The Role of Resilience and Gender in Relation to Infectious-Disease-Specific Health Literacy and Anxiety During the COVID-19 Pandemic

Anxiety is one of the psychological problems being experienced by the general population during the current coronavirus disease 2019 (COVID-19) pandemic. Health literacy, such as infectious-disease-specific health literacy, is associated with anxiety, but the mechanism of such association is not clear. This study explored the relationship between infectious-disease-specific health literacy and anxiety. We conducted an online survey in Hubei province, the early epicenter of the COVID-19 pandemic. A total of 1038 COVID-19-negative participants accomplished a battery of online survey tools determining their sociodemographic characteristics, perceived risk of acquiring COVID-19, infectious-disease-specific health literacy, resilience, and anxiety symptoms. We examined the moderated mediation models, in which the mediator was resilience and the moderator was gender. Most (63%) of the study participants experienced at least mild anxiety. The indirect effect of infectious-disease-specific health literacy on anxiety through resilience was -0.282 (95% confidence interval [CI] = [-0.511, -0.083]), contributing to 32.7% of the total effect of health literacy on anxiety. Resilience fully mediated the association. The mediation effect of resilience tended to be stronger for the male participants than for the female participants as the moderation effect of gender remained until we included perceived risk of acquiring COVID-19 in the model. Resilience was found to mediate the association between infectious-disease-specific health literacy and anxiety. Individuals with good infectious-disease-specific health literacy are more likely to acquire higher resilience, which may in turn decrease their anxiety level. Males may benefit more from the mediation effect of resilience during the current pandemic. Infectious-disease-specific health literacy programs may help reduce the anxiety of the program participants by enhancing their resilience during a pandemic.