key: cord-0934172-ep2gzgtj
authors: Chereka, Alex Ayenew; Demsash, Addisalem Workie; Ngusie, Habtamu Setegn; Kassie, Sisay Yitayih
title: Digital health literacy to share COVID-19 related information and associated factors among healthcare providers worked at COVID-19 treatment centers in Amhara region, Ethiopia: A cross-sectional survey
date: 2022-04-14
journal: Inform Med Unlocked
DOI: 10.1016/j.imu.2022.100934
sha: c7bfdb1a1309fc6fc43a4e5a6cc12ad19f62ae27
doc_id: 934172
cord_uid: ep2gzgtj

BACKGROUND: Coronavirus (CoV) is a novel respiratory virus that can cause severe acute respiratory syndrome (SARS). It affects millions of people in the world and thousands of people in Ethiopia. In responding to this, digital health technologies help to reduce COVID-19 outbreaks by sharing accurate and timely COVID-19 related information. Additionally, digital solutions are used for remote consulting during the pandemic, in creating COVID-19 related awareness, for distribution of the vaccine, and so on. Therefore, this study aimed to assess digital health literacy to share COVID-19 related information and associated factors among healthcare providers who worked at COVID-19 treatment centers in the Amhara region, Northwest Ethiopia. METHOD: An institutional-based cross-sectional survey was conducted from April 4 to May 4, 2021. The study included 476 healthcare providers who worked at COVID-19 treatment centers in the Amhara region. A pretested, structured self-administered questionnaire was used to collect data. EpiData 4.6 and SPSS version 26 were used for data entry and analysis respectively. Bi-variable and Multivariable logistic regression analysis was used to identify factors associated with the dependent variable. A P-value of less than 0.05 was used to declare statistical significance. RESULT: A total of 456 respondents were participated in the study, with 95.8% response rate. Digital health literacy to share COVID-19 related information found to be 50.4% (95% CI: 46–55). Educational status [AOR = 4.37, 95% CI(2.08–9.17)], training [AOR = 3.00, 95% CI (1.80–5.00)], attitude [AOR = 1.99, 95% CI(1.18–3.36)], perceived usefulness [AOR = 2.01, 95% CI(1.22–3.32)], perceived ease of use [AOR = 2.00, 95% CI(1.25–3.21)] and smartphone access [AOR = 5.21, 95% CI(2.34–9.62)] were significantly associated with digital health literacy to sharing of COVID-19 related information at P-value less than 0.05. CONCLUSION: This finding indicated that approximately half of the respondents had digital health literacy to share COVID-19 related information which was inadequate. Improving respondents’ educational status, computer training, smartphone access, perceived usefulness, perceived ease of use, and attitude was necessary to measure digital health literacy to sharing of COVID-19 related information.

media, email, and others [49] . Therefore, the study aimed to assess digital health literacy to share COVID-19 related information and identify its associated factors among healthcare providers who worked at the COVID-19 treatment center in the Amhara region, Northwest Ethiopia.

The study was conducted an institutional-based cross-sectional survey among healthcare providers who worked at COVID-19 treatment centers in the Amhara region. The study was 

The source population was all healthcare providers who worked at COVID-19 treatment centers in the Amhara region. Additionally, all healthcare providers who worked in COVID-19 treatment centers at those COVID-19 treatment center hospitals that were available during the data collection period were study populations.

The inclusion criteria were all healthcare providers who worked in COVID-19 treatment centers and permanent employees in the COVID-19 treatment center hospitals, who worked six months and above at hospitals. However, all healthcare providers were not available during the data J o u r n a l P r e -p r o o f collection period due to some reasons. Such as illness, annual leave, and other cases were excluded from this study.

Sample size (n) was determined by single population proportion formula by using p = 50% because this study was new for a specific disease. With Standard deviation (Zα/2 = 1.96 for a 95% CI) and margin of error (d=5%). With the formula: 

To check the consistency and validity, a pretested and structured self-administered questionnaire was used to collect the data with all necessary precautions for COVID-19 prevention during the data collection period. The tool was adapted and modified from different literature that previously studded with related to digital health literacy to sharing of COVID-19 related information [33, 37, 40, 42, 50, 51] . Five data collectors (two data collectors were public health officers, two data collectors were laboratory professionals and one data collector was an anesthesia professional) and two supervisors were participating in the data collection.

