Assessment of Digital Health Literacy among University Students: Influence of Course Type and Online Health Information Seeking

Articles in Press

Document Type : Original Article

Authors

1 Centre for Interdisciplinary Research in Health (CIIS), Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 4169-055 Porto, Portugal

2 Centro de Biotecnologia e Química Fina, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal

3 Centre for Interdisciplinary Research in Health (CIIS), Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal.

4 CIIS, Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, Porto, Portugal

Abstract

Background and Objective: E-health literacy involves the ability to search for, find, estimate and evaluate information about health and/or health services. Online sources of health information are now a privileged way of accessing information, especially among students. The aim of this study was to access the level of e- health literacy in a sample of Portuguese university students; and to relate the level of e-health literacy with sociodemographic characteristics; analyze differences between health and non-health students and with the use of online health information. 

Material and Methods: An observational cross-sectional study was conducted on Portuguese university students. All students completed a questionnaire consisting of social-demographic characteristics, and sources of health online information used. The digital health literacy score was assessed by the eHEALS scale validated for the Portuguese population. Descriptive and inferential analysis was applied, as well as multivariate regression models. 

Results: In this study, 534 university students participated; the median age was 21.0. The level of e-health literacy was 28.8 (5.6). Health-sciences students had higher digital health literacy scores than students from other fields. Most students considered the internet to be useful and very useful in making health decisions. Students' use of health online information sources such as official health websites (OR= 2.6; CI 95%= 1.5;4.3) and professional health websites (OR= 2.3; CI95%= 1.4; 3.8) increased their likelihood of having a sufficient level of e-health literacy. While the use of information sources such as social networks (OR= 0.5; 95%CI: 0.3;0.9) decreases the likelihood of having a sufficient level of e-health literacy.

Conclusion: Health students showed higher levels of health literacy, demonstrating the importance of including health education in the curricula of other areas. As a practical implication, there is a need to include health education, health campaigns, and the promotion of healthy lifestyles in curricula in order to increase health literacy in university.

Keywords

Acknowledgements: Not applicable.


Availability of Data and Materials: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


Conflicts of interest: The authors declare no conflict of interest.


Consent for publication: Not applicable.


Ethics Approval and Consent to Participate: This study was conducted in accordance with the Declaration of Helsinki; this study was approved by Ethical Committee of Universidade Católica Portuguesa (number 207; CES; May 2022). 


Funding: This work was not funded. 


Authors’ Contributions: SA and EP conceptualized and designed the study. SA collected the data, performed the analysis, interpreted the findings, and drafted the manuscript. All authors approved the final version for submission. 

