Investigating age-related COVID-19 digital health literacy and sense of coherence among adolescents and young adults in schools across Northern Ghana

Medina Srem‐Sai1, Francis Ankomah2, Edmond Kwesi Agormedah3, Frank Quansah4, John Elvis Hagan5, Orkan Okan6, Kevin Dadaczynski7, Thomas Schack8
1Department of Health, Physical Education, Recreation and Sports, University of Education, P. O. Box 25, Winneba, Ghana
2Department of Education and Psychology, University of Cape Coast, PMB Cape Coast, Cape Coast, Ghana
3Department of Business & Social Sciences Education, University of Cape Coast, PMB Cape Coast, Cape Coast, Ghana
4Department of Educational Foundations, University of Education, P. O. Box 25, Winneba, Ghana
5Department of Health, Physical Education and Recreation, University of Cape Coast, PMB Cape Coast, Cape Coast, Ghana
6Department of Sports and Health Science, Technical University Munich, 80992, Munich, Germany
7Department of Health Science, Fulda University of Applied Sciences, 36037, Fulda, Germany
8Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 10 01 31, 33501, Bielefeld, Germany

Tóm tắt

Abstract Introduction The empirical link between digital health literacy (DHL) and sense of coherence (SoC) has been extensively discussed in the literature. Yet, there seems to be limited evidence regarding the roles of age and depression status in the link between DHL and SoC of adolescents and young adults (AYAs), especially during the COVID-19 crises. This study investigated the interplay between age, DHL, SoC and psychological distress. Particularly, the study examined the following: (1) relationship between DHL and SoC, (2) moderating role of age in the relationship between DHL and SoC as well as (3) moderating role of depression in the relationship between DHL and SoC. Methods The study used a cross-sectional survey to select 998 AYAs in secondary schools in Northern Ghana through questionnaire administration using a stratified sampling procedure. Results Findings reveal that age was positively and significantly related to DHL and SoC. However, age failed to moderate the relationship between DHL and SoC. With the same level of DHL, students who exhibited depressive symptoms compared to those without, had lower levels of SoC regardless of their age. Conclusions Although AYAs’ DHL are likely to differ across different age brackets, this gap does not affect their rates of SoC and depression. Nonetheless, there is a need to improve DHL through regular standard training on internet search using basic audio-visual materials like laptops, smart phones, tablets, and lab computers for adolescent and young adult students. Additionally, school authorities, in collaboration with other stakeholders should develop student-centred cognitive-behavioural strategies aimed at reducing depressive symptoms in secondary school students who are at risk of depression in Northern Ghana.

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Tài liệu tham khảo

WHO (2022). Adolescent and young adult health: Fact sheet. https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions

Eyiah-Bediako S, Quansah F, Omotosho JA, Hagan JE Jr. Assessment of peer pressure and sexual adventurism among adolescents in Ghana: the moderating role of child-rearing practices. Soc Sci. 2021;10:418.

Park MJ, Scott JT, Adams SH, Brindis CD, Irwin CE Jr. Adolescent and young adult health in the United States in the past decade: little improvement and young adults remain worse off than adolescents. J Adolesc Health. 2014;55(1):3–16.

Addadey JA, Quansah F, Mawusi RM, Ankoma-Sey RV. Trapped in the ‘web’: challenges of grade 9 pupils in choosing a course to pursue in senior high schools in Ghana. Open Education Studies. 2022;4:106–19. https://doi.org/10.1515/edu-2022-0006.

Ankoma-Sey VR, Nsoh J, Quansah F. Phenomenological experiences of the girl-child in accessing technical education. Am J Human Soc Sci. 2019;4(4):498–505. https://doi.org/10.20448/801.44.498.505.

Edjah K, Ankomah F, Domey E, Laryea JE. Stress and its impact on academic and social life of undergraduate university students in Ghana: a structural equation modeling approach. Open Educ Stud. 2020;2(1):37–44.

Mulye TP, Park MJ, Nelson CD, Adams SH, Irwin CE Jr, Brindis CD. Trends in adolescent and young adult health in the United States. J Adolesc Health. 2009;45(1):8–24.

Frimpong JB, Agormedah EK, Srem-Sai M, Quansah F, Hagan JE. Examining risk perception and coping strategies of senior high school teachers in Ghana: Does COVID-19-related knowledge matter? COVID. 2022;2(5):660–73.

Hagan JE Jr, Quansah F, Ankomah F, Agormedah EK, Srem-Sai M, Frimpong JB, Schack T. Linking COVID-19-related awareness and anxiety as determinants of coping strategies’ utilization among senior high school teachers in Cape Coast metropolis, Ghana. Soc Sci. 2022;11(3):137.

