{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T09:00:34Z","timestamp":1765357234438,"version":"build-2065373602"},"reference-count":47,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T00:00:00Z","timestamp":1667433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The pandemic of COVID-19 caused significant changes in economies and societies with a major impact on the entire education process. However, these changes did not invalidate a constant effort of adaptation. This cross-sectional, descriptive, and correlational study used an online questionnaire administered to students from various study cycles at higher education institutions in Portugal, with the aim of exploring the influence of literacy and mental health on the use of mental health promotion strategies during COVID-19 confinement. A total of 329 students from higher education institutions participated in this study, mostly from the age group 18\u201324 years (n = 272; 82.7%) and female (n = 265, 80.5%). The most mentioned health promotion strategies during this period included studying (n = 170; 51.7%); physical activities (n = 151, 45.9%); social networking (n = 124, 37.7%); cooking activities (n = 120, 36.5%); and listening to music (n = 118, 35.9%). Academic success is self-reported, and it is weakly correlated with the MHI5 (r = 0.103, p = 0.063). Students in the pre-graduate programs studied more during the times of the pandemic and used this activity as a mental-health-promoting strategy with a statistically significant difference (p = 0.033). Although it was difficult to improve health literacy related to COVID-19 in such a short period of time, there was a very strong motivation to access, understand, evaluate, communicate, synthesize, and apply information and knowledge to maintain mental health through self-care using health promotion strategies.<\/jats:p>","DOI":"10.3390\/ijerph192114393","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T03:28:10Z","timestamp":1667532490000},"page":"14393","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Literacy and Mental Health of Portuguese Higher Education Students and Their Use of Health Promotion Strategies during Confinement in the COVID-19 Pandemic"],"prefix":"10.3390","volume":"19","author":[{"given":"Ana","family":"Oliveira","sequence":"first","affiliation":[{"name":"Health School, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal"},{"name":"Faculty of Nursing, University of Rovira e Virgili, 43003 Tarragona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8125-5384","authenticated-orcid":false,"given":"Joana","family":"Nobre","sequence":"additional","affiliation":[{"name":"Health School, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal"},{"name":"Faculty of Nursing, University of Rovira e Virgili, 43003 Tarragona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1092-7825","authenticated-orcid":false,"given":"Henrique","family":"Luis","sequence":"additional","affiliation":[{"name":"Health School, Polytechnic Institute of Portalegre, 7300-555 Portalegre, Portugal"},{"name":"Unidade de Investiga\u00e7\u00e3o em Ci\u00eancias Orais e Biom\u00e9dicas (UICOB), RHODes-Rede de Higienistas Orais para o Desenvolvimento da Ci\u00eancia Faculdade de Medicina Dent\u00e1ria, Universidade de Lisboa, Rua Teresa Ambr\u00f3sio, 1600-277 Lisbon, Portugal"},{"name":"Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, 2410-541 Leiria, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2233-5752","authenticated-orcid":false,"given":"Luis","family":"Luis","sequence":"additional","affiliation":[{"name":"Center for Innovative Care and Health Technology (ciTechcare), Polytechnic of Leiria, 2410-541 Leiria, Portugal"},{"name":"School of Health Sciences, Polytechnic of Leiria, 2410-541 Leiria, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8306-8702","authenticated-orcid":false,"given":"N\u00faria","family":"Albacar-Riob\u00f3o","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, University of Rovira e Virgili, 43003 Tarragona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1174-0744","authenticated-orcid":false,"given":"Lara","family":"Pinho","sequence":"additional","affiliation":[{"name":"Nursing School, University of Evora, 7000-811 Evora, Portugal"},{"name":"Comprehensive Health Research Center, 7002-554 Evora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5620-3478","authenticated-orcid":false,"given":"Carlos","family":"Sequeira","sequence":"additional","affiliation":[{"name":"Nursing School of Porto, 4200-072 Porto, Portugal"},{"name":"Group Inovation and Development in Nursing (NursID), Centro de Investiga\u00e7\u00e3o em Tecnologias e Servi\u00e7os de Sa\u00fade (CINTESIS), 4200-450 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet"},{"key":"ref_2","unstructured":"WHO (2022). COVID-19 Weekly Epidemiological Update, 19 October 2022. Report No."},{"key":"ref_3","unstructured":"Team EGMR (2005). Literacy for Life, UNESCO."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1057\/jphp.2016.18","article-title":"A review of health literacy: Definitions, interpretations, and implications for policy initiatives","volume":"37","author":"Charles","year":"2016","journal-title":"J. Public Health Policy"},{"key":"ref_5","unstructured":"Luis, L. (2010). Literacia em Sa\u00fade e Alimenta\u00e7\u00e3o Saud\u00e1vel: Os novos Produtos e a Escolha dos Alimentos, Escola Nacional de Sa\u00fade P\u00fablica, Universide Nova de Lisboa."