Volume 21, Issue 82 (11-2021)
refahj 2021, 21(82): 161-188 |
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Omrani S A, Sheikhi S, Khaledi A, Safari S. (2021). The Relationship Between Health Literacy and Social Commitment with Health Self-Care during the Covid-19 disease pandemic. refahj. 21(82), 161-188.
URL: http://refahj.uswr.ac.ir/article-1-3883-en.html
URL: http://refahj.uswr.ac.ir/article-1-3883-en.html
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Introduction: The epidemic of coronavirus has created many problems for different communities and cultures (Yu, et al., 2021). Studies show that after the global epidemic, many businesses have been disrupted (Probst et al., 2020), and unemployment has risen in many societies (Fairlie et al., 2020). Due to the novelty of this disease, many of its side effects remain unknown; however, various scientific evidence confirms the association of this disease with many life-threatening diseases (Bansal et al., 2020; Tejada Meza et al., 2020). Concerns about life-threatening consequences as well as socio-economic problems caused by coronavirus disease has increased psychological problems in societies (Ahmed et al., 2020). Because there is currently no specific treatment for this disease, health self-care is the most effective option in preventing this viral disease. As a result, it is necessary to identify the factors affecting health self-care in the general population. One of the effective factors in health self-care is health literacy. Evidence from the research literature also confirms the role of health literacy in health-related behaviors and health care (Shin & Lee, 2018, Wong et al., 2018). In addition to health literacy, the role of social commitment in caring behaviors has also been emphasized (Khosravi et al., 2012, Menaha & Reddy, 2018). The review of the literature and scientific evidence shows that health literacy and social commitment play an important role in health and care behaviors. However, most research has been conducted among nurses and staff of different organizations. Due to the high prevalence of coronavirus and the need for health self-care in the general population, research in identifying effective indicators in health seems necessary. Therefore, this study aimed to investigate the relationship between health literacy and social commitment with health self-care during the coronavirus epidemic.
Methods: The method of the present study was cross-sectional. The statistical population of the present study included all Iranians aged 15 to 64 years in February and March 2021. The sample size was determined by Cochran’s formula for an infinite population; as a result, at an error level of 0.05, 384 samples were considered for the present study. With the possibility of incomplete answers to some questionnaires as well as the presence of outdated data (response based on a specific pattern), to prevent the required sample from quorum, 15% was added to the estimated sample volume, and the required sample was 450 people. 447 people were selected by the available sampling method. Some criteria were considered for sample selection. Inclusion criteria were 1) age range of 15 to 64 years; 2) reading ability; and 3) informed consent to participate in the study. The instruments were Health Literacy Questionnaire by Montazeri et al. (2014), Social Commitment Questionnaire by Salami and Ghaffarizadeh (2009), and a researcher-made Health Self-Care Questionnaire. The researcher-made health self-care questionnaire was developed focusing on the coronavirus epidemic period. To ensure that the most important and correct content (question need) is selected, the content validity ratio (CVR) was used. Also, to ensure that the tool questions are best designed to measure the intended content, the content validity index (CVI) was used. To determine the content validity of the questionnaire, this tool was sent to eight experts in the field of health and behavioral sciences. Responses were calculated based on the content validity ratio formula and adapted to the Lawshe table. Content validity index was evaluated based on Waltz and Basel content validity index. In this study, the content validity index was calculated,and it was 0.81 using the Waltz and Basel content validity index formula. The factor analysis method was used to examine the structural validity of this scale.
Due to the limitations and health considerations related to the Corona epidemic, the questionnaire was distributed online through the Google Form web application. For this purpose, the link to complete the questionnaire along with a guide text was published on social networks. At the beginning of the questionnaire, explanations were provided about the objectives of the study, and it was guaranteed that to complete the questionnaire, there is no need to register identity information and the data is reported with numerical codes. To prevent non-registration of answers, all items and questions of the questionnaire were defined as “Required” in the Google Form online questionnaire, and it was necessary to register all the answers to send the questionnaire to the server. However, the data was clean-up after entering into the software. Then, the data were analyzed using SPSS.v16 and ArcMap GIS 10.5 software and Pearson correlation coefficient and stepwise regression statistical tests.
Finding: The mean (standard deviation) age of participants was 30.24 (1.46) years. The gender of 65.3% (n=292) was female. About marital status, 53% (n=237) were married, 44.5% (n=199) were single, and 2.5% had other statuses. In terms of education, most participants (28.9%) had a bachelor’s degree. Among the study participants, 3.4% reported a history of coronavirus disease.
