The Impact of Sense of Coherence and E-Health Literacy on Health Anxiety in Elderly Women: A Cross-Sectional Study

While the Internet can be a valuable resource for learning about health issues, for those without adequate e-health literacy skills, it can have adverse effects on unwanted anxiety and cyberchondria risk. Improving e-health literacy is essential to manage health and death anxiety and help reduce the risk of cyberchondria. The aim of this study is to determine the e-health literacy, health anxiety, cyberchondria and death anxiety levels of university students, evaluate them in terms of independent variables and examine the relationship between the scales. The study was completed with 568 students receiving education in the health department of a university. Data were obtained using the e-Health Literacy Scale, Health Anxiety Inventory, Cyberchondria Severity Scale, and Death Anxiety Scale. The chi-square, Mann-Whitney U, Kruskal-Wallis, Tamhane's T2 post hoc tests, and Spearman correlation were used to analyze the data. The mean score of e-health literacy was 28.63±4.65; health anxiety was 19.11±8.37, cyberchondria was 86.30±18.28 and death anxiety was 7.34±2.14. Cyberchondria is low in women and those who do not conduct online research on health. E-health literacy was higher in those earning above the minimum wage. Health and death anxiety was low in men and in those who did not conduct online health-related research. Health anxiety was positively correlated with cyberchondria and death anxiety and negatively correlated with e-health literacy. There was a positive relationship between cyberchondria and E-health literacy and death anxiety. This study highlights the complex relationship between eHealth literacy, health anxiety, cyberchondria and death anxiety. It shows that low e-health literacy can increase health anxiety, which in turn can worsen cyberchondria and death anxiety. By emphasising the importance of e-health literacy in health education, the findings may help students manage their anxiety, make informed health decisions, and increase their professional competence.

To explore the associations and gender differences between health anxiety, eHealth literacy and self-reported health in Chinese university students. 1,205 university students aged 18-22 years were voluntarily recruited to respond to an online self-report questionnaire. The severity level of health anxiety among university students was ranked as lifestyle anxiety, psychological anxiety, appearance anxiety, physical anxiety. There were significant gender differences in appearance anxiety, and yet no in eHealth literacy of university students. eHealth literacy was positively associated with self-reported health; health anxiety was negatively associated with self-reported health. Female's eHealth literacy, lifestyle, psychological and physical anxiety, and male's eHealth literacy, appearance anxiety significantly impacted on their self-reported health. The lower eHealth literacy or the more health anxiety, the worse their self-reported health. The findings underscored the importance for university students to improve eHealth literacy and reduce health anxiety. Appropriate interventions with gender differences were urgently needed.

BackgroundDespite the relatively high prevalence of low health literacy among individuals living with chronic obstructive pulmonary disease (COPD), limited empirical attention has been paid to the cognitive and health literacy–related skills that can uniquely influence patients’ health-related quality of life (HRQoL) outcomes.ObjectiveThe aim of this study was to examine how health literacy, electronic health (eHealth) literacy, and COPD knowledge are associated with both generic and lung-specific HRQoL in people living with COPD.MethodsAdults from the COPD Foundation’s National Research Registry (n=174) completed a cross-sectional Web-based survey that assessed sociodemographic characteristics, comorbidity status, COPD knowledge, health literacy, eHealth literacy, and generic/lung-specific HRQoL. Hierarchical linear regression models were tested to examine the roles of health literacy and eHealth literacy on generic (model 1) and lung-specific (model 2) HRQoL, after accounting for socioeconomic and comorbidity covariates. Spearman rank correlations examined associations between ordinal HRQoL items and statistically significant hierarchical predictor variables.ResultsAfter adjusting for confounding factors, health literacy, eHealth literacy, and COPD knowledge accounted for an additional 9% of variance in generic HRQoL (total adjusted R2=21%; F9,164=6.09, P<.001). Health literacy (b=.08, SE 0.02, 95% CI 0.04-0.12) was the only predictor positively associated with generic HRQoL (P<.001). Adding health literacy, eHealth literacy, and COPD knowledge as predictors explained an additional 7.40% of variance in lung-specific HRQoL (total adjusted R2=26.4%; F8,161=8.59, P<.001). Following adjustment for covariates, both health literacy (b=2.63, SE 0.84, 95% CI 0.96-4.29, P<.001) and eHealth literacy (b=1.41, SE 0.67, 95% CI 0.09-2.73, P<.001) were positively associated with lung-specific HRQoL. Health literacy was positively associated with most lung-specific HRQoL indicators (ie, cough frequency, chest tightness, activity limitation at home, confidence leaving home, sleep quality, and energy level), whereas eHealth literacy was positively associated with 5 of 8 (60%) lung-specific HRQoL indicators. Upon controlling for confounders, COPD knowledge (b=−.56, SE 0.29, 95% CI −1.22 to −0.004, P<.05) was inversely associated with lung-specific HRQoL.ConclusionsHealth literacy, but not eHealth literacy, was positively associated with generic HRQoL. However, both health literacy and eHealth literacy were positively associated with lung-specific HRQoL, with higher COPD knowledge indicative of lower lung-specific HRQoL. These results confirm the importance of considering health and eHealth literacy levels when designing patient education programs for people living with COPD. Future research should explore the impact of delivering interventions aimed at improving eHealth and health literacy among patients with COPD, particularly when disease self-management goals are to enhance HRQoL.

