eHealth literacy, digital information seeking, and health-promoting lifestyle among liver transplant recipients: a cross-sectional study

Background Digital health tools are increasingly integrated into long-term transplant follow-up, but their value depends on patients' ability to find, understand, appraise, and use electronic health information. Evidence on eHealth literacy and its behavioral context among liver transplant recipients remains limited, particularly in China. Methods A cross-sectional study was conducted from February to March 2026 among 126 adult liver transplant recipients at West China Hospital, Sichuan University. Participants completed a general information questionnaire, the Chinese eHealth Literacy Scale (eHEALS), and the Health-Promoting Lifestyle Profile II Revised (HPLP-II R). Group comparisons, Spearman correlation analyses, and HC3 heteroscedasticity-robust multiple linear regression were performed. Additional covariate-adjusted models examined total HPLP-II R and its six dimensions; the dimension-level analysis was treated as exploratory and Holm adjustment was used for six dimension-specific tests. Results The mean total eHEALS score was 24.66 ± 9.21. Internal consistency in the current sample was high for total eHEALS (Cronbach's alpha = 0.977) and total HPLP-II R (alpha = 0.907). In the sociodemographic and internet-related model, older age was associated with lower perceived eHealth literacy ( B = −0.171 per year, 95% CI −0.272−0.070, beta = −0.190, P = 0.001), and participants who did not search online for disease-related information scored substantially lower than those who did ( B = −10.635, 95% CI −13.103−8.166, beta = −0.574, P < 0.001). After adjustment for the same sociodemographic and internet-related covariates, total HPLP-II R remained positively associated with perceived eHealth literacy ( B = 0.195, 95% CI 0.078–0.312, beta = 0.233, P = 0.001). In the adjusted dimension-level model, health responsibility remained positively associated with eHealth literacy ( B = 0.582, 95% CI 0.189–0.974, beta = 0.235, nominal P = 0.004; Holm-adjusted P = 0.022), whereas the nominal association with spiritual growth did not remain significant after multiplicity adjustment (Holm-adjusted P = 0.188). Conclusion Perceived eHealth literacy varied considerably among liver transplant recipients. Older age and absence of online disease-information seeking were associated with lower eHealth literacy, although the information-seeking association should be interpreted cautiously because of conceptual overlap and possible bidirectionality. Health-promoting lifestyle, particularly health responsibility, remained associated with eHealth literacy after covariate adjustment. These cross-sectional findings identify patient and behavioral characteristics for prospective evaluation rather than causal determinants and should be interpreted in light of single-center convenience sampling and potential selection and non-response bias.