M. Comprehensive Health Literacy in Japan is Lower Than in Europe: A Validated Japanese-Language Assessment of Health Literacy. BMC Public Health 2015; 15(1): 505-516
PMid:26001385 PMCid:PMC4491868  
27. Durusu-Tanrıöver M, Yıldırım HH, Demiray Ready FN, Çakır B, Akalın E. Turkey Health Literacy Survey, 1. Edition, Sağlık-Sen Publising, Ankara 2014;35-52.  
28. Carvalho GS, Araújo MCP, Boff ETO, Tracana RB, Nunes LS. European health literacy scale (HLS-EU-BR) applied in a Brazilian higher education population of Rio Grande do Sul (RS European health literacy scale (HLS-EU-BR) applied in a Brazilian higher education population of Rio Grande do Sul (RS19. European Science Education Research Association 2016; 9;1289-95.  
29. Sørensen K, Pelikan JM, Rothlin F, Ganahl K, Slonska Z, Doyleet G. et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). European Journal of Public Health 2015; 25:1053- 8.
PMid:25843827 PMCid:PMC4668324  
30. Ergün, S. Health Literacy in School of Health Students. Kocaeli Medical J 2017;6;3:1-6  
31. Tzur Bitan D, Grossman-Giron A, Bloch Y, Mayer Y, Shiffman N, Mendlovic S. Fear of COVID-19 scale: Psychometric characteristics, reliability and validity in the Israeli population. Psychiatry research, 2020; 289, 113100.
32. Limcaoco RSG, Mateos EM, Fernandez JM, Roncero C. Anxiety, worry and perceived stress in the world due to the COVID-19 pandemic, March 2020. Preliminary Results. medRxiv
33. Qiu J, She B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen. Psychiatry 2020; 33, e100213. 1136/gpsych-2020-100213.
PMid:32215365 PMCid:PMC7061893  
34. Sakib N, Mamun MA, Bhuiyan AI, Hossain S, Al Mamun F, Hosen I. et al. Psychometric validation of the Bangla fear of COVID-19 scale: confirmatory factor analysis and Rasch analysis. Int. J. Ment. Health. Ad. 2020; 1-22 Advance online publication.  
35. Bakioğlu F, Korkmaz O, Ercan H. Fear of COVID-19 and positivity: mediating role of intolerance of uncertainty, depression, anxiety, and stress. International Journal of Mental Health and Addiction 2020;
PMid:32837421 PMCid:PMC7255700  
36. Reznik A, Gritsenko V, Konstantinov V, Khamenka N, Isralowitz R. COVID-19 Fear in Eastern Europe: Validation of the Fear of COVID-19 Scale. Int J Ment Health Addict. 2020;12:1-6. doi: 10.1007/s11469-020-00283-3.
PMid:32406404 PMCid:PMC7217343  
37. Duong VT, Lin IF, Sorensen K, Pelikan JM, Van Den Broucke S, Lin YC, Chang PW. Health literacy in Taiwan: A Population-Based Study. Asia Pacific Journal of Public Health 2015; 27(8): 871-880.
38. Zhang Y, Zhang F, Hu P, Huang W, Lu L, Bai R, Sharma M, Zhao, Y. Exploring Health Literacy in Medical University Students of Chongqing, China: A Cross-Sectional Study. Plos One 2016; 11(4): e0152547..
PMid:27050169 PMCid:PMC4822854  
39. Scarmozzino F, Visioli F. Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample. Foods. 2020;9(5):675
PMid:32466106 PMCid:PMC7278864  
40. Pellegrini M, Ponzo V, Rosato R, Scumaci E, Goitre I, Benso A, et al. Changes in weight and nutritional habits in adults with obesity during the "lockdown" period caused by the COVID-19 virus emergency. Nutrients. 2020;12(7):2016.
PMid:32645970 PMCid:PMC7400808  
41. Zhao A, Li Z, Ke Y, Huo S, Ma Y, Zhang Y, et al. Dietary diversity among Chinese residents during the COVID-19 outbreak and its associated factors. Nutrients. 2020;12(6):1699.
PMid:32517210 PMCid:PMC7352896  
42. Ammar A, Brach M, Trabelsi K, Chtourou H, Boukhris O, Masmoudi L, et al. Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19 international online survey. Nutrients. 2020;12(6):1583.
PMid:32481594 PMCid:PMC7352706