Journals / Current Research in Social Sciences / 2026 / Cilt: 12 Sayı: 1

The Mediating Role of E-Health Literacy in the Relationship between Health Perception and Health Service Utilization

Sağlık Algısı ile Sağlık Hizmeti Kullanımı Arasındaki İlişkide E-Sağlık Okuryazarlığının Aracılık Rolü

Abide Aksungur(Altındağ İlçe Sağlık Müdürlüğü)0000-0002-8140-0289
Pages
144–159
Publication Date
2026-05-31
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

This study determined the levels of health perception, e-health literacy, and healthcare utilization, analyzed them with respect to participant characteristics, evaluated the relationships among these variables, and revealed the mediating role of e-health literacy in the relationship between health perception and healthcare utilization, a topic not previously covered in the literature.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:This study was designed to determine the mediating role of e-Health literacy in the relationship between health perception and healthcare utilization.
📊
Key Findings & Data:The research was conducted with 443 individuals residing in a central district of Ankara.
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Conclusion & Impact:This study determined the levels of health perception, e-health literacy, and healthcare utilization, analyzed them with respect to participant characteristics, evaluated the relationships among these variables, and revealed the mediating role of e-health literacy in the relationship between health perception and healthcare utilization, a topic not previously covered in the literature.
🔬Design:Survey & Empirical Study
📍Scope:Comprehensive Sample
⚙️Variables:E-Sağlık Okuryazarlığı · Sağlık Algısı · Sağlık Davranışları

Abstract

This study was designed to determine the mediating role of e-Health literacy in the relationship between health perception and healthcare utilization. The research was conducted with 443 individuals residing in a central district of Ankara. Data were collected using a survey method with convenience sampling. The data collection form included demographic questions along with items from the Health Perception Scale, the e-Health Literacy Scale, and the Healthcare Utilization Scale. The construct validity of the scales was assessed using Confirmatory Factor Analysis (CFA). The reliability of the scales was evaluated based on Cronbach's Alpha (CA) and Composite Reliability (CR) coefficients. Differences in participant characteristics were analyzed using the independent samples t-test and one-way ANOVA. Relationships between variables were examined through Pearson and Spearman correlation tests. Mediation analyses were conducted using the Process Macro 4.1 software. The scales were found to be compatible with the study data, and reliable according to CA and CR coefficients. Significant positive relationships were identified between the Health Perception Scale, e-Health Literacy Scale, and Healthcare Utilization (p<0.05). It was determined that e-health literacy had a mediating effect on the relationship between health perception and healthcare utilization. The study identified that e-health literacy plays a mediating role in the relationship between health perception and healthcare utilization. This finding is anticipated to be valuable for researchers and other stakeholders. This study determined the levels of health perception, e-health literacy, and healthcare utilization, analyzed them with respect to participant characteristics, evaluated the relationships among these variables, and revealed the mediating role of e-health literacy in the relationship between health perception and healthcare utilization, a topic not previously covered in the literature.

