The effect of individual factors on health behaviors among college students: the mediating effects of eHealth literacy

Association between social capital, mental health, and digital health literacy among the university students in China: a multigroup analysis based on major difference

BACKGROUND

This study aimed to clarify medical-nonmedical difference on the relationship between social capital, mental health and digital health literacy of university students in China, and furtherly provide evidence-based suggestions on the improvement of the digital health literacy for the university students.

METHODS

The snowball sampling method was used to collect data from the university students (including medical students and nonmedical students) through online questionnaires, and finally 1472 university students were included for the data analysis, of whom, 665 (45.18%) were medical students, 807 (54.82%) were nonmedical students; 462 (31.39%) were male, 1010 (68.61%) were female. Mean value of the age was 21.34 ± 2.33 for medical students vs. 20.96 ± 2.16 for nonmedical students. Descriptive analysis, chi-square test analysis, one-way Analysis of Variance (conducted by SPSS) and structural equation modeling (conducted by AMOS) were employed to explore the difference on the relationship between social capital, mental health and digital health literacy between the medical students and nonmedical students.

RESULTS

The mean value of the digital health literacy was 36.27 (37.33 for medical students vs. 35.39 for nonmedical students). The SEM analysis showed that there was a statistically positive correlation between social capital and digital health literacy (stronger among the nonmedical students (0.317) than medical students (0.184)). Mental health had a statistically positive impact on the digital health literacy among medical students (0.242), but statistically significant correlation was not observed in nonmedical students (0.017). Social capital was negatively correlated with the mental health for both medical students and NMS (stronger among the nonmedical students (0.366) than medical students (0.255)). And the fitness indices of SEM were same between medical students and nonmedical students (GFI = 0.911, AGFI = 0.859, CFI = 0.922, RMSEA = 0.074).

CONCLUSION

The digital health literacy of the university student was relatively high. Both social capital and mental health could exert a positive effect on digital health literacy, while social capital was found to be positively associated with mental health. Statistical difference was found between medical students and nonmedical students on the above correlations. Implications were given on the improvement of the digital health literacy among university students in China.

The Mediating Role of Students' Health Information Literacy Skills: Exploring the Relationship Between Web Resource Utilization and Health Information Evaluation Proficiency

BACKGROUND

In an increasingly digital age, students rely heavily on web resources to access health information. However, evaluating the reliability and relevance of such information is crucial for informed decision-making. This study examines the importance of students' health information literacy skills (HILS) as mediators, particularly their ability to utilize web resources and successfully evaluate health information.

OBJECTIVES

This research investigates the mediating role of students' HILS in the relationship between their utilization of web resources and their proficiency in evaluating health information.

METHOD

An online survey was distributed to current students at a public university in Bangladesh as part of the data collection process for this study. Using Google Forms, the authors created a structured questionnaire. The survey was distributed through Messenger groups, Facebook pages and email invitations to reach the target audience effectively. The researchers thoroughly analysed the gathered data using structural equation modelling (SEM) techniques and SmartPLS-4 software to look for correlations between the variables.

RESULT

The study revealed that among the 122 participants, a significant number (N = 47) accessed internet health information on an occasional basis, whereas 30 individuals reported using it infrequently. The data revealed that 58 individuals, accounting for 47.5% of the sample, possessed the necessary abilities to access and assess online health information. Additionally, 57 participants, representing 46.7% of the sample, demonstrated proficiency in conducting online health information searches. The measurement model demonstrated good convergent validity, as evidenced by composite reliability (CR) scores and Cronbach's ⍺ values over 0.700 and an average extracted variance (AVE) of 0.500. The structural model demonstrated R2 values exceeding 0.1, thus validating its dependable forecasting capability. Notable effects were seen, with f2 values of 0.335 and 0.317 for the challenges in accessing and evaluating health information (CAEHI) to health information evaluation (HIE) and CAEHI to HILS relationships, respectively. The mediation analysis found that HILS act as a mediator between types of web resources (TWRs) and HIE, with TWR having an indirect impact on HIE through HILS.

DISCUSSION

The result supports all hypotheses. Therefore, it is evident that students' HILS mediate the relationship between utilization of web resources and their proficiency in evaluating health information.

CONCLUSION

This study's findings could significantly impact instructional practices meant to raise students' health information literacy. This initiative seeks to enable students to make informed decisions about their health by providing them with the necessary tools to analyse and evaluate health-related information.

PATIENT OR PUBLIC CONTRIBUTION

Research on health information literacy can assist patients and the general public by instructing them on how to assess trustworthy online health resources. Students gave insightful feedback that assisted in shaping the study and guaranteeing its relevancy. If they better comprehend health information literacy, patients and the general public can use web-based resources and critically evaluate health information more accurately.

Associations Between Sociodemographic Characteristics, eHealth Literacy, and Health-Promoting Lifestyle Among University Students in Taipei: Cross-Sectional Validation Study of the Chinese Version of the eHealth Literacy Scale

BACKGROUND

The popularization of the internet and rapid development of mobile devices have led to an increased inclination and opportunities to obtain health-related information online. The eHealth Literacy Scale (eHEALS), widely used for measuring eHealth literacy, assesses an individual's ability to search, understand, appraise, and use eHealth information. However, the Chinese version of the eHEALS multiple-factor model remains to be validated, and the correlation between eHEALS and the health-promoting lifestyle profile (HPLP) among university students is rarely explored in Taiwan.

OBJECTIVE

This study aimed to examine the fit, validity, and reliability of the Chinese eHEALS multiple-factor model and to clarify the predictive effects of eHEALS on the HPLP among university students.

METHODS

University students in Taipei, the capital of Taiwan, were recruited, and 406 valid questionnaires including sociodemographic characteristics, eHEALS, and HPLP responses were collected. Confirmatory factor analysis was performed to validate the Chinese eHEALS. Independent sample t test, 1-way ANOVA, and multiple linear regression analyses were conducted to examine the relationship between sociodemographic variables and the HPLP. Pearson product-moment correlation and binary logistic regression analyses were performed to ascertain the predictive effects of eHEALS on the HPLP.

RESULTS

The Chinese eHEALS exhibited an optimal fit when delineated into the search, usage, and evaluation 3-factor model (comparative fit index=0.991, Tucker-Lewis index=0.984, root mean square error of approximation=0.062), and its validity and reliability were confirmed. The mean eHEALS score of university students was 3.17/4.00 (SD 0.48) points, and the score for the evaluation subscale was the lowest (mean 3.08, SD 0.56 points). Furthermore, there were significant sex, institution orientation, daily reading time, daily screen time, primary information channel, and perceived health status differences in the HPLP: male participants (t404=2.346, P=.02), participants attending general university (t404=2.564, P=.01), those reading ≥1 hour daily (F2,403=17.618, P<.001), those spending <3 hours on mobile devices or computers daily (F2,403=7.148, P<.001), those acquiring information from others (t404=3.892, P<.001), and those with a good perceived health status (F2,403=24.366, P<.001) had a significantly higher score. After adjusting for sociodemographic variables, the eHEALS score remained an independent predictor of the HPLP. Compared to students with relatively high eHEALS scores, those with relatively low eHEALS scores had a 3.37 times risk of a negative HPLP (adjusted odds ratio [OR]=3.37, 95% CI 1.49-7.61), which could explain 14.7%-24.4% of the variance (Cox-Snell R2=0.147, Nagelkerke R2=0.244, P=.004).

CONCLUSIONS

There is room for improvement in eHealth literacy among university students in Taipei. eHEALS may be used to screen students who require HPLP improvement, thereby providing appropriate eHealth literacy training programs, particularly those targeting evaluation literacy. Additionally, the 3-factor model of the Chinese eHEALS used in this study results in more definite scale content, thus increasing the practicality and applicability of this scale in health-promoting studies.

The development of health literacy scale for acute complications of diabetes for children with type 1 diabetes (8-12 years)

PURPOSE

This study aimed to develop a Health Literacy Scale for Acute Complications of Diabetes for Children with Type 1 Diabetes (8-12 years of age) and to test the instrument in terms of its psychometric properties.

METHODS

The study is of methodological design and was conducted with 222 children, aged 8 to 12 years, with type 1 diabetes who were registered at a training and research hospital's diabetes outpatient clinic. The item pool of the study consisted of 22 statements. Ten experts were asked to review the scale, and when content validity was confirmed, the scale items were amended until the draft scale had 22 items. The children themselves completed the "Diagnostic Form for Children with Diabetes" and "Health Literacy Scale for Acute Complications of Type 1 Diabetes for Children (8-12 years)" questionnaire between June 2021 and October 2022. Exploratory factor analysis (EFA), item-total correlation, and split-half reliability testing were employed for psychometric properties.

RESULTS

The scale comprised 19 items and 3 factors containing information on acute complications of diabetes and health literacy.

CONCLUSION

A valid and accurate instrument was developed to measure the acute complications of diabetes in children and their health literacy. As such, the scale can be used as a practical tool in evaluating the understanding and implementation skills of children with Type 1 diabetes regarding the management of acute complications of the disease and in assessing their health literacy.