BackgroundIn the last decade, electronic health (eHealth) literacy has attracted the attention of the scientific community, as it is associated with the self-management of patients with chronic diseases and the quality and cost of care. It is estimated that 80% of people with chronic diseases are cared for at home by a family member, friend, or relative. Informal carers are susceptible to physical and mental health problems, as well as social and financial hardships. Nevertheless, there seems to be a research gap in terms of carers’ needs, skills, and available resources in the age of new technologies, with the vital role of eHealth literacy of the carers remaining unexplored.ObjectiveThe aim of this study was to investigate the level of eHealth literacy and health literacy of primary and secondary carers of people with dementia, to explore the association between health and eHealth literacy, as well as their association with the caregiving variables: self-efficacy, coping, and caring perceptions.MethodsA sample of 200 primary carers (the carer who supports the people with dementia in everyday living) and 200 secondary carers (family member, friend, or other person in the social network assisting the primary carer in their role) will be recruited from dementia day care centers and Alzheimer’s associations in Greece and Cyprus. The study will be a cross-sectional correlational descriptive study. Tools to be used include the eHealth Literacy Scale adapted for carers to measure eHealth literacy, European Health Literacy Survey Questionnaire 16 (HLS-EU-Q16), Single Item Literacy Screener, Revised Scale for Caregiving Self-Efficacy, Carers of Older People in Europe (COPE) index for caregiving perceptions, and COPE brief to measure selected coping strategies. Descriptive statistics will be reported, and correlations between different variables will be explored with parametric and nonparametric measures.ResultsAs a preliminary study, the HLS-EU-Q16 has been validated in 107 older people. The internal consistency of the scale as estimated using Cronbach alpha coefficient was .77, somewhat lower than other validation studies. Recruitment of pilot study participants started in May 2017.ConclusionsCarers’ eHealth literacy is a new field. Whereas previous studies have focused on the role and impact of low eHealth literacy and health literacy among older adults, the eHealth literacy of carers, and in fact carers of people with dementia, has not been explored. We hypothesize an association between eHealth literacy and health literacy level with carers’ perceptions about caregiving role, self-efficacy, and coping strategies. A possible moderator in these associations is the secondary carers’ eHealth and health literacy level, which will also be explored. By confirming the above hypotheses, tailored eHealth literacy interventions for carers of people with dementia and their families will be developed as a direct outcome of this research.

