{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T14:54:49Z","timestamp":1776869689683,"version":"3.51.2"},"reference-count":40,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T00:00:00Z","timestamp":1606867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>We aim to evaluate the associations between digital health literacy (DHL) related to COVID-19 and online information-seeking behavior among university students. Methods: A total of 3.084 students (75.7% women), with an average age of 24.2 (SD = 7.5) participated in this cross-sectional study, most of whom (36.5%) were from social sciences and pursued a bachelor\u2019s degree (50.7%). Data on COVID-19-related DHL and online information-seeking behavior were collected using an online questionnaire. Logistic regression models were performed. Results: As the pandemic progressed, participants showed a lower chance of achieving a sufficient DHL (OR = 0.7; 95% CI = 0.6; 0.9). Using search engines more often (e.g., Google) (OR = 0.7; 95% CI = 0.5; 0.9), Wikipedia (OR = 0.7; 95% CI = 0.6; 0.9) and social media (e.g., Facebook) (OR = 0.7; 95% CI = 0.6; 0.9) decreased the likelihood of achieving sufficient DHL related to COVID-19. More frequent use of websites of public bodies (OR = 1.7; 95% CI = 1.1; 2.5) increased the odds of reporting sufficient DHL. Conclusion: DHL is associated with university students\u2019 online information-seeking behavior in the time of COVID-19. From a community and public health perspective, programs aiming at improving DHL should be highlighted.<\/jats:p>","DOI":"10.3390\/ijerph17238987","type":"journal-article","created":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T20:25:49Z","timestamp":1606940749000},"page":"8987","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":85,"title":["Associations between COVID-19-Related Digital Health Literacy and Online Information-Seeking Behavior among Portuguese University Students"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6986-0007","authenticated-orcid":false,"given":"Rafaela","family":"Ros\u00e1rio","sequence":"first","affiliation":[{"name":"School of Nursing, University of Minho, 4710-057 Braga, Portugal"},{"name":"Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7941-0285","authenticated-orcid":false,"given":"Maria R. O.","family":"Martins","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, 1349-008 Lisboa, Portugal"}]},{"given":"Cl\u00e1udia","family":"Augusto","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Minho, 4710-057 Braga, Portugal"},{"name":"Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal"}]},{"given":"Maria Jos\u00e9","family":"Silva","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Minho, 4710-057 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3791-3236","authenticated-orcid":false,"given":"Silvana","family":"Martins","sequence":"additional","affiliation":[{"name":"Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9741-8141","authenticated-orcid":false,"given":"Ana","family":"Duarte","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Minho, 4710-057 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1406-4585","authenticated-orcid":false,"given":"In\u00eas","family":"Fronteira","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, 1349-008 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2042-309X","authenticated-orcid":false,"given":"Neida","family":"Ramos","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, 1349-008 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1714-4783","authenticated-orcid":false,"given":"Orkan","family":"Okan","sequence":"additional","affiliation":[{"name":"Faculty of Educational Science, Interdisciplinary Centre for Health Literacy Research, Bielefeld University, 33615 Bielefeld, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7367-5362","authenticated-orcid":false,"given":"Kevin","family":"Dadaczynski","sequence":"additional","affiliation":[{"name":"Department of Nursing and Health Science, Fulda University of Applied Sciences, 36037 Fulda, Germany"},{"name":"Center for Applied Health Science, Leuphana University of L\u00fcneburg, 21335 L\u00fcneburg, Germany"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sykes, S., Wills, J., Rowlands, G., and Popple, K. (2013). Understanding critical health literacy: A concept analysis. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-150"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1377\/hlthaff.2011.1169","article-title":"New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond The Cycle Of Costly \u2018Crisis Care\u2019","volume":"31","author":"Koh","year":"2012","journal-title":"Health Aff."