The rapid expansion of digital technologies has transformed the manner in which individuals access, understand, and utilize health information. The widespread availability of smartphones, internet connectivity, mobile applications, telemedicine platforms, electronic health records, and online health portals has fundamentally altered healthcare delivery and patient engagement across the globe. As health systems increasingly adopt digital solutions, the ability of individuals to effectively navigate digital health resources has emerged as a critical determinant of health outcomes and healthcare utilization. This ability is commonly referred to as digital health literacy (DHL), a concept that extends beyond traditional health literacy by incorporating competencies related to digital information access, evaluation, and application in health-related decision-making [1].

Digital health literacy, often used interchangeably with eHealth literacy, has been defined as the capacity to seek, find, understand, appraise, and apply health information obtained from electronic sources to address health problems and make appropriate health decisions [1,2]. The concept integrates elements of traditional literacy, health literacy, information literacy, media literacy, and digital literacy, enabling individuals to effectively interact with contemporary healthcare technologies [3]. In an era characterized by rapid digitalization of healthcare services, digital health literacy has become increasingly important for patients seeking reliable health information, managing chronic diseases, scheduling appointments, accessing laboratory results, and participating in teleconsultations[4].

Globally, the adoption of digital health technologies has accelerated substantially over the past decade, particularly following the coronavirus disease 2019 (COVID-19) pandemic. Healthcare systems increasingly rely on digital platforms to deliver services, disseminate health information, and facilitate patient-provider communication [5]. Consequently, individuals with higher levels of digital health literacy are better equipped to access credible health information, interpret medical advice, engage in preventive health practices, and make informed healthcare decisions. Conversely, inadequate digital health literacy may contribute to misinformation exposure, delayed healthcare utilization, poor adherence to treatment recommendations, and unfavorable health outcomes [6].

Healthcare-seeking behavior refers to the sequence of actions undertaken by individuals when they perceive a health problem and decide whether, when, and where to seek medical care. It is influenced by multiple factors, including socioeconomic status, educational attainment, cultural beliefs, accessibility of healthcare services, health awareness, and health literacy [7]. In the digital era, healthcare-seeking behavior is increasingly shaped by online health information sources. Individuals frequently consult search engines, social media platforms, health websites, and mobile applications before visiting healthcare facilities. Such information-seeking practices can influence symptom interpretation, self-care decisions, treatment preferences, and utilization of healthcare services [8].

Several studies have demonstrated a positive association between digital health literacy and online health information-seeking behavior. Individuals possessing higher digital health literacy are more likely to access trustworthy health information, critically evaluate digital content, and engage actively in health-related decision-making [9,10]. Furthermore, digital health literacy has been associated with improved patient empowerment, enhanced self-management of chronic diseases, increased preventive health behaviors, and better communication with healthcare professionals [11]. These findings suggest that digital health literacy may significantly influence healthcare-seeking patterns and healthcare utilization.

Despite the growing importance of digital health literacy, substantial disparities persist across populations. Factors such as age, educational level, income, occupation, geographic location, and internet accessibility contribute to variations in digital health literacy levels [12]. Rural populations often face additional barriers, including limited internet infrastructure, lower digital skills, reduced access to digital devices, and fewer opportunities for digital health education. In contrast, urban populations generally have greater exposure to digital technologies and healthcare information resources [13]. These disparities may contribute to differences in healthcare-seeking behavior between urban and rural communities, potentially exacerbating existing health inequities.

In India and many other low- and middle-income countries, digital health initiatives have gained considerable momentum through national programs aimed at improving healthcare accessibility and efficiency. The implementation of digital health missions, telemedicine services, and electronic health information systems has created new opportunities for patient engagement. However, the effectiveness of these initiatives largely depends on the population’s ability to utilize digital health resources effectively. Understanding the level of digital health literacy among adults attending primary healthcare centers is therefore essential for designing targeted interventions that promote equitable access to healthcare services and improve health outcomes.

Primary healthcare centers serve as the first point of contact for most individuals seeking healthcare services and play a crucial role in disease prevention, health promotion, diagnosis, and treatment. Assessing digital health literacy within this setting provides valuable insights into patients’ capacity to engage with digital health resources and the extent to which such competencies influence healthcare-seeking behavior. Moreover, comparing urban and rural populations can help identify existing disparities and inform policy measures aimed at reducing the digital divide in healthcare.

