Prospective association of eHealth literacy and health literacy with physical activity among Chinese college students: a multiple mediation analysis

Background: The COVID-19 pandemic has decreased physical activity (PA) while increasing demand for electronic health resources. eHealth literacy (EHL) is expected to aid eHealth use and health promotion. EHL was raised on the grounds of health literacy (HL). This study explored the associations among EHL, HL, and PA in Chinese college students and identified mediating mechanisms in the EHL/HL-PA relationship. Methods: An integrated social-cognitive model was proposed. A total of 947 Chinese college students (52.8% women, age = 19.87 ± 1.68 years) completed the three-wave data collection. Path analysis was performed. Results: An adequate good-to-fit model was indicated. Perceived EHL (PEHL) was significantly associated with perceived HL (PHL) and HL performance (HLP); PHL was negatively related to HLP; PEHL was significantly associated with self-efficacy (SE) and social support (SS); PHL had a significant effect on SS but not SE; HLP significantly affected SS but not SE; SS and SE positively predicted intention (INT), which then predicted PA. SS mediated PEHL/PHL-INT links; SE mediated the PEHL-INT link; SS and INT jointly mediated PEHL/PHL/HLP-PA; SE and INT jointly mediated PEHL-PA. Conclusion: Relationships among EHL, HL, and PA were explored with multiple mediating mechanisms identified. Differential SE and SS roles in EHL/HL-PA links suggest new mechanisms to inform EHL/HL intervention development.