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Pre-Vaccination COVID-19 Vaccine Literacy in a Croatian Adult Population: a Cross-Sectional Study

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Pre-Vaccination COVID-19 Vaccine Literacy in a Croatian Adult Population: a Cross-Sectional Study International Journal of Environmental Research and Public Health Article Pre-Vaccination COVID-19 Vaccine Literacy in a Croatian Adult Population: A Cross-Sectional Study Ivana Gusar 1,2 , Suzana Konjevoda 1,3,*, Grozdana Babi´c 1, Dijana Hnatešen 2,4,5, Maja Cebohinˇ 2,5,6 , Rahela Orlandini 7,8 and Boris Dželalija 1,3,8 1 Department of Health Studies, University of Zadar, 23000 Zadar, Croatia; [email protected] (I.G.); [email protected] (G.B.); [email protected] (B.D.) 2 Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; [email protected] (D.H.); [email protected] (M.C.)ˇ 3 General Hospital Zadar, 23000 Zadar, Croatia 4 Clinical Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia 5 Nursing Institute “Professor Radivoje Radi´c”,Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia 6 Medical School Osijek, 31000 Osijek, Croatia 7 Department of Health Studies, University of Split, 21000 Split, Croatia; [email protected] 8 School of Medicine, University of Split, 21000 Split, Croatia * Correspondence: [email protected]; Tel.: +385-98-352-969 Abstract: Despite world-level efforts and the endeavors of scientists and medical professionals in suppressing the COVID-19 pandemic, inadequate levels of vaccine literacy of the general population can represent a grave obstacle. The aim of this study was to evaluate COVID-19 vaccine literacy in the Croatian adult general population before vaccination began. The specific objectives were to test Citation: Gusar, I.; Konjevoda, S.; differences regarding socio-demographic characteristics and to examine perceptions and attitudes Babi´c,G.; Hnatešen, D.; Cebohin,ˇ M.; about vaccination against COVID-19 considering the level of VL against COVID-19. A cross-sectional Orlandini, R.; Dželalija, B. study with a translated and psychometrically tested questionnaire was conducted in 1227 participants Pre-Vaccination COVID-19 Vaccine Literacy in a Croatian Adult before the start of vaccination, from 15 to 31 January 2021. The results show a medium level of Population: A Cross-Sectional Study. vaccine literacy (M = 2.37, SD = 0.54) and a significant difference between functional and interactive- Int. J. Environ. Res. Public Health 2021, critical vaccine literacy (p < 0.001). The level of vaccine literacy grew with the level of education 18, 7073. https://doi.org/10.3390/ (p = 0.031) and reduced with age (p < 0.001). Participants who were employed, had chronic diseases, ijerph18137073 took medicine, or consumed alcohol daily had a lower level of vaccine literacy. There is room for progress in the COVID-19 VL level for the adult population in Croatia, especially at the interactive- Academic Editor: Paul B. Tchounwou critical VL, which could have an important role in people accepting the vaccine against the COVID-19 disease. A satisfactory level of vaccine literacy in the population is necessary because it can contribute Received: 16 May 2021 to the fight against the pandemic. Accepted: 30 June 2021 Published: 2 July 2021 Keywords: COVID-19; vaccine literacy; vaccination; pandemic; general population Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- 1. Introduction iations. The pandemic caused by the coronavirus is a major public health challenge that the world has recently confronted [1–3]. Due to its fast spread, not long after the infection had appeared in China at the end of 2019, Croatia was also added to the list of countries affected by the pandemic in February of 2020 [4]. As the number of infected grew, discussion re- Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. garding the necessity of stronger prevention arose, which was not only about introducing This article is an open access article additional restrictions in behavior and habits of residents but also about commencing distributed under the terms and immunization. As in other countries around the world [5,6], the need for immunization in conditions of the Creative Commons Croatia is also highly covered by the media. In addition to the adjustment and sensitization Attribution (CC BY) license (https:// of the general population, the media could also cause negative effects [7], since not only is creativecommons.org/licenses/by/ true information provided, but false information is provided as well, which is a great threat 4.0/). to public health [8,9]. In this extraordinary period, besides health and economic systems, Int. J. Environ. Res. Public Health 2021, 18, 7073. https://doi.org/10.3390/ijerph18137073 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 7073 2 of 10 the