Empowering Women through a Path Analysis: Identification of Effective Factors based on Social Support and Community Participation on e-Health Literacy in Women’s Virtual Health Society

Document Type : Original Article


1 Midwifery Study Program, Sekolah Tinggi Ilmu Kesehatan Tri Mandiri Sakti Bengkulu, Bengkulu, Indonesia

2 Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia

3 Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

4 Centre for Bioethics and Medical Humanities, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.


Background and Objective: The virtual community plays a crucial role in increasing health literacy. A successful and empowered woman demands an adequate level of health literacy. Knowing the determinants affecting e-health literacy in the virtual community was hoped to optimize efforts to increase e-health literacy. This research is aimed to assess the determinants that affect e-health literacy in virtual communities for empowering women. 

Materials and Methods: A study with a cross-sectional approach was used to assess the determinants of e-health literacy. A total of 117 samples were taken using the total sampling technique. Data was collected using demographic variables checklist, social support, community participation, e-health literacy, and information process paradigms questionnaire. Data was analyzed for path analysis using Stata 13 software.

Results: The path analysis showed that social support and community participation in women had a significant positive direct effect (p<0.05) on health literacy. The community participation, information processing paradigm, ethnicity, number of social media owned, age, education, distance from home to healthcare facilities, and number of healthcare places significantly indirectly affect health literacy (p <0.05).

Conclusion: To empower woman’s health literacy in online communities, we should pay attention to increase social support, community participation, processing information paradigm, ethnicity, number of social media owned, age, education, distance from home to healthcare facilities, and number of healthcare places. 


Acknowledgments: The authors would like to thank administrators of the virtual health community and participants for their generous research support.

Availability of data and materials: The data of the research is not openly available, and it will be available from the corresponding author upon reasonable request. 

Conflict of interest: The authors declare that there is no conflict of interest.

Consent for publication: Not applicable.

Ethics approval and consent to participate: This research was done by the Declaration of Helsinki and was approved by the research ethics committee at the Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia (UNS No:20/UN27.06.6.1/KEP/EC/2021). Before obtaining the data, all participants signed informed consent.

Funding: No financial support has been received from any institution for this research.

Author contributions: Conceptualization: AP and VSM; Data curation: VSM, AP, RSP, and EPP; Formal analysis: VSM, AP and EPP; Investigation: VSM; Methodology: VSM, AP, RSP, and EPP; Project administration: EPP; Resources: AP, RSP, and EPP; Validation: AP, RSP, and EPP; Visualization: RSP; Writing–original draft: VSM; Writing–review & editing: AP, RSP, and EPP.


