Relationship between Health Literacy and Acceptance of Rumors Related to COVID-19 Vaccination among Iranian Adult Population


Health literacy

How to Cite

Tajik Jalali, M., Ahmadi Marzaleh, M., Askarian, F., Najibi, S. M., Soltani, A., & Delavari, S. (2022). Relationship between Health Literacy and Acceptance of Rumors Related to COVID-19 Vaccination among Iranian Adult Population. Iranian Red Crescent Medical Journal, 24(9).


Background: Rumors concerning various aspects of the fight against COVID-19, vaccination, in particular, have become one of the main challenges for managers and policymakers who have to deal with different aspects of the disease. This necessitates the recognition of the factors that influence the prevention and spread of these rumors.

Objectives: The current study aimed to investigate the link between health literacy among adults and their acceptance of COVID-19 vaccination rumors in Iran.

Methods: This cross-sectional study was conducted from November 15 to December 15, 2021, in different provinces of Iran. The study population included Iranian adults, aged 18 years and older, who were selected using the snowball sampling method. The data collection tools involved two questionnaires: the Health Literacy Questionnaire, which consists of 33 items, and the COVID-19 Vaccine Rumor Questionnaire which assesses 17 rumors related to COVID-19 vaccination collected from various news sources.

Results: The number of completed questionnaires was 1158 out of 2163 questionnaire visits (74% response rate). Univariate analysis showed that health literacy had a statistically significant association with sociodemographic variables of gender, marital status, ethnicity, place of residence, and level of education. The results of data analysis also demonstrated a significant correlation between the average of rumors’ acceptance and the sociodemographic variables of gender, marital status, ethnicity, place of residence, and level of education. The results of the Pearson correlation coefficient test showed a significant and negative relationship between health literacy and rumor belief (P= 0.000, r=-0.590), indicating that those with a higher level of health literacy had a lower level of rumor acceptance.

Conclusion: Based on the findings of the present study, health literacy has a significant effect on reducing the credibility of rumors and other misinformation among community members. Macro-level decisions and policies are needed to improve factors such as health literacy and can help individuals identify and track rumors and make decisions based on reliable information on vaccination.


Montagni I, Ouazzani-Touhami K, Mebarki A, Texier N, Schück S, Tzourio C, et al. Acceptance of a Covid-19 vaccine is associated with ability to detect fake news and health literacy. J Public Health. 2021;43(4):695-702. doi: 10.1093/pubmed/fdab028. [PubMed: 33693905].

Zhang F, Or PPL, Chung JWY. The effects of health literacy in influenza vaccination competencies among community-dwelling older adults in Hong Kong. BMC Geriatr. 2020;20(1):1-7. doi: 10.1186/s12877-020-1504-5. [PubMed: 32171262].

Cheng M, Wang S, Yan X, Yang T, Wang W, Huang Z, et al. A COVID-19 rumor dataset. Front Psychol. 2021;12:1-10. doi: 10.3389/fpsyg.2021.644801. [PubMed: 34135812].

Na K, Garrett RK, Slater MD. Rumor acceptance during

public health crises: Testing the emotional congruence hypothesis. J Health Commun. 2018;23(8):791-9. doi: 10.1080/10810730.2018.1527877. [PubMed: 30325720].

Hotez PJ. COVID19 meets the antivaccine movement. Microbes Infect. 2020;22(4):162-4. doi: 10.1016/j.micinf.2020.05.010. [PubMed: 32442682].

Ammar A, Trabelsi K, Brach M, Chtourou H, Boukhris O, Masmoudi L, et al. Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study. Biol

Sport. 2021;38(1):9-21. doi: 10.5114/biolsport.2020.96857. [PubMed: 33795912].

Peyravi M, Soltani A, Ahmadi M, Marzaleh MA. Iran’s coping experiences with covid-19: strategies and recommendations. Disaster Med Public Health Prep. 2020:1-2. doi: 10.1017/dmp.2020.441. [PubMed: 33203494].

Rahmani Moghadam E, Zarrin V, Keshipour H, Raei M. Crisis Management in COVID-19 Pandemic. J Mar Med. 2020;2(1):61-2.