BackgroundGiven the recognized importance of preventing poor dietary behaviors during adolescence, we need a better understanding of college students’ dietary behaviors. Studies have found that individual factors and electronic health (eHealth) literacy may affect one’s dietary behaviors. However, few studies have fully investigated the effect of the three levels of eHealth literacy (functional, interactive, and critical) and the interactive effect of individual factors (eg, gender, monthly expenses, and frequency of cooking) and the three levels of eHealth literacy on the four aspects of dietary behaviors (consumer health, balanced diet, regular eating habits, and unhealthy food intake).ObjectiveThis study aimed to investigate whether individual differences and higher eHealth literacy are associated with more positive dietary behaviors and less unhealthy dietary intake.MethodsThe eHealth Literacy Scale is a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy. The Dietary Behaviors Scale is a 14-item instrument developed to measure four aspects of dietary behaviors of college students. A questionnaire was administered to collect background information about participants’ gender, monthly expenses, and frequency of cooking. A national sample of college students was surveyed, and 813 responses were obtained. We conducted a multiple regression analysis to examine the association among individual factors, eHealth literacy, and dietary behaviors.ResultsThis study found that functional eHealth literacy was negatively related to unhealthy food intake (beta=−.11; P=.01), and interactive eHealth literacy was positively related to balanced diet (beta=.25; P<.001) and consumer health (beta=.15; P=.02). Moreover, critical eHealth literacy was positively related to consumer health (beta=.30; P<.001) and regular eating habits (beta=.20; P=.002). Finally, the interactive effect between gender and interactive eHealth literacy was negatively related to balanced diet (beta=−.22; P<.001). The interactive effect between monthly expenses and functional eHealth literacy was positively related to balanced diet (beta=.07; P=.03), although the interactive effect between monthly expenses and critical eHealth literacy was negatively related to balanced diet (beta=−.10; P=.047).ConclusionsThis study showed that Taiwanese college students with higher functional eHealth literacy were more likely to engage in fewer unhealthy food consumption practices. Those who had higher interactive and critical eHealth literacy were more likely to engage in positive dietary behaviors than those with functional eHealth literacy. Surprisingly, females with high interactive eHealth literacy were more likely to have a poor balanced diet. In contrast, students with higher monthly expenses and higher functional eHealth literacy were more likely to have a balanced diet. However, students with higher monthly expenses and higher critical eHealth literacy were less likely to maintain a balanced diet.

This cross-sectional study aimed to investigate the association between electronic health (eHealth) literacy and oral health outcomes, including the number of teeth and brushing frequency. A total of 478 participants were included in the study and assessed for their eHealth literacy levels. Demographic variables, including age, gender, income, and education, were collected. The participants' number of teeth and brushing frequency were also recorded. Multiple regression analyses were performed to examine the relationship between eHealth literacy and oral health outcomes, adjusting for sociodemographic variables. The study sample consisted of both males (66.5%) and females (33.5%), with a mean age of 31.95 years. Among the participants, 16.95% were classified as having inadequate eHealth literacy, 24.06% had problematic eHealth literacy, and the majority (59.00%) demonstrated sufficient eHealth literacy. There was a significant association between eHealth literacy and oral health outcomes. Individuals with problematic eHealth literacy had a higher likelihood of having a greater number of teeth (RR = 1.12, 95% CI: 1.05-1.20, p < 0.001) compared to those with inadequate eHealth literacy. Similarly, individuals with sufficient eHealth literacy showed a higher likelihood of having more teeth (RR = 1.14, 95% CI: 1.07-1.21, p < 0.001) compared to the inadequate eHealth literacy group controlling for age, gender, income, and education. Individuals with problematic eHealth literacy exhibited a tendency towards lower odds of irregular brushing (OR = 0.39, 95% CI: 0.15-1.02, p = 0.054), although this result was marginally significant. In contrast, individuals with sufficient eHealth literacy had significantly lower odds of irregular brushing frequency (OR = 0.24, 95% CI: 0.10-0.62, p = 0.003) compared to the inadequate eHealth literacy group. The findings suggest a positive association between eHealth literacy and oral health outcomes. Improving eHealth literacy may have implications for promoting better oral health behaviors and outcomes.