Given the increasing digitalization of healthcare and the growing reliance on online health information, investigating the relationship between digital health literacy and healthcare-seeking behavior has become a public health priority. Therefore, this study aims to assess digital health literacy among adults attending primary healthcare centers in urban and rural communities and examine its impact on healthcare-seeking behavior. The findings may contribute to the development of evidence-based strategies to enhance digital health competencies, improve healthcare utilization, and promote equitable access to healthcare services across diverse populations.

Study Design and Setting A facility-based analytical cross-sectional study was conducted to assess digital health literacy and its impact on healthcare-seeking behavior among adults attending primary healthcare centers in urban and rural communities. The study was carried out in selected Primary Health Care Centers (PHCs) located in urban and rural areas of Tertiary care centre and hospital, telangana state between May 2025 and October 2025. The selected PHCs provide comprehensive primary healthcare services, including preventive, promotive, curative, and referral services to the local population. Study Population The study population comprised adults aged 18 years and above who attended the selected primary healthcare centers during the study period. Both male and female participants were included irrespective of their socioeconomic status, educational background, or occupation. Inclusion Criteria ● Adults aged ≥18 years. ● Individuals attending the selected primary healthcare centers during the study period. ● Individuals capable of understanding and responding to the questionnaire. ● Individuals who provided written informed consent to participate in the study. Exclusion Criteria ● Critically ill patients requiring immediate medical attention. ● Individuals with cognitive impairment or severe psychiatric illness affecting their ability to respond. ● Healthcare professionals and healthcare workers attending the facility. ● Participants unwilling to provide informed consent. Sample Size The sample size was calculated using the formula for estimating a proportion in a cross-sectional study: [ n=\frac{Z^2pq}{d^2} ] Assuming a 50% prevalence of adequate digital health literacy (due to limited local evidence), a confidence level of 95% (Z = 1.96), and an absolute precision of 7%, the minimum required sample size was estimated. To improve representativeness and account for incomplete responses, a final sample size of 200 participants was included in the study. The sample was equally distributed between urban and rural primary healthcare centers, with approximately 100 participants recruited from each setting. Sampling Technique A multistage sampling approach was employed. Initially, urban and rural primary healthcare centers were selected through simple random sampling from the list of functioning PHCs in the study area. Subsequently, eligible participants attending the selected centers during the study period were recruited using systematic random sampling. Every kth eligible patient attending the outpatient department was approached until the required sample size was achieved. Study Tool Data were collected using a structured, pretested interviewer-administered questionnaire consisting of four sections: Section I: Sociodemographic Characteristics Information regarding age, gender, marital status, educational status, occupation, monthly income, place of residence, and socioeconomic status was collected. Section II: Health-Related Characteristics Data regarding the presence of chronic diseases, frequency of healthcare utilization, health insurance status, and self-perceived health status were obtained. Section III: Digital Health Literacy Assessment Digital health literacy was assessed using the validated eHealth Literacy Scale (eHEALS) developed by Norman and Skinner. The scale consists of eight items measured on a five-point Likert scale ranging from strongly disagree (1) to strongly agree (5), yielding a total score ranging from 8 to 40. Higher scores indicate better digital health literacy. Participants scoring above the median score were categorized as having adequate digital health literacy, while those scoring below the median were categorized as having inadequate digital health literacy. Section IV: Healthcare-Seeking Behavior Healthcare-seeking behavior was assessed using questions related to: ● Preferred source of health information. ● Frequency of online health information searching. ● Use of telemedicine services. ● Delay in seeking professional healthcare. ● Self-medication practices. ● Utilization of healthcare facilities following online health information searches. ● Preference for public or private healthcare facilities. Data Collection Procedure Prior to commencement of data collection, permission was obtained from the concerned health authorities and administrators of the selected primary healthcare centers. The questionnaire was pretested among 20 adults attending a healthcare facility outside the study setting to assess clarity, comprehensibility, and feasibility. Necessary modifications were incorporated based on participant feedback. Eligible participants were approached after completion of their consultation. The objectives and procedures of the study were explained, and written informed consent was obtained. Face-to-face interviews were conducted in a private setting to ensure confidentiality and minimize response bias. Each interview required approximately 15–20 minutes to complete. Study Variables Dependent Variable ● Healthcare-seeking behavior. Independent Variables ● Digital health literacy score. ● Age. ● Gender. ● Educational status. ● Occupation. ● Monthly income. ● Place of residence (urban/rural). ● Internet accessibility. ● Frequency of internet use. ● Presence of chronic illness. Statistical Analysis Data were entered into Microsoft Excel and analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY, USA). Data cleaning and validation were performed before analysis. Descriptive statistics were used to summarize study variables. Categorical variables were presented as frequencies and percentages, whereas continuous variables were expressed as mean ± standard deviation (SD) or median with interquartile range (IQR), depending on data distribution. Associations between digital health literacy and healthcare-seeking behavior were assessed using the Chi-square test or Fisher's exact test as appropriate. Independent sample t-test or Mann–Whitney U test was used for continuous variables. Variables with p < 0.20 in bivariate analysis were included in multivariable logistic regression analysis to identify independent predictors of appropriate healthcare-seeking behavior. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. A p-value < 0.05 was considered statistically significant.

