JMIR Publications

ABSTRACT

Background:

Urolithiasis is a highly prevalent urological condition with recurrence rates exceeding 50% within five years. While eHealth literacy has been associated with better health outcomes, its dynamic interplay with illness cognitions, particularly illness-related helplessness, acceptance, and perceived benefits—remains poorly understood. Guided by Leventhal's Common-Sense Model, this study examined the bidirectional relationships between eHealth literacy and illness cognitions over a six-month period following urolithiasis surgery.

Objective:

To investigate the directionality and magnitude of longitudinal associations between eHealth literacy and three dimensions of illness cognitions (helplessness, acceptance, and perceived benefits) in postoperative urolithiasis patients.

Methods:

A three-wave longitudinal design was employed with 368 patients who underwent urolithiasis surgery. Data were collected at 1 month (T1), 3 months (T2), and 6 months (T3) postoperatively. eHealth literacy was measured using the eHealth Literacy Scale (eHEALS), and illness cognitions were assessed with the Illness Cognition Questionnaire (ICQ). Cross-lagged panel models (CLPMs) were estimated to examine bidirectional effects while controlling for autoregressive stability.

Results:

The primary CLPM (eHEALS–Helplessness) demonstrated good fit (χ²=9.94, df=6, P=0.127; CFI=0.988; TLI=0.967; RMSEA=0.050). Significant bidirectional cross-lagged effects were identified: higher eHEALS predicted lower Helplessness (T1→T2: β=−0.096, P=0.003; T2→T3: β=−0.245, P<0.001), while Helplessness also predicted lower eHEALS (T1→T2: β=−0.099, P=0.017; T2→T3: β=−0.139, P=0.010), revealing a bidirectional negative spiral. Supplementary models revealed that eHEALS predicted increased Acceptance (β=0.098 at T2→T3, P=0.010) and Perceived Benefits (β=0.083–0.092, P<0.01), with reverse effects being non-significant.

Conclusions:

eHealth literacy and illness helplessness are reciprocally related in a bidirectional negative spiral, while eHealth literacy exerts unidirectional effects on promoting acceptance and perceived benefits. These findings delineate a public health causal chain—eHealth literacy → adaptive illness cognitions → improved self-management → reduced recurrence risk—that supports the integration of eHealth literacy interventions into postoperative care and tiered healthcare systems to facilitate cognitive adaptation and recurrence prevention in urolithiasis.