Currently submitted to: JMIR mHealth and uHealth
Date Submitted: May 14, 2026
Open Peer Review Period: May 15, 2026 - Jul 10, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Association between digital health literacy profiles and quality of life: The mediating role of medical cost-coping behaviors in gynecological cancer patients
ABSTRACT
Background:
With the rapid digitalization of oncology care, digital health literacy has become a critical determinant of self-management and quality of life (QoL) among gynecologic cancer patients. However, most existing studies treat digital health literacy as a homogeneous construct, potentially overlooking distinct skill patterns among patients. Furthermore, the rising financial burden of cancer treatment often forces patients to adopt various medical cost-coping behaviors, yet the underlying mechanism of how different digital health literacy profiles influence these behaviors and subsequent well-being remains poorly understood.
Objective:
The study aimed to identify heterogeneous patterns of digital health literacy via Latent Profile Analysis and to elucidate how medical cost-coping behaviors mediate the relationship between these digital health literacy profiles and QoL among gynecologic cancer patients.
Methods:
A convenience sample of gynecologic cancer patients was recruited between January and April 2024. Participants were assessed for digital health literacy, medical cost-coping behaviors and QoL. Latent profile analysis was performed using Mplus 8.3 to identify digital health literacy subgroups. Mediation analysis was conducted using the lavaan package in R 4.3.3 software, adjusting for key sociodemographic and clinical covariates.
Results:
A total of 378 questionnaires were analyzed. Three distinct digital health literacy profiles emerged: “Digital health novices” (n=86, 22.75%), “Competent navigators” (n= 217, 57.41%) and “Critical but hesitant users” (n=75, 19.84%). Mediation analysis revealed that higher digital health literacy proficiency was positively associated with QoL. Medical cost-coping behaviors significantly mediated this relationship. Compared to the “Digital health novices”, the total effects of on QoL were 13.23 for “Competent navigators” and 20.32 for “Critical but hesitant users” (both P <0.001). The indirect effects via reduced medical cost-coping behaviors were 2.78 (95% CI: 1.47–4.39) and 4.34 (95% CI: 2.69–6.23), respectively.
Conclusions:
This study highlights the heterogeneity of digital health literacy among gynecologic cancer patients. Findings suggest that proficient digital health literacy not only directly enhances QoL but also indirectly improves health outcomes by mitigating maladaptive cost-coping behaviors. Future interventions could focus on empowering patients to seek, evaluate, and apply digital health information to reduce maladaptive medical cost coping behaviors and improve overall well-being. Clinical Trial: NA
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