{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T16:43:53Z","timestamp":1783183433880,"version":"3.54.6"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T00:00:00Z","timestamp":1694995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare, Japan","doi-asserted-by":"publisher","award":["H27-Lifestyle-ippan-002"],"award-info":[{"award-number":["H27-Lifestyle-ippan-002"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Health literacy (HL) can be regarded as a key element of non-pharmaceutical interventions used in emergency responses. The present study aimed to determine the associations of combinations of general HL and COVID-19-related HL with COVID-19 protective behaviors and healthy lifestyle behaviors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A questionnaire survey was conducted from December 2020 to January 2021 among residents in Japanese metropolitan areas. Valid responses were received from 1,443 residents. The levels of HL were categorized into four groups: low level in both HLs (reference), high level in general HL only, high level in COVID-19-related HL only, and high level in both HLs. The total scores of eight COVID-19 protective behaviors were dichotomized into low and high adherence. Healthy lifestyle behaviors included healthy and balanced diet, adequate sleep, and regular exercise. Poisson regression analyses were conducted to examine the associations between the HL groups and high adherence to COVID-19 protective behaviors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>High level in COVID-19-related HL only was associated with high adherence to COVID-19 protective behaviors [prevalence ratio (PR), 1.25; 95% confidence interval (CI), 1.09\u20131.45], while high level in general HL only was associated with healthy and balanced diet (PR, 1.49; 95% CI, 1.04\u20132.13), adequate sleep (PR, 1.46; 95% CI, 1.02\u20132.10), and regular exercise (PR, 2.00; 95% CI, 1.29\u20133.13). High level in both HLs showed the highest prevalence of high adherence to COVID-19 protective behaviors and healthy lifestyle behaviors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings indicate that COVID-19-related HL and general HL can both be considered to enhance protective behaviors.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1208815","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T07:40:32Z","timestamp":1695109232000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["General health literacy, COVID-19-related health literacy, and protective behaviors: evidence from a population-based study in Japan"],"prefix":"10.3389","volume":"11","author":[{"given":"Keiko","family":"Murakami","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Kuriyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1038\/s41562-021-01079-8","article-title":"A global panel database of pandemic policies (Oxford COVID-19 government response tracker)","volume":"5","author":"Hale","year":"2021","journal-title":"Nat Hum Behav"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1038\/s41562-020-0884-z","article-title":"Using social and behavioural science to support COVID-19 pandemic response","volume":"4","author":"Bavel","year":"2020","journal-title":"Nat Hum Behav"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e004450","DOI":"10.1136\/bmjgh-2020-004450","article-title":"Behaviour adoption approaches during public health emergencies: implications for the COVID-19 pandemic and beyond","volume":"6","author":"Jalloh","year":"2021","journal-title":"BMJ Glob Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"100213","DOI":"10.1016\/j.onehlt.2021.100213","article-title":"Assessing the impact of non-pharmaceutical interventions on the transmissibility and severity of COVID-19 during the first five months in the Western Pacific Region","volume":"12","author":"Yeoh","year":"2021","journal-title":"One Health"},{"key":"ref5","article-title":"Advice for the public: coronavirus disease (COVID-19)","year":"2020"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1016\/S0140-6736(18)32225-6","article-title":"Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"392","year":"2018","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"daab197","DOI":"10.1093\/heapro\/daab197","article-title":"Health literacy as a social vaccine in the COVID-19 pandemic","volume":"38","author":"Okan","year":"2023","journal-title":"Health Promot Int"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e249","DOI":"10.1016\/S2468-2667(20)30086-4","article-title":"COVID-19: health literacy is an underestimated problem","volume":"5","author":"Paakkari","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/1471-2458-12-80","article-title":"Health literacy and public health: a systematic review and integration of definitions and models","volume":"12","author":"S\u00f8rensen","year":"2012","journal-title":"BMC Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1578","DOI":"10.1093\/heapro\/daaa157","article-title":"Health promotion glossary 2021","volume":"36","author":"Nutbeam","year":"2021","journal-title":"Health Promot Int"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e25042","DOI":"10.2196\/25042","article-title":"Relationship between coronavirus-related eHealth literacy and COVID-19 knowledge, attitudes, and practices among US adults: web-based survey study","volume":"23","author":"An","year":"2021","journal-title":"J