Association of 24-hour movement guideline adherence, mental health and quality of life in young adults: the role of e-Health literacy

Background

The spread of Covid-19 and resultant infection prevention strategies have disturbed the life routine of Chinese young adults, led to reduced physical activity (PA), prolonged screen time (ST) and inadequate sleep duration (SP), and made immense influence on their mental health (MH) and quality of life (QoL). E-Health literacy (EHL) can enable citizens to use available online information to respond to the highly complex information environment and make appropriate health decisions.

Objective

This study aims to examine associations between adhering to 24-h movement (24HM) guidelines and MH and QoL among young adults, as well as to identify any mediating or moderating role of EHL in these associations.

Methods

1742 young adults (20.03 ± 1.54 years old, 68.6% females) from north and south China completed self-report measures of 24HM (PA, ST and SP), health indicators (MH and QoL), EHL and demographic information through an online survey between 4 Apr and 16 Jun 2022. Generalized linear mixed models were applied for data analysis.

Results

Results showed that adhering to PA, ST and SP guidelines were all positively connected with QoL while MH was associated with adhering ST or SP guidelines. Adhering to more of 24HM guidelines was linked to better MH and QoL. EHL significantly mediated the association of guideline adherence and QoL and moderate that of guideline adherence and MH.

Conclusion

This is the first study to investigate the role of EHL on the associations between 24HM and MH as well as QoL during the Covid-19. The findings may contribute to further empirical research or intervention that aims to promote MH or QoL among young adults more effectively or provide valuable references for developing relevant strategies or policy of health promotion or public health events in China.

Associations of eHealth Literacy with Social Activity among Community-Dwelling Older Adults: A Cross-Sectional Study

Older adults who use digital technology are desired to adapt to digitalization and literacy. One required aspect is eHealth literacy, measured with the eHealth Literacy Scale (eHEALS). Many studies on eHealth literacy have used the eHEALS to examine the health behaviors of college students, relatively younger adults, and Internet users. However, the relevance of eHealth literacy to social activity has not yet been studied in older adults. The purposes of this study were to examine the relationship between eHealth literacy and health behaviors and social activities (community, cultural, and sports activities) and to investigate the factors associated with eHEALS scores among community-dwelling older adults. The mean eHEALS score was 12.4 points (SD 8.2), with the majority (73.3%) having the lowest score (the lowest score is 8 points). Males (17.6, SD 10.5) scored significantly higher than females (11.8, SD 7.7). The eHEALS score had a significant relationship with both cultural and community activity. Five factors significantly associated with having the lowest eHEALS score were cultural activity at least once a week, no cultural activity, no community activity, total IADL score, and intellectual activity. These results suggest that eHealth literacy is associated with community activity and cultural activity among older adults.

Effects of Digital Health Literacy Program on Sufficient Health Behavior Among Thai Working-Age People With Risk Factors for Noncommunicable Diseases

BACKGROUND

Noncommunicable diseases (NCDs) account for more than 75% of deaths in Thailand, which is higher than the global average of 71%.

OBJECTIVE

The aim of this study was to investigate the effects of the Digital Health Literacy (DHL) and Sufficient Health Behavior (SHB) Program on Thai working-age adults age 20 to 65 years with risk factors for NCDs (i.e., overweight and lacking physical activity), and compare the health literacy (HL) and SHB of participants living in urban and semi-urban areas at posttest.

METHODS

Using the lottery method, this one-group pretest-posttest quasi-experimental design randomly selected 200 participants and assigned them to two equally sized groups. The data were gathered through surveys with an item discrimination power between .20 and .86 and a reliability of 0.94 and were statistically analyzed using t-test and F-test.

KEY RESULTS

The DHL and SHB Program comprises six sessions over a 12-week period, and activities designed to enhance knowledge of NCDs, HL, health communication, and health behavior modification. It was conducted by health care workers from urban and semi-urban public hospitals via Zoom using various digital toolkits such as YouTube, animations, infographics, role-play videos, clips, and e-books. At the posttest, the participants had higher HL (t = 2.67, p = .001) and SHB (t = 3.36, p = .001). There was a difference in SHB scores (F = 4.640, p = .032) between those living in urban and those in semi-urban areas, but no difference in HL scores (F = 1.436, p = .232).

CONCLUSIONS

The DHL and SHB Program improved HL and SHB in Thai working-age adults with risk factors for NCDs in both urban and semi-urban communities. [HLRP: Health Literacy Research and Practice. 2024;8(2):e93-e101.].

The mediating effect of eHealth literacy on the relationship between health personality and quality of life in community-dwelling older adults

AIMS

To explore the relationship between health personality and quality of life among community-dwelling older adults and to examine the mediating effect of eHealth literacy on this relationship.

METHODS

A total of 413 community-dwelling older adults from central China were recruited from September 2022 to January 2023. A cross-sectional investigation was conducted using the Chinese versions of the Health Personality Assessment (HPA), eHealth Literacy Scale (eHEALS), and 12-item Short Form Health Survey (SF-12). Correlations between the three variables were examined by Pearson analysis, and mediation analysis was conducted to explore the direct, indirect, and total effects of the health personality on quality of life vis-à-vis eHealth literacy.

RESULTS

Health personality factors (including health neuroticism, health openness, and health conscientiousness), eHealth literacy, and quality of life are significantly correlated (P<0.05); eHealth literacy can play a significant mediating role in the relationship between health neuroticism (β= -0.256, 95 %CI: [-0.405, -0.119]), health openness (β = 0.488, 95 % CI: [0.343,0.652]), health conscientiousness (β= 0.489, 95 % CI: [0.354, 0.634]) and quality of life.

CONCLUSION

This study revealed that the effect of health personality factors (including health neuroticism, health openness, and health conscientiousness) on quality of life in older adults was mediated through eHealth literacy.

IMPACT

Individual personality is essential to understanding eHealth literacy and quality of life among community-dwelling older adults. It may be helpful to identify the health personality traits of older adults first, then implement targeted interventions accordingly to enhance eHealth literacy and ultimately improve quality of life.

Prospective association of eHealth literacy and health literacy with physical activity among Chinese college students: a multiple mediation analysis

Background

The COVID-19 pandemic has decreased physical activity (PA) while increasing demand for electronic health resources. eHealth literacy (EHL) is expected to aid eHealth use and health promotion. EHL was raised on the grounds of health literacy (HL). This study explored the associations among EHL, HL, and PA in Chinese college students and identified mediating mechanisms in the EHL/HL-PA relationship.

Methods

An integrated social-cognitive model was proposed. A total of 947 Chinese college students (52.8% women, age = 19.87 ± 1.68 years) completed the three-wave data collection. Path analysis was performed.

Results

An adequate good-to-fit model was indicated. Perceived EHL (PEHL) was significantly associated with perceived HL (PHL) and HL performance (HLP); PHL was negatively related to HLP; PEHL was significantly associated with self-efficacy (SE) and social support (SS); PHL had a significant effect on SS but not SE; HLP significantly affected SS but not SE; SS and SE positively predicted intention (INT), which then predicted PA. SS mediated PEHL/PHL-INT links; SE mediated the PEHL-INT link; SS and INT jointly mediated PEHL/PHL/HLP-PA; SE and INT jointly mediated PEHL-PA.

Conclusion

Relationships among EHL, HL, and PA were explored with multiple mediating mechanisms identified. Differential SE and SS roles in EHL/HL-PA links suggest new mechanisms to inform EHL/HL intervention development.

Preparing for the future of healthcare: Digital health literacy among medical students in Lahore, Pakistan

Objective

Digital Health Literacy (DHL) is becoming a cardinal competence for all healthcare professionals (HCPs) including medical students for meaningful digital transformation of healthcare. As medical students need to navigate an increasingly digitalized healthcare environment, thus the study's objective was to assess digital health literacy among medical students.

Methods

This cross-sectional analytical study was conducted at King Edward Medical University, Lahore from October 2022 to August 2023. Medical students were asked to complete a pen and paper questionnaire of the Digital Health Literacy Instrument (DHLI) after informed consent. DHLI covers seven categories: operational skills, information searching strategy, analyzing the usefulness of online information, navigational abilities, contributing user-generated material to internet-based platforms, and privacy protection. SPSS was used for data analysis.

Results

Eight hundred ninety one medical students, from first year to final year, participated in the study. The overall mean score for DHL was 63.5 (SD=8.82). Medical students achieved a score of 83.2% of total score in their operational abilities, and 82.3% proficiency in privacy protection, which were deemed highly desirable. Furthermore, they achieved a satisfactory level in navigation skill (76.0%), information searching (73.1%), adding content (71.0%), determining the significance of data (70.1%), and assessing data reliability (68.7%), based on the overall score. A significant relationship was observed between the performance level of DHL domains and gender with higher scores in males in all domains except protecting privacy, which was higher in females and clinical years students (p-value < 0.05).

Conclusion

The assessment of the DHL of medical students was deemed desirable. But certain obstacles were encountered in few domains of DHL i.e., data reliability, relevance determination, and content augmentation. It is imperative to elevate the level of DHL of medical students to harness the potential of digital technologies in enhancing healthcare.

Association between digital health literacy and physical activity levels among individuals with and without long-term health conditions: Data from a cross-sectional survey of 19,231 individuals

Objectives

This study explored associations between digital health literacy and physical activity levels and assessed potential interactions of long-term health conditions.

