Health Literacy and Anxiety Among Hemodialysis Patients During the Coronavirus Disease Pandemic [Letter]

Dear editor

We have read a paper by In Yoon et al about Health Literacy and Anxiety Among Hemodialysis Patients During the Coronavirus Disease Pandemic.¹ We congratulate the authors for valuable information explaining the relationship between health literacy and anxiety levels of hemodialysis patients during the Covid-19 pandemic. Because of that we want to share our views on health literacy, which has an important role in the decision-making process of patients undergoing hemodialysis treatment.²

n Yoon et al’s study aims to determine the relationship between health literacy and anxiety levels in patients undergoing hemodialysis and found that the more knowledge patients have about their disease, the more anxiety they experience.¹ Frings et al, who found that digital health literacy that develops and is easily accessible to patients can exacerbate the anxiety experienced because patients still have difficulty evaluating the information obtained.³ However, Holden et al in her writing found that patients those with low health literacy will face difficulties in obtaining information related to their disease so that their quality of life tends to be worse, while patients who have high health literacy will be able to play an active role in managing their health.²

In Yoon et al collected data using a questionnaire, then measured the patient’s anxiety level using the Coronavirus Anxiety Scale (CAS) and Generalized Anxiety Disorder (GAD), we considered all of these measuring tools to be quite effective,¹ but we recommend adding another instrument, which can assist in the process of measuring the anxiety scale, namely the work behavior scale and the two-dimensional Saturation Assessment Tool (Psychosomatic Complaints and Fatigue).⁴ Another instrument that can be used is a digital survey developed by a consortium of Covid-HL researchers, namely the Future Anxiety Scale and the Digital Health Literacy Instrument (DHLI).⁵

In conclusion, we agree that the health literacy of patients undergoing hemodialysis has an influence on the anxiety they experience.¹ We recommend one of the online courses that can reduce the anxiety experienced by patients undergoing hemodialysis therapy, namely the Internet cognitive behavioral therapy (iCBT) course. Online specifically for patients with anxiety disorders who are guided by a doctor, where in the initial testing phase this course can reduce anxiety, depression, and health pressures. iCBT provides 18 online courses specific to the diagnosis and transdiagnostics for anxiety disorders and can be easily accessed to help manage symptoms of anxiety and mental disorders for patients in need.⁵