Özet

Bu çalışma, sağlık algısı ile sağlık hizmetleri kullanımı arasındaki ilişkide e-Sağlık okuryazarlığının aracılık rolünü belirlemek amacıyla tasarlanmıştır. Araştırma, Ankara’nın merkezi bir ilçesinde ikamet eden 443 bireyle gerçekleştirilmiştir. Veriler, kolayda örnekleme yöntemiyle, anket tekniği kullanılarak toplanmıştır. Veri toplama formu; demografik soruların yanı sıra Sağlık Algısı Ölçeği, e-Sağlık Okuryazarlığı Ölçeği ve Sağlık Hizmetleri Kullanımı Ölçeği maddelerini içermektedir. Ölçeklerin yapı geçerliliği Doğrulayıcı Faktör Analizi (DFA) ile değerlendirilmiş; güvenilirlikleri ise Cronbach's Alpha (CA) ve Bileşik Güvenilirlik (CR) katsayıları temel alınarak incelenmiştir. Katılımcı özelliklerine göre farklılıklar bağımsız örneklem t-testi ve tek yönlü ANOVA ile analiz edilmiştir. Değişkenler arasındaki ilişkiler Pearson ve Spearman korelasyon testleri ile değerlendirilmiştir. Aracılık analizleri Process Macro 4.1 yazılımı kullanılarak gerçekleştirilmiştir. Bulgular, katılımcıların demografik ve sağlık özellikleri açısından çeşitli farklılıklar gösterdiğini; kronik hastalık varlığı, sigara kullanımı ve düzenli ilaç kullanımının sağlık hizmetleri kullanımında anlamlı etkiler yarattığını ortaya koymuştur. Korelasyon analizleri, sağlık algısı, e-sağlık okuryazarlığı ve sağlık hizmetleri kullanımı arasında pozitif ilişkiler olduğunu göstermiştir. Aracılık analizleri sonucunda ise e-sağlık okuryazarlığın, sağlık algısı ile sağlık hizmetleri kullanımı arasındaki ilişkide kısmi aracılık rolü üstlendiği belirlenmiştir. Çalışma sağlık algısı ve e-sağlık okuryazarlığının sağlık hizmetleri kullanımında belirleyici rol oynadığını göstermektedir. Bu doğrultuda, sağlık hizmeti sunumunda ve halk sağlığı politikalarında bireylerin e-sağlık okuryazarlık düzeylerini artırmaya yönelik eğitim ve rehberlik çalışmalarının önemi vurgulanmaktadır.

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Cite This Article

Aksungur, A. (2026). The Mediating Role of E-Health Literacy in the Relationship between Health Perception and Health Service Utilization. Current Research in Social Sciences, Cilt: 12 Sayı: 1, 144–159. https://doi.org/10.30613/curesosc.1775786

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References (55)

