Lower Health Literacy Plagues Some Americans Most Vulnerable to COVID-19

In the midst of the COVID-19 pandemic, some of those most vulnerable to infection and unfavorable outcomes also have the lowest health literacy, according to a new survey. Here are areas where pharmacists and other healthcare professionals could provide beneficial education to protect those Americans from the disease.

CHICAGO – The evolving outbreak of coronavirus disease 2019 (COVID-19) presents an opportunity for pharmacists and other healthcare professionals to education Americans about the importance of following social distancing dictates and other measures to protect public health.

That’s according to an article in Annals of Internal Medicine, which points out that public health messaging has been inconsistent and unclear. Feinberg School of Medicine, Northwestern University-led researchers sought to determine COVID-19 awareness, knowledge, attitudes, and related behaviors among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions.


To do that, the study team conducted a cross-sectional survey linked to three active clinical trials and one cohort study. The survey was fielded at five academic internal medicine practices and two federally qualified health centers.

Participants were 630 adults aged 23 to 88 years living with one or more chronic conditions. Surveyors questioned them about self-reported knowledge, attitudes, and behaviors related to COVID-19 during the week of March 13 through March 20.

Results indicate that about a fourth (24.6%) of participants were “very worried” about getting the coronavirus, but nearly a third could not correctly identify symptoms (28.3%) or ways to prevent infection (30.2%).

At the same time, according to the report, one in four adults (24.6%) believed that they were “not at all likely” to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. Only one in 10 respondents was very confident that the federal government could prevent a nationwide outbreak, however.

Multivariable analyses suggest that participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak. In addition, those with low health literacy had greater confidence in the federal government response.

Researchers say their results are limited because the cross-sectional study of adults with underlying health conditions was conducted in only one city during the initial week of the COVID-19 U.S. outbreak.

“Many adults with comorbid conditions lacked critical knowledge about COVID-19 and, despite concern, were not changing routines or plans,” the authors conclude. “Noted disparities suggest that greater public health efforts may be needed to mobilize the most vulnerable communities”.

Pointing out that the “unprecedented global crisis has also been marked by miscommunication regarding the imminent threat of COVID-19, leading to public confusion and inaction,” the researchers note, “Older adults and those with underlying health conditions are at greatest risk for severe infection and death due to COVID-19. The same factors that make individuals more vulnerable are also associated with reduced ability to access and understand health information, make well-informed decisions, and take optimal health-promoting actions—a skill set commonly called “health literacy” This is especially true when the health information itself is not timely, trusted, consistent, or actionable.”

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