Iran Journal of Nursing

Introduction
The emergence of COIVID-19 was a great challenge in the 21st century, which affected almost all countries in the world. Lockdowns and home quarantine were the first measures to control the transmission of the disease. People’s knowledge of these infectious diseases is also important for disease prevention and control. Health literacy is important in controlling the global spread of COVID-19. Health literacy is defined as the ability to search, find, review and evaluate health information. People with good health literacy have a healthy lifestyle. The Knowledge, Attitude, Practice (KAP) theory suggests that there is not just a single linear relationship between cognition and behavior, and the process of knowledge transforming into behavior will be affected by many factors. Knowledge of COVID-19 has a significant positive effect on health behavior coping with COVID-19. This study aims to investigate the relationship between health literacy and KAP regarding preventive behaviors against COVID-19 in women referring to comprehensive health centers in Zahedan, Southeast of Iran.

Methods
This is a descriptive-analytical study with a cross-sectional design was that was conducted on 144 women who referred to comprehensive health service centers in Zahedan from September to December 2022. The sampling method was multi-stage stratified method by considering a 10% sample dropout. They completed a demographic from, a KAP questionnaire for preventive behaviors against COVID-19, and Savci et al.’s health literacy scale for protection against COVID-19. Data were analyzed using Pearson correlation test, independent t-test, one-way analysis of variance, and regression analysis in SPSS software, version 23 software. The significance level was set at 0.05.

Results
Most of women (56.2%) were in the age group of 20-35 years and married (90.3%) with a middle school education (64.4%). Most of them (81.9%) were willing to receive the COVID-19 vaccine, and 71.3% had no history of hospitalization for COVID-19 infection. Their mean scores of knowledge, attitude, and practice were 14.9±2.93, 42.9±6.69, and 32±6.1, respectively. Their mean score of health literacy was 39.5±11.08. There was a significant relationship between health literacy and knowledge, attitude, and practice (P<0.001).
Practice of women was significant different in terms of age, educational level, and monthly income level. The knowledge and health literacy of women was significantly different in terms of education level (P<0.05). The health literacy of women was also significantly different in terms of monthly income level. Based on the regression model, educational level, monthly income level, and vaccination had a significant relationship with health literacy. These variables accounted for 48% of the variance in the health literacy in the first-order regression model and 61% in the second-order regression model.

Conclusion
The results of this study showed that with the increase in health literacy, the knowledge, attitude and practice regarding preventive behaviors against COVID-19 increases in women. It is recommended to use educational programs to increase health literacy for emerging diseases in women from southern Iran. Health planners and policy makers in Iran can use the results of this study in health promotion interventions.

Ethical Considerations
Compliance with ethical guidelines
Informed consent was obtained from all participants. The present study was approved by the Ethics Committee of Zahedan University of Medical Sciences (code: IR.ZAUMS.REC.1401.009).

Funding
This study was funded by  Zahedan University of Medical Sciences.

Authors' contributions
Writing and editing: Sara Moghimi; Supervision: Maryam Seraji; Data analysis:Zahra Arab Borzu; initial draft preparation and data collection: Fatemeh Eghdam and Sara Rezaei.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all comprehensive health centers in Zahedan, all women who participated in this study, and the Vice-Chancellor for Research and Technology of Zahedan University of Medical Sciencesfor their cooperation and support in this research. 


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