COVID-19 RELATED HEALTH LITERACY, CONSCIOUSNESS AND PREVENTIVE BEHAVIOURS IN PUBLIC: FEAR OF COVID-19 AS MEDIATOR

Background: The COVID-19 pandemic created an unprecedented global health emergency, exposing vulnerabilities in healthcare systems and the public’s preparedness to respond effectively. Beyond clinical interventions, the crisis emphasized the critical role of health literacy in managing public fear, guiding health decisions, and promoting protective behaviours. Insufficient health literacy contributes to misinformation, heightened fear, and psychological distress, while adequate literacy strengthens individual resilience and fosters adherence to recommended preventive practices. Understanding these associations is vital for shaping effective public health strategies. Objective: The study aimed to examine the relationship between COVID-19-related health literacy, health consciousness, and preventive behaviours, with a particular focus on the mediating role of fear of COVID-19 among the general population. Methods: A cross-sectional study was conducted from April to June 2021 among residents of Rawalpindi and Islamabad, Pakistan. A total of 384 individuals participated, recruited through convenience sampling. Data collection was carried out using online Google Forms and physical questionnaires. Standardized scales were employed: European Health Literacy Survey Questionnaire (22 items; α=0.903), Fear of COVID-19 Scale (7 items; α=0.863), Health Consciousness Scale (9 items; α=0.736), and Preventive Coronavirus Infection Behaviour Scale (5 items; α=0.853). Data were analysed using IBM SPSS version 23. Descriptive statistics summarized demographics, while correlation and regression analyses, including the Preacher and Hayes mediation method, tested the hypothesized relationships at a 95% confidence interval. Results: The sample comprised 76.8% females and 61.7% participants aged 15–24 years. Correlation analysis indicated significant negative association between COVID-19-related health literacy and fear of COVID-19 (r=-0.169; p<0.01). Fear was positively correlated with health consciousness (r=0.257; p<0.01) but not with preventive behaviours (r=0.055; ns). Regression results confirmed that health literacy significantly predicted fear (p=0.0004), health consciousness (p<0.01), and preventive behaviours (p=0.0008). Mediation analysis revealed fear partially and negatively mediated the relationships of health literacy with health consciousness and preventive behaviours. Conclusion: COVID-19-related health literacy was shown to be a protective factor that reduced fear and enhanced both health consciousness and preventive behaviours. These findings highlight the importance of promoting health literacy as a frontline strategy to improve pandemic preparedness, mitigate fear-driven psychological distress, and strengthen the public’s capacity for healthy decision-making in future health crises.