COVID-19 Pandemi Döneminde Üniversite Öğrencilerinin Medya Kullanımı, Sağlık Okuryazarlığı, Sağlık Kaygısı ve Sağlık Davranışları

Öz

Pandemi süreci insanların yaşam tarzlarını ve sağlık davranışlarını etkilerken aynı zamanda medya kullanımlarını da etkilemiştir. Bu çalışmanın amacı, COVID-19 salgını sırasında üniversite öğrencilerinin sağlık davranışlarındaki değişimi incelemektir. Sağlık davranışındaki değişiklik, beslenme ve egzersiz alışkanlıklarındaki değişiklikler anlamına gelmektedir. Bu çalışmada medya kullanımı, sağlık okuryazarlığı ve sağlık algısı, sağlık davranışlarındaki değişimin belirleyicileri olarak; sağlık kaygısı ve sağlıklı yaşam becerileri ise aracı değişken olarak ele alınmıştır. Pandeminin ikinci ayında Ankara ilindeki üniversitelerde öğrenim gören 392 üniversite öğrencisine anket uygulanmıştır. Bulgulara göre olumlu sağlık algısı, sağlık okuryazarlığı düzeyi, sağlık kaygısı düzeyi ve sağlıklı yaşam becerileri arttıkça sağlık davranışlarındaki değişim de artmaktadır. Yol analizi bulgularına göre daha olumlu sağlık algısı ve yüksek sağlık okuryazarlığı düzeyi, sağlıklı yaşam becerileri aracılığı ile sağlık davranışlarında daha yüksek düzeyde değişiklik sağlamaktadır. Ayrıca, Twitter kullanımı pandemi sürecinde sağlık kaygısını arttırarak, sağlık davranışlarındaki değişimi arttırmıştır. Bulgular, üniversite öğrencilerinin COVID-19’dan korunmak için sağlık davranışlarını değiştirme motivasyonlarının daha iyi anlaşılmasına yardımcı olmuştur.

Anahtar Kelimeler

• COVID-19
• Sağlık kaygısı
• Sağlık algısı
• sağlık okuryazarlığı
• sağlıklı yaşam becerileri
• Üniversite öğrencileri

Media Usage, Health Literacy, Health Anxiety, and Health Behaviors of University Students During the COVID-19 Pandemic

Öz

Living with the pandemic influenced people’s lifestyles and health behaviors as well as their use of media. The aim of this study is to investigate the level of change in health behaviors of university students during the COVID-19 pandemic. The changes in health behaviors refer to changes of mainly eating and exercise behaviors to stay healthy. In this study, media use, health literacy and health perception are the determinants of change in health behaviors; health anxiety and healthy living skills are considered as mediating variables. Questionnaires were filled in by 392 university students in Ankara, Turkey within the second month of the pandemic. According to the findings, as the levels of positive perception of health, health literacy level, health anxiety level, and healthy life skills increase, the level of change in health behavior increases. The path analysis revealed that more positive perceptions of health and higher levels of health literacy are related to higher levels of change in health behaviors through the mediation of healthy life skills. In addition, the use of Twitter increases health anxiety during the pandemic and results in a higher level of change in health behaviors. The findings help to better understand the motivations to change health behaviors for selfprotection against the COVID-19 among university students.

Anahtar Kelimeler

• COVID-19
• Health Anxiety
• Perception of Health
• Health Literacy
• Healthy Life Skills
• University Students