A total of 200 participants were included in the study, comprising 100 participants each from urban and rural primary healthcare centers. The mean age of the participants was 39.8 ± 13.2 years. Females constituted 54.0% of the study population. Overall, 58.5% of participants demonstrated adequate digital health literacy, while 41.5% had inadequate digital health literacy. Urban residents exhibited significantly higher digital health literacy scores compared to rural residents. Participants with adequate digital health literacy were more likely to seek professional healthcare promptly, utilize telemedicine services, and access online health information from reliable sources.

Table 1.Sociodemographic Characteristics of Study Participants (N = 200)

Table 1 presents the sociodemographic profile of the study participants. Of the 200 participants enrolled, 52 (26.0%) were aged 18–29 years, 68 (34.0%) were aged 30–44 years, 49 (24.5%) were aged 45–59 years, and 31 (15.5%) were aged 60 years or older. Females constituted a slightly higher proportion of the study population (54.0%) than males (46.0%). Equal numbers of participants were recruited from urban and rural primary healthcare centers. Regarding educational status, 59 (29.5%) participants had attained graduate-level education or higher, whereas 62 (31.0%) had completed secondary education. Chronic diseases were reported by 76 (38.0%) participants, while 124 (62.0%) had no chronic health conditions.

Table 2. Digital Health Literacy Among Urban and Rural Participants

χ² = 14.86, p < 0.001

As shown in Table 2, adequate digital health literacy was observed among 117 (58.5%) participants, whereas 83 (41.5%) demonstrated inadequate digital health literacy. Among urban participants, 72 (72.0%) had adequate digital health literacy compared with only 45 (45.0%) among rural participants. Conversely, inadequate digital health literacy was more prevalent in rural areas, affecting 55 (55.0%) participants compared with 28 (28.0%) in urban areas. Statistical analysis revealed a significant association between place of residence and digital health literacy (χ² = 14.86, p < 0.001), indicating that urban residents possessed significantly higher levels of digital health literacy than their rural counterparts.

Table 3. Healthcare-Seeking Behavior of Participants (N = 200)

Table 3 summarizes the healthcare-seeking behaviors of the study population. A total of 132 (66.0%) participants reported searching for online health information before seeking medical consultation. Telemedicine services had been utilized by 89 (44.5%) respondents. Prompt healthcare-seeking behavior, defined as seeking professional care within 48 hours of symptom onset, was reported by 126 (63.0%) participants. Government health websites were used as a source of health information by 94 (47.0%) respondents. Furthermore, 141 (70.5%) participants reported consulting a healthcare professional after obtaining online health information, whereas 57 (28.5%) acknowledged practicing self-medication based on information obtained from digital sources.

Table 4. Association Between Digital Health Literacy and Healthcare-Seeking Behavior

Table 4 demonstrates a significant association between digital health literacy and healthcare-seeking behavior. Among participants with adequate digital health literacy, 88 (75.2%) sought professional healthcare within 48 hours of symptom onset compared with only 38 (45.8%) among those with inadequate digital health literacy (p < 0.001). Telemedicine utilization was reported by 67 (57.3%) participants with adequate digital health literacy and by 22 (26.5%) participants with inadequate digital health literacy (p < 0.001). Consultation with healthcare professionals following online health information searches was significantly more common among participants with adequate digital health literacy (81.2%) than among those with inadequate digital health literacy (55.4%) (p< 0.001). In contrast, self-medication practices were significantly more prevalent among participants with inadequate digital health literacy (41.0%) compared with those with adequate digital health literacy (19.7%) (p = 0.001).

