Digital readiness in nursing education: eHealth literacy, AI attitudes, and associated factors among undergraduate...

Digital readiness has become a critical competency for future nurses in the evolving landscape of healthcare. Two essential components of this readiness-eHealth literacy and attitudes toward artificial intelligence (AI)-have gained prominence in nursing education. However, limited evidence exists regarding their interrelationship and associated demographic and behavioral factors, particularly in middle-income countries.

This study aimed to assess eHealth literacy and attitudes toward AI among undergraduate nursing students, identify associated demographic and behavioral factors, and examine the relationship between these two constructs as key dimensions of digital readiness.

A descriptive and cross-sectional analytic study was conducted with 286 undergraduate nursing students at a public university in Türkiye during the 2024-2025 academic year. Participants were recruited using a voluntary, open invitation approach. Data were collected through an online survey, including a sociodemographic questionnaire, the eHealth Literacy Scale (eHEALS), and the General Attitudes Toward Artificial Intelligence Scale. Non-parametric tests and Spearman's rho correlation were used for group comparisons and bivariate associations. Hierarchical multiple regression analysis was performed to evaluate the independent contribution of eHealth literacy to AI attitudes while controlling for potential confounding demographic and behavioral variables.

Of the 286 participants, the majority were female (75.9%) with a mean age of 20.7 years (SD = 2.78), predominantly in the 19-22 age range. Participants reported moderate-to-high eHealth literacy (M = 28.3, SD = 4.92) and favorable attitudes toward AI (M = 65.9, SD = 8.37). Significant differences were observed across gender, academic year, grade point average (GPA), and frequency of AI tool use. Students using generative AI tools such as ChatGPT scored significantly higher on both scales. A positive correlation was found between eHealth literacy and AI attitudes (r = 0.214, p < 0.001). In hierarchical regression analysis, demographic variables accounted for a small proportion of variance in AI attitudes, while behavioral factors (e.g., GPA and AI tool use) significantly improved the model. However, eHealth literacy did not make a statistically significant independent contribution to AI attitudes after controlling for these variables.

Undergraduate nursing students demonstrated promising levels of digital readiness. However, the relationship between eHealth literacy and AI attitudes appears to be context-dependent rather than independently predictive. Behavioral engagement with digital technologies plays a more prominent role in shaping AI attitudes. These findings underscore the need for nursing curricula to move beyond foundational digital literacy and incorporate experiential, practice-oriented AI learning opportunities to support comprehensive digital readiness.