Kaynakça

1. Abdel-Latif M. (2020). The enigma of health literacy and COVID-19 pandemic. Public Health, 185, 95–96. https://doi.org/10.1016/j.puhe.2020.06.030
2. Abel, T., & McQueen, D. (2020). Critical health literacy and the COVID-19 crisis. Health Promotion International, 35(6), 1612-1613. https://doi.org/10.1093/heapro/daaa040
3. Abramowitz, J.S., Olatunji, B.O., & Deacon, B.J. (2007). Health anxiety, hypochondriasis, and the anxiety disorders. Behavior Therapy, 38(1), 86-94. https://doi.org/10.1016/j.beth.2006.05.001
4. Al-Dmour, H., Masa’deh, R., Salman, A., Abuhashesh, M., & Al-Dmour, R. (2020). Influence of social media platforms on public health protection against the Covid-19 pandemic via the mediating effects of public health awareness and behavioral changes: integrated model. Journal of Medical Internet Research, 22(8), e19996. Doi: 10.2196/19996
5. Antunes, R., Frontini, R., Amaro, N., Salvador, R., Matos, R., Morouço, P., & Rebelo-Gonçalves, R. (2020). Exploring lifestyle habits, physical activity, anxiety and basic psychological needs in a sample of Portuguese adults during COVID-19. International Journal of Environmental Research and Public Health, 17(12), 1-13. https://doi.org/10.3390/ijerph17124360
6. Aras, Z., & Bayık Temel, A. (2017). Evaluation of validity and reliability of the Turkish version of health literacy scale. Florence Nightingale Journal of Nursing, 25(2), 85-94. Doi: 10.17672/fnhd.94626
7. Arbuckle, J. L (2011). AMOS 20 user’s guide. Chicago, IL: AMOS Development Corp.
8. Arı, Ç., Ulun, C., Yarayan, Y. E., Dursun, M., Mutlu, T., & Üstün, Ü. D. (2020). Mindfulness, healthy life skills and life satisfaction in varsity athletes and university students. Progress in Nutrition, 22(2): e2020024. Doi: 10.23751/pn.v22i2-S.10561