Quansah F, Ankomah F, Hagan JE Jr, Srem-Sai M, Frimpong JB, Sambah F, Schack T. Development and validation of an inventory for stressful situations in university students involving coping mechanisms: an interesting cultural mix in Ghana. Psych. 2022;4(2):173–86.

Quansah F, Hagan JE Jr, Sambah F, Frimpong JB, Ankomah F, Srem-Sai M, Seibu M, Abieraba RS, Schack T. Perceived safety of learning environment and associated anxiety factors during COVID-19 in Ghana: Evidence from physical education practical-oriented program. Eur J Invest Health Psychol Educ. 2022;12(1):28–41.

Agormedah EK, Henaku EA, Ayite DM, Ansah EA. Online learning in higher education during COVID-19 pandemic: a case of Ghana. J Educ Technol Online Learn. 2020;3(3):183–210.

Ahinkorah BO, Hagan JE Jr, Ameyaw EK, Seidu AA, Schack T. COVID-19 pandemic worsening gender inequalities for women and girls in Sub-Saharan Africa. Front Glob Women’s Health. 2021;2:686984.

Ahmad AR, Murad HR. The impact of social media on panic during the COVID-19 pandemic in Iraqi Kurdistan: online questionnaire study. J Med Internet Res. 2020;22(5):e19556. https://doi.org/10.2196/19556.

Islam MS, Sarkar T, Khan SH, Kamal AH, Hasan SM, Kabir A, Yeasmin D, Islam MA, Chowdhury KI, Anwar KS, Chughtai AA. COVID-19–related infodemic and its impact on public health: a global social media analysis. Am J Trop Med Hygiene. 2020;103(4):1621.

Orso D, Federici N, Copetti R, Vetrugno L, Bove T. Infodemic and the spread of fake news in the COVID-19-era. Eur Soc Emerg Med. 2020;27:327–8.

Bendau A, Petzold MB, Pyrkosch L, Mascarell Maricic L, Betzler F, Rogoll J, et al. Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany. Eur Arch Psychiatry Clin Neurosci. 2020;271:283–91. https://doi.org/10.1007/s00406-020-01171-6.

Lee Y, Yang BX, Liu Q, Luo D, Kang L, Yang F, et al. The synergistic effect of social media use and psychological distress on depression in China during the COVID-19 epidemic. Psychiatry Clin Neurosci. 2020;74:552–3. https://doi.org/10.1111/pcn.13101.

Li M, Xu Z, He X, Zhang J, Song R, Duan W, Yang H. Sense of coherence and mental health in college students after returning to school during COVID-19: the moderating role of media exposure. Front Psychol. 2021;12:3031.

Yao H. The more exposure to media information about COVID-19, the more distressed you will feel. Brain Behav Immun. 2020;87:167–9. https://doi.org/10.1016/j.bbi.2020.05.031.

Chao M, Xue D, Liu T, Yang H, Hall BJ. Media use and acute psychological outcomes during COVID-19 outbreak in China. J Anxiety Disord. 2020;74:102248. https://doi.org/10.1016/j.janxdis.2020.102248.

Keles B, McCrae N, Grealish A. A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents. Int J Adolescence Youth. 2020;25:79–93. https://doi.org/10.1080/02673843.2019.1590851.

Olagoke AA, Olagoke OO, Hughes AM. Exposure to coronavirus news on mainstream media: the role of risk perceptions and depression. Br J Health Psychol. 2020;25:865–74. https://doi.org/10.1111/bjhp.12427.

Horgan A, Sweeney J, Behan L, McCarthy G. Depressive symptoms, college adjustment and peer support among undergraduate nursing and midwifery students. J Adv Nursing. 2016;72:3081–92. https://doi.org/10.1111/jan.13074.

Eriksson M, Lindström B, Antonovsky A. Sense of coherence scale and the relation with health: A systematic review. J Epidemiol Commun Health. 2006;60:376–81.

Antonovsky A. Unraveling the mystery of health: How people manage stress and stay well. San Francisco: Jossey-Bass; 1987.

Antonovsky A. The structure and properties of the sense of coherence scale. Soc Sci Med. 1993;36:725–33.

Antonovsky A. Health, stress, and coping: new perspectives on mental and physical well-being. San Francisco: Jossey-Bass Inc, Publishing; 1979.

Lindström B, Eriksson M. Salutogenesis. J Epidemiol Commun Health. 2005;59:440–2.

