Digital health literacy and trust in health information sources: A comparative study of university students in Japan, the United States, and India

The rapid expansion of the Internet and social media has transformed health communication, highlighting the critical importance for digital health literacy - particularly during the "infodemics" of the COVID-19 pandemic. This study examined digital health literacy and online health information-seeking behaviors among university students - the digital native generation - in Japan, the United States, and India. A cross-national comparison across these culturally and technologically diverse countries provides insights into global variations in digital health literacy. An online survey was administered to 1500 undergraduate students (500 per country) using the Digital Health Literacy Instrument (DHLI) to evaluate their ability in utilizing digital health information. DHLI scores were compared across countries, and associated factors were analyzed. The mean age of participants was 20.6 years. DHLI scores were significantly higher in the US (3.10 ± 0.38) than in India (2.94 ± 0.38) and Japan (2.89 ± 0.42). While students generally demonstrated strong operational skills, many lacked sufficient ability to critically evaluate information and contribute self-generated content, indicating the need for targeted educational support. Importantly, trust in online health information sources, rather than mere usage, was strongly associated with higher DHLI scores. These findings highlight the importance of enhancing individual skills in identifying credible sources and increasing the availability of trustworthy digital health content, particularly from public agencies and official social media platforms. Future research should explore cultural and systemic factors underlying cross-country differences to inform targeted strategies for improving digital health literacy globally.