Health, digital, and eHealth literacies among children experiencing extreme vulnerability in institutional care: A multicenter cross-sectional study.

PURPOSE: Children living in institutional care experience extreme and overlapping vulnerabilities, including the absence of parental guardianship and limited access to consistent health and digital guidance. This study assessed health literacy (HL), digital literacy (DL), and eHealth literacy (eHL) among children in orphanages and identified factors associated with eHL.

METHODS

A multicenter cross-sectional survey was conducted among 165 elementary school-aged children (mean age = 11.43 ± 1.59 years) residing in 15 orphanages in South Korea. eHL was measured using the Korean version of the eHealth Literacy Scale (K-eHEALS). A generalized linear model adjusted for clustering by orphanage was used to identify factors associated with eHL.

RESULTS

Overall, 44.2% of participants had HL levels below the expected grade standard. DL (mean = 2.65/4) and eHL (mean = 3.05/5) were also low. eHL was positively correlated with DL (r = 0.709), HL (r = 0.535), and daily media use time (r = 0.217). In multivariable analysis, DL was the strongest predictor of eHL (β = 0.543), followed by HL (β = 0.229) and duration of institutional residence (β = -0.174), explaining 55.6% of the variance in eHL.

CONCLUSIONS

Children in institutional care demonstrate persistently low levels of HL, DL, and eHL, reflecting conditions of extreme vulnerability.

PRACTICAL IMPLICATIONS: Interventions in institutional care settings should prioritize strengthening both digital and health literacy, as these were the strongest determinants of eHL. Particular attention should be given to children in the early stages of institutional placement, who may require additional support in developing eHL.