Table 1. The result of Pearson correlation coefficient test
P<0.05*, P<0.01**
Also, 18.1% reported having symptoms, but did not seek diagnosis or treatment (mild symptoms). The results of Pearson correlation coefficient test showed that there is a significant relationship between health literacy (r = 0.377, P = 0.000) and social commitment (r = 0.311, P = 0.000) with health self-care (Table 1). The results of the regression analysis test also showed that health literacy and social commitment predict 18% of changes in health self-care behaviors (Table 2).
Table 2. The result of Stepwise regression analysis for prediction of health self-care
P<0.05*, P<0.01**
Discussion
The importance of social commitment among the strata of society is such that commitment can be considered a vital element of social life that expands the field of cooperation and interaction in different dimensions of society, while the decrease of social commitment in the society causes a kind of social alienation in the strata of the society, which prevents the continuation and strengthening of cooperation and social participation. In this case, individualism and utilitarianism, which are the source of many deviations and social disorders, will spread in society. As a result, if people’s social commitment becomes higher, Individualism also decreases and people are more likely to take steps to control the disease through social participation.
During the epidemic of Coronavirus, having health literacy makes people feel responsible towards other people in their community and family. People with high health literacy will adherence health guidelines not only to maintain their health, but also for the health of their family and other members of the community. These people were sensitive to non-compliance with health guidelines because they are aware of the consequences of their actions. Since health literacy and social commitment can be taught, it is recommended to health policymakers and public education providers to promote health self-care during the coronavirus epidemic, focusing on these variables.
Ethical considerations
Contribution of authors
All of authors have contributed to this article.
Funding for article preparation
As of the publication of this article, no direct funding has been received from any entity.
Conflict of interest
This article does not overlap with other published works by the authors.
Following the ethics of research
In this article all rights related to research ethics are respected.
Introduction: The epidemic of coronavirus has created many problems for different communities and cultures (Yu, et al., 2021). Studies show that after the global epidemic, many businesses have been disrupted (Probst et al., 2020), and unemployment has risen in many societies (Fairlie et al., 2020). Due to the novelty of this disease, many of its side effects remain unknown; however, various scientific evidence confirms the association of this disease with many life-threatening diseases (Bansal et al., 2020; Tejada Meza et al., 2020). Concerns about life-threatening consequences as well as socio-economic problems caused by coronavirus disease has increased psychological problems in societies (Ahmed et al., 2020). Because there is currently no specific treatment for this disease, health self-care is the most effective option in preventing this viral disease. As a result, it is necessary to identify the factors affecting health self-care in the general population. One of the effective factors in health self-care is health literacy. Evidence from the research literature also confirms the role of health literacy in health-related behaviors and health care (Shin & Lee, 2018, Wong et al., 2018). In addition to health literacy, the role of social commitment in caring behaviors has also been emphasized (Khosravi et al., 2012, Menaha & Reddy, 2018). The review of the literature and scientific evidence shows that health literacy and social commitment play an important role in health and care behaviors. However, most research has been conducted among nurses and staff of different organizations. Due to the high prevalence of coronavirus and the need for health self-care in the general population, research in identifying effective indicators in health seems necessary. Therefore, this study aimed to investigate the relationship between health literacy and social commitment with health self-care during the coronavirus epidemic.
Methods: The method of the present study was cross-sectional. The statistical population of the present study included all Iranians aged 15 to 64 years in February and March 2021. The sample size was determined by Cochran’s formula for an infinite population; as a result, at an error level of 0.05, 384 samples were considered for the present study. With the possibility of incomplete answers to some questionnaires as well as the presence of outdated data (response based on a specific pattern), to prevent the required sample from quorum, 15% was added to the estimated sample volume, and the required sample was 450 people. 447 people were selected by the available sampling method. Some criteria were considered for sample selection. Inclusion criteria were 1) age range of 15 to 64 years; 2) reading ability; and 3) informed consent to participate in the study. The instruments were Health Literacy Questionnaire by Montazeri et al. (2014), Social Commitment Questionnaire by Salami and Ghaffarizadeh (2009), and a researcher-made Health Self-Care Questionnaire. The researcher-made health self-care questionnaire was developed focusing on the coronavirus epidemic period. To ensure that the most important and correct content (question need) is selected, the content validity ratio (CVR) was used. Also, to ensure that the tool questions are best designed to measure the intended content, the content validity index (CVI) was used. To determine the content validity of the questionnaire, this tool was sent to eight experts in the field of health and behavioral sciences. Responses were calculated based on the content validity ratio formula and adapted to the Lawshe table. Content validity index was evaluated based on Waltz and Basel content validity index. In this study, the content validity index was calculated,and it was 0.81 using the Waltz and Basel content validity index formula. The factor analysis method was used to examine the structural validity of this scale.
