eHealth literacy, well being self-efficacy, and health-promoting way of life amongst vocational school college students: a latent profile and mediation evaluation research

2.1. Study design

A cross-sectional survey was performed at a college of expertise in Wuxi, China, from February to March 2026. A multistage stratified cluster random sampling methodology was used. Students had been first stratified by school (eight schools) and educational 12 months (3 years). Within every college-year stratum, the variety of lessons to be sampled was decided proportionally primarily based on pupil enrollment to make sure representativeness throughout strata. A complete of 24 lessons (roughly 40 college students per class) had been randomly chosen utilizing a computer-generated random quantity methodology, with lessons serving because the sampling clusters. All eligible college students within the chosen lessons had been invited to take part. Data had been collected throughout scheduled class conferences. With the help of head academics and sophistication screens, college students accomplished the questionnaires in a supervised classroom setting. Participation was voluntary, and college students had been knowledgeable that they may decline participation with out penalty.

2.2. Ethical concerns

The research protocol was reviewed and accepted by the Ethics Committee of Changzhi Medical College (Approval No.: RT2026001). Electronic knowledgeable consent was obtained from all individuals earlier than survey completion. For individuals youthful than 18 years, knowledgeable consent was moreover obtained from their dad and mom or authorized guardians. On the primary web page of the net survey, individuals had been knowledgeable of the research function, the voluntary nature of participation, the nameless and confidential dealing with of their knowledge, and that the info could be used for analysis functions solely.

2.3. Participants

Participants had been eligible in the event that they had been full-time vocational school college students, had been capable of learn and full the questionnaire in Chinese independently, and supplied voluntary knowledgeable consent. Students had been excluded in the event that they self-reported a extreme bodily sickness or psychiatric dysfunction that would have an effect on questionnaire completion, or in the event that they had been concurrently collaborating in one other health-related research. A complete of 960 college students had been invited to take part on this survey. Among them, 822 questionnaires had been returned, with a response fee of 85.6%. Of these, 228 responses had been excluded on account of completion time lower than 3 min (n = 221) and lacking important indicators (n = 7). A complete of 594 college students had been included within the ultimate evaluation. A participant move diagram is offered in Figure 1.

2.4. Sample measurement

Schumacker and Lomax (23) beneficial 250–500 individuals for mediation evaluation. In addition, Meyer and Morin (24) advised that LPA typically achieves secure and interpretable outcomes with pattern sizes starting from 200 to 500, whereas pattern measurement bigger than 500 could yield extra strong outcomes. Accordingly, the ultimate pattern measurement within the current research was thought-about ample for the deliberate analyses.

2.5. Data assortment

Data had been collected utilizing an nameless on-line questionnaire distributed by way of class instructors or pupil representatives. Based on earlier research (6, 25), a self-designed questionnaire, together with demographic info and measures of eHealth literacy, well being self-efficacy, and health-promoting way of life, was used to gather knowledge.

2.6. Quality management

To guarantee knowledge high quality, a pilot survey was performed with 30 college students to guage merchandise readability and research feasibility. The common completion time was 6 min, and minor wording revisions had been made primarily based on the pilot outcomes. In the formal survey, responses had been excluded if completion time was lower than 3 min (pre-specified primarily based on pilot research) or in the event that they contained lacking knowledge on key variables, together with the first final result (eHealth literacy scale) and important demographic traits. To encourage participation, all individuals obtained a field of surgical masks and had been eligible for a random prize draw.

Because the core variables on this research (e.g., eHL, HSE, and HPL) had been measured concurrently utilizing self-report questionnaires, widespread methodology bias was thought-about a possible methodological concern. Several procedural measures had been carried out to attenuate this danger, together with nameless participation, voluntary responses, and standardized survey administration procedures. In addition, Harman’s single-factor take a look at was carried out by way of exploratory issue evaluation to look at the extent of widespread methodology bias (33). Consistent with earlier research, extreme widespread methodology bias was thought-about current if the primary issue defined greater than 40% of the overall variance (34). In the current research, the primary unrotated issue accounted for 37.72% of the overall variance, suggesting that widespread methodology bias was unlikely to have considerably affected the research findings, though its presence can’t be utterly dominated out.

Two sensitivity analyses had been performed to look at the robustness of the findings. First, latent profile analyses had been re-estimated utilizing the total pattern to evaluate the steadiness of the recognized profiles. Second, mediation fashions had been re-run with further adjustment for age, hometown, parental training, and main sort.