9. Asmundson, G.J.G., & Taylor, S. (2020). How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. Journal of Anxiety Disorders, 71, 1-2. https://doi.org/10.1016/j.janxdis.2020.102211
10. Asmundson. G.J.G., Taylor, S., Carleton, R.N., Weeks, J.W., & Hadjstavropoulos, H.D. (2012). Should health anxiety be carved at the joint? A look at the health anxiety construct using factor mixture modeling in a non-clinical sample. Journal of Anxiety Disorders, 26(1), 246-251. https://doi.org/10.1016/j. janxdis.2011.11.009
11. Aydemir, Ö., Kırpınar, İ., Satı, T., Uykur, B., & Cengisiz, C. (2013). Reliability and validity of the Turkish version of the health anxiety inventory. Archives of Neuropsychiatry, 50(4), 325-331. Doi: 10.4274/npa.y6383
12. Banerjee D. & Rao T. S. S. (2020). Psychology of misinformation and the media: Insights from the COVID-19 pandemic. Indian Journal of Social Psychiatry, 36(5), 131-137. DOI: 10.4103/ijsp.ijsp_112_20
13. Berkman N. D., Davis, T. C., & McCormack, L. (2010). Health literacy: What is it?, Journal of Health Communication, 15, 9-19. Doi: 10.1080/10810.730.2010.499985
14. CDC (2020). What is Health Literacy? Available at: https://www.cdc.gov/healthliteracy/learn/index. html#:~:text=These%20definitions%20are%20a%20change,to%20make%20appropriate%20health%20 decisions.%E2%80%9D (Access Date: 19.10.2021)
15. Dadaczynski, K., Okan, O., Messer, M., Leung, A., Rosário, R., Darlington, E., & Rathmann, K. (2021). Digital health literacy and online information seeking in times of COVID-19. A cross-sectional survey among university students in Germany (Preprint). Journal of Medical Internet Research, 23(1), 1-18.
16. de-Mateo-Silleras, B., Camina-Martín, M. A., Cartujo-Redondo, A., Carreño-Enciso, L., de-la-Cruz-Marcos, S., & Redondo-Del-Río, P. (2019). Health perception according to the lifestyle of university students. Journal of Community Health, 44(1), 74–80. https://doi.org/10.1007/s10900.018.0555-4
17. di Renzo, L., Gualtieri, P., Pivari, F., Soldati, L., Attinà, A., Cinelli, G., Leggeri, C., Caparello, G., Barrea, L., Scerbo, F., Esposito, E. & De Lorenzo, A. (2020). Eating habits and lifestyle changes during COVID-19 lockdown: An Italian survey. Journal of Translational Medicine, 18(1), 1-15. https://doi.org/10.1186/ s12967.020.02399-5
18. Diamond, J.J., Becker, J.A., Arenson, C.A., Chambers, C.V., & Rosenthal, M.P. (2007). Development of a scale to measure adults’ perceptions of health: Preliminary findings. Journal of Community Psychology, 35(5), 557-561. https://doi.org/10.1002/jcop.20164
19. Field, A. (2009). Discovering statistics using SPSS (3rd ed.). London, United Kingdom: Sage.
20. Fiorillo, A., & Gorwood, P. (2020). The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. European Psychiatry, 63(1), E32. https://doi.org/10.1192/j. eurpsy.2020.35P
21. Flanagan, E. W., Beyl, R. A., Fearnbach, S. N., Altazan, A. D., Martin, C. K., & Redman, L. M. (2021). The impact of COVID‐19 stay‐at‐home orders on health behaviors in adults. Obesity, 29(2), 438-445. https://doi. org/10.1002/oby.23066
22. Franco, J. A., & Carrier, M. L. (2020). Social media use and depression, anxiety, and stress in Latinos: A correlational study. Human Behavior and Emerging Technology, 2, 227-241.
23. Gallo, L. A., Gallo, T. F., Young, S. L., Moritz, K. M., & Akison, L. K. (2020). The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in Australian university students. Nutrients, 12(6), 1865. https://doi.org/10.3390/nu12061865
24. Gao, J., Zheng, P., Jia, Y., Chen, H., Mao, Y., Chen, S., Wang, Y., Fu, H., & Dai, J. (2020) Mental health problems and social media exposure during COVID-19 outbreak. PLoS One, 15(4): e0231924. https://doi. org/10.1371/journal.pone.0231924
25. Garfin, D. R., Silver, R. C., & Holman, E. A. (2020). The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure. Health Psychology, 39(5), 355-357. http://dx.doi.org/10.1037/hea0000875
