Understanding How eHealth Literacy Shapes Health Behaviors and Quality of Life among Socioeconomically Disadvantaged Children

Background: Digital technologies have become integral to how individuals’ access, evaluate, and use health information; however, disparities in eHealth literacy (eHL)-the ability to locate, appraise, and apply digital health resources-may exacerbate existing health inequities, particularly among socioeconomically disadvantaged children. Despite growing research on eHL and health outcomes, evidence remains limited for vulnerable child populations, including those in institutional care. Understanding how digital competencies shape health-promoting behaviors (HPB) and health-related quality of life (HRQoL) is critical for advancing health equity in the digital era. This study examined the relationships among eHL, HPB, and HRQoL in school-aged children from socioeconomically disadvantaged backgrounds, and tested whether HPB mediates the association between eHL and HRQoL using a structural equation modeling framework. Methods: A cross-sectional study was conducted with 234 elementary school-aged children residing in 15 orphanages in South Korea. Participants completed validated assessments of eHL (K-eHEALS), HPB, and HRQoL (PedsQL™ 4.0). Confirmatory factor analysis was used to evaluate construct validity, and structural equation modeling was employed to test direct and indirect associations among eHL, HPB, and HRQoL. Results: The structural model demonstrated acceptable fit (χ²/df = 2.81, RMSEA = 0.088, CFI = 0.956). eHL showed a significant positive direct effect on HPB ( β = 0.177, p < .05), and HPB was significantly associated with HRQoL ( β = 0.382, p < .001). eHL did not directly predict HRQoL ( β = 0.055, p > .05), but a significant indirect effect of eHL on HRQoL through HPB was observed ( β = 0.068, p < .05), confirming the mediating role of HPB. Conclusions: Among socioeconomically disadvantaged children, eHL contributes to better HRQoL primarily through its influence on HPB. Strengthening children’s digital health competencies-alongside targeted behavioral supports-may be essential for reducing health inequities and enhancing well-being in institutional settings. Early, tailored interventions that integrate digital literacy training with health behavior promotion could serve as a strategic approach to improving long-term health outcomes in vulnerable youth.