
Understanding how digital health literacy affects health self-management behaviors: The mediating role of self-efficacy in college students
Zhao, M., Liu, F., Liu, W., Ji, X. & Xue, F. Health management in China. International Journal of Cardiology 176, https://doi.org/10.1016/j.ijcard.2014.06.085 (2014).
Schwartz, D. Unending work and care: Managing chronic illness at home. Geriatr. Nurs. 10, 48–48. https://doi.org/10.1016/s0197-4572(89)80045-x (1989).
Google Scholar
Yang, R., Wang, Y., Li, J. & Xue, C. Influence of self-management ability on physical and mental health of nursing college students. Minerva Surgery https://doi.org/10.23736/s2724-5691.21.09399-0 (2023).
Google Scholar
LeRouge, C. M., Hah, H., Deckard, G. J. & Jiang, H. Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study. JMIR Mhealth Uhealth https://doi.org/10.2196/18391 (2020).
Google Scholar
Long, E., Ponder, M. & Bernard, S. Knowledge, attitudes, and beliefs related to hypertension and hyperlipidemia self-management among African-American men living in the southeastern United States. Patient Educ. Couns. 100, 1000–1006. https://doi.org/10.1016/j.pec.2016.12.011 (2017).
Google Scholar
Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D. & Patton, G. C. The age of adolescence. Lancet Child Adolescent Health 2, 223–228. https://doi.org/10.1016/s2352-4642(18)30022-1 (2018).
Google Scholar
Liu, T. et al. Evaluation of health behaviors and self-rated health among chinese healthcare students. J. Community Health 45, 1006–1016. https://doi.org/10.1007/s10900-020-00820-0 (2020).
Google Scholar
Blake, H., Stanulewicz, N. & McGill, F. Predictors of physical activity and barriers to exercise in nursing and medical students. J. Adv. Nurs. 73, 917–929. https://doi.org/10.1111/jan.13181 (2016).
Google Scholar
Peltzer, K., Pengpid, S., Yung, T. K. C., Aounallah-Skhiri, H. & Rehman, R. Comparison of health risk behavior, awareness, and health benefit beliefs of health science and non-health science students: An international study. Nurs. Health Sci. 18, 180–187. https://doi.org/10.1111/nhs.12242 (2015).
Google Scholar
Gitay, M. N. et al. Gender Differences and Prevalence of Mental Health Problems in Students of Healthcare Units. Commun. Ment. Health J. 55, 849–853. https://doi.org/10.1007/s10597-018-0304-2 (2018).
Google Scholar
Kim, S. & Oh, J. The relationship between E-Health literacy and health-promoting behaviors in nursing students: a multiple mediation model. Int. J. Environ. Res. Public Health https://doi.org/10.3390/ijerph18115804 (2021).
Google Scholar
Marklund, S. et al. Experiences and Factors Affecting Usage of an eHealth Tool for Self-Management Among People With Chronic Obstructive Pulmonary Disease: Qualitative Study. J. Med. Int. Res. https://doi.org/10.2196/25672. (2021).
Google Scholar
Basch, C. H., MacLean, S. A., Romero, R.-A. & Ethan, D. Health Information Seeking Behavior Among College Students. J. Commun. Health 43, 1094–1099. https://doi.org/10.1007/s10900-018-0526-9 (2018).
Google Scholar
Liu, H.-X., Chow, B.-C., Hu, C., Hassel, H. & Huang, W. Y. eHealth usage among Chinese college students: qualitative findings. BMC Public Health https://doi.org/10.1186/s12889-022-13521-1 (2022).
Google Scholar
Brørs, G., Norman, C. D. & Norekvål, T. M. Accelerated importance of eHealth literacy in the COVID-19 outbreak and beyond. Eur. J. Cardiovasc. Nurs. 19, 458–461. https://doi.org/10.1177/1474515120941307 (2020).
Google Scholar
Norman, C. D. & Skinner, H. A. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J. Med0 Int. Res. https://doi.org/10.2196/jmir.8.2.e9 (2006).
Google Scholar
Baumann, E., Czerwinski, F., Rosset, M., Seelig, M. & Suhr, R. Wie informieren sich die Menschen in Deutschland zum Thema Gesundheit? Erkenntnisse aus der ersten Welle von HINTS Germany. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 63, 1151–1160. https://doi.org/10.1007/s00103-020-03192-x (2020).
Google Scholar
Jia, X., Pang, Y. & Liu, L. S. Online health information seeking behavior: A systematic review. Healthcare https://doi.org/10.3390/healthcare9121740 (2021).
Google Scholar
Swire-Thompson, B. & Lazer, D. Public health and online misinformation: Challenges and recommendations. Annu. Rev. Public Health 41, 433–451. https://doi.org/10.1146/annurev-publhealth-040119-094127 (2020).
Google Scholar
Dadaczynski, K. et al. Digital health literacy and web-based information-seeking behaviors of university students in germany during the covid-19 pandemic: Cross-sectional survey study. J. Med. Int. Res. https://doi.org/10.2196/24097 (2021).