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/

  1. Fan H, Lederman R, Smith SP, Chang S. How Trust Is Formed in Online Health Communities: A Process Perspective. CAIS [Internet]. 2014 [cited 2022 Apr 21];34. Available from: https://aisel.aisnet.org/cais/vol34/iss1/28 https://doi.org/10.17705/1CAIS.03428
  2. Lobchuk M, McClement S, Rigney M, Copeland A, Bayrampour H. A Qualitative Analysis of "Naturalistic" Conversations in a Peer-Led Online Support Community for Lung Cancer. Cancer Nursing. 2015 Sep;38(5):E21-31. https://doi.org/10.1097/NCC.0000000000000207 PMid:25254411
  3. Richardson CR, Buis LR, Janney AW, Goodrich DE, Sen A, Hess ML, et al. An Online Community Improves Adherence in an Internet-Mediated Walking Program. Part 1: Results of a Randomized Controlled Trial. J Med Internet Res. 2010 Dec 17;12(4):e71. https://doi.org/10.2196/jmir.1338 PMid:21169160 PMCid:PMC3056526
  4. Setoyama Y, Yamazaki Y, Nakayama K. Comparing support to breast cancer patients from online communities and face-to-face support groups. Patient Education and Counseling. 2011 Nov;85(2):e95-100. https://doi.org/10.1016/j.pec.2010.11.008 PMid:21159482
  5. Litchman ML, Edelman LS, Donaldson GW. Effect of Diabetes Online Community Engagement on Health Indicators: Cross-Sectional Study. JMIR Diabetes. 2018 Apr 24;3(2):e8.https://doi.org/10.2196/diabetes.8603 PMid:30291079 PMCid:PMC6238850
  6. Taylor SE. Social support: A Review. In M. S. Friedman (Ed.), The handbook of health psychology. New York, NY: Oxford University Press; 2011. 189-214 p. https://doi.org/10.1093/oxfordhb/9780195342819.013.0009
  7. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: an updated systematic review. Evid Rep Technol Assess (Full Rep). 2011 Mar;(199):1-941.
  8. Amoah PA, Phillips DR. Health literacy and health: rethinking the strategies for universal health coverage in Ghana. Public Health. 2018 Jun;159:40-9. https://doi.org/10.1016/j.puhe.2018.03.002 PMid:29729490
  9. Khazaei M, Tehrani H, Vahedian-Shahroodi M, Esmaily H, Taghipour A. women's health literacy and some related factors in Mashhad. J Health Lit [Internet]. 2021 Mar [cited 2024 Apr 28];5(4). Available from: https://doi.org/10.22038/jhl.2020.52942.1134
  10. Katadata insight center. Literasi Digital Perempuan Indonesia Belum Setara dengan Laki-Laki (The digital literacy of Indonesian women is not yet equal to that of men) [Internet]. 2022 [cited 2023 Jan 3]. Available from: (https://databoks.katadata.co.id/datapublish/2022/07/14/literasi-digital-perempuan-indonesia-belum-setara-dengan-laki-laki)
  11. Afriyie E, Kumah E, Kokuro C, Botchwey C, Boateng A, Agyei-Baffour P. Health literacy levels of mothers of under 5-year-old children in two districts in Ghana. J Health Lit [Internet]. 2023 Jan [cited 2024 Apr 28];7(4). Available from: https://doi.org/10.22038/jhl.2022.67555.1348
  12. Leight J, Pedehombga A, Ganaba R, Gelli A. Women's empowerment, maternal depression, and stress: Evidence from rural Burkina Faso. SSM - Mental Health. 2022 Dec;2:100160. https://doi.org/10.1016/j.ssmmh.2022.100160 PMid:36688233 PMCid:PMC9792374
  13. Chowdhury S, Rahman MM, Haque MdA. Role of women's empowerment in determining fertility and reproductive health in Bangladesh: a systematic literature review. AJOG Global Reports. 2023 Aug;3(3):100239. https://doi.org/10.1016/j.xagr.2023.100239 PMid:37396340 PMCid:PMC10310482
  14. Meldgaard M, Gamborg M, Terkildsen Maindal H. Health literacy levels among women in the prenatal period: A systematic review. Sexual & Reproductive Healthcare. 2022 Dec;34:100796. https://doi.org/10.1016/j.srhc.2022.100796 PMid:36413879
  15. The Lancet Digital Health. Empowering women in health technology. The Lancet Digital Health. 2022 Mar;4(3):e149. https://doi.org/10.1016/S2589-7500(22)00028-0 PMid:35216746
  16. Suwana F, Lily. Empowering Indonesian women through building digital media literacy. Kasetsart Journal of Social Sciences. 2017 Sep;38(3):212-7. https://doi.org/10.1016/j.kjss.2016.10.004