Methods

A cross-sectional survey was sent to 34,000 inhabitants in Region Zealand, Denmark. The survey included items on physical activity levels and three electronic Health Literacy Questionnaire (eHLQ) scales (1, 4, and 5). Associations were assessed by logistic regression and adjusted for confounders.

Results

A total of 19,231 participated in the survey. Positive associations were found between higher digital health literacy and being active >30 min./week at moderate-to-vigorous intensity (eHLQ 1: OR 1.24, p < 0.001; eHLQ 4: OR 1.13, p = 0.012; eHLQ 5: OR 1.25, p < 0.001), compliance with the World Health Organization minimum recommendations for physical activity (eHLQ 1: OR 1.33 p < 0.001; eHLQ 4: OR 1.08 p = 0.025; eHLQ 5: OR 1.32, p < 0.001), and self-reported physical active (eHLQ 1: OR 1.50 p < 0.001; eHLQ 4: OR 1.24 p < 0.001; eHLQ 5: OR 1.54 p < 0.001), even when fully adjusted for covariates. No significant interaction was found for long-term health conditions. However, individuals with more long-term health conditions exhibited the lowest digital health literacy scores (9% to 19% scored <2.0).

Conclusion

A higher digital health literacy is positively associated with higher physical activity levels. This highlights the importance of screening and promoting digital health literacy in managing digital health and digital physical activity interventions. Future research should explore strategies and targeted interventions to enhance digital health literacy and improve health outcomes.

Descriptive Norms and eHealth Use Among Older Adults: A Cross-Country Comparative Study

eHealth use enables older adults to access and manage healthcare resources, and benefits their health; however, older adults' uptake of eHealth remains low across societies. Social influences such as descriptive norms may be of critical importance in promoting the elderly's usage of eHealth. Based on the Integrative Model of Behavioral Prediction, this study investigates how descriptive norms relate to eHealth use among the elderly in China and the United States. Analysis of the combined sample (N = 1,070) showed that descriptive norms were positively related to eHealth use. Also, descriptive norms were indirectly associated with eHealth use via injunctive norms, attitudes and self-efficacy. Moderated mediation analysis indicated that these direct and indirect relationships differed across the two countries. This study highlights the important role of descriptive norms in promoting older adults' eHealth use behavior and addresses potential country differences in how the elderly respond to descriptive norms. Several important theoretical and practical implications are also discussed.

Social determinants of health literacy: a cross-sectional exploratory study

Despite the importance of health literacy to health-promoting behaviors, few studies have assessed the social determinants of health literacy in a random sample of individuals from the USA. The study evaluated the association of sociodemographic factors with individual health literacy levels. This cross-sectional web-based observational study utilized the Health Literacy Questionnaire (HLQ), a multidimensional instrument measuring nine areas of literacy. Multivariate regression results revealed several factors associated with HLQ scores such as self-rated health rating, frequency of visits to healthcare providers, smoking, gender and rural versus urban residence. Low health literacy was associated with lower self-rated overall health and with less frequent visits to healthcare providers. Males scored higher on engaging with health providers, navigating, understanding the health system and understanding health information well enough to know what to do. These findings can guide healthcare professionals to focus on individuals from groups having lower health literacy scores to promote healthy behaviors.

The relationship between e-health literacy and information technology acceptance, and the willingness to share personal and health information among pregnant women

BACKGROUND

Many factors may affect pregnant women's willingness to accept information (IT) technology and share their personal and health information. One of these factors is their e-health literacy level.

OBJECTIVE

To investigate the relationship between e-health literacy and IT acceptance, as well as the willingness of pregnant women to share their information.

METHODS

This survey was conducted among pregnant women visiting hospitals and private physicians' offices in Zahedan, Iran in 2019. Data were collected using a 4-part questionnaire with 66 questions. The data were analyzed using descriptive (frequency, percentage, mean and standard deviation) and inferential (Pearson correlation coefficient and linear regression) statistics.

RESULTS

The mean scores of electronic health literacy, information technology acceptance, and willingness of pregnant women to share personal and health information were 27.43 ± 5.82, 145.49 ± 25.72, and 19.16 ± 5.47, respectively. There was a significant relationship between IT acceptance and information sharing, which means that with increasing IT acceptance, people were more willing to share their information. Also, the results showed that with the decrease in economic well-being, the willingness to share personal and health information decreases.

CONCLUSION

This study showed that with the increase in e-health literacy of pregnant women, their IT acceptance grows. Increasing IT acceptance improves their willingness to share their information. Setting and updating information-sharing rules and security mechanisms with the participation of people can help reduce concerns and increase public trust. Healthcare policymakers can encourage the use of health IT in the prevention and treatment of diseases by providing relevant education and informing people.

Investigation of the relationship of general and digital health literacy with various health-related outcomes

Background

Despite the growing number of health literacy surveys, we know little about the combined effect of the different dimensions of health literacy on various health-related outcomes.

Objective

Thus, our study aimed to examine the impacts of general and digital health literacy on health behaviour, confidence in vaccination, self-perceived health, and health care utilization.

Methods

Our research was part of the Health Literacy Population Survey 2019-2021, which was an international, multicentre, cross-sectional study. The data were collected via computer-assisted telephone interview in December 2020 in Hungary. Multiple multinomial logistic and multivariate linear regression models were used to analyse the separately effects of general and digital health literacy on the studied outcomes. Moreover, the combined effect of general and digital health literacy was also analysed via sensitivity analyses. In the last step, the interactions between general and digital health literacy were examined using the Johnson-Neyman procedure.

Results

The results did not reveal any associations between health literacy and health behaviour. Health care use was only affected by digital health literacy; however, this effect was inconsistent. Both dimensions of health literacy were positively associated with self-perceived health and vaccination confidence.

Conclusion

Our results suggest that increasing health literacy could promote health and vaccination confidence, while the potential effect of higher digital health literacy on more conscious use of the health care system should be investigated further.

#EntreViagenseAprendizagens: study protocol of a school-based intervention to promote well-being and healthy lifestyles among adolescents

Background

Adolescence is a critical period of development in which well-being usually decreases, mental health problems (e.g., depression, anxiety) increase, and lifestyles become less healthy. Schools are a primary setting for the promotion of the well-being and overall health of adolescents, and preventive actions should be a priority within the scope of health-promoting schools. #EntreViagenseAprendizagens is a school-based intervention aiming to promote well-being and healthy lifestyles among adolescents based on social and emotional learning, positive psychology, and health education approaches.

Methods

This protocol describes a school-based intervention, #EntreViagenseAprendizagens, that will be implemented in several schools in Portugal. The program is aimed at 8th and 9th grade students (14-16 years old) and comprises 20 weekly sessions. One of the sessions is aimed at the students' parents/guardians. The intervention content targets social and emotional skills, health literacy (physical and mental health), healthy lifestyles, character strengths, and well-being. An experimental design will be used in the intervention evaluation. Eighth grade classes will be randomly assigned to the intervention group or the control group. All students complete the same assessment protocol at baseline, post-intervention, and 9-month follow-up. The impact assessment protocol includes measures related to well-being, health literacy, health-related knowledge, attitudes and behaviors, relationships with others, social and emotional skills, and sociodemographic data. Process evaluation includes evaluation forms at the end of each session and at the end of the program and focus groups with students, parents, and teachers at the end of the program.

Discussion

This school-based intervention may play an important role in promoting students' well-being and in preventing unhealthy lifestyles and socio-emotional maladjustment, by focusing on the development of social and emotional skills and health literacy among adolescents, empowering them to face the changing future and grow up healthy. Furthermore, this project aims to provide relevant scientific findings that can contribute to the development of better health-promoting schools.

Translation, cultural adaptation and validity assessment of the Dutch version of the eHealth Literacy Questionnaire: a mixed-method approach

BACKGROUND

The digitalization of healthcare requires users to have sufficient competence in using digital health technologies. In the Netherlands, as well as in other countries, there is a need for a comprehensive, person-centered assessment of eHealth literacy to understand and address eHealth literacy related needs, to improve equitable uptake and use of digital health technologies.

OBJECTIVE

We aimed to translate and culturally adapt the original eHealth Literacy Questionnaire (eHLQ) to Dutch and to collect initial validity evidence.

METHODS

The eHLQ was translated using a systematic approach with forward translation, an item intent matrix, back translation, and consensus meetings with the developer. A validity-driven and multi-study approach was used to collect validity evidence on 1) test content, 2) response processes and 3) internal structure. Cognitive interviews (n = 14) were held to assess test content and response processes (Study 1). A pre-final eHLQ version was completed by 1650 people participating in an eHealth study (Study 2). A seven-factor Confirmatory Factor Analysis (CFA) model was fitted to the data to assess the internal structure of the eHLQ. Invariance testing was performed across gender, age, education and current diagnosis.

RESULTS

Cognitive interviews showed some problems in wording, phrasing and resonance with individual's world views. CFA demonstrated an equivalent internal structure to the hypothesized (original) eHLQ with acceptable fit indices. All items loaded substantially on their corresponding latent factors (range 0.51-0.81). The model was partially metric invariant across all subgroups. Comparison of scores between groups showed that people who were younger, higher educated and who had a current diagnosis generally scored higher across domains, however effect sizes were small. Data from both studies were triangulated, resulting in minor refinements to eight items and recommendations on use, score interpretation and reporting.

