The Relation Between eHealth Literacy and Online Health Information-Seeking Behavior: Systematic Review and...

Online health information-seeking (OHIS) behavior shapes health self-management, and eHealth literacy-the ability to seek, appraise, and apply electronic health information-is regarded as its key driver. Previous reviews aggregated heterogeneous outcomes, focused on measurement properties, or examined single clinical populations, without isolating the eHealth literacy-OHIS link.

This study quantified the strength and heterogeneity of the eHealth literacy-OHIS association and identified its boundary conditions across generation, morbidity status, and information source credibility.

Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), we searched PubMed, Embase, Web of Science Core Collection, PsycINFO, Psychology and Behavioral Sciences Collection, and Library, Information Science, and Technology Abstracts (LISTA) up to March 15, 2026 (PROSPERO [International Prospective Register of Systematic Reviews] CRD420251088300). Eligible studies enrolled participants, measured eHealth literacy with validated instruments, and assessed OHIS. Risk of bias used the modified Newcastle-Ottawa Scale. Correlations were Fisher z-transformed and pooled under a random-effects model with the Hartung-Knapp-Sidik-Jonkman correction; subgroups were age cohort, morbidity status, and source type. Heterogeneity was quantified with I² and τ²; a univariate meta-regression examined temporal trends, and certainty of evidence was rated using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation).

Of 9249 nonduplicate records, 32 studies entered the qualitative synthesis, and 19 (20 effect sizes) the meta-analysis. The grand mean correlation was 0.27 (95% CI 0.15-0.38; P<.001) but is of limited interpretive value given extreme heterogeneity (I²=99%; τ²=0.064; 95% prediction interval -0.26 to 0.67). Correlations were stronger in non-Gen Z (k=12; r=0.39; 95% CI 0.27-0.50; P<.001) than in Gen Z (k=8; r=0.07; 95% CI -0.06 to 0.20; P=.23), in patients (k=3; r=0.58; 95% CI 0.01-0.86; P=.049) than in nonpatients (k=17; r=0.22; 95% CI 0.11-0.32; P<.001), and in professional (k=5; r=0.41; 95% CI 0.11-0.64; P=.02) than in nonprofessional (k=14; r=0.21; 95% CI 0.06-0.35; P=.01) sources. Meta-regression on collection year showed no significant temporal change (b=-0.005 per year; P=.55), and neither the Egger test (P=.60) nor trim-and-fill indicated small-study effects.

The eHealth literacy-OHIS association is best understood through its boundary conditions, not the overall estimate. The association was robust in non-Gen Z and professional-source contexts but near-null in Gen Z, showing that the eHealth literacy scale's behavioral predictive validity is cohort- and platform-dependent. Interventions for Gen Z and nonpatient populations should pair literacy training with motivational cues and professionally curated information environments. GRADE certainty was very low, underscoring the need for longitudinal, performance-based research.