{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:15:07Z","timestamp":1783318507210,"version":"3.54.6"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medical students, as future healthcare professionals, play a critical role in promoting preventive attitudes such as Human Papillomavirus (HPV) testing. However, their own preventive intentions may be influenced by psychological factors. This study aimed to identify latent profiles of health anxiety (HA) among medical students and examine how these profiles relate to HPV testing acceptability through the mediating role of eHealth literacy (eHL), informed by selected constructs from Protection Motivation Theory (PMT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted among 887 medical students at a university in Liaoning, China, using a voluntary response sampling method. Using the Chinese version of the Short Health Anxiety Inventory (CSHAI), the eHealth Literacy Scale (eHEALS), and a tailored acceptability scale, respectively. Data were analyzed using SPSS 25.0 and Mplus 8.3. Following descriptive and correlation analyses, Latent Profile Analysis (LPA) was employed to identify HA subgroups. To rigorously account for classification uncertainty, the Bolck-Croon-Hagenaars (BCH) method was utilized for distal outcome comparisons, followed by the construction of a simple mediation model and a covariate-adjusted multi-categorical mediation model (via a manual 3-step approach). Sequential sensitivity analyses were conducted to verify the robustness of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      LPA identified three distinct HA profiles: \u201cRoutine\u201d (26.2%), \u201cAvoidance\u201d (57.2%), and \u201cVigilance\u201d (16.7%). Significant differences were observed in eHL and HPV testing acceptability across these groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Variable-centered analysis showed that HA was positively associated with eHL, which in turn correlated with higher acceptability. However, person-centered analysis revealed a non-linear J-shaped relationship: compared to the Routine group, the Vigilance group exhibited significantly higher eHL and testing acceptability, whereas the Avoidance group showed significantly lower levels of both. eHL was identified as a significant statistical mediator in the cross-sectional associations across these profiles.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study highlights the significant psychological heterogeneity of HA among medical students, identifying a complex, non-linear association between varying anxiety levels and preventive behavioral intentions. These findings may inform future educational discussions regarding the integration of digital health literacy training and psychological support among medical students.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1862167","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:36:49Z","timestamp":1783316209000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Heterogeneity in health anxiety among medical students and HPV testing acceptability: the mediating role of eHealth literacy from a person-centered perspective"],"prefix":"10.3389","volume":"14","author":[{"given":"Yifan","family":"Gong","sequence":"first","affiliation":[{"name":"Department of Social Medicine, College of Health Management, China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minyi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, College of Health Management, China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Jin","sequence":"additional","affiliation":[{"name":"Beijing Aerospace General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihui","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, College of Health Management, China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, College of Health Management, China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1001\/jama.2023.13174","article-title":"Cervical Cancer screening: a review","volume":"330","author":"Perkins","year":"2023","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1002\/jso.26687","article-title":"Epidemiology and incidence of HPV-related cancers of the head and neck","volume":"124","author":"Roman","year":"2021","journal-title":"J Surg Oncol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/s13027-024-00624-0","article-title":"Prevalence of HPV in anal cancer: exploring the role of infection and inflammation","volume":"19","author":"Ebrahimi","year":"2024","journal-title":"Infect Agent Cancer"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e1517","DOI":"10.1002\/cnr2.1517","article-title":"Lack of knowledge regarding HPV and its relation to oropharyngeal cancer among medical students","volume":"5","author":"Sallam","year":"2022","journal-title":"Cancer Rep (Hoboken)"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"282","DOI":"10.31729\/jnma.8531","article-title":"Medical student syndrome and imposter syndrome: are they real?","volume":"62","author":"Devkota","year":"2024","journal-title":"JNMA J Nepal Med Assoc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1186\/s12909-025-07209-4","article-title":"Addressing medical students\u2019 health challenges: codesign and pilot testing of the preventive remediation for optimal MEdical StudentS (PROMESS) program","volume":"25","author":"M\u00e9tais","year":"2025","journal-title":"BMC Med Educ"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1080\/17437199.2024.2413011","article-title":"Protection motivation theory and health behaviour: conceptual review, discussion of limitations, and recommendations for best practice and future research","volume":"19","author":"Balla","year":"2025","journal-title":"Health Psychol Rev"},{"key":"ref8","volume-title":"Anxiety and the Anxiety Disorders","author":"Beck","year":"1985"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/0272-7358(88)90086-4","article-title":"A review of the relationship between panic and avoidance","volume":"8","author":"Craske","year":"1988","journal-title":"Clin Psychol Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.rcpeng.2020.11.007","article-title":"Factors associated with health anxiety in medical students at a private