CONCLUSION

The Dutch version of the eHLQ showed strong properties for assessing eHealth literacy in the Dutch context. While ongoing collection of validity evidence is recommended, the evidence presented indicate that the eHLQ can be used by researchers, eHealth developers and policy makers to identify eHealth literacy needs and inform the development of eHealth interventions to ensure that people with limited digital access and skills are not left behind.

Comparison of eHealth Literacy Scale (eHEALS) and Digital Health Literacy Instrument (DHLI) in Assessing Electronic Health Literacy in Chinese Older Adults: A Mixed-Methods Approach

This study compared the reliability, construct validity, and respondents' preference of the Chinese version of 8-item eHEALS (C-eHEALS) and 21-item DHLI (C-DHLI) in assessing older adults' electronic health (eHealth) literacy using a mixed-methods approach. A web-based, cross-sectional survey was conducted among 277 Chinese older adults from September to October 2021, and 15 respondents were subsequently interviewed to understand their preference of scale to use in practice. Results showed that the internal consistency and test-retest reliability of both scales were satisfactory. For the construct validity, the C-DHLI score showed stronger positive correlations with having Internet use for health information and higher educational attainments, occupational skill levels, self-rated Internet skills, and health literacy than the C-eHEALS score. In addition, younger age, higher household income, urban residence, and longer Internet use history were only positively correlated with C-DHLI score. Qualitative data suggested that most interviewees perceived the C-DHLI as more readable than C-eHEALS for its clear structure, specific description, short sentence length, and less semantic complexity. Findings revealed that both scales are reliable tools to measure eHealth literacy among Chinese older adults, and the C-DHLI seemed to be a more valid and favored instrument for the general Chinese older population based on the quantitative and qualitative results.

The Relation Between eHealth Literacy and Health-Related Behaviors: Systematic Review and Meta-analysis

BACKGROUND

With widespread use of the internet and mobile devices, many people have gained improved access to health-related information online for health promotion and disease management. As the health information acquired online can affect health-related behaviors, health care providers need to take into account how each individual's online health literacy (eHealth literacy) can affect health-related behaviors.

OBJECTIVE

To determine whether an individual's level of eHealth literacy affects actual health-related behaviors, the correlation between eHealth literacy and health-related behaviors was identified in an integrated manner through a systematic literature review and meta-analysis.

METHODS

The MEDLINE, Embase, Cochrane, KoreaMed, and Research Information Sharing Service databases were systematically searched for studies published up to March 19, 2021, which suggested the relationship between eHealth literacy and health-related behaviors. Studies were eligible if they were conducted with the general population, presented eHealth literacy according to validated tools, used no specific control condition, and measured health-related behaviors as the outcomes. A meta-analysis was performed on the studies that could be quantitatively synthesized using a random effect model. A pooled correlation coefficient was generated by integrating the correlation coefficients, and the risk of bias was assessed using the modified Newcastle-Ottawa Scale.

RESULTS

Among 1922 eHealth literacy-related papers, 29 studies suggesting an association between eHealth literacy and health-related behaviors were included. All retrieved studies were cross-sectional studies, and most of them used the eHealth Literacy Scale (eHEALS) as a measurement tool for eHealth literacy. Of the 29 studies, 22 presented positive associations between eHealth literacy and health-related behaviors. The meta-analysis was performed on 14 studies that presented the correlation coefficient for the relationship between eHealth literacy and health-related behaviors. When the meta-analysis was conducted by age, morbidity status, and type of health-related behavior, the pooled correlation coefficients were 0.37 (95% CI 0.29-0.44) for older adults (aged ≥65 years), 0.28 (95% CI 0.17-0.39) for individuals with diseases, and 0.36 (95% CI 0.27-0.41) for health-promoting behavior. The overall estimate of the correlation between eHealth literacy and health-related behaviors was 0.31 (95% CI 0.25-0.34), which indicated a moderate correlation between eHealth literacy and health-related behaviors.

CONCLUSIONS

Our results of a positive correlation between eHealth literacy and health-related behaviors indicate that eHealth literacy can be a mediator in the process by which health-related information leads to changes in health-related behaviors. Larger-scale studies with stronger validity are needed to evaluate the detailed relationship between the proficiency level of eHealth literacy and health-related behaviors for health promotion in the future.

Impact of Online-Delivered eHealth Literacy Intervention on eHealth Literacy and Health Behavior Outcomes among Female College Students during COVID-19

This study examined the effects of a novel online-delivered eHealth literacy intervention to improve eHealth literacy and positive health behaviors among female college students during COVID-19. Female college students taking a physical education class were allocated to either an online-based eHealth literacy intervention group (n = 62) or a physical education class (n = 58). Weekly two-hour sessions were implemented through Zoom videoconferencing over six weeks. We measured eHealth literacy, exercise self-schemata, and health behavior outcomes (eating, sleep, and exercise) before and after the intervention. A two-way repeated measures ANOVA was conducted to examine within- and between-group differences in all outcomes. The ANOVA (2 × 2) for the interaction effect of group and time showed a statistical significance in eHealth literacy and cognitive-emotional exercise self-schemata. There was a marginally significant interaction effect for exercise but none for eating and sleep. This was the first trial to examine the impact of the online eHealth literacy intervention on eHealth literacy and health behavior outcomes for college students during COVID-19. Preliminary findings indicated that the intervention showed promising effectiveness for improving eHealth literacy and promoting health behaviors among female college students.

The association among eHealth literacy, depressive symptoms and health-related quality of life among older people: A cross-section study

BACKGROUND

eHealth literacy can facilitate the uptake of benefits of health for older persons. The aim of this study was to examine the association of eHealth literacy with depression, health-related quality of life (HRQoL) among older persons.

METHODS

A survey of 6183 participants (aged 60 years and above) from 17 communities was conducted in June 2019. Participants answered questions related to basic information, eHealth literacy scale (eHEALS), geriatric depression scale and the short-form health survey (SF-36). Mediation model and a linear regression analysis were performed to explore the association between the eHEALS scores and related factors.

RESULTS

The mean score of eHEALS was 21.17 (SD = 8.25). eHEALS was significant higher in men, those with living in the city, those with high educated and stable income and those with living with children, as compared to their counterparts, respectively. Moreover, chronic diseases and depressive symptoms negatively associated with eHEALS, while actively obtaining health information and physical activity positively influenced eHEALS. Furthermore, depressive symptoms had direct and indirect effects on HRQoL, as mediated by eHealth literacy.

CONCLUSIONS

The eHEALS acts as a mediator between depressive symptoms and HRQoL. As eHealth literacy is a protector for older people, efforts to improve the older persons' eHealth literacy could help to maintain health status. Therefore, healthcare providers formulate effective programs to improve eHealth literacy for older persons, which can bring benefits for health ageing.

The associations among cognitive social factors, eHealth literacy and health-promoting behaviors in Chinese adolescents

The internet is a critical source of health information. It is important to understand online health information seeking related factors among college students, as modifications in this have the potentials to enhance their health-promoting behaviors in their transition into early adulthood. This study assessed the associations among cognitive social factors, eHealth literacy, online health information seeking and health-promoting behaviors; and examined the potential mediation effect of online health information seeking and eHealth literacy on the association between cognitive social factors and health-promoting behaviors. A cross-sectional, Internet-based survey was conducted in a sample of Chinese college students (n = 289) during April to June 2018. The structural model fitted the data well: X2/df = 2.27; CFI = 0.95; TLI = 0.94; RMSEA = 0.07 (95% CI: 0.06, 0.08); SRMR = 0.07 and the results showed that performance expectancy and health motivation were significantly and positively associated with health-promoting behaviors indirectly through eHealth literacy, adjusting for other cognitive social factors, frequency of online health information seeking and background factors. eHealth literacy is a strong mediator of the association between cognitive social factors (performance expectancy and health motivation) and health-promoting behaviors. Implications and potential interventions to promote eHealth literacy and health-promoting behaviors are discussed.

Infodemic Preparedness and COVID-19: Searching about Public Health and Social Measures Is Associated with Digital Health Literacy in University Students

We aimed to evaluate the associations between information searching about public health and social measures (PHSM) and university students' digital health literacy (DHL) related to the new coronavirus (SARS-CoV-2) and COVID-19.

METHODS

This cross-sectional study included 3,084 Portuguese university students (75.7% females), with an average age of 24.2 (SD = 7.5). Sociodemographic data, DHL questionnaire and online information concerning PHSM were gathered. Cox proportional hazards models were performed.

RESULTS

Students who searched for personal protective measures achieved in shorter time sufficient "evaluating reliability" (HR = 1.4; 95% CI = 1.1; 1.7) and "determining relevance" (HR = 1.5; 95% CI = 1.2; 1.8). Searching for surveillance and response measures was associated with sufficient "determining relevance" (HR = 1.4; 95% CI = 1.1; 1.9). Finally, those students who searched for environmental, economic and psychosocial measures achieved in shorter time "determining relevance" (HR = 1.2; 95% CI = 1.0; 1.4).