Table 5. Multivariable Logistic Regression Analysis of Factors Associated with Appropriate Healthcare-Seeking Behavior

Table 5 presents the independent predictors of appropriate healthcare-seeking behavior identified through multivariable logistic regression analysis. Adequate digital health literacy was significantly associated with appropriate healthcare-seeking behavior, with participants having adequate digital health literacy demonstrating 3.42 times higher odds of exhibiting appropriate healthcare-seeking practices compared with those having inadequate digital health literacy (AOR = 3.42; 95% CI: 1.81–6.46; p < 0.001). Participants with graduate-level education or higher were 2.15 times more likely to demonstrate appropriate healthcare-seeking behavior than those with lower educational attainment (AOR = 2.15; 95% CI: 1.13–4.08; p = 0.019).

Figure 1 Distribution of Digital Health Literacy Levels Among Study Participants

Figure 1 illustrates the distribution of digital health literacy among the study participants. Of the 200 participants included in the study, 58.5% demonstrated adequate digital health literacy, while 41.5% exhibited inadequate digital health literacy. This finding indicates that although a majority of participants possessed sufficient skills to access, understand, and utilize digital health information, a substantial proportion continued to experience limitations in digital health literacy. Such disparities may influence healthcare information access and healthcare-seeking behavior.

Figure 2 Comparison of Digital Health Literacy Between Urban and Rural Participants

Figure 2 illustrates the distribution of digital health literacy levels among participants residing in urban and rural communities. Among urban participants (n = 100), 72.0% demonstrated adequate digital health literacy, while 28.0% exhibited inadequate digital health literacy. In contrast, among rural participants (n = 100), only 45.0% demonstrated adequate digital health literacy, whereas 55.0% had inadequate digital health literacy. The prevalence of adequate digital health literacy was substantially higher among urban residents compared to rural residents. Statistical analysis revealed a significant association between place of residence and digital health literacy (χ² = 14.86, p < 0.001), indicating that urban participants possessed significantly better digital health literacy than their rural counterparts.

Figure 3 Adjusted Odds Ratios of Factors Associated with Appropriate Healthcare-Seeking Behavior

Figure 3 presents the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors independently associated with appropriate healthcare-seeking behavior among study participants. Adequate digital health literacy emerged as the strongest predictor, with participants possessing adequate digital health literacy being 3.42 times more likely to demonstrate appropriate healthcare-seeking behavior compared with those having inadequate digital health literacy (AOR = 3.42; 95% CI: 1.81–6.46; p < 0.001). Participants with graduate-level education or higher also exhibited significantly greater odds of appropriate healthcare-seeking behavior (AOR = 2.15; 95% CI: 1.13–4.08; p = 0.019). Similarly, urban residence was significantly associated with appropriate healthcare-seeking practices (AOR = 1.88; 95% CI: 1.01–3.49; p = 0.046). Regular internet access increased the likelihood of appropriate healthcare-seeking behavior by approximately 2.74 times (AOR = 2.74; 95% CI: 1.45–5.17; p = 0.002).

