With the outbreak of the novel coronavirus disease 2019 (COVID-19) extraordinary public health measures have been undertaken and new information was provided almost daily. People were informed about the introduction of diverse restrictive measures and steadily increasing numbers of new cases and deaths. However, at the same time, accurate information about the disease mechanisms and its consequences was lacking [1]. A feeling of uncertainty and fear can result from the fast changes in everyday life, and cause stress [2]. A strategy that can be used to deal with the uncertainty caused by a health threatening situation is searching for information [3–5].

Several definitions of health information-seeking behavior (HISB) have been provided in the literature. In a concept analysis on the term “health information-seeking behavior,” Lambert and Loiselle [4] defined it as the means that individuals use to obtain knowledge about health, including health promotion, risks and illnesses. The authors concluded that HISB involves only active and intentional engagement in information behaviors with the goal of fostering coping and psychosocial adjustment to an illness or health hazard. However, HISB could also result in negative outcomes as disruptive behaviors, information overload or avoidance, distrust, distress and anxiety [4, 5]. Whether information-seeking will result in positive or negative outcomes depends on personal and contextual factors, as well as the fit between the information sought and the retrieved information [4]. A recent study from China found that online COVID-19 information-seeking was associated with higher respect of preventive behaviors against contracting the disease and that higher worry caused by online information-seeking could further enhance preventive behaviors [6]. In a study from the UK, obsessive-compulsive symptoms were linked to higher information-seeking, which in turn resulted in higher adherence to government guidelines on COVID-19 [7]. Another study from Germany, showed two possible and yet contrasting outcomes associated with distress by information [8]. On one side, the experience of distress by information led to better compliance with preventive measures. On the other side, increased distress was also associated with avoidance of information, and in turn with lower compliance to preventive measures. In a study conducted among students in Finland [9], social media exposure resulted in information overload and information anxiety, which occurs when people perceive a gap between what they know and what they think they need to know about a topic [10]. Furthermore, excessive online health information-seeking might lead to cyberchondria, described as excessive anxiety or distress related to a high intensity of online information-seeking [11]. Especially at the beginning of the COVID-19 pandemic, when information was ample and rapidly evolving, it could have caused affective concerns and ultimately led to information avoidance [12]. Information avoidance might bring under-information about the development of the pandemic and its implications on health care and social life, but also affect health-related behaviors and the psychosocial health of individuals.

People’s HISB and its associated outcomes might depend on their health literacy [13]. In a systematic review of health literacy definitions and models, Sørensen et al. [14] define health literacy as one’s ability “to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course” (p. 3). The scientific evidence in a wide range of health fields shows that health literacy is associated with health-related knowledge, behaviors and ultimately health care access [15] and health outcomes [16]. In the context of the COVID-19 pandemic, health literacy can affect the approaches used to obtain information on the disease [17]. Inadequate health literacy could result in a poorer understanding of the risks associated with COVID-19, its preventive measures and symptoms, as well as in a higher possibility for misinformation, distrust in health authorities and ultimately adverse mental and physical health outcomes [18]. Previous research assessing the relationship between health literacy and COVID-19 information-seeking behavior focused mainly on university students, digital health literacy and online information-seeking [19–22] or other minority groups as immigrant women [23] and the deaf community [24].

Our aims were to 1) describe COVID-19 information-seeking during the early stage of the pandemic in Switzerland and 2) determine the association between health literacy, worry and anxiety, personal COVID-19 situation, and sociodemographic characteristics and a) frequency of information-seeking; b) use of traditional media; c) use of online resources and d) use of personal networks for information on COVID-19.

Respondents reported searching for information on COVID-19 very frequently and using many different sources to get information. We found higher health literacy to be associated with daily information-seeking, use of online resources and less use of personal networks to obtain information on COVID-19. Worries and anxiety did not influence CISB in our sample. Zimmerman [17] showed that during the pandemic people were more likely to use news for health information and to use a higher number of information sources, compared to the period preceding the pandemic. Several sources that report news were often used for CISB in our sample, including newspapers, TV, radio and portals. These sources are common channels of health information for people with lower health literacy [32]. However, our study showed that during a pandemic the use of news sources for obtaining health information is common also among people with higher health literacy. Nonetheless, participants with high health literacy also used online resources to get information; these included mainly official websites that provide public and quality news. Participants with lower health literacy referred more commonly to personal networks. This group might prefer to obtaining health information through dialogue instead of reading, which requires additional comprehension skills. Additionally, it might be more difficult for people with lower health literacy to browse online health information and select reliable information to read, and they might instead prefer being provided with written information [33]. This group might not be aware of the availability of easy-to-access (both in terms of contents and delivery method) and high-quality online information resources. We therefore recommend that efforts aiming at providing information on COVID-19 to people with lower health literacy should concentrate on personal discussion or education about optimal internet navigation and reliable online resources.

An association between health anxiety and information-seeking has been often found in previous research, but there is no evidence that the relationship between the two variables is one-directional [34]. The current study did not find any association between frequency of CISB or any group of information sources and worry and anxiety. A study on the effect of the COVID-19 pandemic on mental health in the Swiss general population identified impaired mental well-being among one third of respondents [35], which is similar to around one third reporting worries and anxiety in our study. A recent study about cyberchondria in the course of the COVID-19 pandemic [36] identified intensive information-seeking as one of the risk factors for greater fear and anxiety. Despite the frequent information-seeking in our participants, we did not identify an association between use of online resources and worry and anxiety. In their concept analysis, Lambert and Loiselle [4] identified two main dimensions of HISB: the information dimension, and the method dimension. The information dimension describes the type (contents) and amount (level of detail) of the search. The method dimension refers to the actions (e.g., reading) performed in order to obtain the information and the used sources (e.g., newspaper). Since our study emphasized on the method dimension, we suggest future research to address the association between worry or anxiety and information type and amount. It is further possible that whether CISB causes further worry and anxiety depends on other aspects than health literacy.

Some aspects related to personal COVID-19 situation were associated with CISB. We found respondents answering during the stage when restrictions were extensively eased to be less likely to seek for information daily. With time people might have gradually decreased the compulsiveness of their searches as a consequence of adaptation to the “new normal.” Additionally, they may have optimized their ideal information path instead of simply avoiding information on the pandemic. However, we have no data on the degree of search detail and time spent to obtain the information. In our study, participants who did not adhere to physical distancing measures did not seek information on COVID-19 daily. In this group the perceived susceptibility to the virus may have been low [37] and resulted in less interest in this topic. Persons who believed to have already had COVID-19 tended not to use personal networks, which might indicate stigmatization of persons with COVID-19 at the early stage of the pandemic [38]. However, among this group, those with high health literacy used personal networks more often than those with low health literacy, indicating that people with a high health literacy might be more capable to communicate about their disease experience with others.

In line with previous literature [39], sex, age and education were associated with CISB. Men were more likely to engage in CISB daily than women, but women used traditional media sources and personal networks more than men. Older participants were more likely to seek for information daily, and preferred traditional media to online resources compared to younger participants. Personal networks were equally important for information-seeking in both old and very young participants, but people in their working age were less likely to use them for information on COVID-19. Older adults might feel higher susceptibility to severe COVID-19. Therefore, they might want to search for information frequently to stay informed about the latest developments. Traditional media might be preferred by this group over online resources because of the ease with which reliable information can be retrieved [33] or familiarity with acquiring health information through these channels [40]. Finally, in line with previous research [39], participants who completed university education reverted to online resources more often than other participants. People with higher education could be more aware of the heterogeneity of online information and trust in their ability to critically assess the retrieved information [41].