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The Impact of E-Health Literacy on Perceived Access to Healthcare Services: A Cross-Sectional Study Among Health Sciences Students in Istanbul, Turkey

This cross-sectional study of 500 health sciences students in Istanbul reveals that higher e-health literacy significantly predicts more favorable perceptions of healthcare access, particularly regarding service acceptability and accommodation, suggesting a need for enhanced digital health training in medical curricula.

Original authors: İlknur Sayan, Didem İstafiloğlu, Serem Akdal

Published 2026-08-13

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CC BY 4.0

Original authors: İlknur Sayan, Didem İstafiloğlu, Serem Akdal

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the healthcare system as a massive, bustling library where the books are medical advice, the librarians are doctors, and the shelves are the clinics and hospitals. For a long time, getting a book meant walking in, waiting in line, and hoping the librarian was in a good mood. But lately, the library has gone digital. Now, you can search for books on your phone, read reviews online, and even chat with librarians through a screen. This shift has created a new superpower: the ability to find, understand, and use that digital health information. Scientists call this "e-health literacy." It's not just about knowing how to type a search; it's about knowing which websites are trustworthy and how to turn that information into a real decision about your health.

But here's the tricky part: just because you have a smartphone and a fast internet connection doesn't mean you feel like you can actually get the care you need. Sometimes, even with all the tech, the system feels locked, too expensive, or just confusing. Researchers wanted to know if having that digital superpower actually makes people feel like the library doors are wide open. They focused on a special group of people: students training to become the future librarians and doctors. If these future professionals feel the system is accessible when they use their digital skills, maybe they'll build a better system for everyone else later.

This study, conducted with 500 health sciences students in Istanbul, Turkey, set out to test a simple idea: Does being good at navigating digital health information make you feel like you have better access to healthcare? The researchers didn't just ask "Do you feel better?" They used a sophisticated statistical tool called Structural Equation Modeling, which is like a high-tech map that traces the exact paths between different ideas to see which ones pull the most weight. They also ran strict checks to make sure the students weren't just guessing or answering questions in a way that made everything look the same by accident.

The results were clear and strong. The study found that e-health literacy has a significant, positive effect on how students perceive their access to healthcare. In the language of the study's "map," the connection between digital skills and feeling like you can get care was strong, with a score of 0.62. This means that for every step up a student took in their digital health skills, their feeling of being able to access healthcare jumped up noticeably. The study measured this with a high degree of confidence, ruling out the possibility that the results were just a fluke or a result of how the questions were asked. In fact, the digital skills explained 38% of the differences in how students felt about their access to care.

The researchers also dug into why this happens. They broke down "access" into four different flavors: how easy it is to get to a place (Accessibility), how friendly and respectful the staff is (Acceptability), how well the system fits your schedule and needs (Accommodation), and how much it costs (Affordability). The study discovered that digital skills had the biggest impact on the "friendly" and "flexible" parts. Students who were good at finding and understanding online health info felt much more confident that the system would treat them well and fit into their lives. Interestingly, the "cost" and "distance" parts were still important, but the digital skills didn't change those feelings as much as they changed the feelings about the human and organizational side of healthcare.

One thing the study made sure to clarify is that this is a snapshot in time. The researchers measured the students' skills and feelings at one specific moment (between April and June 2026). Because of this, they can't say for sure that learning digital skills causes the feeling of better access, only that they are strongly linked. It's like seeing that people who wear bright red shoes are always at the front of the line; it doesn't prove the shoes made them get there first, but it's a very strong clue. The study also noted that while the students felt the system was more accessible, this was based on their own opinions, not on them actually going to a doctor and getting treated.

So, what's the takeaway for the future? The study suggests that teaching future doctors and nurses how to be digital detectives isn't just about teaching them to use computers. It's about giving them the confidence to navigate the healthcare maze. When these students feel like they can find the right information and trust the system, they feel like the doors are open. The authors suggest that if schools add more training on how to critically evaluate online health info, it might help these future professionals feel more connected to the system they will one day run. It's a small step in the classroom that could lead to a much smoother ride for everyone in the hospital later on.

