JMIR Publications

ABSTRACT

Background:

Since the COVID 19 pandemic, health care and health information seeking have become increasingly digitally mediated. It remains unclear whether eHealth literacy is consistently associated with health behaviors across different behavioral functions and social contexts in the post COVID 19 era.

Objective:

To synthesize post COVID 19 evidence on the association between eHealth literacy and health behaviors and to examine whether this association varies by health behavior domain, country income context, and population age structure.

Methods:

We conducted a PRISMA 2020 compliant systematic review and meta analysis registered in PROSPERO (CRD4201009048). PubMed, Embase, and the Cochrane Library were searched from inception to January 28, 2026. Observational studies were eligible if they assessed eHealth literacy using a validated instrument with an explicit score, measured health behavior outcomes that could be classified as health decision making, health promotion, or health management, and collected data in 2020 or later or explicitly reported the timing of data collection. Odds ratios and correlation coefficients were synthesized separately using random effects models with Hartung Knapp adjustment. Funnel plots and trim and fill were used to assess small study effects. Subgroup differences were tested using between group heterogeneity statistics. Studies with non comparable outcomes were summarized narratively.

Results:

Twenty two studies met the inclusion criteria, including 15 studies contributing quantitative effect estimates and 7 studies summarized narratively. Overall associations were directionally positive, with substantial heterogeneity and sensitivity to small study effects. Behavioral domain was the most consistent source of between study variation across effect size frameworks. Income context moderated associations in the correlation based synthesis, whereas age structure did not show significant moderation. Narrative evidence was most consistent for health decision making outcomes, more mixed for health promotion outcomes, and more variable and generally weaker for health management outcomes.

Conclusions:

In post COVID 19 studies, eHealth literacy is generally associated with health behaviors, but the strength and consistency of this relationship vary across behavioral domains and settings. Future longitudinal and intervention research using more comparable behavior measures is needed to clarify directionality and to inform context tailored strategies for improving eHealth literacy and health behavior.