Today, a fifth of the world's population is made up of adolescents aged 10-19, 500 million of these people are adolescent girls, and investing in the health of adolescents is one of the main ways to achieve the Millennium Development Goals. Health concerns are a phenomenon that preoccupies many people at some point in their lives, and in some cases, even though the evidence does not show a specific disease, the person's concerns are not resolved and health anxiety continues. E-health literacy helps people manage important health issues, make informed health decisions, or communicate with doctors. The present study was conducted with the aim of investigating the electronic health literacy promotion strategies in adolescent girls of Iran: a cross-sectional study. This cross-sectional study was conducted in 2023 on 351 teenage girls of Iran, whose information was completely recorded in the Sib system. The sampling method was random and was used to collect information from the Electronic Health Literacy Questionnaire and the Health Anxiety Questionnaire. Finally, the data collected by the questionnaire were coded and analyzed after entering into the computer by SPSS version 25 software using descriptive and analytical tests. The average age of adolescent girls was 0.834 + 85.15 years. The average score of electronic health literacy in adolescent girls was 79.07 + 14.54, and the average health anxiety score was 83.3 + 35.73. There was an inverse statistical relationship between e-health literacy and health anxiety in girls. The highest average score of health literacy at the age of 17 was for "girls whose fathers are retired and whose mothers are housewives", fathers and mothers with university education, mothers in the age group of 35-40 years, and fathers in the age group of 40-45 years. There was a significant relationship between e-health literacy and factors such as parents' occupation, parents' education, being the second child, and having older siblings (0.05 > 0). Improving e-health literacy may be an effective strategy to reduce health anxiety in adolescent girls who are the future mothers of the country. Therefore, developing comprehensive programs for the use of cyberspace, creating simple and understandable media, and educational materials, as well as efficient educational interventions for people with insufficient e-health literacy can be an effective step to develop health literacy skills and ultimately reduce health anxiety among adolescents.

BackgroundElectronic health (eHealth) literacy has become an important topic in health fields. Studies have found that individuals with higher eHealth literacy are more likely to use preventive care services and to have effective interactions with their physicians. In addition, previous studies have revealed a gender difference in the utilization of physician access and outpatient services. Nevertheless, few studies have explored the effect of the three levels of eHealth literacy (functional, interactive, and critical levels) on the four aspects of health services utilization (type, site, purpose, and time interval). It is unclear whether the associations between these three levels of eHealth literacy and the four aspects of health services utilization among college students are positive or negative.ObjectiveThe objective of this study was to investigate the associations among gender, eHealth literacy, and health services utilization.MethodsWe used the eHealth Literacy Scale, a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy, and the Health Services Utilization Scale, which is a 10-item instrument developed to measure the four aspects of health services utilization by college students. A nationally representative sample of 489 college students in Taiwan was surveyed. We conducted multiple regression analysis to examine the associations among gender, eHealth literacy, and health services utilization.ResultsThe study found that being female was negatively related to the purpose aspect of health services utilization (t487=−2.85, P<.01). However, the R2 value of gender on the purpose aspect was low enough to be ignored. Critical (t484=2.98-4.23, P<.01) and interactive eHealth literacy (t484=2.43-2.89, P<.05) were related to three aspects of the health services utilization, and functional eHealth literacy was related to the purpose aspect (t484=−4.99, P<.001).ConclusionsThis study showed that Taiwanese college students with interactive eHealth literacy were more likely to have a higher rate of outpatient care use. Moreover, Taiwanese college students with critical eHealth literacy were more likely to make full use of health services than those with functional eHealth literacy. Finally, the educated and age-restricted sample may attenuate gender disparities in health services utilization among Taiwanese college students.

Health anxiety adversely affects quality of life and increases healthcare utilization. This cross-sectional study investigated the relationship between perceptions of health news, e-health literacy, and health anxiety among 402 adults recruited via non-probability convenience sampling in Türkiye. Data were collected using the Health Anxiety Inventory, e-Health Literacy Scale, and Health News Perception Scale. Mean health anxiety scores were low (0.95 ± 0.45). Women, individuals with lower education, poorer health perception, and those who immediately acted on health information reported higher health anxiety. In regression analysis, lower education, poor self-rated health, immediate application of health information, lower perception of commercial concern, higher behavioral change, and female gender were independently associated with higher health anxiety. Although e-health literacy and trust in health news were negatively correlated with anxiety, these associations were not significant in regression analysis. Transparent, evidence-based communication and strengthening education and e-health literacy may reduce media-induced health anxiety.