university in Lima, Peru","volume":"51","author":"Robles-Mari\u00f1os","year":"2022","journal-title":"Revista Colombiana de Psiquiatr\u00eda (English ed)"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8.2.e9","article-title":"EHealth literacy: essential skills for consumer health in a networked world","volume":"8","author":"Norman","year":"2006","journal-title":"J Med Internet Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"23821205241262590","DOI":"10.1177\/23821205241262590","article-title":"Digital health\/e-health literacy among university students in the COVID-19 era: a systematic review","volume":"11","author":"Fallahi","year":"2024","journal-title":"J Med Educat Curri Develop"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1186\/s12909-025-07177-9","article-title":"Integrating AI in medical education: a comprehensive study of medical students\u2019 attitudes, concerns, and behavioral intentions","volume":"25","author":"Duan","year":"2025","journal-title":"BMC Med Educ"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1111\/hir.12487","article-title":"Perceived and performed electronic health literacy of medical sciences students","volume":"41","author":"Ghaedi","year":"2024","journal-title":"Health Inf Libr J"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1186\/s12889-025-22648-w","article-title":"Investigating e-health literacy and its relationship with self-care behaviors among Iranian middle-aged type 2 diabetes: a cross-sectional study","volume":"25","author":"Sadeghi","year":"2025","journal-title":"BMC Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"4368","DOI":"10.1186\/s12889-025-25636-2","article-title":"Examining the relationships between e-health literacy, cyberchondria, health anxiety, and health perception among foreign university students","volume":"25","author":"Aslan","year":"2025","journal-title":"BMC Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1739","DOI":"10.2147\/NDT.S83501","article-title":"The reliability and validity of a Chinese-version short health anxiety inventory: an investigation of university students","volume":"11","author":"Zhang","year":"2015","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8.4.e27","article-title":"EHEALS: the eHealth literacy scale","volume":"8","author":"Norman","year":"2006","journal-title":"J Med Internet Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"104903","DOI":"10.1016\/j.tra.2026.104903","article-title":"Heterogeneity in women\u2019s nighttime ride-hailing intention: evidence from an LC-ICLV model analysis","volume":"206","author":"Wang","year":"2026","journal-title":"Transp Res A Policy Pract"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1080\/10705511.2014.915181","article-title":"Auxiliary variables in mixture modeling: three-step approaches using Mplus","volume":"21","author":"Asparouhov","year":"2014","journal-title":"Struct Equ Model"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1080\/13548506.2024.2424991","article-title":"Differentiating anxiety profiles in medical students: a latent profile analysis","volume":"30","author":"Ding","year":"2025","journal-title":"Psychol Health Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"290","DOI":"10.70736\/ijoess.552","article-title":"Relationships between health anxiety, intolerance of uncertainty, rumination and selfcompassion: a structural equation and latent profile analysis","volume":"16","author":"Polat","year":"2025","journal-title":"Int J Eurasia Soc Sci \/ Uluslararasi Avrasya Sosyal Bilimler Dergisi"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1186\/s43045-022-00273-2","article-title":"Prevalence and correlates of health anxiety among medical students: a cross-sectional study from the United Arab Emirates","volume":"30","author":"Abdel Aziz","year":"2023","journal-title":"Middle East Curr Psychiatry"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1186\/s40359-025-02788-9","article-title":"The journey of medical field students: uncovering medical student syndrome, personality traits, and their interactions","volume":"13","author":"Abdellatif","year":"2025","journal-title":"BMC Psychol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"077","DOI":"10.1055\/s-0043-1768683","article-title":"Medical students\u2019 syndrome among medical students in the University of Sharjah, UAE","volume":"13","author":"Abdullah","year":"2023","journal-title":"Avicenna J Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"15","DOI":"10.12740\/PP\/30811","article-title":"The prevalence of common mental disorders in the population of adult poles by sex and age structure - an EZOP Poland study","volume":"49","author":"Wci\u00f3rka","year":"2015","journal-title":"Psychiatr Pol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"S488","DOI":"10.1192\/j.eurpsy.2025.1016","article-title":"Health anxiety in medical students: a hidden challenge in medical education","volume":"68","author":"Boussaid","year":"2025","journal-title":"Eur Psychiatry"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"737382","DOI":"10.1155\/2014\/737382","article-title":"Medical students\u2019 experience of and reaction to stress: the role of depression and anxiety","volume":"2014","author":"Saravanan","year":"2014","journal-title":"Sci World J"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"51","DOI":"10.2147\/PRBM.S446448","article-title":"The moderating role of health literacy and health promoting behavior in the relationship among health anxiety, emotional regulation, and Cyberchondria","volume":"17","author":"Fang","year":"2024","journal-title":"Psychol Res Behav Manag"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s11764-022-01260-6","article-title":"Factors influencing the e-health literacy in cancer patients: a systematic review","volume":"17","author":"Zhang","year":"2023","journal-title":"J Cancer Surviv"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e34790","DOI":"10.2196\/34790","article-title":"Online health information seeking behaviors among older adults: systematic scoping review","volume":"24","author":"Zhao","year":"2022","journal-title":"J Med Internet Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e20240160","DOI":"10.1590\/1980-220X-REEUSP-2024-0160en","article-title":"Associations