Braun-Lewensohn O, Idan O, Lindström B, Margalit M. Salutogenesis. Sense of coherence in adolescence. In: Mittelmark M, Sagy S, Eriksson M, Bauer GF, Pelikan JF, Lindström B, Espnes GA, editors. The handbook of salutogenesis. Basel: Springer Nature; 2016.

Chu JJ, Khan MH, Jahn HJ, Kraemer A. Sense of coherence and associated factors among university students in China: cross-sectional evidence. BMC Public Health. 2016;16:336.

Moksnes UK, Espnes GA. Sense of coherence in association with stress experience and health in adolescents. Int J Environ Res Publ Health. 2020;17(1–12):3003. https://doi.org/10.3390/ijerph17093003.

Ängarne-Lindberg T, Wadsby M. Sense of coherence in young adults with and without experience of parental divorce in childhood. J Divorce Remarriage. 2011;52(5):309–21. https://doi.org/10.1080/10502556.2011.585087.

Zakar R, Iqbal S, Zakar MZ, Fischer F. COVID-19 and health information seeking behavior: digital health literacy survey amongst university students in Pakistan. Int J Environ Res Public Health. 2021;18:4009. https://doi.org/10.3390/ijerph18084009.

Chu-Ko F, Chong ML, Chung CJ, et al. Exploring the factors related to adolescent health literacy, health-promoting lifestyle profile, and health status. BMC Public Health. 2021;21:2196. https://doi.org/10.1186/s12889-021-12239-w.

Lin M, Sansom-Daly UM, Wakefield CE, McGill BC, Cohn RJ. Health literacy in adolescents and young adults: perspectives from Australian cancer survivors. J Adolesc Young Adult Oncol. 2017;6(1):150–8. https://doi.org/10.1089/jayao.2016.0024.

Sansom-Daly UM, Lin M, Robertson EG, Wakefield CE, McGill BC, Girgis A, Cohn RJ. Health literacy in adolescents and young adults: an updated review. J Adolesc Young Adult Oncol. 2016;5(2):106–18. https://doi.org/10.1089/jayao.2015.0059.

Nguyen HC, Nguyen MH, Do BN, Tran CQ, Nguyen TT, Pham KM, Pham LV, Tran KV, Duong TT, Tran TV, et al. People with suspected COVID-19 symptoms were more likely depressed and had lower health-related quality of life: the potential benefit of health literacy. J Clin Med. 2020;9:965.

Nguyen LHT, Vo MTH, Tran LTM, Dadaczynski K, Okan O, Murray L, Van Vo T. Digital health literacy about COVID-19 as a factor mediating the association between the importance of online information search and subjective well-being among university students in Vietnam. Front Digit Health. 2021;3:739476. https://doi.org/10.3389/fdgth.2021.739476.

Norman CD, Skinner HA. eHEALS: the eHealth literacy scale. J Med Internet Res. 2006;8:e27.

Van der Vaart R, Drossaert C. Development of the digital health literacy instrument: Measuring a broad spectrum of health 1.0 and health 2.0 skills. J Med Internet Res. 2017;19:e27.

Broucke SVD, Levin-Zamir D, Schaeffer D, Pettersen K, Guttersrud Ø, Finbråten H, de Arriaga MT, Vrdelja M, Link T, Pelikan J. Digital health literacy in general populations: an international comparison. Eur J Public Health. 2020;30:5.

Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H. Health literacy and publfic health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.

Lindström B, Eriksson M. From health education to healthy learning: Implementing salutogenesis in educational science. Scand J Publ Health. 2011;39(6_suppl):85–92.

Liu Y, Meng H, Tu N, Liu D. The relationship between health literacy, social support, depression, and frailty among community-dwelling older patients with hypertension and diabetes in China. Front Public Health. 2020;8:280.

Chun H, Park EJ, Choi SK, Yoon H, Okan O, Dadaczynski K. Validating the digital health literacy instrument in relation to COVID-19 information (COVID-DHL-K) among South Korean undergraduates. Int J Environ Res Public Health. 2022;19:3437.

Kühn L, Bachert P, Hildebrand C, Kunkel J, Reitermayer J, Wäsche H, Woll A. Health literacy among university students: a systematic review of cross-sectional studies. Front Publ Health. 2022;21(9):680999. https://doi.org/10.3389/fpubh.2021.680999.

Rivadeneira MF, Miranda-Velasco MJ, Arroyo HV, Caicedo-Gallardo JD, Salvador-Pinos C. Digital health literacy related to covid-19: validation and implementation of a questionnaire in Hispanic university students. Int J Environ Res Public Health. 2022;19:4092. https://doi.org/10.3390/ijerph19074092.

