Heterogeneity in health anxiety among medical students and HPV testing acceptability: the mediating role of eHealth literacy from a person-centered perspective.

BACKGROUND

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).

METHODS

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.

RESULTS

LPA identified three distinct HA profiles: "Routine" (26.2%), "Avoidance" (57.2%), and "Vigilance" (16.7%). Significant differences were observed in eHL and HPV testing acceptability across these groups (p < 0.001). 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.

CONCLUSION

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.