Digital Health Literacy Related to COVID-19 and Social Media Use among High School Students

Document Type : Original Article

Authors

1 Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga Surabaya, Indonesia 60132

2 Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga Surabaya, Indonesia 60132

3 Medical Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia 60132

Abstract

Background and Objectives: The COVID-19 pandemic raises a concern about the urgent issue of low levels of digital health literacy (DHL). Adequate DHL may mitigate the negative impacts of proliferating misinformation. This study was aimed at examining the COVID-19 related DHL levels and social media use as digital health information sources among high school students in East Java, Indonesia. The differences in DHL levels across sociodemographic factors, medical history, and social media preferences were also analyzed.

Material and Methods: This was a cross-sectional study, conducted in 2021, and enrolled high school students aged 15-18. The subjects were selected for convenience, with a minimum sample size of 384. An online questionnaire was shared through a survey platform. The sociodemographic variables and medical history were collected. The DHL measuring items were adapted from the validated DHL instrument developed in the COVID-19 context.  Data were analyzed with SPSS 17.0.

Results: We collected 432 responses. More than half of respondents (56.5%) have adequate DHL. Although 81.7 percent of respondents reported that searching for online information was easy, only 53.5 percent reported ease in appraising the reliability aspect. Fathers’ education varied by DHL. Students whose fathers hold post-graduate degrees showed a significantly higher level of DHL than those of lower educational backgrounds. Students experiencing COVID-19 infection of their own or close relatives showed higher total DHL and information search scores. Instagram and TikTok were the most frequently chosen social media as digital health information sources, but no significant difference in DHL across the preference for social media.

Conclusion: Even though the information can be obtained easily, there are still difficulties in evaluating its reliability. Considering the proportion of respondents with inadequate DHL, stakeholders in the health and education sectors need to develop DHL-promoting strategies for adolescents. Improvement in evaluating reliability should be the target of focus.

Keywords


Acknowledgements: We would like to thank the Faculty of Medicine, Universitas Airlangga for providing financial support.


Availability of data and materials: The authors confirm that the data generated or analyzed during this study are included in this published article


Conflicts of interests: The authors declare no conflict of interest


Consent for publication: All respondents have given consent for publication, provided that anonymity was ensured.


Ethical approval and consent to participate: This study was approved by the ethics committee of the Faculty of Medicine, Universitas Airlangga (No 136/EC/KEPK/FKUA/2021). Furthermore, the study was performed in line with the principles of the Declaration of Helsinki. All respondents and the school principal of each school gave consent for participation after reviewing the study protocol and questionnaire items.


Funding: This study was funded by RKAT Faculty of Medicine, Universitas Airlangga (No 388/UN3/2021).


Author contributions: NUH, AKR, and ADA conceptualized the main idea and designed the project. NUH acquired the funding. NUH, VIV, AKR, and ADA worked on data acquisition. NUH, AKR, ADA, INW, and VIV conducted data curation and formal analysis. NUH & INW wrote the original draft. NUH, AKR, ADA, and ARM reviewed and edited the draft. All author(s) read and approved the final manuscript

1. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012;12(1):80. https://doi.org/10.1186/1471-2458-12-80 PMid:22276600 PMCid:PMC3292515
2. Htay MNN, Parial LL, Tolabing MC, Dadaczynski K, Okan O, Leung AYM, et al. Digital health literacy, online information-seeking behaviour, and satisfaction of Covid-19 information among the university students of East and South-East Asia. PLoS One. 2022;17(4):e0266276. https://doi.org/10.1371/journal.pone.0266276 PMid:35417478 PMCid:PMC9007389
3. Frings D, Sykes S, Ojo A, Rowlands G, Trasolini A, Dadaczynski K, et al. Differences in digital health literacy and future anxiety between health care and other university students in England during the COVID-19 pandemic. BMC Public Health. 2022;22(1):658. https://doi.org/10.1186/s12889-022-13087-y PMid:35382797 PMCid:PMC8982905
4. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005 PMid:21768583
5. Biasio LR. Vaccine hesitancy and health literacy. Human Vaccines & Immunotherapeutics. 2017;13(3):701-2. https://doi.org/10.1080/21645515.2016.1243633 PMid:27808587 PMCid:PMC5360145
6. Nakayama K, Yonekura Y, Danya H, Hagiwara K. COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study. JMIR Form Res. 2022;6(1):e34966. https://doi.org/10.2196/34966 PMid:34982036 PMCid:PMC8822428
7. Hantrais L, Allin P, Kritikos M, Sogomonjan M, Anand PB, Livingstone S, et al. Covid-19 and the digital revolution. Contemporary Social Science. 2021;16(2):256-70. https://doi.org/10.1080/21582041.2020.1833234
8. Pan American Health Organization. Understanding the infodemic and misinformation in the fight against Covid-19, Department of Evidence and Intelligence for Action in Health. COVID-19 Factsheets2020. Available at: URL: www.paho.org/ish.
9. Kim HK, Tandoc EC. Consequences of Online Misinformation on COVID-19: Two Potential Pathways and Disparity by eHealth Literacy. Frontiers in Psychology. 2022;13 https://doi.org/10.3389/fpsyg.2022.783909 PMid:35237207 PMCid:PMC8882849
10. Amoah PA, Leung AYM, Parial LL, Poon ACY, Tong HH-Y, Ng W-I, et al. Digital Health Literacy and Health-Related Well-Being Amid the COVID-19 Pandemic: The Role of Socioeconomic Status Among University Students in Hong Kong and Macao. Asia Pacific Journal of Public Health. 2021;33(5):613-6. https://doi.org/10.1177/10105395211012230 PMid:33969743
11. Wahyuhadi J, Efendi F, Al Farabi MJ, Harymawan I, Ariana AD, Arifin H, et al. Association of stigma with mental health and quality of life among Indonesian COVID-19 survivors. PLOS ONE. 2022;17(2):e0264218. https://doi.org/10.1371/journal.pone.0264218 PMid:35196326 PMCid:PMC8865694
12. Ortiz N. Digital Health Literacy. World Health Organization. PAHO/WHO. 2017. Available at: URL: https://www.who.int/global-coordination-mechanism/working-groups/digital_hl.pdf.
13. Rosário R, Martins MRO, Augusto C, Silva MJ, Martins S, Duarte A, et al. Associations between COVID-19-Related Digital Health Literacy and Online Information-Seeking Behavior among Portuguese University Students. International Journal of Environmental Research and Public Health [Internet]. 2020; 17(23). https://doi.org/10.3390/ijerph17238987 PMid:33276647 PMCid:PMC7730120
14. Samy M, Abdelmalak R, Ahmed A, Kelada M. Social media as a source of medical information during COVID-19. Medical Education Online. 2020;25(1):1791467. https://doi.org/10.1080/10872981.2020.1791467 PMid:32644872 PMCid:PMC7482858
15. Venegas-Vera AV, Colbert GB, Lerma EV. Positive and negative impact of social media in the COVID-19 era. RCM. 2020;21(4):561-4. https://doi.org/10.31083/j.rcm.2020.04.195 PMid:33388000
16. Gisondi MA, Barber R, Faust JS, Raja A, Strehlow MC, Westafer LM, et al. A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation. J Med Internet Res. 2022;24(2):e35552. https://doi.org/10.2196/35552 PMid:35007204 PMCid:PMC8812140
17. de Albuquerque Veloso Machado M, Roberts B, Wong BLH, van Kessel R, Mossialos E. The Relationship Between the COVID-19 Pandemic and Vaccine Hesitancy: A Scoping Review of Literature Until August 2021. Front Public Health. 2021;9:747787. https://doi.org/10.3389/fpubh.2021.747787 PMid:34650953 PMCid:PMC8505886
18. World Health Organization. Adolescent Health. 2023. Available at: URL: https://www.who.int/health-topics/adolescent-health#tab=tab_1.
19. Taba M, Allen TB, Caldwell PHY, Skinner SR, Kang M, McCaffery K, et al. Adolescents' self-efficacy and digital health literacy: a cross-sectional mixed methods study. BMC Public Health. 2022;22(1):1223. https://doi.org/10.1186/s12889-022-13599-7 PMid:35725389 PMCid:PMC9207829
20. Velasco V, Gragnano A, Gruppo Regionale Hbsc L, Vecchio LP. Health Literacy Levels among Italian Students: Monitoring and Promotion at School. Int J Environ Res Public Health. 2021;18(19). https://doi.org/10.3390/ijerph18199943 PMid:34639245 PMCid:PMC8507908
21. Hamilton JL, Dreier MJ, Boyd SI. Social media as a bridge and a window: The changing relationship of adolescents with social media and digital platforms. Curr Opin Psychol. 2023;52:101633. https://doi.org/10.1016/j.copsyc.2023.101633 PMid:37454640
