Association of health literacy, COVID-19 threat, and vaccination intention among Brazilian adolescents

Pimentel, Sidiany Mendes; Avila, Marla Andréia Garcia de; Prata, Rafaela Aparecida; Nunes, Hélio Rubens de Carvalho; Silva, Juliana Bastoni da

doi:10.1590/1518-8345.6154.3759

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 30 (spe) • 2022 • https://doi.org/10.1590/1518-8345.6154.3759 copy

Association of health literacy, COVID-19 threat, and vaccination intention among Brazilian adolescents^* * This article refers to the call “Adolescent health and the role of nurses”. Edited by Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Publication of this supplement was supported by the Pan American Health Organization (PAHO/WHO). Articles have undergone the journal’s standard peer-review process for supplements. The views expressed in this supplement are those of the authors alone and do not represent the views of PAHO/WHO. This article is part of the research developed in the Professional Master Course of the Graduate Program in Health Sciences (PPGCS) of the Universidade Federal do Tocantins, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

investigate the influence of health literacy on the assessment of COVID-19 threat to health and the intention not to be vaccinated among Brazilian adolescents.

Method:

cross-sectional study with 526 Brazilian adolescents aged 14 to 19 years. Socioeconomic aspects, health-disease profile, health literacy, health threat by COVID-19 and intention not to be vaccinated were analyzed by bivariate association and multiple linear regression with Poisson response.

Results:

higher health literacy score (p=0.010), cardiovascular disease (p=0.006), lower income (p=0.000), and living in the North region (p=0.007) were factors that contributed to feeling more threatened by COVID-19. Health literacy did not influence the intention not to be vaccinated (p=0.091), whose prevalence was lower among adolescents in the Southeast region when compared to those in the North region (p=0.010), among those who attended higher education (p=0,049) and those with higher income (p=0.000).

Conclusion:

health literacy influenced the perception of COVID-19 threat, but not the intention not to be vaccinated. Assessment of COVID-19 threat to health and prevalence of the intention not to be vaccinated were influenced by the region of residence, income, and education, which reinforces the importance of social determinants of health in this context.

Descriptors:
Health Literacy; Vaccination Refusal; COVID-19; Adolescent; COVID-19 Vaccines; Adolescent Health

Highlights:

(1) Average health literacy (HL) score of Brazilian adolescents: 25.3 (p-HLAT-8). (2) Adolescents in the Southeast region felt less threatened by COVID-19. (3) Higher HL score indicated adolescents felt more threatened by COVID-19. (4) Intention not to be vaccinated was observed among adolescents with higher income and education. (5) About 87% of Brazilian adolescents want to be vaccinated against COVID-19.

Characteristic	Total
Characteristic	n	%
Sex
Female	356	67.7
Male	170	32.3
Age	16.93^*	1.6^†
Region
North	258	49.0
Northeast	31	5.9
Midwest	36	6.8
Southeast	191	36.3
South	10	1.9
Schooling level
Elementary	67	12.7
High school	353	67.1
Higher education	106	20.2
Income (number of minimum wages)
<0.5	116	22.1
0.5-1	52	9.9
1-2	136	25.9
2-5	141	26.8
5-10	45	8.6
10-20	26	4.9
>20	10	1.9
Presence of chronic disease
No	477	90.7
Yes	49	9.3
Description of chronic disease
Cardiovascular	22	4.2
Respiratory	5	1.0
Integumentary	3	0.6
Endocrine	3	0.6
Other	16	3.04
Recent hospitalization
No	505	96.0
Yes	21	4.0
Medication use
No	424	80.6
Yes	102	19.4