26. Genç, A., & Karaman, F. (2019). Developing of healthy life skills scale in university students. Istanbul Gelisim University Journal of Health Sciences, 7, 656-669. Doi: 10.38079/igusabder.496557
27. Gerolimatos, L. A., & Edelstein, B. A. (2012). Predictors of health anxiety among older and young adults. International Psychogeriatrics, 24(12), 1998-2008.
28. Gornicka, M., Drywień, M. E., Zielinska, M. A., & Hamułka, J. (2020). Dietary and lifestyle changes during COVID-19 and the subsequent lockdowns among Polish adults: a cross-sectional online survey PLifeCOVID-19 study. Nutrients, 12(8), 2324.
29. Grotz, M., Hapke, U., Lampert, T., & Baumeister, H. (2011). Health locus of control and health behaviour: Results from a nationally representative survey. Psychology, Health & Medicine, 16(2), 129-140.
30. Harnett, S. (2020). Health literacy, social media and pandemic planning. Journal of Consumer Health on the Internet, 24(2), 157–162. https://doi.org/10.1080/15398.285.2020.1756677
31. Hashemi-Shahri, S.M., Khammarnia, M., Ansari-Moghaddam, A., Setoodehzadeh, F., Okati-Aliabad, H., & Peyvand, M. (2020). Sources of news as a necessity for improving community health literacy about COVID-19. Medical Journal of The Islamic Republic of Iran, 34, 63. https://doi.org/10.34171/mjiri.34.63
32. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi. org/10.1080/107.055.19909540118
33. IBM Corp. (2012). IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.
34. Jungmann, S. M., & Witthöft, M. (2020). Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety? Journal of Anxiety Disorders, 73(102239). 1-9. https://doi.org/10.1016/j.janxdis.2020.102239
35. Kadıoğlu, H., & Yıldız, A. (2012). Validity and reliability of Turkish version of perception of health scale. Türkiye Klinikleri Tip Bilimleri Dergisi, 32(1), 47-53. Doi: 10.5336/medsci.2010-21761
36. Kılıç Taran, B. K., & Tosun, N. Z. (2020). Yeni medyada hikayeleştirme kullanımı bağlamında marka sadakati. Türkiye İletişim Araştırmaları Dergisi, 36, 233-252.
37. Lavrakas, P. J. (2008). Encyclopedia of survey research methods. California: Sage Publications.
38. Leite, Â., Ramires, A., De Moura, A., Souto, T., & Maroco, J. (2019). Psychological well-being and health perception: predictors for past, present and future, Archives of Clinical Psychiatry, 46(3), 53-60. http:// dx.doi.org/10.1590/0101.608.30000000194
39. Li, Y., Wang, X., Lin, X., & Hajli, M. (2018). Seeking and sharing health information on social media: A net valence model and cross-cultural comparison. Technological Forecasting and Social Change, 126, 28-40. https://doi.org/10.1016/j.techfore.2016.07.021
40. Liu, C., & Liu, Y. (2020). Media exposure and anxiety during COVID-19: The mediation effect of media vicarious traumatization. International Journal of Environmental Research and Public Health, 17(13), 4720. https:// doi.org/10.3390/ijerph17134720
41. McNeill, A., Harris, P., & Briggs, P. (2016). Twitter influence on UK vaccination and antiviral uptake during the 2009 H1N1 pandemic. Frontiers in Public Health, 4, 1-13. https://doi.org/10.3389/fpubh.2016.00026
42. Mertens, G., Gerritsen, L., Duijndam, S., Salemink, E., & Engelhard, I. M. (2020). Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. Journal of Anxiety Disorders, 74(102258), 1-33. https://doi.org/10.1016/j.janxdis.2020.102258
43. Muñiz, C. (2020). Media System Dependency and Change in Risk Perception During the COVID-19 Pandemic. Trípodos, 1(47), 11-26.
44. Ng, Y. J., Yang, Z. J., & Vishwanath, A. (2018). To fear or not to fear? Applying the social amplification of risk framework on two environmental health risks in Singapore. Journal of Risk Research, 21(12), 1487-1501.
45. Nguyen, H. C., Nguyen, M. H., Do, B. N., Tran, C. Q., Nguyen, T., Pham, K. M., Pham, L. V., Tran, K. V., Duong, T. T., Tran, T. V., Duong, T. H., Nguyen, T. T., Nguyen, Q. H., Hoang, T. M., Nguyen, K. T., Pham, T., Yang, S. H., Chao, J. C., & Duong, T. V. (2020). People with suspected COVID-19 symptoms were more likely depressed and had lower health-related quality of life: the potential benefit of health literacy. Journal of Clinical Medicine, 9(4), 965. https://doi.org/10.3390/jcm9040965
