eHealth literacy, health self-efficacy, and health-promoting lifestyle among vocational college students: a latent profile and mediation analysis study.

BACKGROUND

eHealth literacy (eHL) has emerged as an important competency for promoting health equity. Vocational college students are often considered a digitally vulnerable population. Understanding the heterogeneity of eHL in this population and the underlying psychological mechanisms is essential for designing effective health promotion interventions.

OBJECTIVE

This study aimed to identify latent profiles of eHL among vocational college students, compare differences in health-promoting lifestyle levels across profiles, and examine the mediating role of health self-efficacy.

METHODS

A cross-sectional survey was conducted among vocational college students from February to March 2026. The eHealth Literacy Scale, the Health Self-Efficacy Scale, and the Health-Promoting Lifestyle Profile-II were used to collect data. Latent profile analysis (LPA) was used to identify sub-groups, and bias-corrected bootstrap analyses were performed to test the mediation effects.

RESULTS

A total of 594 vocational college students were included. The mean total eHL score was 25.21 ± 5.26. Three distinct profiles were identified: Low Application-High Confidence (Profile 1, 15%), High Application-Low Critical Thinking (Profile 2, 52%), and High eHealth Literacy (Profile 3, 33%). For health-promoting lifestyle, students in Profiles 2 and 3 scored significantly higher than those in Profile 1 (both p < 0.001), while no significant difference was found between Profile 2 and Profile 3 (p > 0.05). Mediation analysis showed that health self-efficacy partially statistically mediated the association between eHL profile and health-promoting lifestyle when comparing Profile 1 with Profile 2 (effect = 0.463, standard error [SE] = 0.091, 95% confidence interval [CI] 0.345, 0.586) and Profile 1 with Profile 3 (effect = 0.697, SE = 0.126, 95% CI 0.464, 0.963). The proportion mediated increased from 43.62% for the transition from low to moderate eHL to 64.37% for the transition from low to high eHL.

CONCLUSION

eHL among vocational college students was heterogeneous, and health self-efficacy was statistically tested as a significant mediator in the association between eHL profiles and health-promoting lifestyle, though causal inference is limited by the cross-sectional design. These findings suggest that vocational college students should not be treated as a homogeneous population in health promotion practice. Instead, person-centered interventions should be tailored to specific eHL profiles.