Fear of COVID-19 after vaccination dissemination and its relationship with multidimensional health literacy among patients on maintenance haemodialysis

Background and hypothesis.The increased anxiety owing to the COVID-19 pandemic has been suggested to contribute to unhealthy lifestyles and depression in patients undergoing haemodialysis (HD). Therefore, this study aimed to evaluate the degree of fear of COVID-19 after vaccination dissemination and the independent impact of high-order health literacy (HL) on fear, which have not been adequately investigated. Methods.This multicentre cross-sectional study, conducted in 2022, after the widespread availability of the COVID-19 vaccination in Japan, included adults undergoing in-centre HD. Multidimensional HL was measured using the 14-item Functional, Communicative, and Critical Health Literacy Scale. Fear of COVID-19 was measured using the 7-item Japanese version of the Fear of COVID-19 Scale. COVID-19 fear scores in patients with HD were compared with scores of adults in April 2020 (the beginning of the pandemic) using an unpaired t-test. The association between multidimensional HL and COVID-19 fear scores was estimated using a multivariable-adjusted general linear model. Results.A total of 446 patients were analysed, of whom 431 (97%) and nine (2%) received three and two doses of vaccination, respectively. Their COVID-19 fear scores were significantly lower than those of the general population at the beginning of the pandemic (p < 0.001; mean difference -4.4 [95% confidence interval (CI): -5.1 - -3.7]; standardised effect size [ES] 0.77). Higher functional HL was associated with less fear (per 1-pt higher: -2.8 [95% CI: -1.7 - -0.3]; standardised ES -0.51), whereas higher critical HL was associated with greater fear (per 1-pt higher: 3.2 [95% CI: 0.7 - 3.0]; standardised ES 0.80). Communicative HL was not associated with fear. Conclusion.Patients fear of low-functional HL, despite widespread vaccination, can be reduced by providing health information in an easy-to-understand manner. Thus, the fear of sceptics owing to excessive critical HL and honest explanations by healthcare providers may be important. Key learning points What was knownHeightened anxiety stemming from the COVID-19 pandemic exacerbates unhealthy lifestyles and depression, particularly in patients undergoing haemodialysis. Health literacy plays a crucial role in individuals with kidney disease and may mitigate anxiety. Comprehensive data on whether multidimensional health literacy (functional, critical, and communicative) independently correlates with fear of COVID-19, particularly in the context of patients undergoing haemodialysis are lacking. This study addsCOVID-19 fear scores were notably lower in patients undergoing haemodialysis who received the COVID-19 vaccination than in the general population at the onset of the pandemic. Elevated functional health literacy correlated with reduced fear, whereas higher critical health literacy was linked to increased fear. Potential impactFear among individuals with low functional health literacy can be alleviated by delivering health information in a clear and accessible manner, whereas transparent and honest communication from healthcare providers is crucial for patients with heightened fear owing to critical health literacy, who may be sceptical of accurate information.