Med Internet Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e0257552","DOI":"10.1371\/journal.pone.0257552","article-title":"Knowledge and preventive actions toward COVID-19, vaccination intent, and health literacy among educators in Japan: an online survey","volume":"16","author":"Fukuda","year":"2021","journal-title":"PLoS One"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e24577","DOI":"10.2196\/24577","article-title":"Socioeconomic disparities in eHealth literacy and preventive behaviors during the COVID-19 pandemic in Hong Kong: cross-sectional study","volume":"23","author":"Guo","year":"2021","journal-title":"J Med Internet Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1186\/s12889-021-11437-w","article-title":"Mental health, compliance with measures and health prospects during the COVID-19 epidemic: the role of health literacy","volume":"21","author":"Hermans","year":"2021","journal-title":"BMC Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"30342012","DOI":"10.17061\/phrp30342012","article-title":"Health literacy and disparities in COVID-19-related knowledge, attitudes, beliefs and behaviours in Australia","volume":"30","author":"McCaffery","year":"2020","journal-title":"Public Health Res Pract"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e34966","DOI":"10.2196\/34966","article-title":"COVID-19 preventive behaviors and health literacy, information evaluation, and decision-making skills in Japanese adults: cross-sectional survey study","volume":"6","author":"Nakayama","year":"2022","journal-title":"JMIR Form Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"3301","DOI":"10.3390\/ijerph18063301","article-title":"Health literacy, digital health literacy, and COVID-19 pandemic attitudes and behaviors in U.S. college students: implications for interventions","volume":"18","author":"Patil","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1093\/her\/cyac009","article-title":"Assessing COVID-19 health literacy (CoHL) and its relationships with sociodemographic features, locus of control and compliance with social distancing rules during the first lockdown in France","volume":"37","author":"Rodon","year":"2022","journal-title":"Health Educ Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e0254435","DOI":"10.1371\/journal.pone.0254435","article-title":"Factors associated with COVID-19 preventive health behaviors among the general public in Mexico city and the state of Mexico","volume":"16","author":"S\u00e1nchez-Arenas","year":"2021","journal-title":"PLoS One"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"8838","DOI":"10.3390\/ijerph17238838","article-title":"Association of individual health literacy with preventive behaviours and family well-being during COVID-19 pandemic: mediating role of family information sharing","volume":"17","author":"Wong","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1080\/10810730.2011.604702","article-title":"The process-knowledge model of health literacy: evidence from a componential analysis of two commonly used measures","volume":"16","author":"Chin","year":"2011","journal-title":"J Health Commun"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"334","DOI":"10.2188\/jea.JE20130084","article-title":"Japanese study on stratification, health, income, and neighborhood: study protocol and profiles of participants","volume":"24","author":"Takada","year":"2014","journal-title":"J Epidemiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"113207","DOI":"10.1016\/j.socscimed.2020.113207","article-title":"Smoking behavior prevalence in one\u2019s personal social network and peer\u2019s popularity: a population-based study of middle-aged adults in Japan","volume":"260","author":"Takagi","year":"2020","journal-title":"Soc Sci Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1186\/s12889-023-16159-9","article-title":"Socio-psychological factors associated with anticipated stigma toward COVID-19: a cross-sectional study in Japan","volume":"23","author":"Fujii","year":"2023","journal-title":"BMC Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1093\/heapro\/dan017","article-title":"Developing a measure of communicative and critical health literacy: a pilot study of Japanese office workers","volume":"23","author":"Ishikawa","year":"2008","journal-title":"Health Promot Int"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1093\/heapro\/15.3.259","article-title":"Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century","volume":"15","author":"Nutbeam","year":"2000","journal-title":"Health Promot Int"},{"key":"ref27","article-title":"Survey tool and guidance: rapid, simple, flexible behavioural insights on COVID-19","year":"2020"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1017\/S0033291702006074","article-title":"Short screening scales to monitor population prevalences and trends in non-specific psychological distress","volume":"32","author":"Kessler","year":"2002","journal-title":"Psychol Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1002\/mpr.257","article-title":"The performance of the Japanese version of the K6 and K10 in the world mental health survey Japan","volume":"17","author":"Furukawa","year":"2008","journal-title":"Int J Methods Psychiatr Res"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1111\/j.1440-1819.2011.02236.x","article-title":"Screening performance of K6\/K10 and other screening instruments