{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T08:53:28Z","timestamp":1767084808607,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T00:00:00Z","timestamp":1723680000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia (FCT)","award":["UIDB\/05507\/2020","UIDB\/00681\/2020"],"award-info":[{"award-number":["UIDB\/05507\/2020","UIDB\/00681\/2020"]}]},{"name":"National Funds","award":["UIDB\/05507\/2020","UIDB\/00681\/2020"],"award-info":[{"award-number":["UIDB\/05507\/2020","UIDB\/00681\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Despite their familiarity with technology, higher education students often lack the critical skills needed to assess the credibility of online health information, potentially impacting their health decisions and well-being. This study aims to validate and assess the e-Health Literacy Scale among those in Portuguese higher education. In addition, this study focused on measuring their e-health literacy levels and investigating how these skills relate to different sociodemographic variables. This cross-sectional study was conducted in two phases. Initially, the test\u2013retest reliability and reproducibility of measured e-health literacy were assessed with a convenience sample of 20 participants. Subsequently, the e-health scale was applied to a group of 245 Portuguese higher education students. The research took place from January 2023 to April 2024. The scale exhibited robust internal consistency and reproducibility. Male gender consistently correlates with higher levels of e-health literacy. Students demonstrate good levels of e-health literacy (24\/40), reflecting their ability to effectively navigate and utilize health information online. By integrating strategies to further enhance this literacy into university health programs, students can develop essential skills necessary for making informed decisions about their health. This proactive approach not only empowers students to access reliable health resources but also fosters a culture of health literacy that can positively impact their well-being both during their academic journey and beyond graduation.<\/jats:p>","DOI":"10.3390\/healthcare12161626","type":"journal-article","created":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T05:47:11Z","timestamp":1723700831000},"page":"1626","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["From Validation to Assessment of e-Health Literacy: A Study among Higher Education Students in Portugal"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1238-1798","authenticated-orcid":false,"given":"Leandro","family":"Oliveira","sequence":"first","affiliation":[{"name":"CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lus\u00f3fona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal"},{"name":"Polytechnic Institute of Coimbra, Coimbra Health School, Rua 5 de Outubro\u2013S. Martinho do Bispo, Apartado 7006, 3046-854 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0370-3089","authenticated-orcid":false,"given":"Renata Puppin","family":"Zandonadi","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Health Sciences, University of Brasilia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9071-8512","authenticated-orcid":false,"given":"Eduardo Yoshio","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Bras\u00edlia (UnB), Campus Darcy Ribeiro, Asa Norte, Brasilia 70910-900, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4810-6018","authenticated-orcid":false,"given":"Sulaiman","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2857-3065","authenticated-orcid":false,"given":"Haitham","family":"Alzghaibi","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, College of Applied Medical Sciences, Qassim University, Buraydah 51452, Saudi Arabia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0597-7892","authenticated-orcid":false,"given":"Maria Jo\u00e3o","family":"Lima","sequence":"additional","affiliation":[{"name":"CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6346-8319","authenticated-orcid":false,"given":"Edite","family":"Teixeira-Lemos","sequence":"additional","affiliation":[{"name":"CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal"}]},{"given":"Ariana","family":"Saraiva","sequence":"additional","affiliation":[{"name":"Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmonta\u00f1a s\/n, 35413 Arucas, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5286-2249","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Raposo","sequence":"additional","affiliation":[{"name":"CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lus\u00f3fona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"S\u00f8rensen, K., Van Den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., and Brand, H. (2012). Health Literacy and Public Health: A Systematic Review and Integration of Definitions and Models. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-80"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e000351","DOI":"10.1136\/fmch-2020-000351","article-title":"What Is the Meaning of Health Literacy? A Systematic Review and Qualitative Synthesis","volume":"8","author":"Liu","year":"2020","journal-title":"Fam. Med. Community Health"},{"key":"ref_3","first-page":"3061","article-title":"Health Literacy, Social Determinants of Health, and Disease Prevention and Control","volume":"6","author":"Coughlin","year":"2020","journal-title":"J. Environ. Health Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100500","DOI":"10.1016\/j.invent.2022.100500","article-title":"Digital Health Literacy as a Super Determinant of Health: More than Simply the Sum of Its Parts","volume":"27","author":"Wong","year":"2022","journal-title":"Internet Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1264780","DOI":"10.3389\/fdgth.2023.1264780","article-title":"Improving Health Literacy Using the Power of Digital Communications to Achieve Better Health Outcomes for Patients and Practitioners","volume":"5","author":"Fitzpatrick","year":"2023","journal-title":"Front. Digit. Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2225723","DOI":"10.1155\/2022\/2225723","article-title":"The Impact of Information and Communication Technologies (ICTs) on Health Outcomes: A Mediating Effect Analysis Based on Cross-National Panel Data","volume":"2022","author":"Shao","year":"2022","journal-title":"J. Environ. Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"935608","DOI":"10.3389\/fpubh.2022.935608","article-title":"Impacts of the Internet on Health Inequality and Healthcare Access: A Cross-Country Study","volume":"10","author":"Yu","year":"2022","journal-title":"Front. Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Jia, X., Pang, Y., and Liu, L.S. (2021). Online Health Information Seeking Behavior: A Systematic Review. Healthcare, 9.","DOI":"10.3390\/healthcare9121740"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Busse, T.S., Nitsche, J., Kernebeck, S., Jux, C., Weitz, J., Ehlers, J.P., and Bork, U. (2022). Approaches to Improvement of Digital Health Literacy (EHL) in the Context of Person-Centered Care. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19148309"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e11129","DOI":"10.2196\/11129","article-title":"Evaluating the Quality of Health Information in a Changing Digital Ecosystem","volume":"21","author":"Keselman","year":"2019","journal-title":"J. Med. Internet Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e9","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":"ref_12","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.2196\/mhealth.9131","article-title":"Exploring Digital Health Use and Opinions of University Students: Field Survey Study","volume":"6","author":"Montagni","year":"2018","journal-title":"JMIR mHealth uHealth"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kington, R.S., Arnesen, S., Chou, W.-Y.S., Curry, S.J., Lazer, D., and Villarruel, A.M. (2021). Identifying Credible Sources of Health Information in Social Media: Principles and Attributes. NAM Perspect., 2021.","DOI":"10.31478\/202107a"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1177\/0165551516628449","article-title":"Everyday Health Information Literacy among Young Men Compared with Adults with High Risk for Metabolic Syndrome\u2014A Cross-Sectional Population-Based Study","volume":"42","author":"Enwald","year":"2016","journal-title":"J. Inf. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.nedt.2016.04.003","article-title":"EHealth Literacy among Undergraduate Nursing Students","volume":"42","author":"Tubaishat","year":"2016","journal-title":"Nurse Educ. Today"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"105124","DOI":"10.1016\/j.ijmedinf.2023.105124","article-title":"Sociodemographic Determinants of Digital Health Literacy: A Systematic Review and Meta-Analysis","volume":"177","author":"Estrela","year":"2023","journal-title":"Int. J. Med Inform."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ros\u00e1rio, J., Raposo, B., Santos, E., Dias, S., and Pedro, A.R. (2024). Efficacy of Health Literacy Interventions Aimed to Improve Health Gains of Higher Education Students\u2014A Systematic Review. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-18358-4"},{"key":"ref_18","unstructured":"DGES (2024, July 28). Sistema de Ensino Superior Portugu\u00eas, Available online: https:\/\/www.dges.gov.pt\/pt\/pagina\/sistema-de-ensino-superior-portugues."},{"key":"ref_19","unstructured":"Publications Office of the EU (2024, July 28). Education and Training Monitor. Available online: https:\/\/op.europa.eu\/en\/publication-detail\/-\/publication\/2d4c4524-8e68-11ee-8aa6-01aa75ed71a1\/language-en."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Almeida, S., Pinto, E., Correia, M., Veiga, N., and Almeida, A. (2024). Evaluating E-Health Literacy, Knowledge, Attitude, and Health Online Information in Portuguese University Students: A Cross-Sectional Study. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21030271"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1177\/1559827621990574","article-title":"I Read It Online: Understanding How Undergraduate Students Assess the Accuracy of Online Sources of Health Information","volume":"16","author":"Dissen","year":"2021","journal-title":"Am. J. Lifestyle Med."},{"key":"ref_22","first-page":"13","article-title":"N\u00edvel de E-Literacia Em Sa\u00fade Em Alunos Do Ensino Secund\u00e1rio","volume":"11","author":"Pombal","year":"2021","journal-title":"Rev. Recien Rev. Cient\u00edfica Enferm."},{"key":"ref_23","first-page":"19","article-title":"Analysis of the Psychometric Properties of the Portuguese Version of an EHealth Literacy Assessment Tool","volume":"4","author":"Ferreira","year":"2014","journal-title":"Rev. Enferm. Ref."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e507","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":"ref_25","unstructured":"Richardson, E., Wismar, M., and Palm, W. (2016). Investing in Health Literacy: What Do We Know about the Co-Benefits to the Education Sector of Actions Targeted at Children and Young People? [Internet]. Econ. Polit. Wkly., 45."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1002\/uog.5256","article-title":"Reliability, Repeatability and Reproducibility: Analysis of Measurement Errors in Continuous Variables","volume":"31","author":"Bartlett","year":"2008","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1207\/S15327752JPA8001_18","article-title":"Starting at the Beginning : An Introduction to Coefficient Alpha and Internal Consistency","volume":"80","author":"Streiner","year":"2003","journal-title":"J. Pers. Assess."