Front Public Health. 2026 Aug 14;14:1883113. doi: 10.3389/fpubh.2026.1883113. eCollection 2026.
ABSTRACT
BACKGROUND: Digital technologies have become major sources of health information; however, individuals’ ability to integrate such information varies according to their health literacy (HL) and eHealth literacy (e-HL). In concussion management, accurate knowledge and appropriate attitudes are important for symptom recognition and healthcare-seeking behaviors. Nevertheless, the relationships among HL, e-HL, and concussion-related knowledge and attitudes remain poorly understood.
OBJECTIVE: To evaluate the associations of HL and e-HL with concussion-related knowledge and attitudes among parents in South Korea and to examine the indirect associations between HL and these outcomes through e-HL.
METHODS: A cross-sectional online survey was conducted among parents in South Korea. HL and e-HL were assessed using the Korean version of the HLS-EU-Q16 and the eHealth Literacy Scale (eHEALS), respectively. Outcome variables were concussion-related knowledge and attitudes. Observed-variable mediation analyses were used to statistically decompose the associations of HL with these outcomes into direct and indirect components through e-HL. An exploratory sequential mediation model additionally evaluated whether concussion-related knowledge was involved in the indirect association between HL and concussion-related attitudes.
RESULTS: In total, 260 participants completed the survey. HL was positively correlated with e-HL (ρ = 0.45, p < 0.001) and concussion-related attitudes (ρ = 0.19, p = 0.003), but not with concussion-related knowledge (ρ = 0.03, p = 0.657). For concussion-related knowledge, neither HL nor e-HL was significantly associated with the outcome, and no significant indirect association was observed. For concussion-related attitudes, a significant indirect association between HL and attitudes through e-HL was observed (B = 0.117, 95% CI: 0.022-0.220; p = 0.021). The exploratory sequential mediation analysis showed no significant indirect association involving concussion-related knowledge.
CONCLUSION: Higher HL was associated with more favorable concussion-related attitudes, but not with concussion-related knowledge. An indirect association between HL and concussion-related attitudes was observed through e-HL, but not through concussion-related knowledge. This indirect association was consistent with the hypothesized model but did not establish temporal precedence or causal mediation. These findings suggest that future concussion education strategies may benefit from strengthening both HL and e-HL alongside the provision of factual concussion information.
PMID:42666352 | PMC:PMC13522205 | DOI:10.3389/fpubh.2026.1883113
