Understanding the relationship between health literacy (HL) and the choices people make regarding their health has been a growing area of research which has only increased in relevance during the last two years as COVID-19 developed into a worldwide pandemic. While studies have been conducted regarding the manner in which HL is related to individual choices, much less information is available regarding how HL affects adherence to public health policy. The purpose of this study was to examine how HL among parents and youth in Mexico influenced the way they responded to public health guidelines during the COVID-19 pandemic. We hypothesized that higher rates of health literacy would be associated with higher levels of adherence to public health guidelines during the COVID pandemic. If this hypothesis is supported, it would expand our understanding of the value of health literacy from an individual health benefit to a community public health asset.
Surveys were sent to households in Mexico via email where there was a parent/guardian along with a 14-17-year-old youth. The final sample size included data from 373 parent-child dyads (total N = 746), with representation from each Mexican State. Our primary independent variables included various measures of health literacy such as the HLS-Q12 and the AAHLS, while our dependent variable was a single-item question asking, “How often have you followed the instructions of local, state, and national public health officials when community health guidelines were given during the coronavirus pandemic (for example, social distancing, wearing a mask, staying at home, not going to work sick, etc.)?” Controls including parent and child gender, age, access to healthcare services, and health.
Parent HL predicted public health guideline adherence during the COVID pandemic across all HL measures, including a single-item HL scores (b = .03, p < .001), the HLS-Q12 (b = 0.02, p < .01), and the functional (b = 0.26, p < .01), communicative (b = .31, p < .05), and critical (b = 0.17, p < .01) domains of the All Aspects of Health Literacy Scale. Child HL predicted public health guideline adherence during the COVID pandemic even while controlling for parent adherence across 2 of the 5 health literacy indicators, including the single-item HL scores (b = 0.40, p < .001) and the communicative domain of the All Aspects of Health Literacy Scale (b = 0.24, p < .01).
As hypothesized, higher HL among parents and youth was related to following instructions given by public health officials during the COVID pandemic. It is noteworthy that increased HL among youth predicted adherence even when controlling for parental adherence, suggesting to public health officials that it is not enough simply to focus on increasing HL among adults. These results are another signal of the growing importance and expanding influence of HL, suggesting again that communities in Mexico need to create a comprehensive plan to increase community HL. Potential approaches could involve coordinated efforts that involve hospitals, clinics, schools, and other community centers such as libraries.