between health anxiety, eHealth literacy and self-reported health: a cross-sectional study","volume":"58","author":"Chen","year":"2024","journal-title":"Rev Esc Enferm USP"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"783","DOI":"10.3390\/vaccines9070783","article-title":"Integrating health behavior theories to predict COVID-19 vaccine acceptance: differences between medical students and nursing students","volume":"9","author":"Rosental","year":"2021","journal-title":"Vaccine"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"9911410","DOI":"10.1136\/sbmj.9911410","article-title":"Hypochondriasis: an overview with reference to medical students","volume":"319","author":"Howes","year":"1999","journal-title":"BMJ"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1089\/cpb.2006.9.494","article-title":"Worried and wired: effects of health anxiety on information-seeking and health care utilization behaviors","volume":"9","author":"Eastin","year":"2006","journal-title":"CyberPsychol Behav"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.2105\/AJPH.2009.180521","article-title":"Health information\u2013seeking behaviors, health indicators, and health risks","volume":"100","author":"Weaver","year":"2010","journal-title":"Am J Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e25963","DOI":"10.2196\/25963","article-title":"Explaining online information seeking behaviors in people with different health statuses: German representative cross-sectional survey","volume":"23","author":"Link","year":"2021","journal-title":"J Med Internet Res"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1038\/s41386-021-01263-4","article-title":"Measuring maladaptive avoidance: from animal models to clinical anxiety","volume":"47","author":"Ball","year":"2022","journal-title":"Neuropsychopharmacol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1037\/0022-3514.78.6.1024","article-title":"Automatic vigilance: the attention-grabbing power of approach- and avoidance-related social information","volume":"78","author":"Wentura","year":"2000","journal-title":"J Pers Soc Psychol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1089\/tmj.2019.0301","article-title":"Factors in the effectiveness of e-health interventions for chronic Back pain: how self-efficacy mediates e-health literacy and healthy habits","volume":"27","author":"Rabenbauer","year":"2021","journal-title":"Telemed E-Health"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.868279","article-title":"The longitudinal relationship between eHealth literacy, health-promoting lifestyles, and health-related quality of life among college students: a cross-lagged analysis","volume":"10","author":"Li","year":"2022","journal-title":"Front Public Health"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e2200005","DOI":"10.1200\/CCI.22.00005","article-title":"Health literacy and eHealth: challenges and strategies","author":"Hasannejadasl","year":"2022","journal-title":"JCO Clin Cancer Inform"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e66092","DOI":"10.2196\/66092","article-title":"Web-based delivery of an effective church-based intervention program to promote cancer screening (community-based health literacy-focused intervention for breast and cervical cancer control) among Korean immigrant women in the United States: randomized controlled trial","volume":"12","author":"Han","year":"2025","journal-title":"JMIR Hum Factors"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"22","DOI":"10.29063\/ajrh2025\/v29i8s.3","article-title":"Pregnancy health literacy and willingness for HPV testing among pregnant women in Lahore, Pakistan","volume":"29","author":"Sohail","year":"2025","journal-title":"Afr J Reprod Health"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.1007\/s10728-025-00525-2","article-title":"Relationships among Cancer screening participation, E-health literacy, and healthy lifestyle behaviors in a Group of Turkish Women: a structural equation modeling analysis","author":"G\u00f6kduman Kele\u015f","year":"2025","journal-title":"Health Care Anal"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"Michie","year":"2011","journal-title":"Implement Sci"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s13012-017-0605-9","article-title":"A guide to using the theoretical domains framework of behaviour change to investigate implementation problems","volume":"12","author":"Atkins","year":"2017","journal-title":"Implement Sci"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"101427","DOI":"10.1016\/j.pmedr.2021.101427","article-title":"The integrated screening action model (I-SAM): a theory-based approach to inform intervention development","volume":"23","author":"Robb","year":"2021","journal-title":"Prev Med Rep"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1186\/s13690-025-01517-3","article-title":"DOST: a consolidated health behavior model that maps factors influencing cancer screening uptake","volume":"83","author":"Dsouza","year":"2025","journal-title":"Arch Public Health"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12909-024-06595-5","article-title":"Unveiling the interplay of medical professionalism, mental well-being and coping in medical students: a qualitative phenomenological study","volume":"25","author":"Sattar","year":"2025","journal-title":"BMC Med Educ"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1186\/s12909-025-07388-0","article-title":"Identifying strengths and weaknesses in health literacy among medical students: a systematic review","volume":"25","author":"Baralin","year":"2025","journal-title":"BMC Med Educ"},{"key":"ref52","author":"Zou","year":"2024"},{"key":"ref53","author":"Guan","year":"2026"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1862167\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:36:50Z","timestamp":1783316210000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1862167\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":53,"alternative-id":["10.3389\/fpubh.2026.1862167"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1862167","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"article-number":"1862167"}}