Digital health literacy, behavior and knowledge of adolescents for hand hygiene during the COVID-19 pandemic

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

doi:10.1590/1518-8345.7228.4308

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.7228.4308 copy

Digital health literacy, behavior and knowledge of adolescents for hand hygiene during the COVID-19 pandemic^* * The publication of this article in the Thematic Series “Digital health: nursing contributions” is part of Activity 2.2 of Reference Term 2 of the PAHO/WHO Collaborating Centre for Nursing Research Development, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to investigate factors associated with digital health literacy, hand hygiene knowledge and behavior among Brazilian adolescents during the COVID-19 pandemic.

Method:

cross-sectional study with 473 adolescents aged 15 to 19. Data were collected virtually between June and August 2021 through a questionnaire on sociodemographic characteristics, digital health literacy, knowledge and behavior regarding hand hygiene. Variables were adjusted using multiple linear regression models with normal response.

Results:

the average digital health literacy score was 29.89 ±5.30; for hand hygiene knowledge and behavior was 13.1 ±1.5 and 11.1±2.7, respectively. Higher knowledge and behavior scores for hand hygiene were associated with having completed high school, compared to those attending college, among those who attend health courses, seek information about the pandemic and in scientific articles. Higher digital health literacy scores in adolescents who did not wear masks when playing sports (p= 0.017). There was an association between digital health literacy and knowledge (p = 0.000) and behavior (p = 0.000) regarding hand hygiene.

Conclusion:

there is an association between higher digital health literacy scores and hand hygiene knowledge and behavior.

Descriptors:
Health Literacy; Hand Disinfection; Hand Hygiene; COVID-19; Adolescent; Adolescent Health

Highlights:

(1) Average digital health literacy of Brazilian adolescents was 29.89 points

(2) Average knowledge on hand hygiene was 13.1 points and behavior was 11.1.

(3) Knowledge and behavior scores were lower among men.

(4) Higher digital health literacy in adolescents who did not wear masks when playing sports.

(5) There is an association between higher digital health literacy scores and hand hygiene knowledge and behavior.

Variables	Total
Variables	n*	%^†
Gender
Female	314	66,4
Male	155	32,8
Other	4	0,8
Region
Southeast	369	78,0
North East	46	9,7
North	26	5,5
Midwest	18	3,8
South	14	3,0
Age (in years)
18-19	267	56,4
15-17	206	43,6
Education
High school in progress	214	45,2
College in progress	146	30,9
Finished high school	55	11,6
Preparatory course	36	7,6
Secundary education in progress	22	4,7
Bachelor’s degree or technical course in the healthcare field	88	18,6
Paid activity	157	33,2
Parents or guardians are in the healthcare field	114	24,1
Education of parents/guardians
High school	176	37,2
Graduation	121	25,6
Postgraduate	110	23,3
Secundary school	40	8,5
Elementary school	23	4,9
Not literate	3	0,6
Diagnosis of COVID-19	81	17,1
Death of a family member due to COVID-19	21	4,4
Situation in which a mask was not wore
Home	431	91,7
Family reunions	264	55,8
Outdoor environment	152	32,3
Practicing sport	94	19,9
Parties	23	4,9
Work	11	2,3
Others	17	3,6
Search for information about the pandemic	379	80,1
Places where they search for information
Social media^‡	443	93,6
Television	272	57,4
Newspapers	157	33,1
Family	149	31.4
Scientific articles	115	24,3
Other media^§	97	20,5
Friends	95	20,5
School	95	20,0
Faculty	68	14,4
Radio	25	5,28
Websites	11	2,32
Desire to receive vaccine	444	93,9

Variable	n*	%^†
Preventive measures adopted (N=895)
Face mask	379	83,8
Hand hygiene with 70% alcohol	252	55,7
Hand hygiene with soap and water	91	20,1
Social distancing	75	16,6
Social isolation	67	14,8
Personal or environmental hygiene	28	6,2
Others^‡	03	0,7
Difficulties in adopting preventive measures (N=406)
Social distancing	83	21,7
Face mask	73	19,1
No difficulties	62	16,2
Social isolation	66	17,2
Use of alcohol or alcohol gel	46	12,0
Personal or environmental hygiene	56	14,7
Sanitization of hands	18	4,7
Others^§	02	0,5
Information they know about vaccines (N=402)
Vaccine effectiveness	102	24,11
Reduces serious conditions	66	15,60
Side effect	45	10,63
Vaccine production	42	9,92
Benefits of vaccines	28	6,61
Others^\|\|	25	5,91
Mass vaccination	24	5,67
Vaccine doses	23	5,43
Negative information	19	4,49
They do not know	16	3,78
Vaccine needed to fight the pandemic	12	2,83
Information you would like to know (N=319)
Vaccine effectiveness	98	29,96
Different types of vaccines	60	18,34
Vaccination in teenagers	50	15,29
None	33	10,09
Side effect	29	8,86
Post-vaccine	18	5,50
Required doses	13	3,97
Others^¶	10	3,05
Security and distribution	08	2,44

