The mediating effects of digital literacy and self-efficacy on the relationship between learning attitudes and Ehealth literacy in nursing students: A cross-sectional study

eHealth literacy (eHL) is considered an important competency among healthcare providers in healthcare systems, especially following the introduction of information and communication technologies.This study aimed to identify the relationship and direction of factors affecting nursing students' eHL in an online learning environment.A cross-sectional study.Three nursing colleges located in Gyeonggi-do and Gangwon-do in Korea.Participants were 259 nursing students aged 18-29 years who lived in the Seoul metropolitan area.Self-reported data on variables including attitudes toward online learning, digital literacy, self-efficacy, and eHL, were collected and analyzed using an independent t-test and one-way analysis of variance. The mediating effects were verified through the bootstrapping method using the PROCESS macro for SPSS.The results indicated that although attitudes toward online learning affected digital literacy, they did not directly influence eHL. Additionally, digital literacy and self-efficacy were also found to be associated with eHL and mediate the relationship between online learning attitudes and eHL.As online nursing education rapidly becomes commonplace due to the COVID-19 pandemic, attitudes toward online learning, digital literacy, and self-efficacy must be improved to enhance eHL.