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Visscher, B.B., Steunenberg, B., Heijmans, M., Hofstede, J.M., Devill\u00e9, W., Van Der Heide, I., Rademakers, J., Visscher, B.B., Steunenberg, B., and Heijmans, M.J. (2018). Evidence on the effectiveness of health literacy interventions in the EU: A systematic review. BMC Public Health, 18.","DOI":"10.1186\/s12889-018-6331-7"},{"key":"ref_4","unstructured":"Kickbusch, I., Pelikan, J., Apfel, F., and Tsouros, A. (2013). Health Literacy: The Solid Facts, WHO."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1016\/j.socscimed.2008.09.050","article-title":"The evolving concept of health literacy","volume":"67","author":"Nutbeam","year":"2008","journal-title":"Soc. Sci. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1057\/jphp.2016.18","article-title":"A review of health literacy: Definitions, interpretations, and implications for policy initiatives","volume":"37","author":"Charles","year":"2016","journal-title":"J. Public Health Policy"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sorensen, 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_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev-publhealth-090419-102529","article-title":"Understanding and Responding to Health Literacy as a Social Determinant of Health","volume":"42","author":"Nutbeam","year":"2021","journal-title":"Ann. Rev. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Okan, O., Bollweg, T., Berens, E., Hurrelmann, K., Bauer, U., and Schaeffer, D. (2020). Coronavirus-related health literacy: A cross-sectional study in adults during the COVID-19 infodemic in Germany. Int. J. Environ. Res. Public Health, 17.","DOI":"10.2139\/ssrn.3631299"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/713851982","article-title":"Elaborating a definition of health literacy: A commentary","volume":"8","author":"Zarcadoolas","year":"2003","journal-title":"J. Health Commun."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Edwards, M., Wood, F., Davies, M., and Edwards, A. (2012). The development of health literacy in patients with a long-term health condition: The health literacy pathway model. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-130"},{"key":"ref_12","unstructured":"European Commission (2020, July 26). Digital Economy and Society Index (DESI) 2020\u2014Portugal. Available online: https:\/\/ec.europa.eu\/digital-single-market\/en\/scoreboard\/portugal."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.2196\/jmir.6709","article-title":"Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills","volume":"19","author":"Drossaert","year":"2017","journal-title":"J. Med. Internet Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e287","DOI":"10.2196\/jmir.3542","article-title":"The Effect of Individual Factors on Health Behaviors Among College Students: The Mediating Effects of eHealth Literacy","volume":"16","author":"Hsu","year":"2014","journal-title":"J. Med. Internet Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.2196\/jmir.1619","article-title":"eHealth Literacy: Extending the Digital Divide to the Realm of Health Information","volume":"14","author":"Neter","year":"2012","journal-title":"J. Med. Internet Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e19361","DOI":"10.2196\/19361","article-title":"Digital Health Equity and COVID-19: The Innovation Curve Cannot Reinforce the Social Gradient of Health","volume":"22","author":"Crawford","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_17","unstructured":"Google (2020, July 24). COVID-19 Information and Resources 2020. Available online: https:\/\/www.google.com\/covid19\/."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e19374","DOI":"10.2196\/19374","article-title":"COVID-19-Related Web Search Behaviors and Infodemic Attitudes in Italy: Infodemiological Study","volume":"6","author":"Rovetta","year":"2020","journal-title":"JMIR Public Health Surveill."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/S0140-6736(20)30461-X","article-title":"How to fight an infodemic","volume":"395","author":"Zarocostas","year":"2020","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Gao, J., Zheng, P., Jia, Y., Chen, H., Mao, Y., Chen, S., Wang, Y., Hua, F., and Dai, J. (2020). Mental health problems and social media exposure during COVID-19 outbreak. PLoS ONE, 15.","DOI":"10.2139\/ssrn.3541120"},{"key":"ref_21","unstructured":"Dadaczynski, K., Okan, O., and Rathmann, K. (2020). COVID-19 Health Literacy Survey in University Students (COVID-HL-Survey). Questionnaire and Scale Documentation, Public Health Centre Fulda (PHZF) at the Fulda University of Applied Sciences & Interdisciplinary Centre for Health Literacy Research at Bielefeld University."},{"key":"ref_22","unstructured":"World Health Organization (2003). Collaborative Study on Substitution Therapy of Opioid Dependence and HIV\/AIDS General Protocol (Version 2.1), WHO."