  17. Herlina D, Setiawan B, Jiwana G. Digital Parenting: Mendidik Anak di Era Digital (Educate Children in Digital Era). Yogyakarta, Indonesia: Samudra Biru; 2018.
  18. Ng E, Omariba DWR. Health Literacy and immigrants in Canada: Determinants and effects on health outcomes [Internet]. Canada: Canadian Council on Learning; 2010. Available from: http://en.copian.ca/library/research/ccl/health_lit_immigrants_canada/health_lit_immigrants_canada.pdf
  19. Lee BE, Uhm JY, Kim MS. Effects of social support and self-efficacy on eHealth literacy in Korean women undergoing breast cancer treatment: A secondary analysis. Asia-Pacific Journal of Oncology Nursing. 2023 Sep;10(9):100267. https://doi.org/10.1016/j.apjon.2023.100267 PMid:37661958 PMCid:PMC10471924
  20. Duong TV, Aringazina A, Baisunova G, Nurjanah, Pham TV, Pham KM, et al. Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries. Journal of Epidemiology. 2017 Feb;27(2):80-6. https://doi.org/10.1016/j.je.2016.09.005 PMid:28142016 PMCid:PMC5328731
  21. Schulz U, Schwarzer R. Soziale Unterstützung bei der Krankheitsbewältigung: Die Berliner Social Support Skalen (BSSS). Diagnostica. 2003 Apr;49(2):73-82. https://doi.org/10.1026//0012-1924.49.2.73
  22. Lawrence DW. The information-seeking behaviors of professionals and information sources in the field of injury prevention and safety promotion. 2008 Jan 1;
  23. Streiner DL. Finding Our Way: An Introduction to Path Analysis. Can J Psychiatry. 2005 Feb;50(2):115-22. https://doi.org/10.1177/070674370505000207 PMid:15807228
  24. Ringle CM, Wende S, Becker JM. SmartPLS 4 [Internet]. SmartPLS; 2022. Available from: https://www.smartpls.com/
  25. Xia Y, Yang Y. RMSEA, CFI, and TLI in structural equation modeling with ordered categorical data: The story they tell depends on the estimation methods. Behav Res. 2019 Feb;51(1):409-28. https://doi.org/10.3758/s13428-018-1055-2 PMid:29869222
  26. Avogo WA. Social capital, civic engagement, and self-rated health in Ghana. APS. 2013 Nov 4;27(2):188. https://doi.org/10.11564/27-2-440
  27. Nielsen-Bohlman, Panzer, Kindig. Health Literacy: a Prescription to End Confusion. Committee on Health Literacy Board on Neuroscience and Behavioral Health, Institute of Medicine. Washington, DC: Institute of medicine of the national academies; 2004.
    https://doi.org/10.17226/10883 PMid:25009856
  28. Freeman JL, Caldwell PHY, Scott KM. How Adolescents Trust Health Information on Social Media: A Systematic Review. Acad Pediatr. 2023;23(4):703-19. https://doi.org/10.1016/j.acap.2022.12.011 PMid:36581098
  29. Suanrueang P, Suen MW, Lin HF, Er TK, Michaela Quilang Jamora M. The impact of the covid-19 pandemic on anxiety, health literacy, and eHealth literacy in 2020 related to healthcare behavior in Thailand. JPHD [Internet]. 2022 Jan 31 [cited 2022 Aug 29];20(1). Available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/254515 https://doi.org/10.55131/jphd/2022/200115
  30. Purnamasari NI, Pratiwi RI, Razan AP. Peningkatan Literasi Digital: Perempuan Cerdas Tangkal Berita Hoaks (Improving Digital Literacy: Empowered Women Combat Fake News). In: Sinergi Institusi Pendidikan dengan Masyarakat melalui Kegiatan Pengabdian Masyarakat. Yogyakarta, Indonesia: Lembaga Penelitian dan Pengabdian Masyarakat Universitas Amikom Yogyakarta; 2021.
  31. Ridings CM, Gefen D. Virtual Community Attraction: Why People Hang Out Online. Journal of Computer-Mediated Communication. 2006 Jun 23;10(1):00-00. https://doi.org/10.1111/j.1083-6101.2004.tb00229.x
  32. Fielding D. Measuring the diversity dividend for community-level health and women's empowerment in Africa. SSM - Population Health. 2022 Dec;20:101294. https://doi.org/10.1016/j.ssmph.2022.101294 PMid:36444338 PMCid:PMC9700328
  33. Andrulis DP, Brach C. Integrating literacy, culture, and language to improve health care quality for diverse populations. Am J Health Behav. 2007;31 Suppl 1(Suppl 1):S122-133. https://doi.org/10.5993/AJHB.31.s1.16
  34. Singleton K, Krause EMS. Understanding cultural and linguistic barriers to health literacy. Ky Nurse. 2010;58(4):4, 6-9.