22. Dadaczynski K, Okan O, Messer M, Leung AYM, Rosário R, Darlington E, et al. Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study. J Med Internet Res. 2021;23(1):e24097. https://doi.org/10.2196/24097 PMid:33395396 PMCid:PMC7813561
23. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34. https://doi.org/10.2196/jmir.6.3.e34 PMid:15471760 PMCid:PMC1550605
24. Ihsan MN, Meliana A, Hasanatuludhhiyah N, Visuddho V, Purba AKR, D'Arqom A. Attitude and Behavior Towards Covid-19 Control Among High School Students in Surabaya and Sidoarjo, Indonesia. Journal of Community Medicine and Public Health Research. 2023;4(1):25-32. https://doi.org/10.20473/jcmphr.v4i1.41954
25. van der Vaart R, Drossaert C. Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills. J Med Internet Res. 2017;19(1):e27. https://doi.org/10.2196/jmir.6709 PMid:28119275 PMCid:PMC5358017
26. Park E, Kwon M. Testing the Digital Health Literacy Instrument for Adolescents: Cognitive Interviews. J Med Internet Res. 2021;23(3):e17856. https://doi.org/10.2196/17856 PMid:33720031 PMCid:PMC8074835
27. Thompson W, Volkmer I. Social media and COVID-19: A global study of digital crisis interaction among Gen Z and millennials. 2021. Available at: URL: https://www.who.int/news-room/feature-stories/detail/social-media-covid-19-a-global-study-of-digital-crisis-interaction-among-gen-z-and-millennials. https://doi.org/10.46580/124367
28. d'Arqom A, Sawitri B, Nasution Z, Lazuardi R. "Anti-COVID-19" Medications, Supplements, and Mental Health Status in Indonesian Mothers with School-Age Children. Int J Womens Health. 2021;13:699-709.https://doi.org/10.2147/IJWH.S316417 PMid:34285594 PMCid:PMC8286101
29. World Health Organization. Call for Action: Managing the Infodemic. 2020. Available at: URL: https://www.who.int/news/item/11-2-2020-call-for-action-managing-the-infodemic
30. World Health Organization. Infodemic. 2021. Available at: URL: https://www.who.int/health-topics/infodemic#tab=tab_1
31. Zakar R, Iqbal S, Zakar MZ, Fischer F. COVID-19 and Health Information Seeking Behavior: Digital Health Literacy Survey amongst University Students in Pakistan. International Journal of Environmental Research and Public Health [Internet]. 2021; 18(8).
https://doi.org/10.3390/ijerph18084009 PMid:33920404 PMCid:PMC8069684
32. Liu H, Liu W, Yoganathan V, Osburg V-S. COVID-19 information overload and generation Z's social media discontinuance intention during the pandemic lockdown. Technological Forecasting and Social Change. 2021;166:120600. https://doi.org/10.1016/j.techfore.2021.120600 PMid:34876758 PMCid:PMC8640972
33. Papp-Zipernovszky O, Horvath MD, Schulz PJ, Csabai M. Generation Gaps in Digital Health Literacy and Their Impact on Health Information Seeking Behavior and Health Empowerment in Hungary. Front Public Health. 2021;9:635943. https://doi.org/10.3389/fpubh.2021.635943 PMid:34055714 PMCid:PMC8158579
34. Norman CD, Skinner HA. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res. 2006;8(2):e9. https://doi.org/10.2196/jmir.8.2.e9 PMid:16867972 PMCid:PMC1550701
35. Halpern-Felsher B, Baker M, Stitzel S. Decision-making in adolescents and young adults. 2016. In: Handbook of Health Decision Science [Internet]. New York: Springer. https://doi.org/10.1007/978-1-4939-3486-7_12
36. Riiser K, Helseth S, Haraldstad K, Torbjornsen A, Richardsen KR. Adolescents' health literacy, health protective measures, and health-related quality of life during the Covid-19 pandemic. PLoS One. 2020;15(8):e0238161. https://doi.org/10.1371/journal.pone.0238161 PMid:32857806 PMCid:PMC7454983
37. Jones EAK, Mitra AK, Bhuiyan AR. Impact of COVID-19 on Mental Health in Adolescents: A Systematic Review. Int J Environ Res Public Health. 2021;18(5). https://doi.org/10.3390/ijerph18052470 PMid:33802278 PMCid:PMC7967607
38. Vassilakopoulou P, Hustad E. Bridging Digital Divides: a Literature Review and Research Agenda for Information Systems Research. Inf Syst Front. 2023;25(3):955-69. https://doi.org/10.1007/s10796-020-10096-3 PMid:33424421 PMCid:PMC7786312
39. Perrault EK, Hildenbrand GM, McCullock SP, Schmitz KJ, Lambert NJ. Online information seeking behaviors of breast cancer patients before and after diagnosis: From website discovery to improving website information. Cancer Treat Res Commun. 2020;23:100176. https://doi.org/10.1016/j.ctarc.2020.100176 PMid:32388484
40. Kim K, Shin S, Kim S, Lee E. The Relation Between eHealth Literacy and Health-Related Behaviors: Systematic Review and Meta-analysis. J Med Internet Res. 2023;25:e40778. https://doi.org/10.2196/40778 PMid:36716080 PMCid:PMC9926349
41. Wartella E, Rideout V, Montague H, Beaudoin-Ryan L, Lauricella A. Teens, Health and Technology: A National Survey. Media and Communication. 2016;4(3):13-23. https://doi.org/10.17645/mac.v4i3.515
42. NapoleonCat. Instagram users in Indonesia - May 2022. 2022. Available at: URL: https://napoleoncat.com/blog/instagram-users-in-indonesia/#:~:text=There%20were%20108%900%500%20Instagram%20users%20in,were%20the%20largest%20user%20group%20%2841%300%000%29.