This research is reported following the rule of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

2.7. Data evaluation

All statistical analyses had been performed utilizing SPSS 26.0 and Mplus 8.3. Descriptive statistics had been used to summarize individuals’ demographic traits and the principle research variables. Reliability evaluation of the used scales and correlation evaluation between variables had been then carried out.

The LPA was performed to determine eHL profiles amongst vocational school college students. In the LPA, fashions with one to 5 profiles had been estimated. Item means had been freely estimated throughout profiles, whereas merchandise variances had been held equal throughout profiles. The optimum mannequin was chosen primarily based on a number of mannequin match indices, together with the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and the adjusted Bayesian Information Criterion (aBIC) (35). Lower values of AIC, BIC, and aBIC point out higher mannequin match (36). Entropy worth was used to evaluate classification accuracy, with values better than 0.8 indicating good classification accuracy. Model choice additionally thought-about the sensible significance and interpretability of every resolution. In addition, every profile was required to account for no less than 5% of the overall pattern (37). Average posterior possibilities had been used to evaluate classification high quality. Local independence was evaluated by analyzing residual correlations amongst indicators.

Mediation evaluation was carried out utilizing the PROCESS macro (Model 4) to look at the mediating function of HSE within the affiliation between eHL profiles and HPL. eHL profile membership was entered as a categorical impartial variable, with the Low Application–High Confidence profile specified because the reference group. Direct, oblique, and complete results had been estimated utilizing a bias-corrected bootstrap methodology with 5,000 resamples, and 95% confidence intervals (CIs) had been calculated. If the 95% CI didn’t comprise zero, the corresponding impact was thought-about statistically important.

The mediation mannequin consisted of three regression equations: (1) HPL was regressed on eHL profiles to estimate the overall impact; (2) HSE was regressed on eHL profiles to estimate the affiliation between eHL profiles and the mediator; and (3) HPL was regressed on each eHL profiles and HSE to estimate the direct and oblique results. Covariate choice was guided primarily by theoretical relevance and prior empirical proof, with preliminary univariate analyses used solely as supplementary info (6, 25, 38). The identical demographic covariates had been included in all three regression fashions to attenuate potential confounding.

3.1. Sample traits

After excluding invalid questionnaires, a ultimate pattern of 594 college students was included within the evaluation. No important variations in demographic traits had been noticed between included and excluded individuals (all p > 0.05). The ultimate pattern consisted of 594 college students. The imply age was 19.8 ± 1.6 years, starting from 16 to 25 years. Gender, household financial standing, and self-rated well being had been considerably related to HPL (p < 0.05). Table 1 exhibits extra detailed demographic traits of individuals.

3.2. Descriptive statistics

The imply complete scores for eHL, HSE, and HPL had been 25.21 ± 5.26, 81.33 ± 20.12, and 115.68 ± 24.47, respectively. The imply eHL rating was beneath the generally used threshold of 32 for top eHL. Among the HSE dimensions, psychological well-being confirmed the very best merchandise imply rating (23.58 ± 6.38), whereas vitamin confirmed the bottom merchandise imply rating (17.53 ± 4.66). Among the HPL dimensions, well being accountability had the very best merchandise imply rating (29.95 ± 7.98), whereas non secular progress had the bottom merchandise imply rating (15.01 ± 3.88). Detailed descriptive statistics are offered in Table 2.

3.3. Correlation evaluation outcomes

As offered in Table 3, correlation evaluation confirmed that complete scores of the three predominant variables had been considerably positively correlated with one another. Specifically, the eHL complete rating was positively related to each the HSE complete rating (r = 0.46, p < 0.01) and the HPL complete rating (r = 0.35, p < 0.01). Additionally, a powerful constructive correlation was noticed between the HSE complete rating and the HPL complete rating (r = 0.64, p < 0.01).

3.4. Results of latent profiles evaluation of eHL

As proven in Table 4, the AIC, BIC, and aBIC values decreased because the variety of profiles elevated. Considering mannequin match indices, entropy values, profile proportions, statistical assessments, and interpretability, the three-profile resolution was chosen because the optimum mannequin. Compared with the two-profile resolution, the three-profile mannequin demonstrated increased classification accuracy (Entropy = 0.912) and extra balanced profile proportions. Although the four-profile resolution confirmed barely higher match indices, the extra profile appeared to mirror a subdivision of an current profile and didn’t yield significant sensible distinctions. In the five-profile resolution, the LMR take a look at was not statistically important (p = 0.056). The common posterior possibilities for the three-profile mannequin had been 0.984, 0.967 and 0.940, respectively, all exceeding 0.80, indicating passable classification accuracy (Supplementary Table S1). No residual correlations exceeded |0.10|, supporting the belief of native independence. Furthermore, sensitivity evaluation utilizing the total pattern (N = 815) confirmed that the three-profile resolution remained optimum (Supplementary Table S2).