Characteristic	b*	95%CI^†		p^‡
Female participants	0.024	−0.385	0.434	0.907
South region	0.881	−0.519	2.282	0.217
Southeast region	−0.573	−0.988	−0.158	0.007
Midwest region	−0.391	−1.164	0.382	0.322
Northeast region	0.210	−0.615	1.036	0.617
North region^§
Age	0.035	−0.084	0.153	0.565
Higher education	0.359	−0.326	1.043	0.304
High school	0.154	−0.431	0.738	0.606
Elementary^\|\|
Income	−0.263	−0.386	−0.139	0.000
Chronic disease	0.789	0.134	1.444	0.018
Cardiovascular disease	1.628	0.682	2.574	0.001
Recent hospitalization	1.043	0.069	2.017	0.036
Medication use	0.271	−0.213	0.755	0.272
Health literacy	0.041	0.006	0.076	0.021

Characteristic	b^*	95%CI^†		p^‡
South region	1.038	−0.316	2.391	0.133
Southeast region	−0.567	−0.976	−0.157	0.007
Midwest region	−0.244	−0.993	0.505	0.524
Northeast region	0.056	−0.743	0.855	0.891
North region^§
Income	−0.239	−0.361	−0.117	0.000
Chronic disease	0.028	−0.810	0.866	0.948
Cardiovascular disease	1.685	0.479	2.891	0.006
Recent hospitalization	0.803	−0.142	1.747	0.096
Health literacy	0.044	0.010	0.078	0.010

Characteristic	b^*	95%CI^† b		PR^‡	95%CI PR		p^§
Female participants	−0.088	−0.600	0.425	0.92	0.55	1.53	0.738
South region	−0.641	−2.621	1.338	0.53	0.07	3.81	0.525
Southeast region	−1.394	−2.105	−0.683	0.25	0.12	0.51	0.000
Midwest region	−0.313	−1.233	0.607	0.73	0.29	1.84	0.505
Northeast region	−0.163	−1.084	0.757	0.85	0.34	2.13	0.728
North region^\|\|
Age	−0.304	−0.449	−0.158	0.74	0.64	0.85	0.000
Higher education	−3.167	−5.191	−1.143	0.04	0.01	0.32	0.002
High school	−0.400	−0.973	0.174	0.67	0.38	1.19	0.172
Elementary education^¶
Income	−0.462	−0.643	−0.282	0.63	0.53	0.75	0.000
Chronic disease	−0.512	−1.522	0.497	0.60	0.22	1.64	0.320
Cardiovascular disease	−1.088	−3.062	0.886	0.34	0.05	2.43	0.280
Recent hospitalization	0.089	−1.068	1.246	1.09	0.34	3.48	0.880
Medication use	−0.756	−1.538	0.025	0.47	0.21	1.03	0.058
Health literacy	−0.054	−0.090	−0.018	0.95	0.91	0.98	0.003

Characteristic	b^*	95%CI^† b		PR^‡	95%CI PR		p^§
Intercept	2.426	−0.817	5.669	11.32	0.44	289.88	0.143
South region	−0.477	−2.484	1.530	0.62	0.08	4.62	0.641
Southeast region	−0.974	−1.715	−0.234	0.38	0.18	0.79	0.010
Midwest region	−0.162	−1.096	0.773	0.85	0.33	2.17	0.734
Northeast region	−0.445	−1.380	0.489	0.64	0.25	1.63	0.350
North region^\|\|
Age	−0.154	−0.361	0.052	0.86	0.70	1.05	0.143
Higher education	−2.219	−4.426	−0.011	0.11	0.01	0.99	0.049
High school	−0.029	−0.757	0.699	0.97	0.47	2.01	0.938
Elementary education^¶
Income	−0.376	−0.562	−0.190	0.69	0.57	0.83	0.000
Recent hospitalization	−0.379	−1.171	0.414	0.68	0.31	1.51	0.349
Absence of recent hospitalization	0^a
Health literacy	−0.033	−0.071	0.005	0.97	0.93	1.01	0.091

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E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Sidiany Mendes Pimentel E-mail: sidianymp@mail.uft.edu.br https://orcid.org/0000-0003-2460-8443