A total of 56 item questioners within three parts such as socio-demographic characteristics, individual characteristics, organizational related characteristics, and digital health literacy to

share COVID-19 related information. Pretest was conducted among 25 healthcare providers (5% of the total sample size) at Felegehiwot specialized hospital in a COVID-19 treatment center which was similar to our study setting. The correctness, consistency, and quality of the J o u r n a l P r e -p r o o f questionnaire were checked and seen in detail based on the pretest finding. The content validity of the questionnaire was determined based on the view of experts and the reliability was obtained by calculating the value of Cronbach alpha (overall Cronbach alpha =0.89).

To ensure completeness and consistency of the data, first, we coded and cleaned. Then, the data were entered by EpiData version 4.6 and exported to SPSS 26 for further analysis. Summary statistics of socio-demographic variables were presented using frequency tables. Bi-variable logistic regression analysis was computed to control confounding. All independent variables with P-value less than 0.2 in Bi-variable logistic regression were entered into multivariable logistic regression analysis. The strength of the association was described at 95% CI and the level of significance was determined at a P-value of less than 0.05 for multivariable regression analysis model. 

Perceived easiness: Researchers argued that perceived ease of use is the extent to which a person accepts as true that using an exacting technology would be at no cost to that individual. It is the term that represents the degree to which an innovation is perceived not to be difficult to understand, learn or operate. It was measured by six closed-end question items. Study participants who scored median and above the median in the five-point Likert scale of Perceived easiness question were categorized they thought eHealth was easy to use and those who scored below the median were categorized they thought tele monitoring technologies as not easy to use [53] .

Perceived usefulness: Perceived usefulness is the degree to which an individual's perception that using the new technology will enhance or improve her/his performance. it was measured by fourteen closed-end question items. Study participants who scored median and above the median in the five-point Likert scale of perceived usefulness question were categorized as they thought ICT tools as useful for their patient management and those who scored below the median were categorized as they thought ICT tools as not useful for their patient management [53] .

Computer skill: -It is referred to the abilities of healthcare providers which allow using of computers and related technology. We used five items of Likert scale questions to measure basic computer skills of the healthcare providers which ranged from: "1=strongly disagree to 5= strongly agree". Respondents who scored mean and above were considered as they had good computer skills. Whereas respondents who scored below the mean were considered as they had poor computer skills [54, 55] .

Attitude toward digital health: In this study, an attitude refers to the feeling of healthcare providers toward the introduction of digital health technologies. It was measured by six items of Likert scale questions ranging from: "1=strongly disagree to 5= strongly agree". Respondents who scored mean and above were considered as they had a favorable attitude. Whereas respondents who scored below the mean were considered as they had unfavorable attitudes [56, 57] . The detail about the tools used for measuring digital health literacy to share COVIS-19 related information is found in Annex 1. J o u r n a l P r e -p r o o f 

The result of this study showed that out of 456 study participants 230(50.4%) (95% CI; 46-55) of healthcare providers who worked in COVID-19 treatment centers were at a high level in digital health literacy to sharing of COVID-19 related information.

All variables were entered into the binary logistic regression model. 

The present study examined Digital health literacy to share COVID-19 related information and its associated factors in COVID-19 treatment centers of resource-limited settings. The result of the study showed that out of 456 study participants 230(50.4%) (95% CI; 46-55) of healthcare providers who worked in COVID-19 treatment centers were at a high level in digital literacy to sharing of COVID-19 related information.

This finding was consistent with the study conducted in Ethiopia 46.5% [36] , Pakistan 47.8%

[34], 54.3% [33] , and Iran 54.4% [35] . However, this finding was less than the study conducted on Dutch (76%) [37] . This variation could be due to infrastructure, internet penetration, educational system difference among developing countries Ethiopia, and developed countries.

But this finding is also lower than the study conducted in northwest Ethiopia, which was (60%) [39] and (69.3%) [58] . The possible reason for this variation could be the study unit, the study area, and the sample size between the previous study and this study. In this regard, the studies conducted in Northwest Ethiopia were focused on general digital health literacy but our study was specifically on COVID-19. Therefore, the operational definition used in this study has little difference from that of the previous one which could be the other justification for this variation.

