Associations of online social support and internet self-efficacy with traditional Chinese medicine health literacy among Chinese adolescents: a cross-sectional mediation analysis

Purpose To investigate the current status of adolescents’ Traditional Chinese Medicine health literacy (TCMHL) conceptualized as a domain-specific form of health literacy, analyze the relationship among online social support (OSS), Internet self-efficacy (ISE) and TCMHL, and explore the indirect association between OSS and TCMHL through ISE in a cross-sectional model. Methods From August to September 2025, convenience sampling was used to select 393 adolescents in China. Data were collected using a Demographic Questionnaire, the TCMHL Questionnaire, the Adolescent OSS Scale, and the ISE Scale. Associations were examined using Spearman’s correlation analysis, multiple linear regression, and Bootstrap mediation analysis. Results The TCMHL median (IQR) of the 393 adolescents in this study was 64 (52, 72); the OSS mean scores was 77.90 ± 18.112; and the ISE mean score was 70.98 ± 14.034. TCMHL was positively correlated with both OSS ( r = 0.161; p = 0.01) and ISE ( r = 0.242; p < 0.01); OSS was positively correlated with ISE ( r = 0.632; p < 0.01). The indirect association between OSS and TCMHL through ISE was 0.0781 (95% CI: 0.0146–0.1444), accounting for 58.90% of the estimated total association; the adjusted direct association was not statistically significant. Conclusion The level of TCMHL among 393 adolescents in China was low. OSS and ISE were positively associated with TCMHL, and the OSS-TCMHL association included a statistically significant indirect component through ISE. The observed indirect association reflects only statistical correlation and does not establish temporal ordering or causality. Future longitudinal and intervention studies are needed to determine whether changes in OSS or ISE precede changes in TCMHL. The findings support further evaluation of educational approaches combining access to reliable online TCM-related health resources with training in digital information appraisal and application.