Vrdelja M, Vrbovšek S, Klopˇciˇc V, Dadaczynski K, Okan O. Facing the growing COVID-19 infodemic: digital health literacy and information-seeking behaviour of university students in Slovenia. Int J Environ Res Public Health. 2021;18:8507. https://doi.org/10.3390/ijerph18168507.

Maulana H, Gumelar G, Irianda G. Do gender and age affect an individual’s sense of coherence? An environmental psychology perspective of flood survivals in Indonesia. IOP Conf Series Earth Environ Sci. 2021;2021(623):012030. https://doi.org/10.1088/1755-1315/623/1/012030.

Reick S, Hering T. Health literacy of students. Results of an online survey at the Bochum health university (Germany). Int J Health Prof. 2018;5:44–52. https://doi.org/10.2478/ijhp-2018-0007.

Michou M, Panagiotakos DB, Lionis C, Costarelli V. Low health literacy and perceived stress in adults: is there a link? Cent Eur J Public Health. 2021;29(3):195–200.

Dadaczynski, et al. University students’ sense of coherence, future worries and mental health: findings from the German COVID-HL-survey. Health Promotion International. 2022;37:daab070. https://doi.org/10.1093/heapro/daab070.

Zielińska-Więczkowska H, Sas K. Sense of coherence, self-perception of aging and the occurrence of depression among the participants of the university of the third age depending on socio-demographic factors. Clin Interv Aging. 2020;15:1481–91.

Carlén K, Suominen S, Lindmark U, Saarinen MM, Aromaa M, Rautava P, Sillanpää M. Sense of coherence predicts adolescent mental health. J Affect Disord. 2020;2020(274):1206–10.

López-Martínez C, Serrano-Ortega N, Moreno-Cámara S, del Pino-Casado R. Association between sense of coherence and mental health in caregivers of older adults. Int J Environ Res Publ Health. 2019;16(1–10):3800. https://doi.org/10.3390/ijerph16203800.

Uchida H, Tsujino D, Muguruma T, Hino N, Sasaki K, Miyoshi M, Koyama Y, Hirao K. Low sense of coherence is associated with anxiety among adults: Results based on data from all 47 prefectures of Japan. Comprehens Psych. 2018;86:131–6.

Yano K, Kase T, Oishi K. The effects of sensory-processing sensitivity and sense of coherence on depressive symptoms in university students. Health Psychol Open. 2019;6(2):2055102919871638.

Abu-Kaf S, Priel B. Vulnerabilities to depression and sense of coherence among Bedouin Arab and Jewish students: A test of a mediation model. Int J Psychol Counsell. 2012;4(3):31–40. https://doi.org/10.5897/IJPC11.035.

Abu-Kaf S, Khalaf E. Acculturative stress among Arab students in Israel: The Roles of sense of coherence and coping strategies. Int J Environ Res Publ Health. 2020;17(1–19):5106. https://doi.org/10.3390/ijerph17145106.

Hagan JE Jr, Quansah F, Frimpong JB, Ankomah F, Srem-Sai M, Schack T. Gender risk perception and coping mechanisms among Ghanaian university students during the COVID-19 pandemic. In Healthcare. 2022;10(4):687 MDPI.

Quansah F, Hagan JE Jr, Ankomah F, Srem-Sai M, Frimpong JB, Sambah F, Schack T. Relationship between COVID-19 related knowledge and anxiety among university students: Exploring the moderating roles of school climate and coping strategies. Front Psychol. 2022;13:820288.

Quansah F, Ankomah F, Agormedah EK, Abieraba RS, Srem-Sai M, Hagan JE Jr, Okan O, Dadaczynski K, Schack T. COVID-digital health literacy and subjective well-being of students in Ghana: mediation-moderation analyses. Health Sci Rep. 2022;5(6):1–10.

Hagan Jr JE, Quansah F, Frimpong JB, Agormedah EK, Nugba RM, Srem-Sai M, & Schack T. Gender digital health literacy gap across age: A moderated moderation effect on depression among in-school adolescents in Ghana during COVID-19. Psychol Schools 2023;6(9). https://doi.org/10.1002/pits.22942

Sambah F, Quansah F, Srem-Sai M, Frimpong JB, Agormedah EK, Ankomah F, Hagan JE. Assessing secondary school students’ digital health literacy, information searching behaviours, and satisfaction with online COVID-19 information in Northern Ghana. Heliyon. 2023;9(7):1–10. https://doi.org/10.1016/j.heliyon.2023.e17936.

