Associations of Health and Digital Health Literacy with Health-Related Quality of Life: A Cross-Sectional Study in Greece and Cyprus

Articles in Press

Document Type : Original Article

Authors

Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus.

Abstract

Background and Objective: Health literacy and digital health literacy reflect on an individual's ability to access, understand, and use health information and digital tools. Both have been associated with self-efficacy and improved health outcomes. The main aim of this study is to investigate the relationship between health literacy and digital health literacy with health-related quality of life. In addition, the study aims to identify the factors contributing to health and digital health literacy.

Materials and Methods: A cross-sectional online survey was conducted between December 2024 and January 2025. The questionnaire included socio-demographic data, the HLS-EU-Q16, the electronic Health Literacy Scale (eHEALS), while the SF-12 was applied to assess physical and mental health-related quality of life. Descriptive statistics and inferential analysis were applied, including multiple linear and logistic regressions.

Results: The sample included 557 adults, aged 18 years or above (mean age: 31.4 years; 76.5% female). Most participants had an adequate level of health literacy (64.8%), while the average digital health literacy score was 27.92 (sd=7.15). A significant positive correlation between health literacy and digital health literacy was found (r = 0.487, p<0.001). Health literacy was positively associated with educational level and income. Digital health literacy was also associated with higher educational attainment. Health literacy, but not digital health literacy, was significantly associated with better physical and mental health-related quality of life (b = 0.64 and b = 0.84, respectively; p<0.001).

Conclusions: Among adults in Greece and Cyprus, health literacy was generally adequate and positively associated with higher education and income. Digital health literacy correlated with health literacy and education but was not independently related to health-related quality of life. Higher health literacy consistently predicted better physical and mental health-related quality of life, underscoring health literacy as a key, modifiable correlate. These findings support prioritizing health literacy building strategies to advance equity and self-management. 

Keywords

Acknowledgment: The authors express their gratitude to all people who cooperated and assisted in this research.


Availability of data and materials: The materials and data supporting this study are available from the corresponding author upon reasonable request.

Conflicts of interest: The authors declare that they have no competing interests.


Consent for publication: Not applicable.


Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki; the study protocol and informed-consent procedures were assessed and approved by the Cyprus National Bioethics Committee (ΕΕΒΚ ΕΠ 2024.01.383), and written informed consent was obtained from all participants.


Funding: This research does not receive any funding.


Authors' Contribution: AG and DL conceptualized and designed the study. AG collected the data, performed the analysis, interpreted the findings, and drafted the manuscript. DL provided supervision and critically reviewed the manuscript for important intellectual content. 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/

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Journal of Health Literacy

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Available Online from 28 September 2025

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