Google Scholar
Bak, C. K. et al. Digital Health Literacy and Information-Seeking Behavior among University College Students during the COVID-19 Pandemic: A Cross-Sectional Study from Denmark. Int. J. Environ. Res. Public Health https://doi.org/10.3390/ijerph19063676 (2022).
Google Scholar
van der Vaart, R. & Drossaert, C. Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills. Journal of Medical Internet Research 19, https://doi.org/10.2196/jmir.6709 (2017).
van der Vaart, R. et al. Does the eHealth Literacy Scale (eHEALS) Measure What it Intends to Measure? Validation of a Dutch Version of the eHEALS in Two Adult Populations. Journal of Medical Internet Research 13, https://doi.org/10.2196/jmir.1840 (2011).
Bandura, A. Health promotion from the perspective of social cognitive theory. Psychology Press, 299–339 (2013).
Bandura, A. Self-efficacy: toward a unifying theory of behavioral change. 1, 139–161 (1977).
Lorig, K. R. & Holman, H. R. Self-management education: History, definition, outcomes, and mechanisms. Ann. Behav. Med. 26, 1–7. https://doi.org/10.1207/s15324796abm2601_01 (2003).
Google Scholar
Liu, C. et al. Effect of health belief model education on increasing cognition and self-care behaviour among elderly women with malignant gynaecological Tumours in Fujian. China. J. Healthcare Eng. 1–9, 2021. https://doi.org/10.1155/2021/1904752 (2021).
Google Scholar
Huang, X., Xu, N., Wang, Y., Sun, Y. & Guo, A. The effects of motivational interviewing on hypertension management: A systematic review and meta-analysis. Patient Education Counseling https://doi.org/10.1016/j.pec.2023.107760 (2023).
Google Scholar
Shiu, L. S., Liu, C. Y., Lin, C. J. & Chen, Y. C. What are the roles of eHealth literacy and empowerment in self-management in an eHealth care context? A cross-sectional study. J. Clin. Nurs. 32, 8043–8053. https://doi.org/10.1111/jocn.16876 (2023).
Google Scholar
Wang, Y., Song, Y., Zhu, Y., Ji, H. & Wang, A. Association of eHealth Literacy with Health Promotion Behaviors of Community-Dwelling Older People: The Chain Mediating Role of Self-Efficacy and Self-Care Ability. Int. J. Environ. Res. Public Health https://doi.org/10.3390/ijerph19106092 (2022).
Google Scholar
KJ, P. & K, K. Effect Size Measures for Mediation Models: Quantitative Strategies for Communicating Indirect Effects. Psychological Methods 16, 93-115, https://doi.org/10.1037/a0022658.supp (2011).
Schwarzer. Optimistic self-beliefs: Assessment of general perceived self-efficacy in thirteen cultures. World Psychol 3, 177-190 (1997).
Wang, C. K., Hu, Z. F. & Liu, Y. Evidences for Reliability and Validity of the Chinese Versionof General Self Efficacy Scale. Chinese Journal of Applied Psychology, 37–40 (2001).
Villegas Barahona, G., González García, N., Sánchez-García, A., Sánchez Barba, M. & Galindo-Villardón, M. Seven methods to determine the dimensionality of tests: application to the General Self-Efficacy Scale in twenty-six countries. Psicothema 4, 442–448, https://doi.org/10.7334/psicothema2018.113 (2018).
Shuaijun, G. et al. Adaptation and evaluation of Chinese version of eHEALS and its usage among senior high school students. Chinese Journal of Health Education 29, 106–108+123, https://doi.org/10.16168/j.cnki.issn.1002-9982.2013.02.019 (2013).
Yinuo, W., Aimin, W., Yaru, Z. & Heqian, J. Current state of eHealth literacy and its relationship with health promoting behaviors among community-dwelling older adults. J. Nurs. Sci. 37, 100–102 (2022).
Becker, H. & Stuifbergen, A. Self-rated abilities for health practices: A health self-efficacy measure. Health Values: The J Health Behav., Edu. Promotion 17, 42–50 (1993).
Xiaoqun, M., Liming, Y., Su’e, G. & al, e. A study on relativity between self-efficacy and health behaviors of senile people. Chinese Nursing Research, 1437–1439 (2007).
Hayes, A. F. ntroduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press (2018).
E, B. The practice of social research, 10th Edition. Beijing: Huaxia Publishing House (2005).
Kenny, D. A. Measuring Model Fit. Retrieved November (2012).
Jeon, J. & Kim, S. The mediating effects of digital literacy and self-efficacy on the relationship between learning attitudes and Ehealth literacy in nursing students: A cross-sectional study. Nurse Education Today 113, https://doi.org/10.1016/j.nedt.2022.105378 (2022).
Wang, Y. et al. Status and influencing factors of health self-management of undergraduates in a medical university in Anhui Province. J. Gannan Med. Univ. 43, 1263–1268 (2023).