Whereas, this study finding was higher than the study conducted in Korea 38.8% [59] . This different result may be related to the difference between study units of those studies. In our study, the participants were healthcare providers who worked in COVID-19 treatment centers, whereas the previous study was conducted among nursing students. This difference may be the main reason to gate different findings.

According to the result from multi-variable regression analysis, the odds of respondents who were masters and above holders were 4.37 times higher digital health literacy for sharing of COVID-19 related information than that of respondents who were BSc and below holders. This showed that the level of education increased, digital health literacy also increase to share COVID-19 related information. When the levels of educational status increase, awareness, and knowledge about digital health literacy to share COVID-19 related information also increase.

This finding was supported by the study conducted in Ethiopia [36] , the state of Florida [40] , and

Pakistan [60] .

The odds of respondents who had smartphone access were 5.21 times higher digital health literacy to share COVID-19 related information than that of the respondents who had basic phone holders. This indicated that when the smartphone holder increases the respondent's knowledge and awareness about digital literacy for sharing of COVID-19 related information also increases. The reason could be due to if respondents have smartphones they could simply use important applications that help to know digital technology playing on sharing of COVID-19

related information by exercising more [5] .

The odds of respondents who had a favorable attitude were 1.99 times higher digital health literacy to share COVID-19 related information than that of the respondents who had unfavorable attitudes. This indicated that when the respondent's attitude was favorable, the digital health literacy to share COVID-19 related knowledge was high and vice versa. This is because the respondents have a favorable attitude to know digital health; they simply take actions on how to understand the digital technology for applying to share COVID-19 related information. This finding was supported by the study conducted in Ethiopia [36, 58] , Taylor and

Francis [61] Korea [45] .

The odds of respondents who perceive digital tools as useful were 2.01 times higher in digital health literacy level than that of respondents who perceive digital tools were not useful. This might be due to the perceived benefit from using digital health tools enhanced healthcare providers who worked in COVID-19 treatment centers' attitude which ultimately leads sustainably practicing to use it. This is consistent with a previous study conducted in Northwest Ethiopia [39] Respondents who perceived using digital health tools as easy were 2.00 times more likely to have a higher digital health literacy level than that of respondents who perceived digital health tools as not easy. The main justification could be since healthcare providers who worked in COVID-19 treatment centers who consider using digital tools easy were more confident in practicing and building their literacy and it is known that perceived ease of use could be J o u r n a l P r e -p r o o f influencing respondents' acceptance of digital health information technologies [62] . This is in line with the studies conducted in [62] . 

This study was the first study in Ethiopia assessing digital health literacy specifically on COVID-19 related information sharing. However, it was conducted only at two teaching referral hospitals in the Amhara region which might be lower its generalizability to the other treatment centers.

This study shares the limitation of cross-sectional studies. Therefore, it might not provide a strong cause-effect relationship. Additionally, this study wasn't supported by qualitative findings. The comparison of the study was made with limitation since the study specifically assess COVID-19 was lacking.

Considering digital health solutions are vital for tackling the COVID-19 pandemic, the MOH shall provide computer training in collaboration with NGOs. This will help healthcare providers to easily share and communicate COVID-19 related information for evidence-based decision making. In collaboration with other concerned bodies, the MOH shall stress creating awareness about the importance of adopting digital health technologies. distribution questionnaires and after they were informed of the objective and purpose of the study. To keep the confidentiality of information provided by the study subjects, the data collection procedure was anonymous. Finally, data were collected based on the study participants' voluntariness and consents.

Not applicable.

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The authors would like to thank the University of Gondar College of medicine and health science for the approval of ethical clearance and the Amhara region specialized teaching hospitals for giving a supporting letter. The authors would like to express their special thanks to health care providers, data collectors, and supervisors who participated in this study.

AAC and HSN made significant contributions in conception, design, data collection, supervision, data curation, investigation, data analysis, interpretation, and write-up of the manuscript. AWM and SYK have contributed to developing the proposal, validation, revising the manuscript, preparing figures, analysis, visualization, and interpretation of data as well. Finally, all authors (AAC, AWM, HSN, and SYK) reviewed and approved the final manuscript.

Ethical clearance was obtained from the ethical review board of the University of Gondar College of Medicine and Health Science institute of public health (IPH) with ethical reference number: IPH/1476/013. Informed consent was obtained from each study participant before

The authors have declared that no competing interests exist.

The author(s) received no specific funding for this work.

The data will be available upon request from the corresponding author.