An Innovative Contribution to Understanding Health Literacy and eHealth Literacy in Nursing Students: A Cross-Sectional Cluster Analysis

Background: HL and eHL are essential for future nurses. Their low levels in adults are linked to poorer outcomes and higher healthcare costs, emphasizing the need to assess these skills in nursing education. Aim: This study examined HL and eHL levels among nursing students across different years of a Bachelor of Nursing programme and identified subgroups of students. Methods: A cross-sectional study was conducted among students enrolled in all academic years. HL and eHL were assessed using the Health Literacy Questionnaire and the eHealth Literacy Scale (eHEALS). Descriptive statistics summarized participant characteristics and literacy levels. Differences across academic years were examined, and cluster analysis was performed to identify homogeneous student groups. Results: HL and eHL varied across the nursing curriculum. Four distinct clusters emerged: (1) older students, concurrently employed; (2) young, on-track second-year students; (3) students with prior university education; and (4) first-year students without an academic background. ANOVAs indicated significant differences in eight HL dimensions, with Cluster 2 consistently achieving the highest scores and Cluster 4 the lowest. Conclusions: HL and eHL among nursing students appear to be dynamic competencies shaped by sociodemographic and academic factors. Identifying student profiles supports the development of differentiated instructional strategies in nursing education. Although previous research has examined HL and eHL in nursing students, no study to date has defined these competencies in relation to the structure of the nursing curriculum or used cluster analysis to identify subgroups. This represents the main innovative contribution of the current study.