Assessing COVID-19 Vaccine Literacy: A Preliminary Online Survey

"[S]urveys via the web are a suitable method to evaluate and track attitudes during infectious disease outbreaks and assess health literacy skills about vaccination, which can be useful to adapt medical communication strategies, for a better understanding of the value of immunization."

The amount and variety of news about the COVID-19 pandemic have generated an "infodemic" that risks saturating the public with different facts and contradictory information, including those about candidate SARS-CoV-2 vaccines. Health literacy - defined as the knowledge, motivation, and competence to find, understand, and use health information - can be critical in such a context. Conducted in the early days of, and in the context of intense public discussion about, COVID-19 vaccine development, this survey assessed people's abilities to collect and understand information about vaccinations - that is, their vaccine literacy (VL).

Participants (n = 885) in the rapid online survey, offered over 2 weeks beginning on June 6 2020, were Italians aged 18 years and older who were interested looking for information about future COVID-19 vaccines and/or other vaccines via the media. VL levels were assessed by adapting 12 questions from a self-reported questionnaire for adulthood vaccination; some related to VL functional skills (e.g., when reading or listening to information about future COVID-19 vaccines or current vaccines, did you find words you didn't know?), while others assessed VL interactive-critical skills (e.g., when looking for information about future COVID-19 vaccines or current vaccines, did you discuss what you understood about vaccinations with your doctor or other people?). COVID-19 vaccine perceptions and attitudes, current vaccine behaviour, and beliefs about vaccination were also evaluated.

Information sources most frequently used by the respondents were the internet (72%), social media (47%), and TV (49%), followed by newspapers (31%) and radio (11%); other sources accounted for 22%. The mean VL functional score was 2.92, while the interactive-critical score was 3.27, out of a maximum of 4. The functional VL score was lower in females than males, and the interactive-critical mean score was significantly higher among those between 31 and 65 years of age.

No significant association was observed between functional VL score and positive perceptions about future COVID-19 vaccines, except for one question, while the association was highly significant between all questions and the interactive-critical score. All associations between functional as well as interactive-critical VL scores and positive behaviour toward current vaccinations (i.e., acceptance of flu and other vaccines) were significant.

The high percentage (>90%) of participants willing to receive COVID-19 vaccines, when available, was particularly relevant. It contrasts sharply with the low frequency of respondents willing to receive the flu shot in the upcoming season. "These observations reflect a common problem about understandings of the value of flu vaccination and suggest that the positive attitude toward immunization against COVID-19 and other infectious diseases are based more on emotional aspects linked to the present infodemic, rather than on correctly perceiving a potentially upcoming risk of a simultaneous epidemic of COVID-19 and seasonal influenza. All this reinforces the need to improve medical communication."

As the researchers note, health literacy and the ability to search for accurate information can be related to the characteristics and educational level of the individual. On the other hand, the functional skills were challenged by the complexity and technicality of many news and information, thus explaining the lower functional score, also in highly educated persons. "Information about vaccinations is quite complex and its comprehension requires certain abilities, more than just literary skills, i.e. being able to understand healthcare-specific language....These capacities are determined not only by an individual's skills but also by the complexities of the healthcare system that can increase the communication demands placed on people."

Reflecting on the larger implications of the findings, the researchers stress that the infodemic can potentially lead to mistrust and can have a negative impact on behaviour toward all recommended vaccinations. "This may increase the risk of further decreasing vaccine coverage rates, as the pandemic lock-down has already caused a reduction of the immunization practices..."

In conclusion: "Other similar studies are needed, including larger and more representative groups of the population, with the aim of improving knowledge about the relevance of health literacy skills of the public, in particular about the vaccinations during epidemics, and tailoring specific interventions to increase them where necessary, in addition to adapting health communication and counteracting vaccine hesitancy."