Digital Health Literacy and Preventive Health Behaviour: The Mediating Role of Health Awareness and Moderating Effect of Socioeconomic Status among Urban Patients in Indonesia

Indonesia's rapid shift toward digital health services has made the ability to find, judge and use online health information a plausible lever for prevention, yet evidence on how this capability translates into preventive behaviour, and for whom, remains thin in urban Indonesian patient populations. Drawing on the Health Belief Model, Nutbeam's health literacy framework and fundamental cause theory, this study examines whether health awareness mediates the relationship between digital health literacy (DHL) and preventive health behaviour (PHB), and whether socioeconomic status (SES) conditions the direct and indirect pathways. A cross-sectional design was specified for adult outpatients attending community health centres, public hospital outpatient units and private clinics in five Indonesian cities, with 418 patients in the analytic sample. DHL was measured with the eHealth Literacy Scale, health awareness with adapted health consciousness items, and PHB with adapted items from the Health-Promoting Lifestyle Profile II. Measurement quality was assessed through factor loadings, reliability, convergent and discriminant validity, and common method checks; hypotheses were tested through conditional process analysis (Hayes Model 8) with 5,000 bootstrap resamples. DHL predicted health awareness (β = 0.402) and PHB directly (β = 0.196), health awareness predicted PHB (β = 0.354), and the indirect effect was 0.144 (95% CI [0.102, 0.193]), indicating complementary partial mediation. SES did not significantly moderate either pathway (index of moderated mediation = 0.014, 95% CI [−0.016, 0.044]). The article discusses implications for patient education, digital health platforms and policy.