COVID-19-Related Health Literacy of School Leaders in Hong Kong: A Cross-Sectional Study

Sam S. S. LAU*, Eric N. Y. SHUM, Jackie O. T. MAN, Ethan T. H. CHEUNG, Padmore Adusei AMOAH, Angela Y. M. LEUNG, Kevin DADACZYNSKI, Orkan OKAN

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

5 Citations (Scopus)


To date, we know little about COVID-19-related health literacy among school leaders, particularly in East Asia. The present study aimed to assess the level of COVID-19-related health literacy and associated factors (vaccine hesitancy, self-endangering behaviour, and work satisfaction) among school leaders in Hong Kong. A cross-sectional study of 259 school leaders was carried out during the COVID-19 pandemic between April 2021 and February 2022. COVID-19-related health literacy using HLS-COVID-Q22, three subscales of self-endangering work behaviour scales (i.e., “extensification of work”, “intensification of work” and “quality reduction”), and two dimensions of Burnout Assessment Tool (BAT) (i.e., psychosomatic complaints and exhaustion) were used. The study employed independent sample t-test, ANOVA, and multilinear regression models. The findings show that more than half (53.7%) of school leaders had insufficient health literacy. Participants with insufficient health literacy scored significantly higher in the following factors: exhaustion related to work situation (p = 0.029), psychosomatic complaints (p < 0.001), attitude about vaccination (i.e., less agree with vaccination) (p < 0.001), level of informing on COVID-19 related information (i.e., felt less informed) (p < 0.001), and level of confusion about COVID-19-related information (i.e., felt more confused) (p < 0.001). In a linear regression model predicting attitude about coronavirus vaccination, age (β, −0.188, 95% CI, −0.024, −0.005, p = 0.002) and health literacy (β, −0.395, 95% CI, −0.716, −0.361, p < 0.001) were the negative predictors, F(5, 214) = 11.859, p < 0.001. For the linear regression model adjusted for sex and age for predicting health literacy, the model was insignificant. Despite being a highly educated group, this study reveals that one in two Hong Kong school leaders have insufficient health literacy. Inadequate health literacy was strongly associated with a negative attitude about vaccination, low information, and confusion about COVID-19-related information. Additionally, insufficient health literacy was associated with the two secondary symptoms of burnouts. The study highlights an urgent need to develop intervention programmes to promote the COVID-19-specific as well as overall health literacy of the school leaders.
Original languageEnglish
Article number12790
JournalInternational Journal of Environmental Research and Public Health
Issue number19
Publication statusPublished - 6 Oct 2022

Bibliographical note

This article belongs to the Special Issue Proceedings of the International Conference on Environment & Human Health: Challenges & Opportunities in the 21st Century.

This research was funded by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. UGC/IDS(R) 23/20). Part of the data collection was also supported by the Research Collaboration and Development Fund of Lingnan University, Hong Kong (CF21A2). The funding body had no influence on the content of the paper and the publication process.

The protocol of this study was reviewed and approved by the Research Ethics Committee of Hong Kong Baptist University, Hong Kong (REC/20-21/0465).


  • COVID-19
  • school principals
  • school heads
  • health literacy
  • Hong Kong
  • vaccine hesitancy
  • self-endangering work behaviour
  • work satisfaction


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