for mood and anxiety disorders in Japan","volume":"65","author":"Sakurai","year":"2011","journal-title":"Psychiatry Clin Neurosci"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1093\/heapro\/daaa141","article-title":"Critical health literacy in pandemics: the special case of COVID-19","volume":"36","author":"Abel","year":"2021","journal-title":"Health Promot Int"},{"key":"ref32","volume-title":"WHO public health research agenda for managing infodemics","year":"2021"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1016\/S0140-6736(20)30461-X","article-title":"How to fight an infodemic","volume":"395","author":"Zarocostas","year":"2020","journal-title":"Lancet"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1612","DOI":"10.1093\/heapro\/daaa040","article-title":"Critical health literacy and the COVID-19 crisis","volume":"35","author":"Abel","year":"2020","journal-title":"Health Promot Int"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.pec.2020.10.012","article-title":"Health literacy in the general population in the context of epidemic or pandemic coronavirus outbreak situations: rapid scoping review","volume":"104","author":"Matterne","year":"2021","journal-title":"Patient Educ Couns"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/s12955-022-02050-5","article-title":"Measuring COVID-19 health literacy: validation of the COVID-19 HL questionnaire in Spain","volume":"20","author":"Falc\u00f3n","year":"2022","journal-title":"Health Qual Life Outcomes"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"5503","DOI":"10.3390\/ijerph17155503","article-title":"Coronavirus-related health literacy: a cross-sectional study in adults during the COVID-19 infodemic in Germany","volume":"17","author":"Okan","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1186\/s12889-015-1835-x","article-title":"Comprehensive health literacy in Japan is lower than in Europe: a validated Japanese-language assessment of health literacy","volume":"15","author":"Nakayama","year":"2015","journal-title":"BMC Public Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1186\/1471-2458-13-948","article-title":"Measuring health literacy in populations: illuminating the design and development process of the European health literacy survey questionnaire (HLS-EU-Q)","volume":"13","author":"S\u00f8rensen","year":"2013","journal-title":"BMC Public Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1080\/09658211.2014.912331","article-title":"Memory and comprehension for health information among older adults: distinguishing the effects of domain-general and domain-specific knowledge","volume":"23","author":"Chin","year":"2015","journal-title":"Memory"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low health literacy and health outcomes: an updated systematic review","volume":"155","author":"Berkman","year":"2011","journal-title":"Ann Intern Med"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/978-0-387-37759-9_5","article-title":"Cultural capital in health promotion","volume-title":"Health and modernity: the role of theory in health promotion","author":"Abel","year":"2007"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.socscimed.2011.04.004","article-title":"Critical health literacy: a review and critical analysis","volume":"73","author":"Chinn","year":"2011","journal-title":"Soc Sci Med"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","article-title":"Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic","volume":"398","year":"2021","journal-title":"Lancet"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/heapro\/day062","article-title":"Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review","volume":"34","author":"Stormacq","year":"2019","journal-title":"Health Promot Int"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1186\/s12889-017-4912-5","article-title":"Distinct association between educational attainment and overweight\/obesity in unmarried and married women: evidence from a population-based study in Japan","volume":"17","author":"Murakami","year":"2017","journal-title":"BMC Public Health"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"2180","DOI":"10.1186\/s12889-021-12092-x","article-title":"Declines in health literacy and health-related quality of life during the COVID-19 pandemic: a longitudinal study of the Japanese general population","volume":"21","author":"Ishikawa","year":"2021","journal-title":"BMC Public Health"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1093\/heapro\/dax015","article-title":"Improving health literacy in community populations: a review of progress","volume":"33","author":"Nutbeam","year":"2018","journal-title":"Health Promot Int"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1186\/s12889-020-08991-0","article-title":"Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review","volume":"20","author":"Walters","year":"2020","journal-title":"BMC Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1208815\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T07:40:35Z","timestamp":1695109235000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1208815\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,18]]},"references-count":49,"alternative-id":["10.3389\/fpubh.2023.1208815"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1208815","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,18]]},"article-number":"1208815"}}