Due to the limitations and health considerations related to the Corona epidemic, the questionnaire was distributed online through the Google Form web application. For this purpose, the link to complete the questionnaire along with a guide text was published on social networks. At the beginning of the questionnaire, explanations were provided about the objectives of the study, and it was guaranteed that to complete the questionnaire, there is no need to register identity information and the data is reported with numerical codes. To prevent non-registration of answers, all items and questions of the questionnaire were defined as “Required” in the Google Form online questionnaire, and it was necessary to register all the answers to send the questionnaire to the server. However, the data was clean-up after entering into the software. Then, the data were analyzed using SPSS.v16 and ArcMap GIS 10.5 software and Pearson correlation coefficient and stepwise regression statistical tests.
Finding: The mean (standard deviation) age of participants was 30.24 (1.46) years. The gender of 65.3% (n=292) was female. About marital status, 53% (n=237) were married, 44.5% (n=199) were single, and 2.5% had other statuses. In terms of education, most participants (28.9%) had a bachelor’s degree. Among the study participants, 3.4% reported a history of coronavirus disease.
Table 1. The result of Pearson correlation coefficient test
| Variables | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| 1. Social commitment | 1 | |||||||
| 2. Health literacy | 0.199** | 1 | ||||||
| 3. Reading | 0.356** | 0.523** | 1 | |||||
| 4. Access | 0.262** | 0.642** | 0.495** | 1 | ||||
| 5. Understanding | 0.423** | 0.541** | 0.584** | 0.674** | 1 | |||
| 6. Appraisal | 0.365** | 0.635** | 0.653** | 0.542** | 0.511** | 1 | ||
| 7. Decision | 0.411** | 0.542** | 0.345** | 0.456** | 0.498** | 0.547** | 1 | |
| 8. Health self-care | 0.311** | 0.337** | 0.198** | 0.204** | 0.261** | 0.248** | 0.238** | 1 |
P<0.05*, P<0.01**
Also, 18.1% reported having symptoms, but did not seek diagnosis or treatment (mild symptoms). The results of Pearson correlation coefficient test showed that there is a significant relationship between health literacy (r = 0.377, P = 0.000) and social commitment (r = 0.311, P = 0.000) with health self-care (Table 1). The results of the regression analysis test also showed that health literacy and social commitment predict 18% of changes in health self-care behaviors (Table 2).
Table 2. The result of Stepwise regression analysis for prediction of health self-care
| Step | Predictors | B | β | R | R2 | t | Sig. | F | Sig. |
| 1 | (Constant) | 2.901 | - | 0.318 | 0.101 | 39.39 | 0.000** | 42.15 | 0.000** |
| Health Literacy | 0.355 | 0.318 | 33.05 | 0.000** | |||||
| 2 | (Constant) | 0.353 | - | 0.426 | 0.181 | 28.53 | 0.000** | 41.35 | 0.000** |
| Health Literacy | 0.343 | 0.308 | 21.30 | 0.000** | |||||
| Social Commitment | 0.189 | 0.283 | 18.78 | 0.000** |
Discussion
The importance of social commitment among the strata of society is such that commitment can be considered a vital element of social life that expands the field of cooperation and interaction in different dimensions of society, while the decrease of social commitment in the society causes a kind of social alienation in the strata of the society, which prevents the continuation and strengthening of cooperation and social participation. In this case, individualism and utilitarianism, which are the source of many deviations and social disorders, will spread in society. As a result, if people’s social commitment becomes higher, Individualism also decreases and people are more likely to take steps to control the disease through social participation.
During the epidemic of Coronavirus, having health literacy makes people feel responsible towards other people in their community and family. People with high health literacy will adherence health guidelines not only to maintain their health, but also for the health of their family and other members of the community. These people were sensitive to non-compliance with health guidelines because they are aware of the consequences of their actions. Since health literacy and social commitment can be taught, it is recommended to health policymakers and public education providers to promote health self-care during the coronavirus epidemic, focusing on these variables.
Ethical considerations
Contribution of authors
All of authors have contributed to this article.
Funding for article preparation
As of the publication of this article, no direct funding has been received from any entity.
Conflict of interest
This article does not overlap with other published works by the authors.
Following the ethics of research
In this article all rights related to research ethics are respected.
Type of Study: orginal |
Received: 2021/04/28 | Accepted: 2021/10/20 | Published: 2021/11/26
Received: 2021/04/28 | Accepted: 2021/10/20 | Published: 2021/11/26
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