Non-Cochrane · aetiology · PM42424341
The Association Between eHealth Literacy and Health Behaviors During and Since the COVID-19 Pandemic: Systematic Review and Meta-Analysis.
Ruan Boyu, Tian Jiashuai, Wang Xiaoyuan, et al. · Journal of medical Internet research · 2026 · PubMed · doi:10.2196/94233
Findings
24 findings
| Population | ||||
|---|---|---|---|---|
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (continuous score) | Lower eHealth literacy (correlation across the continuum) | Health behaviors (health decision-making, health-promoting, health management) Patient status: patient populations | R 0.46 [0.37, 0.53] GRADE not reported 3 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (continuous score) | Lower eHealth literacy (correlation across the continuum) | Health behaviors (health decision-making, health-promoting, health management) Income level: high-income economies | R 0.46 [0.39, 0.53] GRADE not reported 4 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (continuous score) | Lower eHealth literacy (correlation across the continuum) | Health behaviors (health decision-making, health-promoting, health management) Health behavior domain: health management behaviors | R 0.42 [0.31, 0.52] GRADE not reported 4 studies |
| Participants in cross-sectional studies conducted during or since COVID-19 (2020 or later) | Higher eHealth literacy | Continuous eHealth literacy score (correlation) | Health behaviors (any prespecified domain) Cross-sectional (data collected 2020 or later) · Community and clinical samples; mostly Asia and Middle East · Geriatric status: Older-adult populations | R 0.40 [0.33, 0.46] GRADE not reported 1 study |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (continuous score) | Lower eHealth literacy (correlation across the continuum) | Health behaviors (health decision-making, health-promoting, health management) Income level: low- and middle-income economies | R 0.41 [0.31, 0.51] GRADE not reported 6 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (continuous score) | Lower eHealth literacy (correlation across the continuum) | Health behaviors (health decision-making, health-promoting, health management) Geriatric status: younger or mixed-age populations | R 0.44 [0.37, 0.5] GRADE not reported 9 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (continuous score) | Lower eHealth literacy (correlation across the continuum) | Health behaviors (health decision-making, health-promoting, health management) Health behavior domain: health-promoting behaviors | R 0.44 [0.36, 0.52] GRADE not reported 6 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (continuous score) | Lower eHealth literacy (correlation across the continuum) | Health behaviors (health decision-making, health-promoting, health management) Overall, random effects without Knapp-Hartung (Appendix Table S1) | R 0.43 [0.37, 0.49] GRADE not reported 10 studies |
| Participants in cross-sectional studies conducted during or since COVID-19 (2020 or later) | Higher eHealth literacy | Continuous eHealth literacy score (correlation) | Health decision-making behaviors Cross-sectional (data collected 2020 or later) · Community and clinical samples; mostly Asia and Middle East · Health behavior domain: Health decision-making behaviors | No correlation-based study contributed to this domain (0 studies) No studies found 0 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (continuous score) | Lower eHealth literacy (correlation across the continuum) | Health behaviors (health decision-making, health-promoting, health management) Patient status: general populations | R 0.42 [0.34, 0.5] GRADE not reported 7 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (continuous score) | Lower eHealth literacy (correlation across the continuum) | Health behaviors (health decision-making, health-promoting, health management) Overall | R 0.43 [0.36, 0.51] Very low Downgraded: risk of bias, inconsistency 10 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (categorical, e.g. adequate or high) | Lower eHealth literacy (categorical, e.g. inadequate or low) | Health behaviors (health decision-making, health-promoting, health management) Patient status: patient populations | OR 2.31 [0.89, 5.99] GRADE not reported 2 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (categorical, e.g. adequate or high) | Lower eHealth literacy (categorical, e.g. inadequate or low) | Health behaviors (health decision-making, health-promoting, health management) Income level: high-income economies | OR 2.25 [1.58, 3.2] GRADE not reported 4 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (categorical, e.g. adequate or high) | Lower eHealth literacy (categorical, e.g. inadequate or low) | Health behaviors (health decision-making, health-promoting, health management) Income level: low- and middle-income economies | OR 2.01 [1.17, 3.45] GRADE not reported 2 studies |
| Participants in cross-sectional studies conducted during or since COVID-19 (2020 or later) | Higher eHealth literacy | Low versus high (inadequate versus adequate) eHealth literacy | Health-promoting behaviors Cross-sectional (data collected 2020 or later) · Community and clinical samples; mostly Asia and Middle East · Health behavior domain: Health-promoting behaviors | OR 2.25 [1.58, 3.20] GRADE not reported 4 studies |
