Correlation between health literacy and self-care behaviors in patients with COVID-19

Document Type : Original Article


1 Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran, Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

2 Department of Pediatrics, School of Medicine, Non-Communicable Diseases Research Center Ali Ibn Abitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

3 3Department of Family Medicine, School of Medicine, Ali Ibn Abitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

4 Physiology-Pharmacology Clinical Research Development, Unit Ali Ibn Abitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

5 Department of Physiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.

6 Phd Student in Higher Education , Faculty of Dentistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran


Background and Objectives: To investigate the correlation between health literacy and self-care behaviors among patients with COVID-19 in Rafsanjan, Iran. Due to the prevalence of corona disease worldwide and the lack of definitive and known treatment for it, the ability of patients to take care of themselves and Adherence to maintaining health is the best known way to prevent. 

Materials and methods: This descriptive study was performed in the first 6 months of 2020 on patients referred to health centers in Rafsanjan in 2020 with a confirmed COVID-19. Samples were selected by census method. The Health Literacy Questionnaire (HELIA) and the researcher-made self-care questionnaire were used and completed electronically. 

Results: One hundred and one eligible COVID-19 patients were enrolled in the study, 44.6% of participation having (THL < 132) and 55.4% of participation having (THL ≥ 133), and self-care had a significant weak and positive correlation only with Understand (one of the components of health literacy). 

Conclusions:  The results, showed that health literacy had a significant weak correlation with self-care in patients with COVID-19, therefore patients need proper knowledge and attitude to successfully develop self-care ability in order to successfully control their disease and prevent transmission to others.


