The Effectiveness of Improving Infectious Disease-Specific Health Literacy Among Residents: WeChat-Based Health Education Intervention Program.

BACKGROUND: Infectious disease-specific health literacy (IDSHL) has become an important determinant of infectious disease incidence. It can not only reduce the incidence of re-emerging infectious diseases, but also effectively prevent the emergence of new infectious diseases such as COVID-19. WeChat, as a new media, has been proven to greatly reduce the chance of infectious diseases spreading from person to person, especially in case of respiratory infections. However, there is currently no concrete health education invention program to improve IDSHL using a WeChat public account. OBJECTIVE: The aims of this study were as follows: (1) to determine the IDSHL of the population in Zhejiang, China; (2) to develop a health education program for the improvement of IDSHL using a WeChat public account; and (3) to evaluate the effectiveness of the health education program that was implemented in the prevention of infectious disease outbreaks. METHODS: We used a standardized questionnaire, which consisted of 28 closed-ended questions, to measure the level and score of IDSHL before and after intervention. A multiple-stage stratified random sampling technique was used to select study participants from Zhejiang province in China, who were further divided randomly into 2 groups: the intervention and control groups. From July 2014 to January 2015, a WeChat-based health education intervention program was carried out on the intervention group. Standard descriptive statistics and chi-square and t tests were conducted to analyze the data. RESULTS: A total of 3001 residents participated in the baseline survey of this study. At baseline, participant IDSHL rates were 73.29% and 72.12% for the intervention and control groups, respectively (Χ21=0.5; P=.50). After 7 months of intervention, 9.90% (297/3001) of participants dropped out of the study. Of the lost participants, 119 were from the intervention group and 178 were from the control group. There were significant differences between follow-up and lost participants with respect to age (P=.04), marital status (P=.02) and occupations (P=.002). After intervention, the intervention group scores in the different domains were higher than those in the control group (infectious disease-related knowledge, prevention, management, or treatment, identification of pathogens and infection sources, and cognitive ability). There were significant improvements in the IDSHL of participants in both the intervention and control groups (Χ21=135.9; P<.001 vs Χ21=9.1; P=.003), and there was a greater change in the IDSHL among the intervention group participants than among the control group participants (1230/1359, 90.51% vs 1038/1359, 77.17%). CONCLUSIONS: The health education intervention program using a WeChat public account proved to be an effective, feasible, and well-accepted means to improve the IDSHL of the general population. In the future, this health education intervention program can be used as a reference for prevention and treatment of infectious diseases.

Factors Associated With Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in China: Internet-Based Cross-sectional Study.

BACKGROUND: The novel coronavirus disease COVID-19 is likely to spread from person to person in close-contact settings. The Chinese Center for Disease Control and Prevention released a handbook on COVID-19, which introduced health information to the public, specifically related to wearing masks correctly and adopting preventive measures to avoid COVID-19 infection. OBJECTIVE: The aim of this study was to assess the level of mask knowledge, behavior related to mask usage, and major information channels used for obtaining mask- and COVID-19-related information in China. METHODS: An internet-based survey was conducted primarily using DingXiang Doctor WeChat public accounts. The data about mask knowledge and behavior were collected and analyzed. In addition to descriptive statistics, logistic regression was used to analyze significant risk factors contributing to protective mask behavior. RESULTS: Data were collected from a total of 10,304 respondents to the survey. More than half of the respondents were under 30 years old and nearly three-quarters were women. Over 80% of participants had a bachelor's degree or higher, and the largest proportion of respondents (n=4204, 40.80%) were employed as business/service workers. Over half of the study participants were married (n=5302, 51.46%). The findings revealed that 67.49% (6954/10,304) of the participants practiced protective mask behavior; 97.93% (10,091/10,304) believed that wearing masks is an effective protective measure against COVID-19; 96.85% (9979/10,304) chose a mask that has two or more layers of washable, breathable fabric; and 70.57% (7272/10,304) wore the masks correctly. Gender, age, occupation, and education level had significant effects on behavior, whereas marital status and the infection status of family members were not significantly related to mask-wearing behavior. In addition, WeChat public accounts (9227/10,304, 89.55%) were the most prominent source of obtaining health information for Chinese netizens after the outbreak of COVID-19. CONCLUSIONS: This study elucidated that Chinese netizens' protective mask behavior is far lower than their mask-related knowledge. Improved information channels and adequate information on wearing masks are necessary to improve the public's protective mask behavior, particularly among men, the elderly, and people with less education.

Concerns About Information Regarding COVID-19 on the Internet: Cross-Sectional Study.

