Illness perceptions, fear, and COVID-19 protective behaviours: the mediating role of health literacy.

Publication date: Jul 01, 2025

The COVID-19 pandemic affected both the behaviour and the mental health of people and made the decision-making process on health subjects a difficult task. Based on the Common-Sense Model, the current study aimed to investigate and document the public’s perceptions of COVID-19, examine the relationship between health literacy, fear of COVID-19, and illness perceptions and explore their role in the adoption of protective behaviours. Data from 330 adults were collected through an electronic questionnaire, including the Perceived Stress Scale, the Brief Illness Perceptions Questionnaire, the European Health Literacy Questionnaire-16, the Coronavirus Anxiety Scale, the Fear of COVID-19 Scale, and items related to socio-demographic characteristics, protective behaviours and experience of illness. The results show that increased fear was correlated to more dysfunctional perceptions and increased adherence to protective behaviours (mask use and intention to vaccinate). Increased health literacy was correlated to more functional perceptions and higher intention to use masks, but not to get vaccinated. Health literacy was a significant mediator in the relationship between fear and illness perceptions and between fear and protective behaviours. The results could be useful for promoting public health risk prevention. Targeting strategies for managing negative emotions and enhancing health literacy could be an important step toward more functional illness perceptions and health behaviours.

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