  1. Andersen, R., & Newman, J. F. (2005). Societal and individual determinants of medical care utilization in the United States. The Milbank Quarterly, 83(4), Online-only
  2. Arpacıoğlu, S., & Özdemir, D. (2020). Effect of social media use, health perception and health search behavior on the coronavirus fear. Psikiyatride Güncel Yaklaşımlar, 12, 364–381. https://doi.org/10.18863/pgy.803145
  3. Bautista, J. R. (2015). From solving a health problem to achieving quality of life: Redefining eHealth literacy. Journal of Literacy and Technology, 16(2), 33-54.
  4. Bergman, L., Nilsson, U., Dahlberg, K., Jaensson, M., & Wångdahl, J. (2021). Health literacy and e health literacy among Arabic speaking migrants in Sweden: A cross sectional study. BMC Public Health, 21(1), 2165. https://doi.org/10.1186/s12889-021-12187-5
  5. Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
  6. Can, A., Sönmez, E., Özer, F., Ayva, G., Bacı, H., Kaya, H., Uyan, O., Ulusoy, G., Öğütçü, N., & Aslan, D. (2014). Sağlık arama davranışı olarak internet kullanımını inceleyen bir araştırma. Cumhuriyet Medical Journal, 36(4), 486–494. http://doi.org/10.7197/1305-0028.66422
  7. Carneiro, J. A., Gomes, C. A. D., Durães, W., Jesus, D. R. d., Chaves, K. L. L., Lima, C. d. A., Costa, F. M. d., & Caldeira, A. P. (2020). Negative self perception of health: Prevalence and associated factors among elderly assisted in a reference center. Ciência & Saúde Coletiva, 25, 909–918. https://doi.org/10.1590/1413-81232020253.16402018
  8. Ceylan, S. S., Turan, T., & Erdoğan, Ç. (2022). Examination of the relationship between parents’ confidence in vaccinations and levels of vaccine e Health literacy. Kırşehir Ahi Evran Üniversitesi Sağlık Bilimleri Dergisi, 6(3), 154–164. https://dergipark.org.tr/tr/pub/ahievransaglik/issue/73988/1085718
  9. Chen, J.-Z., Hsu, H.-C., Tung, H.-J., & Pan, L.-Y. (2013). Effects of health literacy to self efficacy and preventive care utilization among older adults. Geriatrics & Gerontology International, 13(1), 70–76. https://doi.org/10.1111/j.1447-0594.2012.00862.x
  10. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
  11. Connelly, J. E., Philbrick, J. T., Smith, G. R., Jr., Kaiser, D. L., & Wymer, A. (1989). Health perceptions of primary care patients and the influence on health care utilization. Medical Care, 27(3), 99-109. https://doi.org/10.1097/00005650-198903001-00009
  12. Deniz, S. (2023). Effects of e health literacy on rational drug use: The mediating role of health perception. International Journal of Health Services Research and Policy, 8(3), 175–182. https://doi.org/10.33457/ijhsrp.1328268
  13. Diamond, J. J., Becker, J. A., Arenson, C. A., Chambers, C. V., & Rosenthal, M. P. (2007). Development of a scale to measure adults’ perceptions of health: Preliminary findings. Journal of Community Psychology, 35(5), 557–561. https://doi.org/10.10020jcop
  14. Ersin, F., Usta, M. E., & Havlioğlu, S. (2021). Investigation of the relationship between health literacy levels and health perceptions of primary school teachers. International Journal of Caring Sciences, 14(3), 2001–2008.
  15. Goodwin, R., & Engström, G. (2002). Personality and the perception of health in the general population. Psychological Medicine, 32(2), 325–332. https://doi.org/10.1017/S0033291701005104
  16. Günlü, A. (2021). The mediating role of e health literacy in the relationship between coronavirus awareness and hope in the COVID 19. https://doi.org/10.21203/rs.3.rs-427296/v1
  17. Guo, S., Naccarella, L., Yu, X., Armstrong, R., Browne, G., Shi, Y., & Davis, E. (2021). Health literacy and its mediating role in predicting health behaviors among Chinese secondary students. Asia Pacific Journal of Public Health, 33(1), 76–83. https://doi.org/10.1177/1010539520980926
  18. Gürkan, K. P., & Ayar, D. (2020). The impact of e health literacy on health promotion behaviors of high school students. The Journal of Pediatric Research, 7(4), 286-292. https://doi.org/10.4274/jpr.galenos.2019.81488
  19. Huang, C. L., Yang, S.-C., & Chiang, C.-H. (2020). The associations between individual factors, eHealth literacy, and health behaviors among college students. International Journal of Environmental Research and Public Health, 17(6), 2108. https://doi.org/10.3390/ijerph17062108
