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

Background: eHealth literacy (eHL) is considered an important competency among healthcare providers in healthcare systems, especially following the introduction of information and communication technologies. Objectives: This study aimed to identify the relationship and direction of factors affecting nursing students' eHL in an online learning environment. Design: A cross-sectional study. Settings: Three nursing colleges located in Gyeonggi-do and Gangwon-do in Korea. Participants: Participants were 259 nursing students aged 18???29 years who lived in the Seoul metropolitan area. Methods: Self-reported data on variables including attitudes toward online learning, digital literacy, self-efficacy, and eHL, were collected and analyzed using an independent t-test and one-way analysis of variance. The mediating effects were verified through the bootstrapping method using the PROCESS macro for SPSS. Results: The results indicated that although attitudes toward online learning affected digital literacy, they did not directly influence eHL. Additionally, digital literacy and self-efficacy were also found to be associated with eHL and mediate the relationship between online learning attitudes and eHL. Conclusions: As online nursing education rapidly becomes commonplace due to the COVID-19 pandemic, attitudes toward online learning, digital literacy, and self-efficacy must be improved to enhance eHL.