pandemic also reflects on the social system of community. Therefore, health literacy of the general population is exceptionally important [10]. Health literacy is defined as a personal, cognitive, and social skill that determines the capability of an individual to access, understand, and use information to improve and maintain personal health [11]. The concept and definition of health literacy are directly connected to health education, whose focus is the ability of an individual to understand and, in the case of having to make a decision, to use health information efficiently [7]. People who have a satisfactory level of health literacy manage their health more effi- ciently [2]. When it comes to types of health literacy, there are functional, interactive, and critical health literacy [12]. Functional health literacy refers to basic reading and writing skills, i.e., language/linguistic skills, including the comprehension of read con- tent [13,14]. Interactive health literacy, also called communicative literacy, implies advanced skills that include cognitive efforts, such as solving problems and making decisions [13,14]. Furthermore, critical health literacy implies the highest level of cognitive and social skills, a critical analysis of health information, an improvement in individual and social capacities, and an understanding of the political and economic dimensions of health [12,13]. So far, research accentuates how individual and social factors affect the level of health literacy of an individual. Moreover, the majority of conceptual models precisely identified personal factors and characteristics of the public health system as the factors that influence the level of health literacy [14]. Nonetheless, during the 1990s, studies showed an interconnection between health literacy and the health of an individual, pointing out a correlation between a lower literacy rate and a poorer/weaker health status [15]. Moreover, the elderly and people with lower education levels are recognized as risk groups, while gender has been shown in previous research to have differing levels of risk [13]. The concept of vaccine literacy (VL) is founded on the concept of health literacy [7] and is defined not only as a level of knowledge about vaccination but also as the devel- opment/construction of a system that would facilitate the communication or spread of messages about vaccines as being necessary, without which the functioning of the health system would be impossible [7]. Bauer and others (2017) conducted research about vaccine rejection in Austria, in which they explained how generally a very low level of knowl- edge is present about vaccination, along with an accentuated fear of the consequences of vaccination [16]. The authors see a potential solution in the implementation of specific education in the early education of children and in raising the awareness of doctors as the most reliable source of health information [16]. The majority of previous research was done in America, and those authors did not establish a clear connection between health literacy level and the decision about vaccination of an individual [17]. American scientists recognize the current global pandemic as a convenient way of promoting vaccination and building resistance to misinformation about COVID-19 disease and vaccination [6]. Given the prevalence of the COVID-19 disease, circumstances caused by the pandemic, and the importance of acceptance of vaccination that will protect the population or at least prevent severe disease caused by this virus, it is important to research the level of VL in the population and examine the potential contribution of VL when accepting the vaccination. Therefore, the aim of this study was to evaluate COVID-19 VL in the Croatian adult general population before vaccination began. The specific objectives were to test differences re- garding socio-demographic characteristics and to examine perceptions and attitudes about vaccination against COVID-19, considering the level of VL against COVID-19. 2. Materials and Methods A cross-sectional study was conducted before vaccination against COVID-19 disease, starting in the period from 15 to 31 January 2021. Due to the epidemiological limitations, the authors of this paper sent to participants Email, Facebook, and Instagram contacts a Google forms survey link with a detailed explanation of the study and a request that they participate, as well as a request that they further disseminate the questionnaire to potential participants older than 18 years. This combination of different social networks was used to Int. J. Environ. Res. Public Health 2021, 18, 7073 3 of 10 ensure greater circulation of the questionnaire and the representation of different groups of participants [18]. Additionally,
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