Electronic Health Literacy and Dietary Behaviors in Taiwanese College Students: Cross-Sectional Study

Abstract

BackgroundGiven the recognized importance of preventing poor dietary behaviors during adolescence, we need a better understanding of college students’ dietary behaviors. Studies have found that individual factors and electronic health (eHealth) literacy may affect one’s dietary behaviors. However, few studies have fully investigated the effect of the three levels of eHealth literacy (functional, interactive, and critical) and the interactive effect of individual factors (eg, gender, monthly expenses, and frequency of cooking) and the three levels of eHealth literacy on the four aspects of dietary behaviors (consumer health, balanced diet, regular eating habits, and unhealthy food intake).ObjectiveThis study aimed to investigate whether individual differences and higher eHealth literacy are associated with more positive dietary behaviors and less unhealthy dietary intake.MethodsThe eHealth Literacy Scale is a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy. The Dietary Behaviors Scale is a 14-item instrument developed to measure four aspects of dietary behaviors of college students. A questionnaire was administered to collect background information about participants’ gender, monthly expenses, and frequency of cooking. A national sample of college students was surveyed, and 813 responses were obtained. We conducted a multiple regression analysis to examine the association among individual factors, eHealth literacy, and dietary behaviors.ResultsThis study found that functional eHealth literacy was negatively related to unhealthy food intake (beta=−.11; P=.01), and interactive eHealth literacy was positively related to balanced diet (beta=.25; P<.001) and consumer health (beta=.15; P=.02). Moreover, critical eHealth literacy was positively related to consumer health (beta=.30; P<.001) and regular eating habits (beta=.20; P=.002). Finally, the interactive effect between gender and interactive eHealth literacy was negatively related to balanced diet (beta=−.22; P<.001). The interactive effect between monthly expenses and functional eHealth literacy was positively related to balanced diet (beta=.07; P=.03), although the interactive effect between monthly expenses and critical eHealth literacy was negatively related to balanced diet (beta=−.10; P=.047).ConclusionsThis study showed that Taiwanese college students with higher functional eHealth literacy were more likely to engage in fewer unhealthy food consumption practices. Those who had higher interactive and critical eHealth literacy were more likely to engage in positive dietary behaviors than those with functional eHealth literacy. Surprisingly, females with high interactive eHealth literacy were more likely to have a poor balanced diet. In contrast, students with higher monthly expenses and higher functional eHealth literacy were more likely to have a balanced diet. However, students with higher monthly expenses and higher critical eHealth literacy were less likely to maintain a balanced diet.

The Associations between Individual Factors, eHealth Literacy, and Health Behaviors among College Students

“…As expected, critical eHealth literacy was positively correlated with dietary behaviors. However, functional and interactive eHealth literacy were not correlated with dietary behaviors, which is not consistent with previous studies that showed that individuals with higher functional [14] and interactive eHealth literacy [6] tended to have balanced diets. These results indicate that the importance of critical eHealth literacy in college students' dietary behaviors is higher than that of functional and interactive eHealth literacy for our participants.…”

“…In recent years, researchers have paid attention to different levels of eHealth literacy and have shown that individuals with higher functional [14] and critical eHealth literacy [14][15][16] tended to have balanced diets and adopt healthy exercise behaviors. In addition, individuals with adequate interactive eHealth literacy tended to have balanced diets [6]. Apparently, individuals with the composite skills of eHealth literacy are more likely to adopt positive health behaviors [17].…”

“…Many studies have revealed that college students have imbalanced diets [5,6], eat fewer than five servings of vegetables and fruits per day [7], and have poor exercise habits [1,8]. It is worrying that college students are engaging in unhealthy dietary behaviors and exercise habits that could increase their risk of health problems later in life.…”

“…In fact, gender has been identified as the strongest predictor of health behaviors [18]. Compared to males, females have been reported to have poor nutrition behaviors [5,6,19] and poor exercise habits [15,19]. Interestingly, the literature seems to have no general consensus regarding the direction of gender differences in dietary behaviors.…”

“…Thus, whether gender differences exist in the perception of the importance of health, subjective health status, dietary supplement use, and eHealth literacy becomes a research question which should not be overlooked. In particular, evidence has demonstrated that gender plays an important role in health behaviors [5,6,15,18,19]; further investigation of whether the interaction of gender and these factors (the perception of the importance of health, subjective health status, dietary supplement use, and eHealth literacy) exist in health behaviors seems to also be important. Unfortunately, few studies have fully investigated these relationships regarding college students' dietary behaviors and exercise habits.…”