Currently submitted to: JMIR Public Health and Surveillance
Date Submitted: Mar 20, 2026
Open Peer Review Period: Mar 24, 2026 - May 19, 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Warning: This is an author submission that is not peer-reviewed or edited.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.
Community-Based Digital Health Literacy and Parental Health Behavior in Stunting Prevention: Evidence from a Mixed-Methods Study in Rural Indonesia
ABSTRACT
Background:
Stunting remains a critical public health challenge in rural Indonesia, with a national prevalence of 19.8% among children under five years. Despite high levels of digital access, parents' capacity to critically evaluate and act on digital health information remains limited. The socio-institutional factors that determine whether digital health promotion translates into preventive behavior are poorly understood in community-based rural settings.
Objective:
This study examined: (1) the level of perceived eHealth literacy among parents in a rural West Java community; (2) socio-cultural and institutional factors shaping the relationship between digital health literacy and parental health behavior; and (3) implications for community-integrated digital health promotion strategies.
Methods:
A convergent mixed-methods design was employed. Quantitative data were collected using the eHealth Literacy Scale (eHEALS; n=175) from purposively sampled parents in Posyandu-active households via structured face-to-face interviews. Qualitative data comprised 15 in-depth interviews, three focus group discussions (total n=24), and four structured Posyandu observation sessions, analyzed thematically using NVivo 12 Plus. Reporting followed COREQ standards.
Results:
Mean eHEALS score was 22.8 (SD 4.7); 76.6% of parents were in the moderate perceived eHealth literacy category, 20.0% low, and 3.4% high. Formal educational attainment was not a statistically significant predictor of perceived eHealth literacy (chi-square=7.113, df=6, P=.311). Four qualitative themes emerged: limited evaluative digital competencies despite broad access; socio-cultural influences on message uptake; Posyandu as the primary institutional mediator; and community-based digital empowerment as a policy priority.
Conclusions:
Parents consistently reported greater behavioral responsiveness to health messages reinforced through Posyandu cadres, suggesting that community-based mediation is a critical pathway linking digital health promotion to preventive behavior. Digital health strategies should be embedded within trusted local health structures rather than deployed as stand-alone interventions Clinical Trial: Not applicable
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