1. Nguyen HC, Nguyen MH, Do BN, Tran CQ, Nguyen TT, 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. Journal of clinical medicine. 2020;9(4):965.
PMid:32244415 PMCid:PMC7231234
2. Paakkari L, Okan O. COVID-19: health literacy is an underestimated problem. The Lancet Public Health. 2020;5(5):e249-e50.
3. Lazcano-Ponce E, Alpuche-Aranda C. Public Health Literacy in the Face of the Covid-19 Pandemic Emergency. Salud publica de Mexico. 2020;62(3):331-40.
4. Khakzadi H, Morshedi H. Association between Health Literacy and Theory of Planned Behavior with Self-Care Behaviors in Type 2 Diabetic Patients. Journal of Torbat Heydariyeh University of Medical Sciences. 2019;6(4):33-46.
5. Peyman N, Abdollahi M. The relationship between health literacy and self-efficacy physical activity in postpartum women. Journal of Health Literacy. 2016;1(1):5-12.
6. Tavakoly Sany SB, Esmaeily A, Lael-Monfared E, Tehrani H, Ferns G, Jafari A. Organizing framework to investigate associations between diabetes knowledge, health literacy, and self-care behaviors in patients with type 2 diabetes based on the extended parallel process model. Journal of Diabetes & Metabolic Disorders. 2020;19(2):1283-92.
PMid:33520836 PMCid:PMC7843697
7. Schwarzer R, Antoniuk A, Gholami M. A brief intervention changing oral self‐care, self‐efficacy, and self‐monitoring. British journal of health psychology. 2015;20(1):56-67.
8. Khodabandeh M, Maleki Avarasin S, Nikniaz L. The Relationship between Health Literacy, Perceived Self-efficacy and Self-care Performance of Female Senior High School Students in Health Promoting Schools of Miyaneh, 2016-2017. Journal of Health Literacy. 2017;2(3):164-76.
9. Jafari A, Nejatian M, Momeniyan V, Barsalani FR, Tehrani H. Mental health literacy and quality of life in Iran: a cross-sectional study. BMC psychiatry. 2021;21(1):1-11.
PMid:34641793 PMCid:PMC8507341
10. Kickbusch IS. Health literacy: addressing the health and education divide. Health promotion international. 2001;16(3):289-97.
11. Delavar F, Pashaeypoor S, Negarandeh R. Health literacy index: A new tool for health literacy assessment. Journal of hayat. 2018;24(1):1-6.
12. Montazeri A, Tavousi M, Rakhshani F, Azin SA, Jahangiri K, Ebadi M, et al. Health Literacy for Iranian Adults (HELIA): development and psychometric properties. Payesh (Health Monitor). 2014;13(5):589-99.
13. Gautam V, Dileepan S, Rustagi N, Mittal A, Patel M, Shafi S, et al. Health literacy, preventive COVID 19 behaviour and adherence to chronic disease treatment during lockdown among patients registered at primary health facility in urban Jodhpur, Rajasthan. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2021;15(1):205-11.
PMid:33387854 PMCid:PMC7833282
14. Barati M, Bayat F, Asadi ZA, Afshari Moshir F, Afshari M. Relationship between health literacy and self-care behaviors in hypertensive patients. J Educ Community Health. 2020:89-96.
15. Tamizkar P, Mohammadi M, Fathnezhad-Kazemi A, Marami S. The relationship between health literacy level and self-care ability in the elderly. Journal of Gerontology. 2019;4(3):54-62.
16. Alizadeh Aghdam MB, Koohi K, Gholizadeh M. The relationship of Self-care and Health Literacy with Mental Health among Citizens of Tabriz City. Journal of Health Based Research. 2017;2(4):381-94.
17. Chaleshgar-kordasiabi M, Ramezani A, Bakhshavand A. Relationship between Health Literacy and Self-care Behaviors in Patients with Type 2 Diabetes. J Health Syst Res. 2020;15(4):262-71.
18. Zahedi S, Darvishpoor Kakhaki A, Hosseini M, Razzaghi Z. The Correlation Between Self-Care And Health Literacy In Patients Undergoing Hemodialysis. Iranian Journal of Diabetes and Metabolism. 2018;17(4):180-8.
19. Kripalani S, Henderson LE, Chiu EY, Robertson R, Kolm P, Jacobson TA. Predictors of medication self-management skill in a low-literacy population. Journal of general internal medicine. 2006;21(8):852-6.
PMid:16881946 PMCid:PMC1831567
20. Do BN, Nguyen P-A, Pham KM, Nguyen HC, Nguyen MH, Tran CQ, et al. Determinants of health literacy and its associations with health-related behaviors, depression among the older people with and without suspected COVID-19 symptoms: A multi-institutional study. Frontiers in public health. 2020;8:694.
PMid:33313037 PMCid:PMC7703185
21. Nguyen HT, Do BN, Pham KM, Kim GB, Dam HT, Nguyen TT, et al. Fear of COVID-19 scale-associations of its scores with health literacy and health-related behaviors among medical students. International Journal of Environmental Research and Public Health. 2020;17(11):4164.
PMid:32545240 PMCid:PMC7311979
22. Tran TV, Nguyen HC, Pham LV, Nguyen MH, Nguyen HC, Ha TH, et al. Impacts and interactions of COVID-19 response involvement, health-related behaviours, health literacy on anxiety, depression and health-related quality of life among healthcare workers: a cross-sectional study. BMJ open. 2020;10(12):e041394.
PMid:33293320 PMCid:PMC7722826
23. Bains SS, Egede LE. Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. Diabetes technology & therapeutics. 2011;13(3):335-41.
PMid:21299402 PMCid:PMC3690006
24. Salehzadeh A, Rahmatpour P. Self-care behaviors and related factors in patients with heart failure reffering to‎ medical & educational center of heart in Rasht.‎. Journal of Holistic Nursing And Midwifery. 2013;23(1):22-9.
25. SangSefidi S, Ghanbari Moghaddam A, Mohamadzadeh M, Karbalaee Z, Mohammadi M. Self-care and its predictive role in the quality of life of the elderly living in the community. Journal of Gerontology. 2018;2(4):64-70.
26. Saatchi M, Panahi M, Ashraf Mozafari A, Sahebkar M, Azarpakan A, Baigi V, et al. Health literacy and its associated factors: A population-based study, Hormuz Island. Iranian Journal of Epidemiology. 2017;13(2):136-44.
27. Farghadani Z, Taheri-Kharameh Z, Amiri-Mehra A, Ghajari H, Barati M. The relationship between health literacy and self-care behaviors among patients with heart failure. Journal of hayat. 2018;24(2):186-96.
28. Fallah Taher pazir E, Zeighami Mohammadi S, Fahidy F. Perception of patients with cardiovascular disease about barriers and benefits of health promotion behaviors. Cardiovascular Nursing Journal. 2012;1(2):16-23.