Communication about COVID-19 with urban American Indian and Alaska Native peoples: the role of health literacy, trust, and information source.

Background: Developing optimal health communication strategies about COVID-19 and vaccines requires an understanding of the health literacy level of populations, trusted sources of information, and perceptions of COVID-19 messaging. We examined how health literacy is related to knowledge about COVID-19 among American Indian and Alaska Native (AI/AN) peoples.

Methods: We surveyed 788 AI/AN peoples at five Tribal health organizations between January and May 2021. We assessed health literacy using a 4-item health literacy index, and knowledge of COVID-19 in three domains: protection against contracting COVID-19; contracting COVID-19, and clinical manifestations of contraction. Questions also included rating trust of COVID-19 information sources and perceptions of messaging.

Results: Participants had a high level of knowledge about COVID-19; however, health literacy was not significantly associated with any domain of COVID-19 knowledge. Participants perceived the most trusted source of COVID-19-related health information to be health professionals, followed by health clinics. Social media was the least trusted source of information. Tribal sources of information were rated on average higher quality than non-tribal sources.

Conclusions: AI/AN peoples had high levels of accurate knowledge about COVID-19 regardless of assessed health literacy. Information sources should include Tribal-led organizations and health professionals to increase uptake of COVID-19 messaging.