},{"key":"ref_23","unstructured":"Marstedt, G. (2018). Das Internet: Auch Ihr Ratgeber fur Gesundheitsfragen? Bev\u00f6lkerungsumfrage zur Suche von Gesundheitsinformationen im Internet und zur Reaktion der \u00c4rzte (The Internet: Also Your Guide to Health Issues? Population Survey on the Search for Health Information on the Internet and the Reaction of Doctors), Bertelsmann Stiftung."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1037\/0278-6133.19.6.586","article-title":"Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy white women","volume":"19","author":"Adler","year":"2000","journal-title":"Health Psychol."},{"key":"ref_25","unstructured":"OECD (2020, July 17). Revised Field of Science and Technology (fos) Classification in the Frascati Manual: 17th July 2020. Available online: https:\/\/www.oecd.org\/science\/inno\/38235147.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1093\/eurpub\/ckv043","article-title":"Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU)","volume":"25","author":"Pelikan","year":"2015","journal-title":"Eur. J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1046\/j.1525-1497.1998.00242.x","article-title":"Health literacy and the risk of hospital admission","volume":"13","author":"Baker","year":"1998","journal-title":"J. Gen. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1001\/jama.288.4.475","article-title":"Association of Health Literacy With Diabetes Outcomes","volume":"288","author":"Schillinger","year":"2002","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/j.1525-1497.2005.40245.x","article-title":"The prevalence of limited health literacy","volume":"20","author":"Parker","year":"2005","journal-title":"J. Gen. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.5993\/AJHB.31.s1.3","article-title":"Health literacy skills of U.S. adults","volume":"31","author":"Rudd","year":"2007","journal-title":"Am. J. Health Behav."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Van Der Heide, I., Rademakers, J., Schipper, M., Droomers, M., S\u00f8rensen, K., and Uiters, E. (2013). Health literacy of Dutch adults: A cross sectional survey. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-179"},{"key":"ref_32","unstructured":"Allington, D., and Dhavan, N. (2020). The Relationship between Conspiracy Beliefs and Compliance with Public Health Guidance with Regard to COVID-19, Centre for Countering Digital Hate."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/1468-5973.12212","article-title":"The effect of social media on the dynamics of (self) resilience during disasters: A literature review","volume":"26","author":"Jurgens","year":"2018","journal-title":"J. Contingencies Crisis Manag."},{"key":"ref_34","unstructured":"Posetti, J., and Bontcheva, K. (2020, August 20). Disinfodemic. Deciphering COVID-19 Disinformation. Policy Brief 1. Available online: https:\/\/en.unesco.org\/sites\/default\/files\/disinfodemic_deciphering_covid19_disinformation.pdf."},{"key":"ref_35","unstructured":"Posetti, J., and Bontcheva, K. (2020, August 20). Disinfodemic. Deciphering COVID-19 Disinformation. Policy Brief 2. Available online: https:\/\/en.unesco.org\/sites\/default\/files\/disinfodemic_dissecting_responses_covid19_disinformation.pdf."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e18831","DOI":"10.2196\/18831","article-title":"Mapping of Health Literacy and Social Panic Via Web Search Data During the COVID-19 Public Health Emergency: Infodemiological Study","volume":"22","author":"Xu","year":"2020","journal-title":"J. Med. Internet Res."},{"key":"ref_37","unstructured":"RECOVERY Collaborative Group, Horby, P., Lim, W.S., Emberson, J.R., Mafham, M., Bell, J.L., Linsell, L., Staplin, N., Brightling, C., and Ustianowski, A. (2020). Dexamethasone in Hospitalized Patients with Covid-19\u2014Preliminary Report. N. Engl. J. Med."},{"key":"ref_38","unstructured":"European Center for Disease Prevention and Control (2020, July 23). Covid-19 Situation Update for the EU\/EEA and the UK 2020. Available online: https:\/\/www.ecdc.europa.eu\/en\/cases-2019-ncov-eueea."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Sentell, T., Vamos, S., and Okan, O. (2020). Interdisciplinary Perspectives on Health Literacy Research Around the World: More Important Than Ever in a Time of COVID-19. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17093010"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1093\/heapro\/daaa042","article-title":"Why health promotion matters to the COVID-19 pandemic, and vice versa","volume":"35","year":"2020","journal-title":"Health Promot. Int."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/23\/8987\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:40:45Z","timestamp":1760179245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/23\/8987"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,2]]},"references-count":40,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["ijerph17238987"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17238987","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,2]]}}}