  20. Jackson, A. D., Kirwan, L., Gibney, S., Jeleniewska, P., Fletcher, G., & Doyle, G. (2020). Associations between health literacy and patient outcomes in adolescents and young adults with cystic fibrosis. European Journal of Public Health, 30(1), 112–118. https://doi.org/10.1093/eurpub/ckz148
  21. Jang, Y., Kim, G., & Chiriboga, D. A. (2005). Health, healthcare utilization, and satisfaction with service: Barriers and facilitators for older Korean Americans. Journal of the American Geriatrics Society, 53(9), 1613–1617.
  22. Kadıoğlu, H., & Yıldız, A. (2012). Sağlık Algısı Ölçeği’nin Türkçe çevriminin geçerlilik ve güvenilirliği. Türkiye Klinikleri Journal of Medical Sciences, 32(1), 47–53.
  23. Kaleta, D., Polańska, K., Dziankowska Zaborszczyk, E., Hanke, W., & Drygas, W. (2009). Factors influencing self perception of health status. Central European Journal of Public Health, 17(3), 122. http://cejph.szu.cz/pdfs/cjp/2009/03/02.pdf
  24. Kim, S.-Y., Im, J.-S., Sohn, S.-J., Choi, J.-S., & Kweon, S.-S. (1999). Self rating perceived health: The influence on health care utilization and death risk. Journal of Preventive Medicine and Public Health, 32(3), 355–360.
  25. Kino, S., & Kawachi, I. (2019). Can health literacy boost health services utilization in the context of expanded access to health insurance? Health Education & Behavior, 47(1), 134–142. https://doi.org/10.1177/1090198119875998
  26. Krakau, I. (1991). Perception of health and use of health care services in a Swedish primary care district: A ten years’ perspective. Scandinavian Journal of Primary Health Care, 9(2), 103–108.
  27. Kumar, R. (2023). E Health literacy and its association with healthcare access and utilization in low income communities. Journal of Empirical Social Science Studies, 7(1), 32–50. from https://publications.dlpress.org/index.php/jesss/article/view/7
  28. Lee, S., & Nam, Y. (2018). The effect of e health literacy on health behavior in health science majors. The Journal of Korean Society for School & Community Health Education, 19(2), 77–86.
  29. Loer, A.-K. M., Domanska, O. M., Kuhnert, R., Houben, R., Albrecht, S., & Jordan, S. (2020). Online survey for the assessment of generic health literacy among adolescents in Germany (GeKoJu): Study protocol. International Journal of Environmental Research and Public Health, 17(5), 1518. https://doi.org/10.3390/ijerph17051518
  30. Marzo, R. R., Su, T. T., Ismail, R., Htay, M. N. N., Essar, M. Y., Chauhan, S., Patalinghug, M. E., Kucuk Bicer, B., Respati, T., & Fitriyana, S. (2022). Digital health literacy for COVID 19 vaccination and intention to be immunized: A cross sectional multi country study among the general adult population. Frontiers in Public Health, 10, 998234. https://doi.org/10.3389/fpubh.2022.998234
  31. McPhail, S. M. (2016). Multimorbidity in chronic disease: Impact on health care resources and costs. Risk Management and Healthcare Policy, 9, 143–156. https://doi.org/10.2147/RMHP.S97248
  32. Mollaoğlu, M., Başer, E., & Candan, F. (2021). Examination of the relationship between health literacy and health perceptions in hemodialysis patients. Journal of Renal Endocrinology, 7(1), e11–e11. https://doi.org/10.34172/jre.2021.11
  33. Murphy, D. A., Lam, P., Naar King, S., Harris, D. R., Parsons, J. T., & Muenz, L. R. (2010). Health literacy and antiretroviral adherence among HIV infected adolescents. Patient Education and Counseling, 79(1), 25–29. https://doi.org/10.1016/j.pec.2009.07.014
  34. Niu, Z., Willoughby, J., & Zhou, R. (2021). Associations of health literacy, social media use, and self efficacy with health information–seeking intentions among social media users in China: A cross sectional survey. Journal of Medical Internet Research, 23(2), e19134. https://doi.org/10.2196/19134
  35. Norman, C. D., & Skinner, H. A. (2006). eHealth literacy: Essential skills for consumer health in a networked world. Journal of Medical Internet Research, 8(2), e506. https://doi.org/10.2196/jmir.8.2.e506
  36. Onyeneho, N. G., Amazigo, U. V., Njepuome, N. A., Nwaorgu, O. C., & Okeibunor, J. C. (2016). Perception and utilization of public health services in Southeast Nigeria: Implication for health care in communities with different degrees of urbanization. International Journal for Equity in Health, 15(1), 12. https://doi.org/10.1186/s12939-016-0294-z
  37. Oral, B., & Cetinkaya, F. (2020). Health perceptions and healthy lifestyle behaviors of Erciyes University students. Medicine Science, 9(4), 829–836. https://doi.org/10.5455/medscience.2020.05.076