46. Nudelman, G., Peleg, S., & Shiloh, S. (2021). The association between healthy lifestyle behaviours and coronavirus protective behaviours. International Journal of Behavioral Medicine, 1-9. https://doi.org/10.1007/ s12529.021.09960-6
47. Okan, O., Bollweg, T. M., Berens, E-M., Hurrelmann, K., Bauer, U., & Schaeffer, D. (2020), Coronavirusrelated health literacy: A cross-sectional study in adults during the COVID-19 infodemic in Germany. International Journal of Environmental Research and Public Health, 17(15), 5503. https://doi.org/10.3390/ ijerph17155503
48. Özdelikara, A., Ağaçdiken-Alkan, S., & Mumcu, N. (2018). Determination of health perception, health anxiety and effecting factors among nursing students. Medical Journal of Bakırköy, 14(3), 275-282. https://doi. org/10.5350/BTDMJB.201.703.10015347
49. Özdin, S., & Bayrak Özdin, Ş. (2020). Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. International Journal of Social Psychiatry, 66(5), 504–511. https://doi.org/10.1177/002.076.4020927051
50. Paakkari L., & Okan O. (2020). COVID-19: Health literacy is an underestimated problem. Lancet Public Health, 5(5), e249-e250. Doi:10.1016/S2468-2667(20)30086-4
51. Primack, B.A., Shensa, A., Escobar-Viera, C.G., Barrett, E.L., Sidani, J.E., Colditz, J.B., & James, A.E. (2017). Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among U.S. young adults. Computers in Human Behavior, 69, 1-9. https://doi.org/10.1016/j. chb.2016.11.013
52. Rathbun, K. P., Loerzel, V., & Edwards, J. (2020). Personal perception of health in urban women of low socioeconomic status: A qualitative study. Journal of Primary Care & Community Health, 11, 1-6. https:// doi.org/10.1177/215.013.2720925951
53. Riiser, K., Helseth, S., Haraldstad, K., Torbjornsen, A., & Richardsen, K. R., (2020). Adolescents’ health literacy, health protective measures, and health-related quality of life during the Covid-19 pandemic. PLoS ONE, 15(8), e0238161. Doi: 10.1371/journal.pone.0238161
54. Romero-Blanco, C., Rodríguez-Almagro, J., Onieva-Zafra, M. D., Parra-Fernández, M. L., Prado-Laguna, M. D. C., & Hernández-Martínez, A. (2020). Physical activity and sedentary lifestyle in university students: Changes during confinement due to the Covid-19 pandemic. International Journal of Environmental Research and Public Health, 17(18), 6567.
55. Salkovskis, P. M., Rimes, K. A., Warwick, H. M., & Clark, D. M. (2002). The health anxiety inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(5), 843–853. https://doi.org/10.1017/s003.329.1702005822
56. Saravia, J.C., & Chau, C. (2017). What factors are related to self-perceived health? The relationship between sense of coherence, behaviors and health on Peruvian emerging adults. Journal of Behavior, Health & Social Issues, 9(2), 111–116. https://doi.org/10.1016/j.jbhsi.2017.11.003
57. Schweizer, K. (2010). Some guidelines concerning the modeling of traits and abilities in test construction. European Journal of Psychological Assessment, 26, 1–2. https://doi.org/10.1027/1015-5759/a000001
58. Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422–445. https://doi.org/10.1037/1082-989X.7.4.422 Sørensen, K., Van den Broucke, S., Pelikan, J.M., Fullam, J., Doyle, G., Slonska, Z., Kondilis, B., Stoffles, V.,
59. Osborne, R.H., & Brand, H. (2013). Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health, 13, 948. https://doi.org/10.1186/1471-2458-13-948
60. Spring, H. (2020). Health literacy and COVID-19. Health Information and Libraries Journal, 37(3), 171-172. https://doi.org/10.1111/hir.12322
61. Statista (2020). Leading countries based on number of Twitter users as of July 2020. Available at: https://www. statista.com/statistics/242606/number-of-active-twitter-users-in-selected-countries/ (Access date: 09.10.2020)
