# The influencing factors and generation path of digital health literacy among adolescents: evidence from 18 provinces in China

## TL;DR

This study explores how digital health literacy develops in Chinese adolescents and identifies factors that promote or hinder it.

## Contribution

The study introduces a new generation path model for adolescent digital health literacy using grounded theory and qualitative insights.

## Key findings

- A literacy foundation, active exploration, and passive arousal promote digital health literacy in adolescents.
- Negative impacts and practical problems hinder the development of digital health literacy.
- Three distinct paths for DHL formation were identified: cognitive-environmental synergy, action-technology driven, and anxiety-action transformation.

## Abstract

This study explores the generation path and influencing factors of digital health literacy (DHL) among adolescents (aged 12–22), addressing gaps in the research by giving insufficient attention to underage youth and the lack of qualitative exploration.

Adopting grounded theory, 74 semistructured online interviews were conducted with adolescents across 18 Chinese provinces, generating 190 thousand words of anonymized text. Through open, axial, and selective coding, 33 initial concepts, 14 core categories, and 6 main categories (literacy foundation, active exploration, passive arousal, positive effects, negative impact, and practical problems) were identified.

The results show that a literacy foundation (digital equipment/channels), active exploration (self-improvement/disease management), and passive arousal (media influence/environmental immersion) promote adolescent DHL, whereas negative impacts (health anxiety/information security) and practical problems (misinformation/supply shortages) hinder it. DHL benefits adolescents individually (fostering health actions, conceptual reconstruction, and habit formation) and socially (enabling digital feedback for health knowledge dissemination). This study also constructed an adolescent DHL generation path model and identified three paths, including the cognitive-environmental synergy path, action-technology driven path, and anxiety-action transformation path, collectively revealing the diverse formation mechanisms of adolescents’ DHL.

Practical suggestions for improving adolescents’ DHL were proposed. The results provided insights into enhancing adolescent DHL and support the optimization of adolescents’ health trajectory via digital tools.