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1177\/070674370705200706","article-title":"Depression literacy in Alberta: Findings from a general population sample","volume":"52","author":"Wang","year":"2007","journal-title":"Can. J. Psychiatry"},{"key":"ref_7","unstructured":"Quah, K.H.a.S. (2008). Health Literacy, Academic Press."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/10810730.2010.499985","article-title":"Health literacy: What is it?","volume":"15","author":"Berkman","year":"2010","journal-title":"J. Health Commun."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"S\u00f8rensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., Brand, H., and (HLS-EU) Consortium Health Literacy Project European (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-80"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e000351","DOI":"10.1136\/fmch-2020-000351","article-title":"What is the meaning of health literacy? A systematic review and qualitative synthesis","volume":"8","author":"Liu","year":"2020","journal-title":"Fam. Med. Community Health"},{"key":"ref_11","first-page":"1","article-title":"Relationship between oral health literacy and oral Health behaviors, knowledge and dental status in Portuguese military enlisted adults","volume":"8","author":"Assuncao","year":"2019","journal-title":"Glob. J. Med. Public Health"},{"key":"ref_12","first-page":"223","article-title":"Assessing the Health literacy level of students in higher education: Evolution throughout the training","volume":"62","author":"Luis","year":"2021","journal-title":"Rev. SPEMD"},{"key":"ref_13","unstructured":"World Health Organization (2004). Promoting Mental Health: Concepts, Emerging Evidence, Practice (Summary Report)."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"182","DOI":"10.5694\/j.1326-5377.1997.tb140071.x","article-title":"\u201cMental health literacy\u201d: A survey of the public\u2019s ability to recognise mental disorders and their beliefs about the effectiveness of treatment","volume":"166","author":"Jorm","year":"1997","journal-title":"Med. J. Aust."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s00787-016-0867-9","article-title":"Enhancing mental health literacy in young people","volume":"25","author":"Kutcher","year":"2016","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.socscimed.2006.09.011","article-title":"\u2018Real men don\u2019t diet\u2019: An analysis of contemporary newspaper representations of men, food and health","volume":"64","author":"Gough","year":"2007","journal-title":"Soc. Sci. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"527","DOI":"10.2147\/AMEP.S207353","article-title":"Electronic health-literacy skills among nursing students","volume":"10","author":"Sharma","year":"2019","journal-title":"Adv. Med. Educ. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1136\/jech.57.7.501","article-title":"Education and income: Which is more important for mental health?","volume":"57","author":"Araya","year":"2003","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_19","unstructured":"Baines, D., and Elliott, R. (2020). Defining Misinformation, Disinformation and Malinformation: An Urgent Need for Clarity during the COVID-19 Infodemic, Department of Economics, University of Birmingham."},{"key":"ref_20","doi-asserted-by":"crossref","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":"ref_21","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.2196\/jmir.8.2.e9","article-title":"eHealth Literacy: Essential Skills for Consumer Health in a Networked World","volume":"8","author":"Norman","year":"2006","journal-title":"J. Med. Internet Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"h1026","DOI":"10.1136\/bmj.h1026","article-title":"Health literacy: Towards system level solutions","volume":"350","author":"Greenhalgh","year":"2015","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e21279","DOI":"10.2196\/21279","article-title":"Effects of COVID-19 on College Students\u2019 Mental Health in the United States: Interview Survey Study","volume":"22","author":"Son","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e22817","DOI":"10.2196\/22817","article-title":"Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study","volume":"22","author":"Wang","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Elmer, T., Mepham, K., and Stadtfeld, C. (2020). Students under lockdown: Comparisons of students\u2019 social networks and mental health before and during the COVID-19 crisis in Switzerland. PLoS ONE, 15.","DOI":"10.31234\/osf.io\/ua6tq"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"113298","DOI":"10.1016\/j.psychres.2020.113298","article-title":"University students\u2019 changes in mental health status and determinants of behavior during the COVID-19 lockdown in Greece","volume":"292","author":"Patsali","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Tavolacci, M., Wouters, E., Van de Velde, S., Buffel, V., D\u00e9chelotte, P., Van Hal, G., and Ladner, J. (2021). The Impact of COVID-19 Lockdown on Health Behaviors among Students of a French University. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18084346"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e25600","DOI":"10.2196\/25600","article-title":"Associations Between Health Literacy, eHealth Literacy, and COVID-19-Related Health Behaviors Among Chinese College Students: Cross-sectional Online Study","volume":"23","author":"Li","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"589927","DOI":"10.3389\/fpsyg.2021.589927","article-title":"A Study on the Psychological Wound of COVID-19 in University Students","volume":"12","author":"Padron","year":"2021","journal-title":"Front. Psychol."