Technical Summary: The Impact of E-Health Literacy on Perceived Access to Healthcare Services

Problem Statement and Context
The rapid digitalization of healthcare delivery has established e-health literacy—the ability to seek, find, understand, and critically evaluate electronic health information—as a critical competency for navigating modern health systems. While the relationship between digital literacy and healthcare access is theoretically grounded in frameworks such as Penchansky and Thomas's multidimensional access model (Availability, Accessibility, Accommodation, Affordability, Acceptability), empirical evidence linking e-health literacy specifically to perceived healthcare access among health sciences students remains limited, particularly within the Turkish context. Furthermore, existing literature often lacks rigorous methodological controls for common method bias (CMB) and discriminant validity using modern criteria like the Heterotrait–Monotrait (HTMT) ratio. This study addresses these gaps by investigating the structural effect of e-health literacy on perceived access among future healthcare professionals in Istanbul.

Methodology
The study employed a quantitative cross-sectional design involving 500 health sciences students from six universities in Istanbul, Turkey. Data were collected between April and June 2026 via structured questionnaires.

Instruments:
- E-Health Literacy: Measured using the 8-item eHealth Literacy Scale (eHEALS).
- Perceived Access: Assessed using a 23-item Perceived Access to Healthcare Services Scale, organized into four dimensions: Accessibility, Acceptability, Accommodation, and Affordability.
Analytical Strategy:
- Bias Control: Common method bias was assessed using Harman's single-factor test.
- Measurement Model: Confirmatory Factor Analysis (CFA) was conducted in LISREL 9.3 to evaluate construct reliability (Composite Reliability, Cronbach's alpha) and validity (Average Variance Extracted, Fornell–Larcker criterion, and HTMT ratios).
- Structural Modeling: A second-order Structural Equation Modeling (SEM) approach was used to test the hypothesized path from e-health literacy to a higher-order perceived access construct.

Key Results

Data Quality and Validity: Harman's single-factor test indicated that the largest component explained only 15.72% of the variance, well below the 25% threshold, suggesting CMB was not a significant threat. All constructs demonstrated strong reliability (Cronbach's $\alpha$ range: 0.76–0.94; CR > 0.70) and convergent validity (AVE > 0.50). Discriminant validity was confirmed via both the Fornell–Larcker criterion and HTMT ratios (all < 0.85, with the highest being 0.548).
Model Fit: The second-order SEM demonstrated a good fit to the data ( $\chi^2/df = 1.97$ ; RMSEA = 0.051; CFI = 0.96; TLI = 0.95; SRMR = 0.047).
Structural Effects: E-health literacy exerted a significant positive effect on perceived healthcare access ( $\beta = 0.62$ , $p < 0.001$ ), explaining 38% of the variance ( $R^2 = 0.38$ ).
Dimensional Contributions: Among the four dimensions of perceived access, Acceptability ( $\lambda = 0.92$ ) and Accommodation ( $\lambda = 0.90$ ) were the strongest contributors to the higher-order access construct, followed by Affordability ( $\lambda = 0.83$ ) and Accessibility ( $\lambda = 0.79$ ).

Key Contributions
The paper identifies three primary methodological contributions to the field:

Rigorous Bias Control: By explicitly testing for common method bias and finding it negligible, the study strengthens the validity of the observed structural relationships, addressing a recurring limitation in e-health literacy literature.
Dual-Criterion Discriminant Validity: The study applies both the Fornell–Larcker criterion and the more sensitive HTMT ratio, representing current best practices for establishing construct distinctness in SEM-based health services research.
Second-Order Modeling: The use of a second-order SEM accurately models the multidimensional theoretical structure of perceived access, treating it as both a set of distinct dimensions and a coherent higher-order construct.

Significance and Claims
The study concludes that higher e-health literacy is robustly and positively associated with more favorable perceptions of healthcare access among health sciences students. The authors claim that this relationship is particularly driven by the Acceptability (trust and attitudes toward providers) and Accommodation (organizational flexibility and navigability) dimensions.

The paper posits that these findings have direct implications for health education policy: integrating structured digital health competency training into health sciences curricula—specifically moving beyond basic internet skills toward critical information appraisal and applied decision-making—may strengthen future professionals' engagement with health systems and help reduce digital health inequities. The authors emphasize that while the results are robust within the studied sample, the cross-sectional nature of the design precludes causal inference, and future research should employ longitudinal designs and objective competency assessments to further validate these findings.

Technical Summary: The Impact of E-Health Literacy on Perceived Access to Healthcare Services

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