},{"key":"ref_28","unstructured":"Hair, J.F., Anderson, R.E., Tatham, R.L., and Black, W.C. (2009). Multivariate Data Analysis, Englewood Cliffs. [7th ed.]."},{"key":"ref_29","unstructured":"Kline, R.B. (2011). Principles and Practice of Structural Equation Modeling, The Guilford Press. [3rd ed.]."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e18155-11","DOI":"10.2196\/18155","article-title":"Association of EHealth Literacy With Lifestyle Behaviors in University Students: Questionnaire-Based Cross-Sectional Study","volume":"22","author":"Tsukahara","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e20220147","DOI":"10.1590\/1980-220x-reeusp-2022-0147en","article-title":"The Association and Intervention Effect between EHealth Literacy and Lifestyle Behaviors among Chinese University Students","volume":"56","author":"Tian","year":"2022","journal-title":"Rev. Esc. Enferm. USP"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1055\/s-0041-1727154","article-title":"EHealth Literacy of Medical and Health Science Students and Factors Affecting EHealth Literacy in an Ethiopian University: A Cross-Sectional Study","volume":"12","author":"Mengestie","year":"2021","journal-title":"Appl. Clin. Inform."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1080\/10810730.2016.1250846","article-title":"The Influence of EHealth Literacy on Perceived Trust in Online Health Communication Channels and Sources","volume":"22","author":"Paige","year":"2016","journal-title":"J. Heal Commun."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"104322","DOI":"10.1016\/j.ijmedinf.2020.104322","article-title":"COVID-19 Information-Related Digital Literacy among Online Health Consumers in a Low-Income Country","volume":"145","author":"Abdulai","year":"2021","journal-title":"Int. J. Med. Inform."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1080\/10810730.2020.1776422","article-title":"Determinants of EHealth Literacy among Adults in China","volume":"25","author":"Lwin","year":"2020","journal-title":"J. Health Commun."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e22894","DOI":"10.2196\/22894","article-title":"Health Literacy, EHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19 Symptoms Among Health Care Workers During Lockdown: Online Survey","volume":"22","author":"Do","year":"2020","journal-title":"J. Med Internet Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Zakar, R., Iqbal, S., Zakar, M.Z., and Fischer, F. (2021). COVID-19 and Health Information Seeking Behavior: Digital Health Literacy Survey amongst University Students in Pakistan. Int. J. Environ. Res. Public Health, 18.","DOI":"10.20944\/preprints202103.0288.v1"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ahmad, I., Taimur, H., Shabbir, S., Shabbir, C.A., Ahsan, A., Ahmad, H.S., and Masuda, G. (2024). Examining Communicative, Critical Health Literacy and EHealth Literacy among International University Students Residing in Japan. Healthcare, 12.","DOI":"10.3390\/healthcare12090941"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e24577","DOI":"10.2196\/24577","article-title":"Socioeconomic Disparities in EHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-Sectional Study","volume":"23","author":"Guo","year":"2021","journal-title":"J. Med. Internet Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e75","DOI":"10.2196\/jmir.1697","article-title":"Internet Use and EHealth Literacy of Low-Income Parents Whose Children Have Special Health Care Needs","volume":"13","author":"Knapp","year":"2011","journal-title":"J. Med. Internet Res."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Shiferaw, K.B., Tilahun, B.C., and Endehabtu, B.F. (2020). Healthcare Providers\u2019 Digital Competency: A Cross-Sectional Survey in a Low-Income Country Setting. BMC Health Serv. Res., 20.","DOI":"10.1186\/s12913-020-05848-5"},{"key":"ref_42","unstructured":"Garcia, F. (2019). Internet Use for Searching Ethical Health Information in Portugal: A Cross Sectional Study. [Master\u2019s Thesis, Universidade NOVA de Lisboa (Portugal)]."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.2196\/ijmr.4749","article-title":"EHealth Literacy: In the Quest of the Contributing Factors","volume":"5","author":"Xesfingi","year":"2016","journal-title":"Interact. J. Med Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e392","DOI":"10.2196\/jmir.3100","article-title":"EHealth Literacy and Health Behaviors Affecting Modern College Students: A Pilot Study of Issues Identified by the American College Health Association","volume":"19","author":"Britt","year":"2017","journal-title":"J. Med. Internet Res."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Huang, C.L., Yang, S.-C., and Chiang, C.-H. (2020). The Associations between Individual Factors, EHealth Literacy, and Health Behaviors among College Students. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17062108"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12955-014-0176-2","article-title":"Sample Size Used to Validate a Scale: A Review of Publications on Newly-Developed Patient Reported Outcomes Measures","volume":"12","author":"Anthoine","year":"2014","journal-title":"Health Qual. Life Outcomes"}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/12\/16\/1626\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:37:00Z","timestamp":1760110620000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/12\/16\/1626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,15]]},"references-count":46,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["healthcare12161626"],"URL":"https:\/\/doi.org\/10.3390\/healthcare12161626","relation":{},"ISSN":["2227-9032"],"issn-type":[{"type":"electronic","value":"2227-9032"}],"subject":[],"published":{"date-parts":[[2024,8,15]]}}}