Variables	Bivariate associations				Multiple regression
Variables	b^†	CI^‡95%		p ^§	b^†	CI^‡95%		p ^§
Gender
Others^\|\|	-0,80	-4,35	2,74	0,657	-0,72	-4,68	3,25	0,723
Male	-0,83	-1,52	-0,14	0,019	-0,70	-1,37	-0,02	0,042
Female^¶
Region
Other regions	-0,43	-1,21	0,36	0,288
Southeast**
Age
18-19 years old	0,09	-0,57	0,75	0,786
15 to 17 years^††
Education
Preparatory course	-0,34	-1,64	0,96	0,609	0,53	-0,81	1,88	0,438
Elementary school II completed	-0,12	-1,72	1,49	0,887	1,21	-0,43	2,86	0,148
High school in progress	0,27	-0,48	1,02	0,485	1,13	0,26	2,00	0,011
Finished high school	1,77	0,66	2,87	0,002	2,28	1,13	3,43	0,000
College in progress^‡‡
Undergraduate courses in the health sector	0,71	-0,13	1,55	0,096	1,16	0,19	2,13	0,019
Work
Yes, outside the house	-0,43	-1,16	0,30	0,251
Yes, at home office	0,34	-1,13	1,81	0,647
Work^§§
Parents/caregivers	-0,49	-1,25	0,27	0,208
Education of parents or guardians
Postgraduate	2,28	-1,83	6,39	0,277
Graduation	1,09	-3,02	5,19	0,604
High school	1,84	-2,25	5,92	0,378
Elementary school II	0,98	-3,22	5,18	0,646
Elementary school I	0,68	-3,63	4,99	0,757
Not educated^\|\|\|\|
Diagnosis of COVID-19	-0,51	-1,38	0,35	0,247
Family death due to COVID-19	-0,64	-2,22	0,95	0,431
Situations in which do not use masks
Family reunions	-0,25	-0,91	0,41	0,462
Practicing sport	0,05	-0,77	0,87	0,914
Parties	-0,25	-1,77	1,27	0,745
Home	0,73	-0,46	1,92	0,229
Work	-1,31	-3,48	0,85	0,235
Outdoor environment	-0,93	-1,63	-0,24	0,008	-0,90	-1,57	-0,23	0,009
Others^¶¶	1,60	-0,15	3,35	0,074	1,83	0,07	3,60	0,042
Search for information about the pandemic	1,40	0,58	2,21	0,001	0,97	0,16	1,78	0,019
Places where they look for information
Scientific articles	1,49	0,74	2,24	0,000	1,23	0,38	2,08	0,005
Universities	1,10	0,18	2,03	0,020	0,06	-1,01	1,13	0,913
Desire to receive vaccine	0,96	-0,45	2,37	0,181	0,43	-0,95	1,81	0,541

Variable	Bivariate associations				Regressão múltipla
Variable	b^†	CI^‡ 95%		p^§	b^†	CI^‡ 95%		p^§
Gender
Male	-2,90	-8,12	2,32	0,276
Female	0,05	-0,97	1,07	0,928
Others^\|\|
Region
Midwest	3,37	0,20	6,53	0,037
North East	0,97	-1,57	3,50	0,454
South	2,28	-1,14	5,70	0,191
Southeast	1,96	-0,14	4,05	0,067
North^¶
Other regions	-0,638	-1,790	0,514	0,277	-0,24	-1,23	0,76	0,639
Age
18-19 years old	1,28	0,32	2,24	0,009	0,96	-0,62	2,54	0,235
15 to 17 years**
Age (in years)	0,42	0,09	0,75	0,013
Education
Preparatory course	-1,14	-3,04	0,76	0,241	-0,83	-2,58	0,92	0,352
Elementary II education in progress	-2,03	-4,36	0,31	0,089	-0,43	-3,04	2,19	0,749
High school in progress	-0,73	-1,83	0,36	0,189	0,20	-1,54	1,95	0,820
Finished high school	2,07	0,46	3,69	0,012	0,89	-0,63	2,40	0,251
Faculty^††
Courses in the health sector	1,14	-0,09	2,36	0,068	0,42	-0,85	1,69	0,514
Work
No	0,08	-1,00	1,15	0,891
Yes, outside the home	0,85	-1,30	3,01	0,438
Yes, at home office^§§
Parents/caregivers	-0,20	-1,32	0,91	0,719
Education parents or guardians
Postgraduate	3,62	-2,40	9,64	0,238
Graduation	2,39	-3,62	8,41	0,435
High school	1,93	-4,06	7,92	0,527
Elementary school II	2,37	-3,79	8,53	0,451
Elementary school I	3,80	-2,52	10,11	0,239
Not literate^\|\|\|\|
Diagnosis of COVID-19	-0,24	-1,51	1,03	0,708
Death of a family member due to COVID-19	-0,09	-2,42	2,23	0,936
Situations in which did not use masks
Family reunions	0,06	-0,91	1,03	0,902
Playing sports	1,24	0,04	2,43	0,042	1,25	0,23	2,27	0,017
Parties	1,01	-1,22	3,23	0,375
Houses	-0,35	-2,09	1,39	0,696
Work	0,83	-2,34	4,01	0,606
Outdoor environments	-0,36	-1,39	0,66	0,485
Others^¶¶	0,09	-2,48	2,66	0,945
Search for information about the pandemic	1,63	0,43	2,83	0,008	0,53	-0,53	1,59	0,323
Places where they search for information
Scientific articles	1,91	0,81	3,02	0,001	0,21	-0,90	1,32	0,707
Universities	1,93	0,57	3,28	0,005	0,66	-0,73	2,06	0,352
Desire to receive vaccine	-1,17	-3,23	0,89	0,267
QHKB-BR*** Knowledge	1,69	1,41	1,97	0,000	1,28	0,97	1,59	0,000
QHKB-BR*** behavior	0,78	0,62	0,95	0,000	0,40	0,22	0,57	0,000

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E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Rafaela Aparecida Prata E-mail: rafaela.prata@unesp.br https://orcid.org/0000-0001-5185-1102