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

  1. Sørensen K, Van Den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. Vol. 12, BMC Public Health. 2012. https://doi.org/10.1186/1471-2458-12-80 PMid:22276600 PMCid:PMC3292515
  2. Qin N, Shi S, Duan Y, Ma G, Li X, Shen Z, et al. Social Media Use, eHealth Literacy, Knowledge, Attitudes, and Practices Toward COVID-19 Vaccination Among Chinese College Students in the Phase of Regular Epidemic Prevention and Control: A Cross-Sectional Survey. Front Public Health. 2022 Jan 27;9. https://doi.org/10.3389/fpubh.2021.754904 PMid:35155334 PMCid:PMC8829334
  3. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000 Sep 1;15(3):259-67. https://doi.org/10.1093/heapro/15.3.259
  4. Kühn L, Bachert P, Hildebrand C, Kunkel J, Reitermayer J, Wäsche H, et al. Health Literacy Among University Students: A Systematic Review of Cross-Sectional Studies. Vol. 9, Frontiers in Public Health. Frontiers Media S.A.; 2022. https://doi.org/10.3389/fpubh.2021.680999 PMid:35127605 PMCid:PMC8814326
  5. Nutbeam, D.; Lloyd JE. Understanding and Responding to Health Literacy as a Social Determinant of Health. Ann Rev Public Health. 2021;42(1). https://doi.org/10.1146/annurev-publhealth-090419-102529
    PMid:33035427
  6. Zhang, N.J., Terry, A. and McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Ann Pharmacother. 2014;48:741-51. https://doi.org/10.1177/1060028014526562 PMid:24619949
  7. Norman C ; Skinner H. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res . 2006;8(2 (e9)). https://doi.org/10.2196/jmir.8.2.e9 PMid:16867972 PMCid:PMC1550701
  8. Sørensen K, Van Den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. (HLS-EU) Consortium Health Literacy Project European. Health literacy and public health: A systematic review and integration of definitions and models. Vol. 12, BMC Public Health. 2012. https://doi.org/10.1186/1471-2458-12-80 PMid:22276600 PMCid:PMC3292515
  9. Salazar-Granizo YE, Hueso-Montoro C, Caparros-Gonzalez RA. Lifestyles and Academic Stress in University Students of Health Sciences: A Mixed-Methodology Study. Healthcare. 2024 Jul 11;12(14):1384. https://doi.org/10.3390/healthcare12141384 PMid:39057527 PMCid:PMC11276596
  10. Hartmann D STT. The new adulthood? The transition to adulthood from the perspective of transitioning young adults. Adv Life Course Res. 2021;253-86. https://doi.org/10.1016/S1040-2608(06)11010-2
  11. Amaral O, Pedro AR, Veiga N, Escoval A, Ferreira M. Literacia em saúde em estudantes do ensino supeior: comparaçã entre estudantes de enfermagem e estudantes de outras áreas literacia em saúde em estudantes do ensino superior de viseu. Revista INFAD de Psicología International Journal of Developmental and Educational Psychology. 2021;2(1):97-106. https://doi.org/10.17060/ijodaep.2021.n1.v2.2122
  12. Dashti S, Abadibavil D, Roozbeh N. Evaluating e-health literacy, knowledge, attitude and practice regarding COVID-19 prevention and Self-Protection among Iranian students: a cross-sectional online survey. BMC Med Educ. 2022;22(1):1-10. https://doi.org/10.1186/s12909-022-03210-3 PMid:35248025 PMCid:PMC8897549
  13. Tomás CC, Queirós PJP, Ferreira T de JR. Analysis of the psychometric properties of the portuguese version of an eHealth literacy assessment tool. Revista de Enfermagem Referencia. 2014 Jun 1;4(2):19-28. https://doi.org/10.12707/RIV14004
  14. Vrdelja M, Vrbovšek S, Klopčič V, Dadaczynski K, Okan O. Facing the growing COVID-19 infodemic: Digital health literacy and information-seeking behaviour of university students in Slovenia. Int J Environ Res Public Health. 2021 Aug 2;18(16). https://doi.org/10.3390/ijerph18168507 PMid:34444255 PMCid:PMC8394972
  15. Park H, Park H. EHealth literacy skills among undergraduate nursing students in the U.s. and South Korea. Stud Health Technol Inform [Internet]. 2016;225:899-900. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27332399
  16. Dadaczynski K, Okan O, Messer M, Leung AYM, Rosário R, Darlington E, 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. Vol. 23, Journal of Medical Internet Research. JMIR Publications Inc.; 2021. https://doi.org/10.2196/24097 PMid:33395396 PMCid:PMC7813561
  17. Bak CK, Krammer J, Dadaczynski K, Orkan O, von Seelen J, Prinds C, 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. 2022 Mar 1;19(6). https://doi.org/10.3390/ijerph19063676 PMid:35329363 PMCid:PMC8955471
  18. Patil U, Kostareva U, Hadley M, Manganello JA, Okan O, Dadaczynski K, et al. Health literacy, digital health literacy, and COVID-19 pandemic attitudes and behaviors in U.S. college students: Implications for interventions. Int J Environ Res Public Health. 2021 Mar 2;18(6). https://doi.org/10.3390/ijerph18063301 PMid:33806763 PMCid:PMC8004744
  19. Rosário J, Dias SS, Dias S, Pedro AR. Health literacy and its determinants among higher education students in the Alentejo region of southern Portugal-A cross-sectional survey. PLoS One. 2024;19(9). https://doi.org/10.1371/journal.pone.0309806 PMid:39316571 PMCid:PMC11421802
  20. Development H, Bumrerraj S. Natasha Aqmarina. Related Academic Fields Journal of Health Literacy Autumn. 2025;10(4).
  21. Alzahrani FM. Effectiveness of animation as a learning tool in applied medical sciences education: A comparative cross-sectional study among university students. Pak J Med Sci. 2025 Sep;41(4):1116-20. https://doi.org/10.12669/pjms.41.4.11204 PMid:40290251 PMCid:PMC12022563
  22. Navas-Echazarreta N, Juárez-Vela R, Martínez-Sabater A, Gea-Caballero V, Chover-Sierra E, Echaniz-Serrano E, et al. Psychometric properties of the Spanish version of the media health literacy questionnaire (MeHLit-SV). Front Public Health. 2024;12. https://doi.org/10.3389/fpubh.2024.1440386 PMid:39381769 PMCid:PMC11458485
  23. Almeida S, Pinto E, Coreira M, Veiga N, Almeida A. E-Health Literacy, Knowledge, Attitude, and Health Online Information in Portuguese University Students: A Cross-Sectional Study. Int J Environ Res Public Health. 2024;21(3):271. https://doi.org/10.3390/ijerph21030271 PMid:38541272 PMCid:PMC10970587
  24. Rosário R, Martins MRO, Augusto C, Silva MJ, Martins S, Duarte A, et al. Associations between covid-19-related digital health literacy and online information-seeking behavior among portuguese university students. Int J Environ Res Public Health. 2020 Dec 1;17(23):1-11. https://doi.org/10.3390/ijerph17238987 PMid:33276647 PMCid:PMC7730120
  25. Pedro A, Rosário R, Monteiro I, Cerqueira M, Roque S, Assunção V, et al. Health literacy in higher education students: findings from a Portuguese study. Eur J Public Health. 2022 Oct 21;32(Supplement_3). https://doi.org/10.1093/eurpub/ckac130.140 PMCid:PMC9835489
Journal of Health Literacy

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Available Online from 25 November 2025

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