Journal of Modern Medical

Introduction
The rapid spread of COVID-19 in the world created countless problems for societies and changed the existing systems and regular structures, including the lifestyle of people. Exposure to too much information or misleading information in curbing COVID-19 affected the different aspects of people’s lives and caused mental health problems in them. The Internet has become one of the main sources of health-related information and allows its users to acquire the necessary knowledge to improve their personal health and prevent diseases. The increase in the use of the Internet and mobile phones has made health information available to anyone, anywhere and at any time. The ability to find, understand and evaluate health-related information from electronic resources and use this information to identify or solve a health problem is called e-health literacy. With several key goals, e-health entered in various fields such as patient health records, online health interventions, education and learning, mobile phone technologies, and research. We found no systematic review study that examined the impact of e-health literacy on the mental state of people during the COVID-19 pandemic. Therefore, this review study aims to determine the relationship between e-health literacy and the mental state of people during the pandemic.
Methods
This review study follows the PRISMA guidelines. A search was conducted in PubMed, Scopus and Web of Science databases to find articles in English published from the time of the COVID-19 outbreak to August 3, 2021 using the keywords “Electronic Health Literacy”, “COVID-19”, “Mental State”. The studies that investigated the impact of e-health literacy on the mental state of people during the pandemic were included. All short articles, letters to the editor, conference abstracts, observational studies, review articles, as well as articles whose full texts were not accessible and were written in a language other than English, were excluded from the study. Retrieved studies were entered into EndNote software based on the search strategy. The titles, abstracts, and full texts of the articles were independently examined by researchers using the STROBE checklist. Articles that were confirmed based on at least 20 of the 22 items in the checklist were included in the study. After selecting studies, data were collected using a data extraction form which included: First author’s name, year of study, country of study, design of study, purpose of study, number of samples/sampling method, instruments, and main conclusion.
Results
The initial search yielded 116 articles. After examining the articles based on the criteria, finally 6 articles were left for review in the present study. The age of participants in most of the selected articles was in a range of 18-85 years. Their study population were health care workers (n=2), outpatients (n=1), elderly (n=1) and the general public (n=1). The countries where studies were conducted were England (n=1), Croatia (n=1), Vietnam (n=1), the Netherlands (n=1), China (n=1), and Pakistan (n=1). The study design in 83.33% of articles (n=5) was descriptive and 16.66% (n=1) was prospective cohort. In 83% of the articles (n=5), the assessment tool was a questionnaire and in 17% (n=1) the tool was a standard evaluation form. In all articles, the positive role of e-health literacy on people’s mental health was mentioned. They showed that e-health literacy, through increasing people’s knowledge and coping skills, leads to reducing the fear of COVID-19, increasing resilience and well-being, supporting mental well-being, and finally improving the quality of life of people.
Discussion
The COVID-19 is associated with psychological disorders and mental health problems. In this regard, the use of electronic health applications as digital interventions has become popular in almost all healthcare sectors. This indicates the importance and necessity of e-health literacy. In this study, an attempt was made to identify the role of e-health literacy in changing the mental state of people during the COVID-19 pandemic. Due to the small number of conducted studies, more studies are recommended to examine the level of e-health literacy and its impact on the mental state of different groups of society during the pandemic. It seems that understanding the relationship between e-health literacy and people’s mental health can provide useful information to policy makers and health planners to improve mental health and improve e-health literacy of people in society. The present study can play an important role in planning to use mobile health applications to improve the health-related quality of life of people. Considering the effect of e-health literacy on people’s mental health, it is recommended to emphasize the importance of this issue in the media and medical centers so that people become aware of it.

Ethical Considerations
Compliance with ethical guidelines
Considering that it is a review study, it does not have any specific ethical guidelines. Ethics standards in research has been observed.

Funding
This article is not sponsored by any organization or institution and all its financial resources are provided by the first author or authors.

Authors' contributions
Data collection: Erfan Rajabi and Meisam Dastani; Study design: Fatemeh Ameri and Narjes Hadi Tavallaee; Results reporting: Narjes Taghizadeh and Zahra Jalali.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors acknowledge the cooperation and assistance of Ferdows Paramedical and Health Faculty and Gonabad University of Medical Sciences and all the dear ones who helped us in this research.
 

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