Dadaczynski K, Okan O, Rathmann K. COVID-19 health literacy survey: University Students (COVID-HL-Survey). Questionnaire and scale documentation. Public Health Centre Fulda (PHZF) at the Fulda University of Applied Sciences & Interdisciplinary Centre for Health Literacy Research at Bielefeld University 2020. https://doi.org/10.4119/unibi/2942920

Martins S, Augusto C, Martins MR, Silva MJ, Okan O, Dadaczynsky K, Duarte A, Fronteira I, Ramos N, Rosário R. Adaptation and validation of the digital health literacy instrument for Portuguese university students. Health Promot J. 2022;1:390–8. https://doi.org/10.1002/hpja.580.

Agormedah EK, Quansah F, Ankomah F, Hagan JE Jr, Srem-Sai M, Abieraba RSK, Frimpong JB, Schack T. Assessing the validity of digital health literacy instrument for secondary school students in Ghana: the polychoric factor analytic approach. Front Digi Health. 2022;4(968806):1–12. https://doi.org/10.3389/fdgth.2022.968806.

Lorini C, Velasco V, Bonaccorsi G, Dadaczynski K, Okan O, Zanobini P, Vecchio LP. Validation of the COVID-19 digital health literacy instrument in the Italian language: a cross-sectional study of Italian university students. Int J Environ Res Public Health. 2022;19:6247. https://doi.org/10.3390/ijerph19106247.

WHO. Wellbeing Measures in Primary Health Care: The DEPCARe Project; WHO Regional Office for Europe: Copenhagen, 1998.

Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom. 2015;84:167–76. https://doi.org/10.1159/000376585.

Seb-Akahomen OJ, Okogbenin EO, Obagaye OM, Erohubie PO, Aweh BE. The 5-item WHO well-being index as a screening tool for depression in a population of doctors and nurses in Nigeria during the COVID-19 pandemic. Open J Depres. 2021;10(2):43–53.

Low KY, Pheh KS, Tan CS. Validation of the WHO-5 as a screening tool for depression among young adults in Malaysia. Curr Psychol. 2023;42(10):7841–4.

Quansah F, Hagan JE Jr, Ankomah F, Agormedah EK, Nugba RM, Srem-Sai M, Schack T. Validation of the WHO-5 well-being scale among adolescents in Ghana: Evidence-based assessment of the internal and external structure of the measure. Children. 2022;9(7):991.

Schumacher J, Wilz G, Gunzelmann T, Brähler E. The Antonovsky Sense of Coherence Scale. Test statistical evaluation of a representative population sample and construction of a brief scale. Psychotherapie Psychosomatik Medizinische Psychologie. 2000;50(12):472–82.

Leung AY, Parial LL, Tolabing MC, Sim T, Mo P, Okan O, Dadaczynski K. Sense of coherence mediates the relationship between digital health literacy and anxiety about the future in aging population during the COVID-19 pandemic: a path analysis. Aging Ment Health. 2022;26(3):544–53.

Susuawu C, Asiegbor J. The multilingual situation of Ghana and how multilingualism contributes to National Development. Int J Innov Res Dev. 2021;10(4):112–7. https://doi.org/10.24940/ijird/2021/v10/i4/APR21036Page112.

Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. 2nd ed. New York: The Guildford Press; 2018.

Ofori-Boateng K, Bab I. Assessment of poverty levels in selected districts of rural Ghana. J Poverty Invest Dev. 2015;8:130–55.

World Bank. Ghana: Poverty Assessment; World Bank: Washington, DC, USA, 2020

Quansah F, Ankomah F, Agormedah EK, Ntumi S, Hagan JE, Srem-Sai M, … & Schack T. A cross-sectional study of university students' pocket money variance and its relationship with digital health literacy and subjective well-being in Ghana. Health Sci Rep. 2023;6(2):e1095. https://doi.org/10.1002/hsr2.1095

Quansah F, Agormedah EK, Hagan JE, Frimpong JB, Ankomah F, Srem-Sai M, … & Schack T. Subjective social status and well-being of adolescents and young adults in Ghanaian schools: conditional process analysis. BMC Psychol 2023;11(1):1–14. https://doi.org/10.1186/s40359-023-01158-7

Dzakadzie Y, Quansah F. Modelling unit non-response and validity of online teaching evaluation in higher education using generalizability theory approach. Front Psychol. 2023;14:1202896. https://doi.org/10.3389/fpsyg.2023.1202896.

Amoako I, Srem-Sai M, Quansah F, Anin S, Agormedah EK, Hagan JE Jr. Moderation modelling of COVID-19 digital health literacy and sense of coherence across subjective social class and age among university students in Ghana. BMC Psychol. 2023;11:337. https://doi.org/10.1186/s40359-023-01334-9.