| Participants in cross-sectional studies conducted during or since COVID-19 (2020 or later) | Higher eHealth literacy | Low versus high (inadequate versus adequate) eHealth literacy | Health decision-making behaviors (COVID-19 vaccine uptake) Cross-sectional (data collected 2020 or later) · Community and clinical samples; mostly Asia and Middle East · Health behavior domain: Health decision-making behaviors | OR 2.70 [1.74, 4.19] GRADE not reported 1 study |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (categorical, e.g. adequate or high) | Lower eHealth literacy (categorical, e.g. inadequate or low) | Health behaviors (health decision-making, health-promoting, health management) Geriatric status: older-adult populations | OR 1.59 [1.21, 2.08] GRADE not reported 2 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (categorical, e.g. adequate or high) | Lower eHealth literacy (categorical, e.g. inadequate or low) | Health behaviors (health decision-making, health-promoting, health management) Geriatric status: nonolder-adult populations | OR 2.55 [1.85, 3.51] GRADE not reported 4 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (categorical, e.g. adequate or high) | Lower eHealth literacy (categorical, e.g. inadequate or low) | Health behaviors (health decision-making, health-promoting, health management) Overall | OR 2.12 [1.47, 3.05] Low 6 studies |
| Participants in cross-sectional studies conducted during or since COVID-19 (2020 or later) | Higher eHealth literacy | Low versus high (inadequate versus adequate) eHealth literacy | Health management behaviors (medication adherence) Cross-sectional (data collected 2020 or later) · Community and clinical samples; mostly Asia and Middle East · Health behavior domain: Health management behaviors | OR 1.55 [1.11, 2.17] GRADE not reported 1 study |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (categorical, e.g. adequate or high) | Lower eHealth literacy (categorical, e.g. inadequate or low) | Health behaviors (health decision-making, health-promoting, health management) Patient status: general populations | OR 2.18 [1.68, 2.83] GRADE not reported 4 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (categorical, e.g. adequate or high) | Lower eHealth literacy (categorical, e.g. inadequate or low) | Health behaviors (health decision-making, health-promoting, health management) Overall, random effects without Knapp-Hartung (Appendix Table S2) | OR 2.12 [1.64, 2.74] GRADE not reported 6 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (per unit increase in score) | Lower eHealth literacy (per unit decrease) | Health behaviors (health decision-making, health-promoting, health management) Overall, random effects without Knapp-Hartung (Appendix Table S3) | OR 1.07 [1.03, 1.12] GRADE not reported 3 studies |
| People in observational studies with data collected in 2020 or later (COVID-19 and post-COVID-19 period) | Higher eHealth literacy (per unit increase in score) | Lower eHealth literacy (per unit decrease) | Health behaviors (health decision-making, health-promoting, health management) Overall | OR 1.07 [0.89, 1.3] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies |
Included primary studies 31
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Chau 2026 Level of eHealth Literacy and Its Associations With Health Behaviors and Outcomes in Chinese Older Adults: Cross-Sectional Analysis of… DOI:10.2196/74110 | 2026 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Chau 2026 Level of eHealth Literacy and Its Associations With Health Behaviors and Outcomes in Chinese Older Adults: Cross-Sectional Analysis of… PMID:41616099 | 2026 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Choi 2021 eHealth Literacy, Awareness of Pandemic Infectious Diseases, and Healthy Lifestyle in Middle School Students. PMID:34438590 | 2021 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Do 2020 Health Literacy, eHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19… DOI:10.2196/22894 | 2020 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Do 2020 Health Literacy, eHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19… PMID:33122164 | 2020 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Guo 2021 Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study DOI:10.2196/24577 | 2021 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Guo 2021 Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study. PMID:33784240 | 2021 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Guo 2024 Urban-Rural Differences in the Association of eHealth Literacy With Medication Adherence Among Older People With Frailty and Prefrailty:… DOI:10.2196/54467 | 2024 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Guo 2024 Urban-Rural Differences in the Association of eHealth Literacy With Medication Adherence Among Older People With Frailty and Prefrailty:… PMID:39259181 | 2024 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Hakeem 2023 The Association between Electronic Health Literacy and Oral Health Outcomes among Dental Patients in Saudi Arabia: A Cross-Sectional Study. PMID:37372921 | 2023 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Jing 2021 DOI:10.11847/zgggws1134059 | NR | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Kalayou 2022 Myth and Misinformation on COVID-19 Vaccine: The Possible Impact on Vaccination Refusal Among People of Northeast Ethiopia: A… DOI:10.2147/rmhp.s366730 | 2022 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Kalayou 2022 Myth and Misinformation on COVID-19 Vaccine: The Possible Impact on Vaccination Refusal Among People of Northeast Ethiopia: A… PMID:36213385 | 2022 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Kwon 2023 The relationship between depression, anxiety, e-health literacy, and health-promoting behavior in nursing students during COVID-19 DOI:10.1097/md.0000000000032809 | 2023 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Kwon 2023 The relationship between depression, anxiety, e-health literacy, and health-promoting behavior in nursing students during COVID-19. PMID:36820579 | 2023 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Lee 2023 Associations of eHealth literacy and knowledge with preventive behaviours and psychological distress during the COVID-19 pandemic: a… DOI:10.1136/bmjopen-2022-069514 | 2023 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Lee 2023 Associations of eHealth literacy and knowledge with preventive behaviours and psychological distress during the COVID-19 pandemic: a… PMID:38101826 | 2023 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Li 2021 Associations Between Health Literacy, eHealth Literacy, and COVID-19–Related Health Behaviors Among Chinese College Students:… DOI:10.2196/25600 | 2021 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Li 2021 Associations Between Health Literacy, eHealth Literacy, and COVID-19-Related Health Behaviors Among Chinese College Students:… PMID:33822734 | 2021 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Moradi 2025 Differential Impact of eHealth Literacy on Wellness Behaviors of Iranian Nurses: Descriptive Correlational Cross-Sectional Study DOI:10.2196/80792 | 2025 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Moradi 2025 Differential Impact of eHealth Literacy on Wellness Behaviors of Iranian Nurses: Descriptive Correlational Cross-Sectional Study. PMID:41066644 | 2025 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Mousazadeh 2025 Association between health-promoting lifestyle and electronic health literacy among Iranian university students DOI:10.1186/s12909-025-06823-6 | 2025 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Mousazadeh 2025 Association between health-promoting lifestyle and electronic health literacy among Iranian university students. PMID:39955560 | 2025 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Qian 2024 Assessment of electronic health literacy and its association with self-management among gout patients: A cross-sectional study. PMID:39507850 | 2024 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Rezakhani Moghaddam 2022 The role of e-health literacy and some cognitive factors in adopting protective behaviors of COVID-19 in Khalkhal residents. PMID:35942262 | 2022 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Sun 2025 Correlation analysis of electronic health literacy, compliance behavior, and quality of life in middle-aged and older patients with… PMID:41446526 | 2025 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Toyer Sahin 2026 The effects of e-Health and artificial intelligence literacy levels on disease self-management in patients with diabetes DOI:10.1016/j.diabres.2026.113082 | 2026 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Toyer Sahin 2026 The effects of e-Health and artificial intelligence literacy levels on disease self-management in patients with diabetes. PMID:41490818 | 2026 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Tran 2022 Predictors of eHealth Literacy and Its Associations with Preventive Behaviors, Fear of COVID-19, Anxiety, and Depression among… PMID:35409448 | 2022 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Yu 2023 Association between eHealth literacy, diabetic behavior rating, and burden among caregivers of children with type 1 diabetes:… DOI:10.1016/j.pedn.2023.08.012 | 2023 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
| Yu 2023 Association between eHealth literacy, diabetic behavior rating, and burden among caregivers of children with type 1 diabetes:… PMID:37597400 | 2023 | this review only | Health behaviors (health decision-making, health-promoting, health management) | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Human participants in observational studies with data collected in 2020 or later (during or since COVID-19) | General and patient populations in 19 cross-sectional studies (China, Iran, South Korea, Turkey, Saudi Arabia, Ethiopia, Vietnam, Hong Kong); 3 studies of older-adult focus in grouped OR synthesis, 1 in correlation synthesis |
| Intervention | Higher eHealth literacy assessed with a named instrument or clearly described operational measure with an explicit score | Higher eHealth literacy, mostly measured with eHEALS (9 of 10 correlation studies; all grouped and continuous OR studies) |
| Comparison | Lower eHealth literacy (categorical comparison) or per-unit increase in eHealth literacy score (continuous); correlation with behavior score | Lower eHealth literacy (grouped OR, n=6); per-unit eHealth literacy score (continuous OR, n=3); correlation (n=10) |
| Outcomes | Health behaviors classified a priori as health decision-making, health-promoting, or health management behaviors | Health-promoting (correlation n=6, grouped OR n=4, continuous OR n=3), health management (correlation n=4, grouped OR n=1), health decision-making (grouped OR n=1) behaviors |
| Study designs | Observational studies, cross-sectional designs eligible | Cross-sectional studies (n=19) |
| Timing | Data collected 2020 or later; search January 1, 2020 to March 27, 2026 | Data collected 2020 to 2025 |