CONCLUSIONS

Searching for PHSM was significantly associated with an increased likelihood of achieving sufficient DHL subscales in a shorter time. Further studies are needed, including developing strategies to increase the availability of high-quality information concerning public health and social measures and to improve (digital) health literacy.

eHealth literacy measurement tools: a systematic review protocol

BACKGROUND

Improving eHealth literacy (eHL) is one of the biggest challenges currently facing the global healthcare community. Indeed the use of digital services has the potential to engage patients in care as well as improve the effectiveness of chronic disease self-management, it remains highly dependent on a patient's specific skills and experiences in the health care systems. Although eHealth literacy has gained momentum in the past decade, it remains an underresearched area, particularly eHealth literacy measurement. The aim of the review is to identify patient-reported outcome measures (PROMs) of eHealth literacy for adult populations and to summarize the evidence on their psychometric properties.

METHODS

We will conduct a systematic literature review of the tools used to measure eHealth literacy for adult population. The search strategy aims to find published studies. A three-step search strategy will be used in this review. Published studies will be searched in CINAHL, PubMed, PsycINFO, and Web of Science from inception until end. Grey literature will be searched to find theses. Database search strategies will be formulated and tested with the assistance of an expert Health Sciences Librarian. The selection of studies will be done by two independent reviewers. Disagreements will be resolved through consensus, and a third reviewer will solve discrepancies. Furthermore, two reviewers will independently evaluate the methodological rigor of the instruments development and testing and assign a grade using the standardized Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Disagreements will be discussed with a third reviewer, expert in psychometrics. Extracted data will be aggregated and analyzed to produce a set of synthesized findings that will be used to develop evidence-informed recommendations in regard of eHL instruments. We will present a synthesis of all instruments, their psychometric properties, and make recommendations for eHL instrument selection in practice. Reporting will be informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and a PRISMA flow diagram.

DISCUSSION

This systematic review will summarize the evidence on the psychometric properties of PROMs instruments used to measure eHL and will help clinicians, managers, and policy-makers to select an appropriate instrument.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021232765.

The relationship between COVID-19-related prevention cognition and healthy lifestyle behaviors among university students: Mediated by e-health literacy and self-efficacy

BACKGROUND

At present, few studies have explored the mediating effect of e-Health literacy and self-efficacy on prevention cognition and healthy lifestyle behaviors during the normalization stage of COVID-19 prevention and control. This study aimed to determine the associations among COVID-19-related prevention cognition, self-efficacy, e-Health literacy, and healthy lifestyle behaviors at university students.

METHODS

By using a stratified cluster random sampling method, 971 students from five universities were recruited between May and August 2021 in Guangzhou, China. We collected participants' demographic characteristics, and assessed self-efficacy, COVID-19-related prevention cognition, e-Health literacy, and healthy lifestyle behaviors. A structural equation model was used for mediation analysis.

RESULTS

The overall mean value of healthy lifestyle behaviors of college students was 0.307 (SD 0.389). Between COVID-19-related prevention cognition, e-Health literacy, self-efficacy, and healthy lifestyle behaviors (r = 0.132-0.505, P < 0.01) were a significant positive correlation. The COVID-19-related prevention cognition had a direct and positive predictive effect on healthy lifestyle behaviors, with a direct effect value of 0.136. e-Health literacy and self-efficacy played both an independent mediating and serial-multiple mediating roles in the association between COVID-19-related prevention cognition and healthy lifestyle behaviors, and the indirect effect values were 0.043, 0.020 and 0.035, respectively.

CONCLUSIONS

The results showed that the emphasis on improving college students' prevention cognition, supplemented by improving e-Health literacy and self-efficacy, could improve college students' healthy lifestyle behaviors.

LIMITATIONS

This study was a cross-sectional investigation with no causal relationship between variables.

Perceived Information Distortion about COVID-19 Vaccination and Addictive Social Media Use among Social Media Users in Hong Kong: The Moderating Roles of Functional Literacy and Critical Literacy

During the COVID-19 pandemic, distorted information about the COVID-19 vaccination is widely disseminated through social media. The present study examined the association between perceived information distortion about COVID-19 vaccination on social media, individuals’ functional and critical literacy, and addictive social media use (SMU), as well as the moderating roles of functional and critical literacy in the association between perceived information distortion and addictive SMU among social media users in Hong Kong. A web-based, cross-sectional survey was conducted among 411 Chinese citizens from June to August 2021. Findings showed that after adjusting for significant background variables, including age, gender, marital status, education, occupation, and income, functional literacy was negatively associated with addictive SMU. In addition, significant moderation effects of functional literacy and critical literacy were also observed, such that a positive association between perceived information distortion on social media and addictive SMU was significant among participants with lower functional literacy or higher critical literacy. Findings highlight the importance of improving functional literacy in addictive SMU prevention for social media users. Special attention should also be paid to the potential influence of critical literacy on addictive SMUs.

The Longitudinal Relationship Between eHealth Literacy, Health-Promoting Lifestyles, and Health-Related Quality of Life Among College Students: A Cross-Lagged Analysis

Objectives

This study aimed to explore the longitudinal associations between eHealth literacy, health-promoting lifestyles, and health-related quality of life (HRQoL) among college students.

Methods

From December 2019 (T1) to December 2020 (T2), we administered the eHealth literacy scale, Short-Form Health Survey (SF-12), and Short-Form Health-Promoting Lifestyle Profile Scale to 1,181 college students in Jinan, China. Participants were recruited for 12 months for the two-stage survey.

Results

Stable positive correlations were shown between eHealth literacy, health-promoting lifestyles, and HRQoL across time. The cross-lagged analysis showed that eHealth literacy at T1 predicted health-promoting lifestyles at T2 (β = 0.080, P = 0.006); however, health-promoting lifestyles at T1 did not predict eHealth literacy at T2 (β = −0.026, P = 0.499). HRQoL at T1 predicted health-promoting lifestyles at T2 (β = 0.147, P < 0.001); however, similar to the eHealth literacy finding, health-promoting lifestyles at T1 did not predict HRQoL at T2 (β = 0.045, P = 0.142). eHealth literacy was also bi-directionally associated with HRQoL, and the prediction effect of eHealth literacy at T1 to HRQoL at T2 (β = 0.078, P = 0.008) was slightly higher than the prediction effect of HRQoL at T1 to eHealth literacy at T2 (β = 0.074, P = 0.023).

Conclusion

eHealth literacy and HRQoL may be antecedents for college students' health-promoting lifestyles. There may be significant bi-directional relationships between eHealth literacy and HRQoL.

The relationship between e-health literacy and health-promoting behaviors of Turkish hospital nurses

The increase in information technologies has made it easy to access much health information online. In this context, e-health literacy emerges as a skill for acquiring health information. Obtaining health information through information technology for health promotion requires e-health literacy. The aim of this study was to examine the e-health literacy and the health-promoting behaviors of Turkish hospital nurses directly involved in patient care. This descriptive and cross-sectional study was carried out with 451 nurses working in two large training and research hospitals in Izmir between June and August 2019. Data were collected using the Turkish version of the Healthy Lifestyle Behavior Scale II and the Turkish version of the e-Health Literacy Scale. Descriptive statistics and multiple linear regression analysis were used for data analysis. Nurses were found to have moderate levels of healthy lifestyle behaviors (130.56 ± 21.90) and e-health literacy (29.87 ± 5.39). There was significant relationship between the e-health literacy levels of the nurses and their overall health-promoting behaviors (R = .349; F = 12,381; p = 0.013), health responsibility (R = .326; F = 10,567; p = 0.014), spiritual development (R = .242; F = 5.276; p = 0.001) and interpersonal relations (R = .343; F = 9.896; p = 0.001) scores. The results of this study showed that the development of strategies to improve the e-health literacy of nurses may contribute to the maintenance of health-promoting behaviors of both nurses and their patients.

Reserve Soldiers’ Psychological Resilience Impact to Sustainable Military Competences: On the Mediating Role of Psychological Skills (Effort, Self-Efficacy, Proactivity)

This research aims to explore an analytical model, gauge the interplay between psychological resilience and achieved military competencies, and examine an intermediary role of effort, proactivity, and self-efficacy. In this study, 337 reserve soldiers from Lithuania were investigated with the Lithuanian Military Training Competences Assessment Scale, Resilience Scale, Self-Efficacy Scale, Short Grit Scale (Grit-S), and Proactivity Scale. Our findings highlighted the importance of the psychological resilience of reserve soldiers due to its positive relationship with the personality traits. Implicit interconnectedness between psychological resilience and psychological skills together with military competences was researched, and it became evident that self-efficacy determined a statistically important mediating role (indirect effect = 0.264 **, p < 0.05) between reservists’ psychological resilience and perceived military training course results. However, the other components included in the study did not have a mediating effect (effort indirect effect = 0.03, p > 0.1; proactivity indirect effect = 0.094, p > 0.1). The research findings are important because of greater prominence of the role of reserve troops in military operations around the world and achievements in the domain of security and defense. This study has great theoretical and empirical value in making decisions concerning the psychological resilience of reserve soldiers’ promotion and sustainable improvement of military preparedness strategies.

eHealth usage among Chinese college students: qualitative findings

BACKGROUND

The information technology has developed rapidly with the evolution of internet environment transformed from requiring computer skills for information searching to self-managing health data and applying information. Therefore, a more diverse range of eHealth skills is required and these skills are referred as eHealth literacy. However, most eHealth literacy studies focused mainly on information searching skills. Little is known about eHealth usage behaviors of college students in this day and age.