Hao, S., Tu, X., Liang, S. & Liu, T. Analysis on status of health self-management ability and e-health literacy and their correlation among medical students. Occupation Health 39, 389–394. https://doi.org/10.13329/j.cnki.zyyjk.2023.0068 (2023).
Google Scholar
Chen, Y., Xie, L., Dai, Y., Zhao, J. & Zhou, Z. Intern Nursing Students ‘ Psychological Stress and Health Self-management Ability Correlation Research. China Higher Medical Education, 13–15 (2024).
Yuanxi, W., Xi, Y. & Ping, C. Influence of Social Support on Learning Motivation of Medical College Students: Mediating Effects of Self-efficacy. Heilongjiang Sci. 15, 60–63 (2024).
Zhang, S. et al. Analysis of the mediating effect between ehealth literacy and health self-management of undergraduate nursing students’ mental health literacy. BMC Nurs. https://doi.org/10.1186/s12912-024-01920-1 (2024).
Google Scholar
Ting, Y., Jia-zeng, C., Lu-sheng, H. & Jing, F. Correlation analysis on health promoting lifestyle, emotional regulation and e-health literacy of nursing students. Chine. J. Health Education 40, 835–838 (2024).
Alahmadi, M. A. et al. The prevalence of sedentary behavior among university students in Saudi Arabia. BMC Public Health https://doi.org/10.1186/s12889-024-18107-7 (2024).
Google Scholar
Wu, Y. et al. Associations between e-health literacy and chronic disease self-management in older Chinese patients with chronic non-communicable diseases: a mediation analysis. BMC Public Health https://doi.org/10.1186/s12889-022-14695-4 (2022).
Google Scholar
Liu, S. et al. Impact of digital health literacy on health-related quality of life in Chinese community-dwelling older adults: the mediating effect of health-promoting lifestyle. Front. Public Health https://doi.org/10.3389/fpubh.2023.1200722 (2023).
Google Scholar
Rangraz, J. F. et al. Health care needs, eHealth literacy, use of mobile phone functionalities, and intention to use it for self-management purposes by informal caregivers of children with burns: a survey study. BMC Med. Inform. Decision Making https://doi.org/10.1186/s12911-023-02334-w (2023).
Google Scholar
Xu, G., Xu, Y., Tu, X., Hao, S. & Liu, T. The Association between Self-Rated Health and Health Self-Management Ability of Healthcare Undergraduates: The Chain Mediating Roles of eHealth Literacy and Resistance to Peer Influence. Int. J. Environ. Res. Public Health https://doi.org/10.3390/ijerph192114501 (2022).
Google Scholar
Zhang, Q., Huang, F., Zhang, L., Li, S. & Zhang, J. The effect of high blood pressure-health literacy, self-management behavior, self-efficacy and social support on the health-related quality of life of Kazakh hypertension patients in a low-income rural area of China: a structural equation model. BMC Public Health https://doi.org/10.1186/s12889-021-11129-5 (2021).
Google Scholar
Wu, Y. et al. Chinese Community Home-Based Aging Institution Elders’ Self-Management of Chronic Non-Communicable Diseases and Its Interrelationships with Social Support, E-Health Literacy, and Self Efficacy: A Serial Multiple Mediation Model. Patient Prefer. Adherence 17, 1311–1321. https://doi.org/10.2147/ppa.S412125 (2023).
Google Scholar
Andersen, R. M. National health surveys and the behavioral model of health services use. Med. Care 46, 647–653. https://doi.org/10.1097/MLR.0b013e31817a835d (2008).
Google Scholar
RM, A., PL, D. & SE, B. Improving access to care in America: individual and contextual indicators. Changing the US health care system: Key issues in health services policy and management, 3–31 (2014).
Travers, J. L., Hirschman, K. B. & Naylor, M. D. Adapting Andersen’s expanded behavioral model of health services use to include older adults receiving long-term services and supports. BMC Geriatr. https://doi.org/10.1186/s12877-019-1405-7 (2020).
Google Scholar
Xie, Z. et al. An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension. BMC Public Health https://doi.org/10.1186/s12889-020-09274-4 (2020).
Google Scholar
Zhang, J., Zheng, S. & Hu, Z. The Effect of Physical Exercise on Depression in College Students: The Chain Mediating Role of Self-Concept and Social Support. Front. Psychol. https://doi.org/10.3389/fpsyg.2022.841160 (2022).
Google Scholar
Yang, S.-C., Luo, Y.-F. & Chiang, C.-H. The Associations Among Individual Factors, eHealth Literacy, and Health-Promoting Lifestyles Among College Students. J. Med. Int. Res. https://doi.org/10.2196/jmir.5964 (2017).
Google Scholar
Li, S. et al. The Longitudinal Relationship Between eHealth Literacy, Health-Promoting Lifestyles, and Health-Related Quality of Life Among College Students: A Cross-Lagged Analysis. Front. Public Health https://doi.org/10.3389/fpubh.2022.868279 (2022).
Google Scholar