  38. Rasekaba, T. M., Pereira, P., Rani, G. V., Johnson, R., McKechnie, R., & Blackberry, I. (2022). Exploring telehealth readiness in a resource limited setting: Digital and health literacy among older people in rural India (DAHLIA). Geriatrics (Basel), 7(2), 28. https://doi.org/10.3390/geriatrics7020028
  39. Ratzan, S. C., & Parker, R. M. (2004). Health literacy: A prescription to end confusion. National Academies Press. Retrieved from https://www.nap.edu/catalog/10883/health literacy
  40. Souto, T. S., Ramires, A., Leite, Â., Santos, V., & Santo, R. E. (2018). Perceção da saúde: Validação de uma escala para a população portuguesa. Trends in Psychology, 26, 2167–2183. https://doi.org/10.9788/TP2018.4-17Pt
  41. Spitzer, S., & Shaikh, M. (2022). Health misperception and healthcare utilisation among older Europeans. The Journal of the Economics of Ageing, 22, 100383. https://doi.org/10.1016/j.jeoa.2021.100383
  42. Şahin, E., Çatıker, A., Özdil, K., & Bulucu Büyüksoy, G. D. (2023). Predictors of e health literacy in pregnant women: A structural equation model analysis. International Journal of Gynecology & Obstetrics, 160(3), 783–789. https://doi.org/10.1002/ijgo.14416
  43. Şahin, T., & Kerkez, N. (2023). A study on investigation of the relationship between health literacy and health perception. Balıkesir Sağlık Bilimleri Dergisi, 12(2), 336–346. https://doi.org/10.53424/balikesirsbd.1177899
  44. Şenol, V., Cetinkaya, F., Ünalan, D., Balcı, E., & Öztürk, A. (2010). Determinants of self rated health in general population in Kayseri, Turkey. Türkiye Klinikleri Tıp Bilimleri Dergisi, 30(1), 88-96.
  45. Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Pearson.
  46. Tamer Gencer, Z. (2017). Norman ve Skinner’ın e sağlık okuryazarlığı ölçeğinin kültürel uyarlaması için geçerlilik ve güvenilirlik çalışması. İstanbul Üniversitesi İletişim Fakültesi Dergisi, (52), 131-145.
  47. Tomczak, M. & Tomczak, E. (2014). The need to report effect size estimates revisited. An overview of some recommended measures of effect size. Trends in Sport Sciences, 1(21), 19–25.
  48. Uğrak, U., Aksungur, A., & Akyüz, S. (2024). Development of the healthcare utilization scale [Conference presentation abstract]. VI. International Social Sciences Congress, Sarajevo, Bosnia and Herzegovina. https://www.ius.edu.ba/en/event/vi-international-social-sciences-congress
  49. Uğrak, U., Uzuntarla, Y., Cihangiroğlu, N., & Akyüz, S. (2016). Investigation of the relationship between chronic disease and tendency to use healthcare services. Abant Medical Journal, 5(3), 158–165. https://doi.org/doi: 10.5505/abantmedj.2016.82653
  50. Uzunhasanoğlu, G., Şen, H., & Ugrak, U. (2024). Sağlık meslek yüksekokulu öğrencilerinin ruh sağlığıokuryazarlığının belirlenmesi. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi, 12(1), 164-178.
  51. World Health Organization. (2020). 172 countries and multiple candidate vaccines engaged in COVID-19 vaccine global access facility. Retrieved July 10, 2024, from https://www.who.int/news/item/24-08-2020-172-countries-and-multiple-candidate-vaccinesengaged-in-covid-19-vaccine-global-access-facility
  52. Yılmaz, E., & Çetin, F. (2022). Cerrahi kliniğinde yatan hastaların sağlık okuryazarlığı düzeylerinin sağlık algısı ve ameliyat korkusuna etkisi, İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 7(1), 61-67. https://dergipark.org.tr/en/pub/ikcusbfd/issue/68428/997716
  53. Yigitalp, G., Bayram Değer, V., & Ciftci, S. (2021). Health literacy, health perception and related factors among different ethnic groups: A cross sectional study in southeastern Turkey. BMC Public Health, 21(1), 1109. https://doi.org/10.1186/s12889-021-11119-7
  54. Zhang, X., Li, C., Liu, M., Sun, J., Yue, H., & Bao, H. (2024). The mediation effect of health literacy on social support and health lifestyle of patients with chronic diseases. Applied Nursing Research, 75, 151763. https://doi.org/10.1016/j.apnr.2024.151763
  55. Zibrik, L., Khan, S., Bangar, N., Stacy, E., Lauscher, H. N., & Ho, K. (2015). Patient and community centered eHealth: Exploring eHealth barriers and facilitators for chronic disease self management within British Columbia’s immigrant Chinese and Punjabi seniors. Health Policy and Technology, 4(4), 348–356. http://doi.org/10.1016/j.hlpt.2015.08.002