E-Health literacy among adults seeking care from a tertiary care hospital in Bihar, India

Abstract Background eHealth literacy, defined as the ability to seek, understand, and evaluate health information from electronic sources, is increasingly critical in modern healthcare. Bihar, a state in India with rapidly increasing internet penetration, presents a unique context for evaluating e-health literacy. Objectives The primary objective of this study is to assess the status of e-health literacy among adults seeking healthcare at a tertiary care hospital in Bihar. The secondary objective is to determine the sociodemographic and behavioral factors associated with e-health literacy in this population. Methods A cross-sectional observational study was conducted among 385 adults recruited between October and December 2024. Participants were interviewed using eHealth literacy scale alongside questionnaires assessing health behaviours. Data were analyzed using JAMOVI 2.2.2 software and statistical analyses were performed using logistic regression to identify associations between eHealth literacy status and health outcomes while adjusting for confounders. Results The study revealed that the mean eHEALS score was 28.7 (±4.6) on a scale of 8-40. Multivariable logistic regression analysis revealed that male gender was positively associated with higher eHealth literacy ([aOR: 2.46; 95% CI: 1.06-5.73]), as well as was having a comorbidity ([aOR: 3.87; 95% CI: 1.91-7.84]). Behavioral factors, including the use of websites ([aOR: 4.92; 95% CI: 2.39-10.12]) and health apps ([aOR: 15.99; 95% CI: 5.99-42.66]) for health-related information, were strongly associated with higher eHealth literacy scores. Conclusions The study shows that 53.2% of participants have poor e-health literacy. Gender-specific digital literacy programs and the integration of eHealth training into primary care services, are critical steps forward. Key messages • 53.2% of adults in Bihar have poor eHealth literacy. Gender-specific digital literacy programs and eHealth training in primary care can empower underserved populations and improve health outcomes. • Behavioral factors like using websites and health apps strongly enhance eHealth literacy.