OBJECTIVES

This study aimed to investigate how Chinese college students engage with eHealth tools and to determine the elements of their eHealth literacy.

METHODS

A purposive sample of 18 Chinese college students was recruited for in-depth interviews. Interviewees included three males and three females of each city (Beijing, Wuhan and Putian) from sports, medical, and non-health-related majors. Conventional content analysis was applied for data analysis.

RESULTS

The eHealth usage of different-major-students were compared and profiled by three themes of Expectance, Usage pattern and Perception. In Expectances, non-health major students applied eHealth only for urgent health need, sport major students used it to monitor health while medical major students, as frequent users for searching health database. In Usage pattern, purposes of eHealth for personal, practical and theoretical were identified for non-health major, sport major and medical major groups, respectively. In Perceptions, sport students felt more curious about eHealth than the other groups who perceived either fear (non-health students) or skeptical (medical students). By compiling those themes, the whole picture of eHealth usage was emerged. Based on that, the current study identified the related skills using the trilogy of Web 1.0 to 3.0, and derived a conceptual framework for eHealth literacy in the present day.

CONCLUSIONS

The current study obtained a comprehensive understanding of eHealth usage and a framework of eHealth literacy required for Chinese college students. And it gives a clearer look at web 3.0 related eHealth behaviors.

How to predict the electronic health literacy of Chinese primary and secondary school students?: establishment of a model and web nomograms

Background

The internet has become an important resource for the public to obtain health information. Therefore, the ability to obtain and use such resources has become important for health literacy. This study aimed to establish a prediction model of Chinese students’ electronic health literacy (EHL) to guide government policymaking and parental interventions, identify the predictors of EHL in Chinese students using random forests, and establish a corresponding prediction model to help policymakers and parents determine whether primary and secondary school students have high EHL.

Methods

This is a cross-sectional study. From June to August 2021, a cluster sample survey was conducted with 1,300 students from seven primary and secondary schools in Shaanxi Province, China. We evaluated 1,235 primary and secondary school students using the e-health literacy scale. The data were divided into training and testing datasets in a 70:30 ratio for further analysis using random forest. The predictive accuracy of the score was measured using the area under the receiver operating characteristic curve. We also used decision curve analysis to determine the usefulness of the prediction model by quantifying the net benefits at different threshold probabilities in the validation dataset. 

Results

We found that 33.6% of students had high EHL. The univariate analysis showed that age (P < 0.001), grade (P < 0.001), employment status (P < 0.001), household location (P < 0.001), parental phubbing behavior (P < 0.001), and general self-efficacy (P < 0.001) were significantly associated with EHL. A random forest classification model was developed with the training dataset (872 students), and seven variables were confirmed as important: age, grade, employment status, father education level, game time, parental phubbing behavior, and general self-efficacy. The validation of the model showed good discrimination, with an area under the curve of 0.975 in the training dataset and 0.738 in the testing dataset. The model was translated into an online risk calculator, which is freely available (https://xietao.shinyapps.io/DynNomapp/).

Conclusions

In this study, an intuitive tool to predict the EHL of Chinese primary and secondary school students was developed and validated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13421-4.

Validation of the COVID-19 Digital Health Literacy Instrument in the Italian Language: A Cross-Sectional Study of Italian University Students

The Coronavirus Disease 19 (COVID-19) pandemic and the associated “infodemic” have shown the importance of surveillance and promotion of health literacy, especially for young adults such as university students who use digital media to a very high degree. This study aimed to assess the validity and reliability of the Italian version of the COVID-19 adapted version of the Digital Health Literacy Instrument (DHLI). This cross-sectional study is part of the COVID-19 University Students Survey involving 3985 students from two Italian universities. First, item analysis and internal consistency were assessed. Then, Principal Component Analysis (PCA) and Confirmatory Factor Analyses (CFA) were performed comparing different models. The Italian DHLI showed good psychometric characteristics. The protecting privacy subscale was excluded, given the criticalities presented in the validation process. CFA confirmed the four-factor structure, also including a high-order factor. This result allows using the scale to measure a global level of digital health literacy and consider its levels separately for each construct component: searching the web for information, evaluating reliability, determining personal relevance, and adding self-generated content.

Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study

BACKGROUND

The rapid development of digital health has reduced the time and cost of medical treatment, bringing efficient and economical benefits. However, older adults all over the world are deficient in digital health knowledge and skills to varying degrees. This study intends to investigate the current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China, so as to provide theoretical reference for global digital health researches and the construction of gerontological digital health service models.

METHODS

A cross-sectional survey was conducted from September 2020 to April 2021 in Chongqing, China. 572 community-dwelling older adults (≥ 65 years) were surveyed by stratified sampling. Data on sociodemographic characteristics, Internet usage, attitude towards Internet health information and digital health literacy were collected. Wherein, the digital health literacy assessment adopted the Digital Health Literacy Assessment Scale for community-dwelling older adults, which was developed by the research group, proven to be with good internal consistency (0.941), split-half reliability (0.889), test-retest reliability (0.941), content validity (0.967), criterion validity (0.938) and construct validity. The influencing factors were explored by univariate analysis and multiple linear regression analysis.

RESULTS

The average score of digital health literacy was 37.10 (SD 18.65). Univariate analysis showed that there were statistically significant differences in the comparison of digital health literacy according to 16 variables, such as different age and education levels. Multiple linear regression analysis showed that education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy, while age and perceived risk were negatively correlated with digital health literacy.

CONCLUSION

The overall digital health literacy of community-dwelling older adults in Southwest China is relatively low. In the future, health professionals should fully consider the diverse influencing factors of digital health literacy, assess individual differences and provide targeted intervention programs. Meanwhile, global public health authorities should integrate health resources effectively, and seek health service models for older adults in line with the development of the digital age to narrow the digital divide.

Electronic health literacy and health-related outcomes among older adults: A systematic review

This review aims to identify, appraise, and synthesize research evidence of the association between electronic health (eHealth) literacy and health outcomes in older adults. English-written articles that presented the relationships between eHealth literacy and health-related outcomes in older adults were identified by searching five scientific databases (Web of Science, PubMed, Cochrane Library, APA PsycInfo, and EMBASE) hand-searching reference lists. Searches yielded 2993 studies after duplicates were removed, of which 24 publications were included in the final review. eHealth literacy was relatively low in older adults, and the eHealth Literacy Scale, developed by Norman and Skinner in 2006, was the most frequently used instrument in the included studies (21/24, 87.5%). The health-related outcomes associated with eHealth literacy were grouped into four categories: physical, behavioral, psychosocial, and cognitive. For behavioral (e.g., health-promoting behaviors, self-care, and medication adherence) and cognitive (e.g., health knowledge and health decision making) outcomes, the evidence was mostly consistent that eHealth literacy was positively associated with better outcomes. For physical (e.g., health-related quality of life) and psychosocial outcomes (e.g., anxiety and self-efficacy), the associations were less consistent, with some studies showing significant associations while others showed no associations. Most included studies were assessed as moderate quality. Overall, higher eHealth literacy is associated with more positive health behaviors and better health knowledge and attitude in older adults, however, the associations with some physical and psychosocial outcomes are less consistent. Clarifying the pathways of the relationships between eHealth literacy and some health-related outcomes is needed for further exploring their underlying mechanisms.

Validating the Digital Health Literacy Instrument in Relation to COVID-19 Information (COVID-DHL-K) among South Korean Undergraduates

Digital health literacy is crucial in accessing and applying health information in the COVID-19 pandemic period. Young college students are exposed daily to digital technologies, and they have further increased the use of digital information during the COVID-19 period. This study aimed to adapt DHLI into Korean and to assess the psychometric properties, during the COVID-19 pandemic period. A cross-sectional, nationwide, and web-based survey was conducted among 604 Korean undergraduates from 23 December 2020 to 8 January 2021. On the basis of the Digital Health Literacy Instrument (DHLI) by the Global COVID HL Network, the Korean questionnaire was developed by group translation, expert reviews, and forward-backward translation for validation. The scale reliability and validity were examined using Cronbach's alpha and confirmatory factor analysis. Results support the theoretical and empirical four-factor structure (search, express, evaluate, use) in the coronavirus-related DHL among Korean University students. Internal reliability of the overall scale was high (Cronbach's α = 0.908). The four-factor model was supported by confirmatory factor analysis (GFI = 0.972, CFI = 0.984, TLI = 0.978, RMSEA = 0.045). This study revealed that the COVID-DHL-K is a valid and reliable measure with appropriate psychometric characteristics.

Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey

Background

High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison.

Objective

The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc).

Methods

Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses.

Results

As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R²=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R²=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians.

Conclusions

In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research.

Seniors’ eHealth literacy, health and education status and personal health knowledge

Background

The COVID-19 pandemic made eHealth literacy skills and online health activities essential for seniors.

Research aims

(a) To examine the differences in eHealth literacy dimensions (awareness of sources, recognizing quality and meaning, understanding information, perceived efficiency, validating information) as related to participants’ health status and education level. (b) To explore the effect of eHealth literacy dimensions on participants’ personal health knowledge.