62. Suka, M., Odajima, T., Okamoto, M., Sumitani, M., Igarashi, A., Ishikawa, H., Kusama, M., Yamamoto, M., Nakayama, T., & Sugimori, H. (2015). Relationship between health literacy, health information access, health behavior, and health status in Japanese people. Patient Education and Counseling, 98(5), 660–668. https://doi.org/10.1016/j.pec.2015.02.013
63. Szwarcwald, C. L., Damacena, G. N., Souza Júnior, P. R. B. D., Almeida, W. D. S. D., Lima, L. T. M. D., Malta, D. C., ... & Pereira, C. A. (2015). Determinants of self-rated health and the influence of healthy behaviors: Results from the National Health Survey, 2013. Revista Brasileira de Epidemiologia, 18, 33-44.
64. Toci, E., Burazeri, G., Sorensen, K., Jerliu, N., Ramadani, N., Roshi, E., & Brand, H. (2013). Health literacy and socioeconomic characteristics among older people in transitional Kosovo. British Journal of Medicine & Medical Research, 3, 1646–1658.
65. Tull, M. T., Barbano, A. C., Scamaldo, K. M., Richmond, J. R., Edmonds, K. A., Rose, J. P., & Gratz, K. L. (2020). The prospective influence of COVID-19 affective risk assessments and intolerance of uncertainty on later dimensions of health anxiety. Journal of Anxiety Disorders, 75(102290), 1-8
66. Tyrer, P. (2020). COVID‐19 health anxiety. World Psychiatry, 19(3), 307-308. Doi: 10.1002/wps.20798 Usher, K., Bhullar, N., & Jackson, D. (2020). Life in the pandemic: Social isolation and mental health. Journal of Clinical Nursing, 29, 2756-2757. https://doi.org/10.1111/jocn.15290
67. Vannucci, A., Flannery, K. M., & Ohannessian, C. M. (2017). Social media use and anxiety in emerging adults. Journal of Affective Disorders, 207, 163–166. https://doi.org/10.1016/j.jad.2016.08.040
68. von Wagner, C., Knight, K., Steptoe, A., & Wardle, J. (2007). Functional health literacy and health-promoting behaviour in a national sample of British adults. Journal of Epidemiology and Community Health, 61(12), 1086–1090. https://doi.org/10.1136/jech.2006.053967
69. Vozikis, A., Drivas, K., & Milioris, K. (2014). Health literacy among university students in Greece: determinants and association with self-perceived health, health behaviours and health risks. Archives of Public Health, 72(1), 15. https://doi.org/10.1186/2049-3258-72-15
70. Wise, T., Zbozinek, T. D., Michelini, G., & Hagan, C. C. (2020). Changes in risk perception and protective behavior during the first week of the COVID-19 pandemic in the United States, Royal Society Open Science, Preprint at PsyArXiv https://osf.io/dz428
71. Xu, C., Zhang, X., & Wang, Y. (2020). Mapping of health literacy and social panic via Web search data during the COVID-19 public health emergency: infodemiological study. Journal of Medical Internet Research, 22(7), e18831. https://doi.org/10.2196/18831
72. Yokokawa, H., Fukuda, H., Yuasa, M., Sanada, H., Hisaoka, T., & Naito, T. (2016). Association between health literacy and metabolic syndrome or healthy lifestyle characteristics among community-dwelling Japanese people. Diabetology & Metabolic Syndrome, 8(1), 1-9. https://doi.org/10.1186/s13098.016.0142-8
73. Young, D. R., Phillips, J. A., Yu, T., & Haythornthwaite, J. A. (2006). Effects of a life skills intervention for increasing physical activity in adolescent girls. Archives of Pediatrics & Adolescent Medicine, 160(12), 1255-1261.
74. Zheng, Y., Goh, E., & Wen, J. (2020) The effects of misleading media reports about COVID-19 on Chinese tourists’ mental health: A perspective article. Anatolia, 31(2), 337-340, https://doi.org/10.1080/13032. 917.2020.1747208
75. Zhong, B., Huang, Y., & Liu, Q. (2020). Mental health toll from the coronavirus: Social media usage reveals Wuhan residents’ depression and secondary trauma in the COVID-19 outbreak. Computers in Human Behavior, 114(106524), 1-10. https://doi.org/10.1016/j.chb.2020.106524
76. Zoellner, J., You, W., Connell, C., Smith-Ray, R. L., Allen, K., Tucker, K. L., Davy, B. M., & Estabrooks, P. (2011). Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: findings from the rural Lower Mississippi Delta. Journal of the American Dietetic Association, 111(7), 1012–1020. https://doi.org/10.1016/j.jada.2011.04.010