{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:10:59Z","timestamp":1788952259348,"version":"build-2803163510"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"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>Objectives<\/jats:title>\n                    <jats:p>This study explores the mechanisms by which E-health literacy among inpatients in county-level public hospitals influences patient loyalty. It further examines the mediating role of value co-creation and the moderating effect of perceived social support, seeking to provide empirical evidence for the digital transformation of county hospitals and patient relationship management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A stratified random sampling method was employed to survey 784 inpatients in county-level public hospitals in Shandong Province. E-health literacy, value co-creation, perceived social support, and patient loyalty were assessed using a structured questionnaire. Correlation analysis, regression analysis, and moderated mediation models were applied to examine both the direct and indirect effects of E-health literacy on patient loyalty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>E-health literacy was positively associated with patient loyalty, and value co-creation mediated this relationship. Furthermore, perceived social support was found to moderate the relationship between E-health literacy and patient loyalty, suggesting that elevated perceived social support weakened the positive association between E-health literacy and patient loyalty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>E-health literacy appears to be an important factor associated with inpatient loyalty in county-level public hospitals. Value co-creation and perceived social support play important mediating and moderating roles, respectively, within this process. By enhancing patients\u2019 E-health literacy, promoting value co-creation behaviors, and leveraging social support resources, it is possible to foster sustained improvements in patient loyalty and advance the quality of smart healthcare services in county-level public hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1940333","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:17:38Z","timestamp":1788949058000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of E-health literacy on patient loyalty in county-level public hospitals: the mediating role of value co-creation and the moderating role of perceived social support"],"prefix":"10.3389","volume":"14","author":[{"given":"Mengjiao","family":"Yang","sequence":"first","affiliation":[{"name":"School of Management, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengxin","family":"Fan","sequence":"additional","affiliation":[{"name":"School of Public Health, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bei","family":"Lu","sequence":"additional","affiliation":[{"name":"Liuzhou People's Hospital Affiliated to Guangxi Medical University","place":["Liuzhou, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Management, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongming","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Management, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenqiang","family":"Yin","sequence":"additional","affiliation":[{"name":"School of Management, Shandong Second Medical University","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1136\/svn-2017-000101","article-title":"Artificial intelligence in healthcare: past, present and future","volume":"2","author":"Jiang","year":"2017","journal-title":"Stroke Vasc Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"845577","DOI":"10.3389\/fpubh.2022.845577","article-title":"Editorial: smart hospital innovation: technology, service, and policy","volume":"10","author":"Hu","year":"2022","journal-title":"Front Public Health"},{"key":"ref3","volume-title":"Global Strategy on digital Health 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