Methods

We used a cross-sectional design with a convenience sample of 298 Israeli seniors aged 65 or over during the second lockdown. The questionnaire was composed of three sections: (a) background characteristics, (b) an eHealth Literacy scale, and (c) perceived personal health knowledge.

Results

Participants with an excellent health status reported higher levels of awareness of sources and perceived efficiency than participants with poor or good health statuses. Furthermore, participants with a graduate degree understand online information better than participants with a high school education. Moreover, it was found that participants with a high school education sense that they are being smart on the net more than participants with an undergraduate degree. Finally, we found that eHealth literacy dimensions influenced the participants’ personal health knowledge.

Conclusion

As the population ages, it becomes more at risk for disease, and as a result, its health status weakens. Therefore, it is important to provide seniors with appropriate intervention programs for improving their eHealth literacy, which may eliminate health inequality. In addition, caregivers need to develop patients’ eHealth literacy skills—finding, evaluation, and interpretation of online health knowledge relevant to them.

A Comprehensive Analysis of E-Health Literacy Research Focuses and Trends

Objective: To sort out the research focuses in the field of e-health literacy, analyze its research topics and development trends, and provide a reference for relevant research in this field in the future. Methods: The literature search yielded a total of 431 articles retrieved from the core dataset of Web of Science using the keywords “ehealth literacy”, “E-health literacy” and “electronic health literacy”. A bibliometric analysis was performed by using CiteSpace to explore the development history, hot themes, and trends of future research in the field of e-health literacy. Results: The thematic evolution path in e-health literacy was divided into three stages. The research focuses were inspected from four aspects: evaluation, correlation with health-promotion behaviors, influencing factors, and intervention measures for improvement. Conclusion: E-health literacy research faces challenges such as the development of the connotation of the term, the objectivity of evaluation methods, and the long-term impact of interventions. Future research themes in e-health literacy will include the standardization of evaluation instruments and the individualization of therapeutic strategies.

COVID-19 crisis: Influence of eHealth literacy on mental health promotion among Saudi nursing students

Objective

This study aims to determine the influence of eHealth literacy on mental health promotion among Saudi nursing students.

Method

This cross-sectional study was conducted from 19 April to 21 May 2020. A total of 468 nursing students responded to the self-administered online survey. Two instruments, namely, the eHealth Literacy Scale and the Positive Mental Health Scale, were used. Statistical tools such as frequency, percentage, mean, and standard deviation were used for the descriptive analysis. Multiple regression analysis was employed to analyse the relationship between eHealth literacy, health promotion, and its predictors.

Results

The results showed that 30.3% of nursing students were dissatisfied with their general health. Students perceived high self-assessed eHealth literacy and positive mental health. Students in the 4th year had lower scores than those of students in the 2nd year. Nursing students perceived that the quarantine and public social distancing lowered their mental health scores. Finally, the eHealth literacy mean scores resulted in a 0.21-point increase in the positive mental health scores.

Conclusion

The finding of the study shows that the eHealth literacy positively influnce the mental health status of Saudi Nursing students.

Investigating predictors of self-care behavior among homebound older adults: The role of self-efficacy, eHealth literacy, and perceived social support

PURPOSE

This study aimed to investigate the predictors of self-care behavior among homebound older adults using the Health Empowerment theory as a framework.

DESIGN

This was a cross-sectional, predictive correlational study.

METHODS

Sixty-eight participants were randomly selected from five Hong Kong community centers from May 21, 2020 through July 20, 2020. Self-care behaviors were assessed using the Chinese version of Partners in Health. Self-efficacy, eHealth literacy, and perceived social support were assessed as potential predictors of self-care behaviors. A multiple linear regression analysis was adopted to examine the predictive effects.

RESULTS

The age of the sample ranged from 61 to 85 years (mean = 71.7, SD = 6.0). Participants who reported having sufficient or more than sufficient financial resources had better self-care behaviors than those who claimed to have insufficient financial resources (F = 5.08, p = 0.009). Statistically significant correlations were found between the participants' eHealth literacy (r = 0.54, p < 0.001), perceived social support (r = 0.60, p < 0.001), and self-care behaviors. eHealth literacy (β = 0.13, p = 0.007) and perceived social support (β = 0.13, p < 0.001) were significant predictors of self-care behaviors. Collectively, the three variables accounted for 41% of the variances in self-care behaviors.

CONCLUSIONS

The findings in this study suggest that eHealth literacy and perceived social support are two key factors that predicted the self-care behaviors of this vulnerable population.

CLINICAL RELEVANCE

In this technological era, the use of eHealth, together with enhanced social support, can lead to better self-care among older adults, particularly those who are homebound.

The Impact of Scholastic Factors on Physical Activity Levels during the COVID-19 Lockdown: A Prospective Study on Adolescents from Bosnia and Herzegovina

Scholastic factors (academic achievement) are hypothesized to be important determinants of health-related behaviors in adolescents, but there is a lack of knowledge on their influence on physical activity levels (PAL), especially considering the COVID-19 pandemic and the imposed lockdown. This study aimed to investigate the associations between scholastic factors and PAL before and during the pandemic lockdown. The participants were adolescents form Bosnia and Herzegovina (n = 525, 46% females), who were observed prospectively at the baseline (before the pandemic lockdown) and during the lockdown in 2020 (follow-up). The scholastic factors (grade point average, behavioral grade, school absences, unexcused absences) were evidenced at the baseline (predictors). The outcome (PAL) was evaluated using the Physical Activity Questionnaire for Adolescents at the baseline and the follow-up. Gender, age, parental/familial conflict, and sport participation were observed as confounders. No significant influence of the predictors on PAL were evidenced at the baseline or at the follow-up. The scholastic variables were significantly associated with the changes of PAL which occurred due to pandemic lockdown, with a lower risk for negative changes in PAL among adolescents who were better in school (OR = 0.56, 95%CI: 0.34–0.81, and OR = 0.66, 95%CI: 0.34–0.97, for the grade point average and behavioral grade, respectively). Students who do well in school are probably more aware of the health benefits of proper PAL, and therefore are devoted to the maintenance of their PAL even during the home-confinement of lockdown. Public health authorities should focus more on helping adolescents to understand the importance and benefits of proper PAL throughout the school system.

The Association Between Patients' eHealth Literacy and Satisfaction With Shared Decision-making and Well-being: Multicenter Cross-sectional Study

Background

Although previous studies have shown that a high level of health literacy can improve patients’ ability to engage in health-related shared decision-making (SDM) and improve their quality of life, few studies have investigated the role of eHealth literacy in improving patient satisfaction with SDM (SSDM) and well-being.

Objective

This study aims to assess the relationship between patients’ eHealth literacy and their socioeconomic determinants and to investigate the association between patients’ eHealth literacy and their SSDM and well-being.

Methods

The data used in this study were obtained from a multicenter cross-sectional survey in China. The eHealth Literacy Scale (eHEALS) and Investigating Choice Experiments Capability Measure for Adults were used to measure patients’ eHealth literacy and capability well-being, respectively. The SSDM was assessed by using a self-administered questionnaire. The Kruskal-Wallis one-way analysis of variance and Wilcoxon signed-rank test were used to compare the differences in the eHEALS, SSDM, and Investigating Choice Experiments Capability Measure for Adults scores of patients with varying background characteristics. Ordinary least square regression models were used to assess the relationship among eHealth literacy, SSDM, and well-being adjusted by patients’ background characteristics.

Results

A total of 569 patients completed the questionnaire. Patients who were male, were highly educated, were childless, were fully employed, were without chronic conditions, and indicated no depressive disorder reported a higher mean score on the eHEALS. Younger patients (SSDM_{≥61 years}=88.6 vs SSDM_{16-30 years}=84.2) tended to show higher SSDM. Patients who were rural residents and were well paid were more likely to report good capability well-being. Patients who had a higher SSDM and better capability well-being reported a significantly higher level of eHealth literacy than those who had lower SSDM and poorer capability well-being. The regression models showed a positive relationship between eHealth literacy and both SSDM (β=.22; P<.001) and well-being (β=.26; P<.001) after adjusting for patients’ demographic, socioeconomic status, lifestyle, and health status variables.

Conclusions

This study showed that patients with a high level of eHealth literacy are more likely to experience optimal SDM and improved capability well-being. However, patients’ depressive status may alter the relationship between eHealth literacy and SSDM.

Measuring a Broad Spectrum of eHealth Skills in the Web 3.0 Context Using an eHealth Literacy Scale: Development and Validation Study

BACKGROUND

eHealth literacy (EHL) refers to a variety of capabilities that enable individuals to obtain health information from electronic resources and apply it to solve health problems. With the digitization of health care and the wide availability of health apps, a more diverse range of eHealth skills is required to properly use such health facilities. Existing EHL measurements focus mainly on the skill of obtaining health information (Web 1.0), whereas skills for web-based interactions (Web 2.0) and self-managing health data and applying information (Web 3.0) have not been well measured.

OBJECTIVE

This study aims to develop an EHL scale (eHLS) termed eHLS-Web3.0 comprising a comprehensive spectrum of Web 1.0, 2.0, and 3.0 skills to measure EHL, and evaluate its validity and reliability along with the measurement invariance among college students.

