E-health literacy and health system distrust: exploring a nonlinear association in a cross-sectional study

E-health literacy is essential for navigating digital health resources and making informed health decisions. Although higher literacy is assumed to foster institutional trust, its relationship with health system distrust remains unclear.

The aim of this study was to examine the association between e-health literacy and health system distrust, considering possible nonlinear patterns and sociodemographic moderators.

A cross-sectional survey was conducted among 384 adults in our institution using the e-Health Literacy Scale and the Health System Distrust Scale. Sociodemographic data and digital device use were recorded. Nonparametric comparisons, multiple linear, and quadratic regression analyses were performed, adjusting for confounders.

E-health literacy differed significantly by education, socioeconomic status, employment, and device use (p<0.05). Distrust varied by socioeconomic and marital status. Linear regression showed no significant association between e-health literacy and distrust (p=0.552). After adding a quadratic term, a statistically significant nonlinear association emerged (p<0.001), with predicted distrust varying across levels of e-Health literacy. High socioeconomic status independently predicted lower distrust (B=-4.97, p=0.002).

E-Health literacy shows a modest, nonlinear association with health system distrust in this sample. However, the small explained variance indicates that distrust is largely shaped by factors beyond digital health competence. Further research is needed to clarify underlying mechanisms.