COVID-19 health literacy and health promotion: insights from Romania

Background

Health literacy among school principals plays an important role in implementing prevention strategies yet remains underexplored in Romania. This study addresses whether principals’ COVID-19-related health literacy correlates with school health promotion activities, aiming to inform targeted interventions for enhanced child health education and pandemic preparedness.

Methods

A cross-sectional study (COVID-HL Principals Survey), using an online survey, was conducted between February and April 2022 and assessed health literacy (using the HLS-COVID-Q22 instrument) and health promotion (custom scale based on WHO Health Promoting Schools framework). Pearson correlations and a multiple linear regression model were used to assess associations, controlling for age, sex, school type, setting, and student numbers.

Results

The final sample included 463 principals or administrative board members from public and private schools across Romania (71.7% female, mean age 47.2 years). The results showed a positive and significant correlation between health literacy and health promotion, indicating that higher health literacy was associated with stronger engagement in health-promoting activities. In regression analysis, sex and the total number of students showed significant associations with health promotion, while age, school type, and school setting did not. Most schools (48%) had not participated in health education programs during the pandemic, although many (84%) reported displaying preventive materials about COVID-19.

Conclusions

The findings suggest that improving health literacy among school leaders may strengthen school-based health promotion, with potential implications for future public health and education policy in Romania.

Key messages

• COVID-19 health literacy among Romanian school principals positively correlates with school health promotion initiatives.

• Most schools displayed COVID-19 prevention materials despite low health education program participation, highlighting missed child health policy opportunities.