BACKGROUND: Since the outbreak of COVID-19, the Chinese government and the Chinese Center for Disease Control and Prevention have released COVID-19-related information to the public through various channels to raise their concern level of the pandemic, increase their knowledge of disease prevention, and ensure the uptake of proper preventive practices. OBJECTIVE: Our objectives were to determine Chinese netizens' concerns related to COVID-19 and the relationship between their concerns and information on the internet. We also aimed to elucidate the association between individuals' levels of concern, knowledge, and behaviors related to COVID-19. METHODS: The questionnaire, which consisted of 15 closed-ended questions, was designed to investigate Chinese netizens' knowledge about COVID-19. The self-selection online survey method of nonprobability sampling was used to recruit participants through Dingxiangyisheng WeChat (a public, medical, and health service platform in China) accounts. Standard descriptive statistics and multivariate logistic regression analyses were conducted to analyze the data. RESULTS: In total, 10,304 respondents were surveyed on the internet (response rate=1.75%; 10,304/590,000). Nearly all (n=9803, 95.30%) participants were concerned about "confirmed cases" of COVID-19, and 87.70% (n=9036) received information about the outbreak through social media websites. There were significant differences in participants' concerns by sex (P=.02), age (P<.001), educational attainment (P=.001), and occupation (P<.001). All knowledge questions and preventive practices were associated with concerns about COVID-19. The results of the multivariate logistic regression indicated that participants' sex, educational attainment, occupation and employment status, knowledge acquisition, and concern level were significantly associated with the practice of proper preventive behaviors. CONCLUSIONS: This study elucidated Chinese netizens' concerns, information sources, and preventive behaviors related to the COVID-19 pandemic. Sex, educational attainment, occupation and employment status, knowledge acquisition, and level of concern were key factors associated with proper preventive behaviors. This offers a theoretical basis for the government to provide targeted disease prevention and control information to the public.

Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study.

BACKGROUND: In early 2020, over 80,000 cases of coronavirus disease (COVID-19) were confirmed in China. Public prevention and control measures, along with efforts from all sectors of society, were undertaken to control and eliminate disease transmission. OBJECTIVE: This paper describes Chinese citizens' response to the epidemic, the preventive measures they implemented to avoid being infected, and the public strategies that were carried out by the government, health workers, etc. We also discuss the efficacy of these measures in controlling the epidemic in China. METHODS: Information on the responses and behaviors of Chinese citizens were collected through a cross-sectional, internet-based survey using Dingxiang Doctor's public account on WeChat. Information on public strategies implemented by all sectors of society to control the epidemic and data on new COVID-19 cases were collected from the internet, mainly from government websites. Standard descriptive statistics and multivariate logistic regression analyses were conducted to analyze the data. RESULTS: A total of 10,304 participants responded to the survey, with 10,198 valid responses; 74.1% (n=7557) were female and 25.9% (n=2641) were male. Overall, 98.2% (n=10,013) of participants paid high or very high attention to the epidemic, with WeChat being their main information source (n=9400, 92.2%). Over half the participants (n=5878, 57.7%) were confident that the epidemic could be curbed in China; 92.4% (n=9427) opened windows for ventilation more frequently than usual; 97.9% (n=9986) used masks in public; 95.7% (n=9759) avoided large crowds and stayed at home as much as possible; and 97.9% (n=9988) washed their hands more often than usual. Women were more likely to practice these behaviors than men (P<.001). With a series of strict public control measures, like nationwide health education campaigns, holiday extensions, the Examine and Approve Policy on the resumption of work, close management of working and living quarters, a health QR (Quick Response) code system, community screening, and social distancing policies, the number of new cases have decreased dramatically since February 12, 2020. CONCLUSIONS: The methods employed by Chinese citizens and authorities have effectively curtailed the spread of COVID-19, demonstrating that this pandemic can be brought under control as long as the right measures are taken.

[Smoking and secondhand smoking in Zhejiang province, China].

OBJECTIVE: To describe the prevalence rates of smoking, quitting and passive smoking in different populations on their status of education, occupation and geographic distribution. METHODS: A total of 13 408 residents aged 15-69 from 45 counties through stratified multi-stage cluster sampling from Zhejiang province were selected and surveyed, using questionnaires. Data from 13 326 subjects were used for analysis. Indicators as smoking, current smoking, and secondhand smoke exposure, etc., were calculated by weight on age proportions from the 2010 census. RESULTS: Among the adults aged 15 years and older, there were an estimated number of 12.90 million (29.59%) smokers, with 9.99 million (22.92%)current smokers, 8.45 million (19.38%) daily current smokers. The prevalence rates of smoking were 41.18% for men, 3.69% for women, with 45-54 year-old group the highest (51.66%) for men while the group of 65-69 year-olds was the highest (4.62%) in women. The overall rate of quitting was 22.56%. 40.19% of the smokers had thought about quitting, with the main means as self-restriction (87.59%) in conducting the behavior of smoking cessation. Among those non-smokers at age 15 or older, it was estimated that 67.90% (22.77 million) of them had been exposed to secondhand smoke. SHS exposure was the highest in the indoor workplace (62.84%), among all the venues. Knowledge on tobacco among residents seemed to be relatively poor, with only 31.52% of the population were aware that smoking could cause serious three diseases (stoke, heart disease, and lung cancer). 34.04% of the population were aware that secondhand smoking could cause all the three diseases (heart disease, lung disease, and lung cancer). CONCLUSION: Current prevalence of smoking in males in Zhejiang province remained at a high level, indicating that the publicity programs on the knowledge of smoking tobacco was not strong enough and the task of control smoking should be taken more arduously.