Developing digital health literacy among nursing interns: A sequential mediation model of preceptor support,...

With the rapid digitalization of healthcare systems, nursing interns must safely and effectively navigate digital health technologies during clinical training. Digital health literacy (DHL) is essential for safe nursing practice, yet the mechanisms driving its development within authentic clinical learning environments remain poorly understood.

To assess DHL levels among nursing interns and examine how preceptor and departmental support fosters DHL via digital self-efficacy, technology acceptance, and clinical information-technology use.

A nationwide, multi-centre cross-sectional study.

Eleven undergraduate nursing institutions across China.

A total of 1593 undergraduate nursing interns who had completed at least four months of clinical practice.

Validated instruments assessed DHL, digital self-efficacy, technology acceptance, clinical information-technology use, and perceived preceptor and departmental support. Data analysis involved descriptive statistics, correlation analysis, and multiple linear regression. Structural equation modelling (SEM) with bias-corrected bootstrap estimation evaluated the direct and indirect pathways underlying the hypothesized sequential mechanism of DHL development.

Participants demonstrated a moderate-to-high DHL level (60.55 ± 8.87), with the privacy protection subscale scoring highest and the skills and application subscale scoring lowest. SEM revealed a clear sequential mechanism underlying DHL development. Preceptor and departmental support exerted a strong indirect effect on DHL (total indirect effect = 0.185, p < 0.001) by enhancing nursing interns' digital self-efficacy and technology acceptance, which sequentially promoted clinical information-technology use, ultimately leading to higher DHL scores.

DHL among nursing interns can be conceptualized as a practice-based clinical competence developed through a sequential mechanism involving psychological and behavioral engagement with digital technologies. Integrating educational support and confidence-building strategies into clinical internships is essential, as these factors indirectly foster DHL through enhanced digital self-efficacy, technology acceptance, and clinical information-technology use, preparing a digitally competent nursing workforce capable of navigating modern healthcare systems.