},{"key":"ref_30","first-page":"77","article-title":"Mental Health Inventory: Um estudo de adapta\u00e7\u00e3o \u00e0 popula\u00e7\u00e3o portuguesa","volume":"2","year":"2001","journal-title":"Psicol. Sa\u00fade Doen\u00e7as"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_32","unstructured":"Mar\u00f4co, J. (2011). An\u00e1lise Estatistica com o SPSS Statistics: Report Number, P\u00earo Pinheiro."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"King, N., Rivera, D., Cunningham, S., Pickett, W., Harkness, K., McNevin, S., Milanovic, M., Byun, J., Khanna, A., and Atkinson, J. (2021). Mental health and academic outcomes over the first year at university in international compared to domestic Canadian students. J. Am. Coll. Health, 1\u201310.","DOI":"10.1080\/07448481.2021.1982950"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1080\/09638237.2017.1417567","article-title":"Mental health and academic attitudes and expectations in university populations: Results from the healthy minds study","volume":"27","author":"Lipson","year":"2018","journal-title":"J. Ment. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1136\/oemed-2021-108097","article-title":"Trajectories of mental health among UK university staff and postgraduate students during the pandemic","volume":"79","author":"Carr","year":"2022","journal-title":"Occup. Environ. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.1192\/bjo.2020.24","article-title":"Predictors of mental health and academic outcomes in first-year university students: Identifying prevention and early-intervention targets","volume":"6","author":"Duffy","year":"2020","journal-title":"BJPsych Open"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1080\/09638237.2022.2091766","article-title":"The impact of the COVID-19 pandemic on student mental health and wellbeing in UK university students: A multiyear cross-sectional analysis","volume":"31","author":"Bennett","year":"2022","journal-title":"J. Ment. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e26330","DOI":"10.2196\/26330","article-title":"Physical Activity, Nutritional Habits, and Sleeping Behavior in Students and Employees of a Swiss University During the COVID-19 Lockdown Period: Questionnaire Survey Study","volume":"7","author":"Taeymans","year":"2021","journal-title":"JMIR Public Health Surveill."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1080\/17461391.2020.1842910","article-title":"COVID-19 lockdown: Physical activity, sedentary behaviour and sleep in Italian medicine students","volume":"21","author":"Luciano","year":"2021","journal-title":"Eur. J. Sport Sci."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Cruyt, E., De Vriendt, P., De Letter, M., Vlerick, P., Calders, P., De Pauw, R., Oostra, K., Rodriguez-Bail\u00f3n, M., Szmalec, A., and Merch\u00e1n-Baeza, J.A. (2021). Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-10673-4"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Kim, Y.J., and Cho, J.H. (2020). Correlation between Preventive Health Behaviors and Psycho-Social Health Based on the Leisure Activities of South Koreans in the COVID-19 Crisis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17114066"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s11126-017-9535-6","article-title":"Social Media Use and Mental Health among Young Adults","volume":"89","author":"Berryman","year":"2018","journal-title":"Psychiatr. Q."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e19684","DOI":"10.2196\/19684","article-title":"Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens","volume":"22","author":"Li","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1002\/pra2.546","article-title":"What Does Channel Say? Understanding How Social Media Social Capital Facilitates COVID-19-Related Information-Seeking and Opinion-Expression on Two Types of Platforms: User-oriented versus Content-oriented","volume":"58","author":"Hu","year":"2021","journal-title":"Proc. Assoc. Inf. Sci. Technol."},{"key":"ref_45","first-page":"1440","article-title":"COVID-19 Lockdown-Related Changes in Mood, Health and Academic Functioning","volume":"11","author":"Hendriksen","year":"2021","journal-title":"Eur. J. Investig. Health Psychol. Educ."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12199-021-00950-4","article-title":"Students\u2019 attitude and sleep pattern during school closure following COVID-19 pandemic quarantine: A web-based survey in south of Iran","volume":"26","author":"Ranjbar","year":"2021","journal-title":"Environ. Health Prev. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1111\/inm.12999","article-title":"The impact of the COVID-19 pandemic on the mental health of Portuguese university students","volume":"31","author":"Sequeira","year":"2022","journal-title":"Int. J. Ment. Health Nurs."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14393\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:09:54Z","timestamp":1760144994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/14393"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,3]]},"references-count":47,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["ijerph192114393"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192114393","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,11,3]]}}}