Based on the LPA and the response patterns illustrated in Figure 2, the three profiles had been labeled to mirror their distinct eHL patterns. Profile 1 (n = 89, 15%), labeled Low Application-High Confidence, was characterised by low scores on Finding assets, Available assets, and Using info (all < 2.0) and comparatively excessive scores on Decision confidence and Answering questions (all > 3.0). Profile 2 (n = 309, 52%), labeled High Application-Low Critical Thinking, demonstrated excessive scores on Where to search out (4.25) and Answering questions (3.90) however a notably low rating on Distinguishing high quality (1.97). Profile 3 (n = 196, 33%), labeled High eHL, exhibited constantly excessive scores throughout all objects, with imply merchandise scores starting from 3.36 to 4.51.

3.5. Differences in HSE and HPL throughout eHL profiles

Table 5 exhibits the numerous variations in HSE complete scores (F[2,591] = 67.067, p < 0.001) and HPL complete scores (Welch’s F[2,564] = 59.739, p < 0.001) throughout the three recognized eHL profiles. Specifically, HSE complete scores elevated stepwise throughout the three eHL profiles, with Profile 3 exhibiting the very best scores, adopted by Profile 2 and Profile 1; all pairwise comparisons had been statistically important (all p < 0.05). Regarding HPL, college students in Profile 2 and Profile 3 exhibited considerably increased HPL complete scores than these in Profile 1 (p < 0.001), whereas no important distinction was discovered between Profile 2 and Profile 3 (p > 0.05).

3.6. Mediation impact of HSE

Gender, educational 12 months, household financial standing, and self-rated well being had been included as covariates in all mediation fashions to regulate for potential confounding. With the Low Application–High Confidence profile because the reference group, each the High Application–Low Critical Thinking profile (β = 1.062, p < 0.001) and the High eHL profile (β = 1.083, p < 0.001) had been positively related to HPL in Model 1. Both profiles had been additionally positively related to HSE in Model 2 (R² = 0.279, p < 0.001; Table 6). After HSE was included within the mannequin, the associations between eHL profiles and HPL had been weakened however remained statistically important. The regression coefficients decreased to 0.599 for the High Application–Low Critical Thinking profile and 0.386 for the High eHL profile (Table 6).

As proven in Figure 3 and Table 7, the oblique impact of HSE for the High Application–Low Critical Thinking profile was 0.463 (95% CI: 0.345–0.586), accounting for 43.62% of the overall impact. For the High eHL profile, the oblique impact was 0.697 (95% CI: 0.560–0.840), accounting for 64.37% of the overall impact. The 95% CIs for each oblique results didn’t embody zero. Sensitivity analyses with further adjustment for age, hometown, parental training, and main sort yielded constant outcomes (Supplementary Tables S3, S4), indicating robustness of the findings.

4.1. Strengths and limitations

This research has a number of strengths. First, to our data, it’s the first research to determine distinct eHL profiles amongst vocational school college students utilizing LPA, which captures the heterogeneity of eHL on this inhabitants. Second, grounded in Social Cognitive Theory, it additional clarifies the mediating function of HSE within the pathway from eHL profiles to HPL. Third, the identification of a ceiling impact highlights the significance of environmental and systemic elements, and the proposed tailor-made intervention methods for various subgroups could provide sensible implications for digital well being training.

However, a number of limitations needs to be acknowledged when deciphering these findings. First, the cross-sectional design limits causal inference, notably concerning the noticed mediation results. Future longitudinal, multicenter research with goal measures are due to this fact warranted. Second, all variables had been measured utilizing self-report questionnaires, which can introduce recall bias and customary methodology variance. Although Harman’s single-factor take a look at didn’t point out extreme widespread methodology bias, this chance can’t be utterly dominated out. Third, the research was performed in a single college in China, and participation was voluntary, which can restrict generalizability and introduce self-selection bias. In addition, potential class-level clustering results weren’t explicitly accounted for, which can have led to underestimation of ordinary errors. Finally, though knowledge cleansing procedures had been carried out to enhance knowledge high quality, the absence of embedded attention-check objects could have restricted the flexibility to determine insufficient-effort responses.