Health Literacy regarding Prevention and Control of COVID-19 in Iran

Document Type : Original Article


1 Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran

2 Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran

3 Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran


Background and Objective: Health literacy is a critical factor in the management of non-communicable and communicable diseases, such as COVID-19. The present study aimed to evaluate the status of health literacy concerning the prevention and control of COVID-19 among Iranian population in 2020.

Materials and Methods: The present cross-sectional study was conducted using a researcher-made online questionnaire (The questionnaire consisted of seven multiple-choice demographic items and 50 questions on the health literacy of respondents during the coronavirus epidemic.) to collect data from 1200 Iranian compatriots selected via convenience sampling in 2020. Collected data were analyzed by running T-test, one‑way analysis of variance, Pearson test, and regression test using SPSS25 software. Significance level was considered <0.05.

Results: The mean score of health literacy was 66.33±15.48 indicating higher rates in women, age group of 20-25 years, single people, urbanites, employees, healthy people, and individuals with academic education (p<0.001). Study variables could predict 42.5% health literacy concerning the prevention and control of COVID-19. Gender, residential area, health status, level of education, and occupation were significant predictors of health literacy (p<0.001).

Conclusion: Based on the findings, the health literacy of Iranian people was at a relatively desirable level. However, health authorities are required to design and implement purposeful and theory-based educational programs to raise the level of awareness in society.


1. Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, Zhang LJ. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology 2020; 200490. Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, Zhang LJ. Coronavirus Disease 2019 (COVID-19): A Perspective from China. Radiology. 2020 Aug;296(2):E15-E25. PMID: 32083985; PMCID: PMC7233368.
2. Mirmohammadkhani M, Paknazar F, Rashidy-pour A. Evaluation of the epidemiological pattern of COVID-19 applying basic reproduction number: An educational review article. Koomesh. 2020; 22(3): 373-379.  
3. Coronavirus disease (COVID-19) outbreak, Situation Report-86 WHO; 2020 [March 8]; Available from:  
4. Tuite AR, Bogoch I, Sherbo R, Watts A, Fisman DN, Khan K. Estimation of COVID-2019 burden and potential for international dissemination of infection from Iran. Med Rxiv 2020. PMID: 32176272; PMCID: PMC7081176.  
5.Shahyad S, Mohammadi M T. Psychological Impacts of Covid-19 Outbreak on Mental Health Status of Society Individuals: A Narrative Review. J Mil Med. 2020; 22(2): 184-192.  
6.Farahani M N. Changes in Attitude, Beliefs and Values and COVID-19 pandemic. Journal of Research in Psychological Health 2020; 14(1).  
7. Tavassoli E, Hesary FB. Knowledge, skill, and preventive behaviors regarding COVID-19 among the public in Shahrekord of Iran. JEdu Health Promot 2021;10:125. PMID: 34222500; PMCID: PMC8224523.  
8. Paakkari L,Okan O. COVID-19: health literacy is an underestimated problem. Lancet Public Health 2020; 5(5): e249-e250  
9. Namratha R, Kandula a, Phyllis A, Nsiah-Kumi b, Gregory Makoul c, Josh Sager d and et al. The relationship between health literacy and knowledge improvement after a multimedia type 2 diabetes education program. Patient Education and Counseling 75 (2009) 321-327.  
10. Alidosti A, Tavassoli E, Babaei Heydarabadi A, Reisi M. Health Literacy, Awareness and Self-Efficacy among Cardiovascular Patients Visiting Medical Centers of Shahr-e Kord. Mal J Med Health Sci 2019; 15(2): 9-15.  
11. IOM (Institute of Medicine). Health literacy: a prescription to end confusion. Washington, DC: National Academy of Sciences; 2004.  
12. Arnold CL, Davis TC, Berkel HJ, Jackson RH, Nandy I, London S. Smoking status, reading level, and knowledge of tobacco effects among low-income pregnant women. Prev Med 2001;32: 313-320.  
13. Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, Ren J, Peel J. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health 2002;92: 1278-1283  
14. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan GD, Bindman AB. Association of health literacy with diabetes outcomes. JAMA 2002; 288:475-482.  
15. Kindig DA, Panzer AM, Nielsen-Bohlman L. Health Literacy: A Prescription to End Confusion: National Academies Press; 2004.  
16. DeWalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes. Journal of general internal medicine 2004;19(12): 1228-1239
17. Sudore RL, Mehta KM, Simonsick EM, Harris TB, Newman AB, Satterfield S, et al. Limited literacy in older people and disparities in health and healthcare access. Journal of the American Geriatrics Society 2006; 54(5):770-776.  
18. Javadzade SH, Sharifirad G, Radjati F, Mostafavi F, Reisi M, Hasanzade A. Relationship between health literacy, health status, and healthy behaviors among older adults in Isfahan, Iran. Journal of education and health promotion 2012:1.  
19. Sudore RL, Yaffe K, Satterfield S, Harris TB, Mehta KM, Simonsick EM, et al. Limited literacy and mortality in the elderly: the health, aging, and body composition study. Journal of general internal medicine 2006; 21(8): 806-812. PMID: 16881938; PMCID: PMC1831586.  
20.Yusefi AR, Barfar E, Daneshi S, Bayati M, Mehralian Gh , Bastani P. Health literacy and health promoting behaviors among inpatient women during COVID-19 pandemic. BMC Women's Health 2022; 22: 77. PMID: 35300684, PMCID: PMC8929241.  
21. Lawshe CH. A quantitative approach to content validity. Personnel Psych 1975; 28: 563-575.  
22. Waltz CF, Bausell RB. Nursing Research: Design, Statistics, and Computer Analysis. Philadelphia: W.B. Saunders Co; 1981:45.  
23.Okan O, Michael Bollweg T, 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. Int. J. Environ. Res. Public Health 2020, 17(15):1-20. PMID: 32751484; PMCID: PMC7432052.  
24. McCaffery K , Dodd RH , Cvejic E , Ayrek J , Batcup C , Isautier J. Health literacy and disparities in COVID-19-related knowledge, attitudes, beliefs and behaviours in Australia. medRxiv. 2020; 9(30): 30342012. PMID: 33294907,  
25. Rubeena Zakar, Sarosh Iqbal, Muhammad Zakria Zakar, Florian Fischer. COVID-19 and Health Information Seeking Behavior: Digital Health Literacy Survey amongst University Students in Pakistan. Int J Environ Res Public Health. 2021 Apr; 18(8): 4009.  
26. Schaeffer D, Berens E M, Vogt D. Health Literacy in the German Population. Dtsch. Arztebl. Int 2017; 114(4): 53-60.
27. Tehrani H, Vali M, Nejatian M, Moshki M, Charoghchian Khorasani E, Jafari A. The status of depression literacy and its relationship with quality of life among Iranian public population: a cross sectional study. BMC psychiatry. 2022;22(1):1-9.
PMid:36100889 PMCid:PMC9472397  
28. Dadipoor S, Ramezankhani A , Aghamolaei T , Rakhshani F , Safari-Moradabadi A. Evaluation of Health Literacy in the Iranian Population. Health Scope 2018; 7(3):e62212.  
29. Saberi MK, Paknahad S, Jowkar AR. Health Literacy of Patients with Breast Cancer: A Qualitative Study. J Qual Res Health Sci 2019; 8(2): 131-42.  
30. Reisi M, Mostafavi F, Javadzade SM, Mahaki B, Sharifirad G. Assessment of some predicting factors of self-efficacy in patients with type 2 diabetes. Iranian Journal of Endocrinology and Metabolism 2015; 17(1): 44-52.  
31.Silva JG, Silva CS, Alexandre B, Morgado P. Health Literacy of the Inland Population in Mitigation Phase 3.2 of the COVID-19 Pandemic in Portugal: A Descriptive Cross-Sectional Study. Port J Public Health 2020; 38:51-61.  
32. Afshari M, Khazaei S, Bahrami M, Merati H. Investigating adult health literacy in Tuyserkan City. J Educ Community Health 2014; 1(2):48-55.  
33. Olyani S, Gholian Aval M, Tehrani H, Mahdiadeh M. School-based mental health literacy educational interventions in adolescents: a systematic review. Journal of Health Literacy. 2021;6(2):69-77  
34. Borji M, Tarjoman A, Otaghi M, Salimi E, Naseri A. Health Literacy Level and its Related Factors among the Elderlies in Ilam in 2015. IJN 2017; 30 (108):33-43.  
35. Tehrani Banihashemi S, Amirkhani M, Haghdoost A, Alavian S, Asgharifard H, Baradaran H. Health literacy in the five provinces of the country and its effective factors. Journal of Medical Education Development Center 2007; 4(1):1-9.  
36. Moradi M, Bahrami Nia S. The Study of Health Literacy of Patients Referring to Specialist Physicians' Offices in Kermanshah City. Payavard 2019; 13 (4):291-301.  
37. Izadirad H, Zareban I. The Relationship of Health Literacy with Health status, Preventive Behaviors and Health services Utilization in Baluchistan, Iran. J Educ Community Health. 2015; 2 (3):43-50.