BackgroundElectronic health (eHealth) literacy may play an important role in individuals’ engagement with online mental health-related information.AimTo examine associations between eHealth literacy and psychological outcomes among Nigerians during the Coronavirus disease-2019 (COVID-19) pandemic.MethodsThis was a cross-sectional study among Nigerians conducted using the ‘COVID-19’s impAct on feaR and hEalth (CARE) questionnaire. The exposure: eHealth literacy, was assessed using the eHealth literacy scale, and psychological outcomes were assessed using the PHQ-4 scale, which measured anxiety and depression; and the fear scale to measure fear of COVID-19. We fitted logistic regression models to assess the association of eHealth literacy with anxiety, depression, and fear, adjusting for covariates. We included interaction terms to assess for age, gender, and regional differences. We also assessed participants’ endorsement of strategies for future pandemic preparedness.ResultsThis study involved 590 participants, of which 56% were female, and 38% were 30 years or older. About 83% reported high eHealth literacy, and 55% reported anxiety or depression. High eHealth literacy was associated with a 66% lower likelihood of anxiety (adjusted odds ratio aOR, 0·34; 95% confidence interval, 0·20–0·54) and depression (aOR: 0·34; 95% CI, 0·21–0·56). There were age, gender, and regional differences in the associations between eHealth literacy and psychological outcomes. eHealth-related strategies such as medicine delivery, receiving health information through text messaging, and online courses were highlighted as important for future pandemic preparedness.ConclusionConsidering that mental health and psychological care services are severely lacking in Nigeria, digital health information sources present an opportunity to improve access and delivery of mental health services. The different associations of e-health literacy with psychological well-being between age, gender, and geographic region highlight the urgent need for targeted interventions for vulnerable populations. Policymakers must prioritize digitally backed interventions, such as medicine delivery and health information dissemination through text messaging, to address these disparities and promote equitable mental well-being.

Purpose: This study aimed to investigate whether women's cyberchondria levels differ according to some socio-demographic demographic characteristics and the effect of health anxiety and e-health literacy on cyberchondria levels. Methods: The descriptive and cross-sectional study was conducted between December 2022 and March 2023 with women who applied to the gynecology outpatient clinic of a state hospital. The purposive sampling method was used, and 178 women were included in the study. The data were collected using a personal information form, Cyberchondria Severity Scale (CSS), Health Anxiety Inventory (HAI), and eHealth Literacy Scale (eHEALS). ANOVA, t-test, Pearson correlation, and hierarchical linear regression analysis analyzed the data. Results: In this study, the cyberchondria levels of the participants differed according to some socio-demographic characteristics (p&lt; 0.05). The participants' mean score was 28.25 ± 8.45 on the CSS, 18.93 ± 10.78 on the HAI, and 25.65 ± 9.05 on the eHEALS. There was a positive and moderate relationship between the level of cyberchondria and health anxiety (r= 0.416; p=0.001) and e-health literacy (r= 0.378; p=0.001). Hierarchical regression analysis revealed that spending six hours or more on the Internet per day (β = 0.130), health anxiety (β = 0.319) and e-health literacy (β = 0.273) were predictors of cyberchondria (p&lt; 0.05), and these variables explained 35% of the variance in cyberchondria (F=14.279; p=0.001). Conclusion: The study provides new findings in health-related Internet use research and contributes to the ongoing debate on the possible predictors of cyberchondria.

BackgroundVariations in an individual’s electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points.ObjectiveThe aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated with class membership.MethodsMedical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership.ResultsOf the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00; P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29; P=.007).ConclusionsThe identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients’ varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on individuals’ internet use frequency and health information amount preferences.

