The relationship between social support, e-Health literacy, sleep quality and Internet addiction disorder in college students: a cross-sectional study

Background: The widespread use of the Internet has increased the risk of Internet addiction disorder (IAD), particularly among university students. This study aims to investigate the relationship between social support and Internet addiction disorder, with a focus on the mediating roles of e-Health literacy and sleep quality. Methods: A cross-sectional survey was conducted among university students in Nantong, China, using simple random sampling. Valid data were collected from 774 participants (response rate: 95.51%). Measures included sociodemographic characteristics, Internet Addiction Test (IAT), Perceived Social Support Scale (PSSS), e-Health Literacy Scale (e-HEALS), and Pittsburgh Sleep Quality Index (PSQI). Structural equation modeling (SEM) with bootstrap testing was employed to examine the multiple mediation effects. Results: The baseline score for Internet addiction disorder was 38.16 (SD = 0.48). Social support, e-Health literacy, poor sleep quality, and Internet addiction disorder were significantly negatively related to each other. All paths in the research model were statistically significant, and social support cognition level was an important factor affecting Internet addiction disorder, and the direct effect accounted for 45.60% of the total effect. The total indirect effect of social support through e-Health literacy and sleep quality on Internet addiction disorder was statistically significant. Conclusion: Enhancing social support, improving e-Health literacy, and promoting better sleep quality may effectively reduce Internet addiction disorder among university students. These findings provide a theoretical basis for targeted interventions.