Evaluating the influence of health literacy and health-promoting COVID-19 protective behaviors on the spread of infection during the COVID-19 pandemic: A meta-analysis

Background. Health literacy and self-efficacy related to COVID-19 pandemic management are closely linked. Therefore, synthesis of relevant evidence regarding the positive aspects of health literacy and health-promoting protective measures among individuals during COVID-19 pandemic is necessary. Objectives. To determine the influence of e-health literacy and health-promoting coronavirus disease 2019 (COVID-19) protective behaviors on the spread of infection during the COVID-19 pandemic. Materials and methods. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, MEDLINE, PsycINFO, EMBASE, and Cochrane Library databases, as well as PROSPERO and ClinicalTrials.gov registry platforms were searched for eligible literature published from January 2020 to July 2022. Studies were included based on predefined Population, Intervention, Comparison, Outcomes and Study design (PICOS) criteria, and a summary of each study was prepared. To estimate the effect size, the standardized mean difference (SMD) of the evaluated parameters, e-health literacy and health-promoting COVID-19 protective behaviors was extracted. Using RevMan and MedCalc software, a meta-analysis was performed. Results. Twelve eligible studies involving a total of 9854 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals were included in the meta-analysis. The pooled SMD for e-health literacy was 40.39 (95% confidence interval (95% CI): 28.14-52.63), with the following heterogeneity values: Tau(2) of 396.80, chi 2 of 669.48, degrees of freedom (df) of 11, I-2 of 98%, Z value of 6.47, and p < 0.001. Similarly, the pooled SM for COVID-19 protective behaviors was 15.90 (95% CI: 10.96-20.84) with Tau(2) of 55.25, chi(2) of 252.92, df of 11, I-2 of 98%, Z of 6.31, and p < 0.001. Conclusions. This study confirmed that e-health literacy and health-promoting COVID-19 protective behaviors have a strong positive impact on preventing the spread of COVID-19 infection and on its effective management. We recommend that interventions and applicable policies for promoting such e-literacy programs and preventative measures be given a high level of consideration.