Shahamatinejad S. The Relationship between health anxiety and emotion regulation with rumors on social networks during the COVID-19 Pandemic. J Couns Psychol. 2021;3(1):38-48. doi:


Nooraei S, Entezari M, Hushmandi K, Raei M. Stress and

anxiety caused by COVID-19 in the communities. J Mar Med. 2020;2(1):65-6.

Lai K, Xiong X, Jiang X, Sun M, He L. Who falls for rumor? Influence of personality traits on false rumor belief. Pers Individ Differ. 2020;152:109520. doi: 10.1016/j.paid.2019.109520.

Gallotti R, Valle F, Castaldo N, Sacco P, De Domenico M. Assessing the risks of ‘infodemics’ in response to COVID-19 epidemics. Nat Hum Behav. 2020;4(12):1285-93. doi: 10.1038/s41562-020-00994-6. [PubMed: 33122812].

Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475-82. doi: 10.1001/jama.288.4.475. [PubMed: 12132978].

Abel T, McQueen D. Critical health literacy and the COVID-19 crisis. Health Promot Int. 2020;35(6):1612-3. doi: 10.1093/heapro/daaa040. [PubMed: 32239213].

Montazeri A, Tavousi M, Rakhshani F, Azin A, Jahangiri K, Ebadi M, et al. Health literacy for Iranian Adults (HELIA): development and psychometric properties. Payesh. 2014;13(5):589-99.

Okan O, Bollweg TM, Berens E-M, Hurrelmann K, Bauer U, Schaeffer D. Coronavirus-related health literacy: A cross-sectional study in adults during the COVID-19 infodemic in Germany. Int J Environ Res Public Health. 2020;17(15):1-20. doi: 10.3390/ijerph17155503. [PubMed: 32751484].

Paasche‐Orlow MK, Parker RM, Gazmararian JA, Nielsen‐Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20(2):175-84. doi: 10.1111/j.1525-1497.2005.40245.x. [PubMed: 15836552].

Nutbeam D, Kickbusch I. Advancing health literacy: a global challenge for the 21st century. Health Promot Int. 2000;15(3):183-4. doi:10.1093/heapro/15.3.183.

Lee HY, Lee J, Kim NK. Gender differences in health literacy among Korean adults: do women have a higher level of health literacy than men? Am J Mens Health. 2015;9(5):370-9. doi: 10.1177/1557988314545485. [PubMed: 25122719].

Ahmadi FZ, Mehrmohammadi M, Talaee E, Fardanesh H, Paknahad M, Taghizadeh S, et al. Health literacy among students of Farhangian University. Payesh. 2018;17(3): 257-66.

He L, Chen Y, Xiong X, Zou X, Lai K. Does science literacy guarantee resistance to health rumors? The moderating effect of self-efficacy of science literacy in the relationship between science literacy and rumor belief. Int J Environ Res Public Health. 2021;18(5):1-10. doi: 10.3390/ijerph18052243. [PubMed: 33668310].

Afassinou K. Analysis of the impact of education rate on the rumor spreading mechanism. Physica A. 2014;414:43-52. doi: 10.1016/j.physa.2014.07.041.

Greenhill KM, Oppenheim B. Rumor has it: The adoption of unverified information in conflict zones. Int Stud Q. 2017;61(3):660-76. doi: 10.1093/isq/sqx015.

Oh HJ, Lee H. When do people verify and share health rumors on social media? The effects of message importance, health anxiety, and health literacy. J Health Commun. 2019;24(11):837-47. doi: 10.1080/10810730.2019.1677824. [PubMed: 31609678].

Johri M, Subramanian SV, Sylvestre MP, Dudeja S, Chandra D, Koné GK, et al. Association between maternal health literacy and child vaccination in India: a cross-sectional study.

J Epidemiol Community Health. 2015;69(9):849-57. doi: 10.1136/jech-2014-205436. [PubMed: 25827469].

Meppelink CS, Smit EG, Fransen ML, Diviani N. “I was right about vaccination”: Confirmation bias and health literacy in online health information seeking. J Health Commun. 2019;24(2):129-40. doi: 10.1080/10810730.2019.1583701. [PubMed: 30895889].

Lorini C, Santomauro F, Donzellini M, Capecchi L, Bechini A, Boccalini S, et al. Health literacy and vaccination: A systematic review. Hum Vaccin Immunother. 2018;14(2):478-88. doi: 10.1080/21645515.2017.1392423. [PubMed: 29048987].