Introduction/Aim: Data about electronic health (eHealth) literacy and potential differences in eHealth literacy between university students are lacking. The aim of this study was to evaluate eHealth literacy in students of sports and medicine and to assess the factors associated with better eHealth literacy. Material and Methods: This cross-sectional study was carried out from April to October 2017 among final year students of the Faculty of Sports and Physical Education and the Faculty of Medicine, University of Belgrade, Serbia. A total of 89 sports students and 301 medical students were included. The eHealth Literacy Scale (eHEALS) was used to evaluate eHealth literacy. Results: Compared with sports students, medical students had higher median eHEALS score (27 vs. 30, respectively, p=0.008). Medical students were twice as confident as sports students in their efforts to locate helpful online health resources and use online health information. A significant hierarchical linear regression model was not obtained in the sample of sports students regarding predictors of better eHealth literacy. In the sample of medical students, the following was associated with better self-perceived eHealth literacy: being female, residing outside of the capital before becoming a student, younger age at the time of the first Internet use, the use of health-related websites and smartphone apps as well as lower influence of online health-related information on decision making regarding health. Conclusion: Medical students were more confident in perceiving their eHealth literacy skills compared to sports students. The factors associated with better eHealth literacy may depend on the fields of study.

BackgroundIncreased access to the internet has facilitated widespread availability of health information. Thus, electronic health (eHealth) literacy—the ability to seek, find, understand, and appraise health information from electronic resources and apply that knowledge in making a health-related decision—is a crucial skill. Despite the increasing use of the internet as a source of health information in developing countries, only a few studies have examined the eHealth literacy of young adults, who frequently use the internet to access health information in these developing countries.ObjectiveThe aim of this study was to assess the patterns of internet use and eHealth literacy levels among university students pursuing a non–health-related degree in Pakistan. We also examined the association of the eHealth literacy levels of these young adults with their physical activity levels and dietary supplement intake.MethodsStudents from 2 leading engineering universities in Pakistan were invited to participate in a cross-sectional anonymous web-based survey in order to collect data on their internet use, eHealth literacy, and dietary supplement intake. Of the 900 eligible university students who were invited to participate, 505 (56.1%) students who completed the questionnaire were included in the analysis. The findings were converted to median values and frequency analyses were performed. The associations between the variables were determined using the chi-square test; P≤.05 was considered significant.ResultsIn this study, the median eHealth literacy scale (eHEALS) score was 29, which did not vary across gender. The most common type of health-related information that was searched by the participants was that related to maintaining a healthy lifestyle (305/505, 60.4%). Participants with high eHEALS scores were those who used the internet frequently for finding people with similar health issues (P<.001). The use of specific social media platforms was not associated with the perceived eHealth literacy levels. Neither the frequency of physical activity nor the dietary supplement use was associated with the eHealth literacy of the participants.ConclusionsUniversity students in non–health-related disciplines in Pakistan expressed high confidence in their skills to find health-related information on the internet, as indicated by the aggregate eHEALS scores. However, the findings of our study show that the perceived eHealth literacy was not associated with health behaviors such as physical activity and dietary supplement intake. Further research is necessary to investigate the extent to which eHealth literacy can be considered as a panacea for solving public health challenges in developing countries.

BackgroundThis study aimed to understand the relationship between e-health literacy, health perception, cyberchondria, and health anxiety among foreign university students in Turkey. International students often face unique challenges such as language barriers, cultural differences, and limited familiarity with local healthcare systems, which may lead them to rely more heavily on online health information and shape their responses to health-related uncertainty and stress. Understanding these dynamics is essential from a public health perspective, as this population represents a vulnerable group whose health behaviors and digital engagement have important implications for both individual well-being and broader community health.MethodsA cross-sectional design was used in the study. The sample consisted of 352 foreign students selected through the convenience sampling method. The study data were collected from a university in the Western Black Sea Region in Turkey between June 2024 and November 2024. A serial multiple mediation analysis was applied to examine the direct and indirect effects of health perception on e-health literacy.ResultsThe findings show that health perception positively affects e-health literacy, but cyberchondria and health anxiety have important mediating roles in this relationship. Findings suggest that individuals with negative health perception are more likely to exhibit behaviors such as increased health-related information-seeking, which may be associated with elevated levels of cyberchondria and health anxiety. The serial mediating role of cyberchondria and health anxiety further exacerbates the negative impact of negative health perception on e-health literacy.ConclusionsThe study highlights the complex interplay between psychological factors and digital health behaviors among foreign students. Improving e-health literacy requires addressing health perception and mitigating anxiety-related behaviors. The findings suggest the importance of developing culturally tailored digital health literacy programs to support informed decision-making and reduce vulnerability to online health misinformation.