METHODS

In study 1, 421 Chinese college students (mean age 20.5, SD 1.4 years; 51.8% female) and 8 health experts (mean age 38.3, SD 5.9 years; 87.5% female) were involved to develop the eHLS-Web3.0. The scale development included three steps: item pool generation, content validation, and exploratory factor analysis. In study 2, 741 college students (mean age 21.3, SD 1.4 years; 52.2% female) were recruited from 4 Chinese cities to validate the newly developed eHLS-Web3.0. The construct validity, convergent validity, concurrent validity, internal consistency reliability, test-retest reliability, and measurement invariance across genders, majors, and regions were examined by a series of statistical analyses, including confirmatory factor analysis (CFA) and multigroup CFAs using SPSS and Mplus software packages.

RESULTS

Based on the item pool of 374 statements collected during the conceptual development, 24 items (4-10 items per subscale) were generated and adjusted after cognitive testing and content validity examination. Through exploratory factor analysis, a 3-factor eHLS-Web3.0 was finally developed, and it included acquisition (8 items), verification (6 items), and application (10 items). In study 2, CFAs supported the construct validity of the 24-item 3D eHLS-Web3.0 (χ2244=903.076, χ2244=3.701, comparative fit index=0.924, Tucker-Lewis index=0.914, root mean square error of approximation [RMSEA]=0.06, and standardized root mean residual [SRMR]=0.051). The average variance extracted (AVE) value of 0.58 and high correlation between eHLS-Web3.0 subscales and the eHealth Literacy Scale (r=0.725-0.880, P<.001) indicated the convergent validity and concurrent validity of the eHLS-Web3.0. The results also indicated satisfactory internal consistency reliability (α=.976, ρ=0.934-0.956) and test-retest reliability (r=0.858, P<.001) of the scale. Multigroup CFA demonstrated the 24-item eHLS-Web3.0 to be invariant at all configural, metric, strength, and structural levels across genders (female and male), majors (sport-related, medical, and general), and regions (Yinchuan, Kunming, Xiamen, and Beijing).

CONCLUSIONS

The 24-item 3D eHLS-Web3.0 proved to be a reliable and valid measurement tool for EHL in the Web 3.0 context among Chinese college students.

Facing the Growing COVID-19 Infodemic: Digital Health Literacy and Information-Seeking Behaviour of University Students in Slovenia

The entire world is faced with the COVID-19 pandemic, which is also accompanied by an infodemic. This refers to the rapid spread of (accurate and false) information, mainly through internet usage increasing. Digital health literacy (DHL) is therefore important for addressing challenges related to online health information and services, as well as for navigation through the complex information landscape with huge amounts of different (and conflicting) information about COVID-19. The aim of this study is to examine the level of DHL in relation to COVID-19 in Slovenian university students and to determine online information-seeking behaviour in order to plan and prepare effective communication interventions for this sub-population. A cross-sectional survey, administered by an online questionnaire, was conducted to collect data on DHL. A total of 3621 students participated, of whom 70% were female and the average age was 22.65 years (SD = 4.65). Bivariate analyses were performed to assess the association of key characteristics with DHL. Overall, the results show that the level of DHL among students is sufficient. Most difficulties were reported in assessing the reliability of information (n = 1484, 49.3%). Approximately one third of the students (n = 847, 27.9%) reported having problems in finding information of their interest, and somewhat more (n = 900, 29.6%) reported difficulties in making a selection among all the information found. Students with a sufficient level of DHL are more likely to seek information through search engines and websites of official institutions, while students with a limited level of DHL more frequently reported using social media for health information searches. It is necessary to establish interventions for a systematic lift of the DHL and health literacy (HL) of all population groups.

Perceived Efficiency Outcomes, Sources and Awareness of Online Health Information among the Elderly during COVID-19

The Internet and social media are crucial platforms for health information. Factors such as the efficiency of online health information, the outcomes of seeking online health information and the awareness of reliable sources have become increasingly important for the elderly during the COVID-19 pandemic. This study aimed to examine differences between elderly individuals' income above and below the average monthly wage in relation to their online health information efficiency and the outcomes of seeking online health information; to evaluate types of online information sources with online health information efficiency and the outcomes of seeking online health information; and to explore online health information efficiency as a mediator between health status and awareness of online sources. A cross-sectional study design was conducted with 336 elderly participants age 65 or older. The participants volunteered to complete a questionnaire. No differences were found between the two groups regarding efficiency in retrieving health information from official online health sites and Google. Perceived efficiency mediated health status and awareness of online sources. In these challenging times, it is important to provide a tailor-made education strategy plan for reliable sources of online health information for the elderly, in order to enhance their technology safety skills. It is also important to explore other mediating variables between health status and awareness of online sources.

Predicting Writing Styles of Web-Based Materials for Children's Health Education Using the Selection of Semantic Features: Machine Learning Approach

BACKGROUND

Medical writing styles can have an impact on the understandability of health educational resources. Amid current web-based health information research, there is a dearth of research-based evidence that demonstrates what constitutes the best practice of the development of web-based health resources on children's health promotion and education.

OBJECTIVE

Using authoritative and highly influential web-based children's health educational resources from the Nemours Foundation, the largest not-for-profit organization promoting children's health and well-being, we aimed to develop machine learning algorithms to discriminate and predict the writing styles of health educational resources on children versus adult health promotion using a variety of health educational resources aimed at the general public.

METHODS

The selection of natural language features as predicator variables of algorithms went through initial automatic feature selection using ridge classifier, support vector machine, extreme gradient boost tree, and recursive feature elimination followed by revision by education experts. We compared algorithms using the automatically selected (n=19) and linguistically enhanced (n=20) feature sets, using the initial feature set (n=115) as the baseline.

RESULTS

Using five-fold cross-validation, compared with the baseline (115 features), the Gaussian Naive Bayes model (20 features) achieved statistically higher mean sensitivity (P=.02; 95% CI -0.016 to 0.1929), mean specificity (P=.02; 95% CI -0.016 to 0.199), mean area under the receiver operating characteristic curve (P=.02; 95% CI -0.007 to 0.140), and mean macro F1 (P=.006; 95% CI 0.016-0.167). The statistically improved performance of the final model (20 features) is in contrast to the statistically insignificant changes between the original feature set (n=115) and the automatically selected features (n=19): mean sensitivity (P=.13; 95% CI -0.1699 to 0.0681), mean specificity (P=.10; 95% CI -0.1389 to 0.4017), mean area under the receiver operating characteristic curve (P=.008; 95% CI 0.0059-0.1126), and mean macro F1 (P=.98; 95% CI -0.0555 to 0.0548). This demonstrates the importance and effectiveness of combining automatic feature selection and expert-based linguistic revision to develop the most effective machine learning algorithms from high-dimensional data sets.

CONCLUSIONS

We developed new evaluation tools for the discrimination and prediction of writing styles of web-based health resources for children's health education and promotion among parents and caregivers of children. User-adaptive automatic assessment of web-based health content holds great promise for distant and remote health education among young readers. Our study leveraged the precision and adaptability of machine learning algorithms and insights from health linguistics to help advance this significant yet understudied area of research.

Comparing Factors Associated With eHealth Literacy Between Young and Older Adults

The purpose of the current study was to compare the factors associated with adults' eHealth literacy, which is vital for health consumers. A secondary data analysis was conducted with data collected from November 2017 to February 2018 for a project on the development of a Korean version of the eHealth Literacy Scale. Participants were recruited through an online survey for young adults (n = 210, mean age = 25.5 [SD = 4.7] years) and a face-to-face survey for older adults (n = 187, mean age = 73.2 [SD = 4.8] years). Hierarchical multiple regression analyses were used to analyze data and determine eHealth literacy predictors. Older adults held more positive attitudes toward internet health information than young adults (mean = 16.49 [SD = 2.54] and 17.04 [SD = 2.41], respectively; p = 0.029); however, eHealth literacy levels were comparable (mean = 30.50 [SD = 4.62] and 30.95 [SD = 4.17], respectively; p = 0.305). Attitude toward internet health information was a significant predictor of eHealth literacy in both groups, and age was only a predictor among young adults. These results elucidate predictors of eHealth literacy and inform strategies to improve eHealth literacy among young and older adults. [Journal of Gerontological Nursing, 46(8), 46-56.].

The Relationship between E-Health Literacy and Health-Promoting Behaviors in Nursing Students: A Multiple Mediation Model

The availability of a wide range of online health-related information on the internet has made it an increasingly popular source of health information, particularly for people in their 20s. This study aimed to explore possible multistep and indirect pathways of association between e-health literacy and health-promoting behaviors through social media use for health information, online health information-seeking behaviors, and self-care agency among nursing students. The study included 558 nursing students from three different universities in South Korea. Data were collected using structured questionnaires from 2 August to 29 August, 2019. The results show that e-health literacy had a significant direct effect on health-promoting behaviors through the three mediators. Moreover, the overall model explained 46% of the total variance in health-promoting behaviors. Based on these findings, it is necessary to introduce interventions that improve e-health literacy and develop a strategy to promote healthy behaviors. It is also necessary to develop programs to improve e-health literacy competency in nursing students. Moreover, health interventions that improve health-promoting behaviors should be developed, and research to evaluate the effect of the interventions should be conducted.