The present study assessed digital health literacy and its impact on healthcare-seeking behavior among adults attending primary healthcare centers in urban and rural communities. The findings revealed that 58.5% of participants possessed adequate digital health literacy, while 41.5% demonstrated inadequate digital health literacy. Furthermore, significant associations were observed between digital health literacy and multiple indicators of healthcare-seeking behavior, including prompt healthcare utilization, telemedicine use, consultation with healthcare professionals following online information searches, and reduced self-medication practices. In the present study, more than half of the participants exhibited adequate digital health literacy. This finding is consistent with the growing penetration of digital technologies and internet-based health information resources worldwide. Similar findings were reported by Lee et al., who observed that individuals with higher levels of health literacy were more likely to access and effectively utilize online health information resources [14]. Likewise, Yuen et al., in their systematic review, reported that educational attainment, internet accessibility, and digital competency significantly influence digital health literacy levels among adults [15]. The relatively high prevalence of adequate digital health literacy observed in the current study may reflect increasing exposure to smartphones, internet services, and digital health platforms in both urban and rural settings. A notable finding of the present study was the significant urban–rural disparity in digital health literacy. Urban participants demonstrated substantially higher levels of adequate digital health literacy than rural participants (72.0% vs. 45.0%). This finding aligns with previous research indicating that urban populations generally have greater access to digital infrastructure, internet connectivity, educational opportunities, and healthcare information resources. A study by Sundell et al. reported that digital health literacy was significantly associated with educational level, internet access, and geographic location, with urban residents exhibiting superior digital competencies compared with rural populations [16]. Similarly, Wang et al. found that rural populations often experience barriers related to digital access and health information utilization, contributing to lower digital health literacy levels [17]. These findings underscore the persistent digital divide and the need for targeted interventions aimed at improving digital health literacy among rural populations. The study also demonstrated that online health information-seeking behavior was common among participants, with 66.0% reporting that they searched for health information online before seeking professional medical care. This observation is consistent with the findings of Jia et al., who reported that online health information seeking has become an increasingly prevalent component of healthcare decision-making globally [18]. Increased availability of internet-based health information empowers individuals to participate actively in health-related decisions; however, the quality and reliability of accessed information remain important concerns. Telemedicine utilization was reported by 44.5% of participants, indicating a substantial acceptance of digital healthcare services. Participants with adequate digital health literacy were significantly more likely to utilize telemedicine services than those with inadequate digital health literacy. Similar observations have been reported by Kim and Xie, who found that higher eHealth literacy levels were associated with greater engagement in digital health services and improved health outcomes [19]. The increasing integration of telemedicine into healthcare delivery systems highlights the importance of strengthening digital health literacy to maximize the benefits of digital healthcare innovations. An important finding of this study was the significant relationship between digital health literacy and prompt healthcare-seeking behavior. Participants with adequate digital health literacy were significantly more likely to seek professional healthcare within 48 hours of symptom onset compared with those having inadequate digital health literacy. These findings support the concept that individuals possessing greater abilities to obtain, evaluate, and apply digital health information are more likely to make informed decisions regarding timely healthcare utilization. Similar findings were reported by Nutakor et al., who demonstrated that higher digital health literacy was positively associated with health-promoting behaviors and improved self-management practices [20]. The present study further revealed that participants with adequate digital health literacy were significantly more likely to consult healthcare professionals after obtaining health information online. This finding suggests that digitally literate individuals are better able to critically appraise online information and recognize the importance of professional medical advice. Lee et al. similarly reported that individuals with higher health literacy levels are more likely to engage in informed discussions with healthcare providers and utilize health information appropriately [14]. Conversely, self-medication practices were significantly more prevalent among participants with inadequate digital health literacy. Individuals with limited digital health literacy may have difficulty distinguishing reliable from unreliable online health information, potentially leading to inappropriate self-diagnosis and self-treatment. Al-Ruzzieh et al. reported that inadequate eHealth literacy is associated with poor interpretation of online health information and increased vulnerability to misinformation [21]. This finding highlights the need for educational interventions that improve individuals' abilities to critically evaluate digital health content and reduce harmful self-medication practices. Multivariable logistic regression analysis identified adequate digital health literacy as the strongest independent predictor of appropriate healthcare-seeking behavior. Participants with adequate digital health literacy were more than three times as likely to demonstrate positive healthcare-seeking practices compared with those having inadequate literacy. This finding is supported by evidence from Fitzpatrick et al., who emphasized that digital health literacy facilitates informed decision-making, enhances patient engagement, and promotes appropriate utilization of healthcare services [22]. Additionally, graduate-level education, urban residence, and regular internet access were independently associated with appropriate healthcare-seeking behavior. These findings are consistent with previous studies indicating that socioeconomic and educational factors play important roles in shaping health information utilization and healthcare decision-making [15,23]. The findings of the present study have important public health implications. As healthcare systems continue to expand digital service delivery, improving digital health literacy becomes essential for ensuring equitable access to healthcare resources. Community-based digital literacy programs, targeted interventions for rural populations, promotion of reliable health information sources, and strengthening digital infrastructure may help bridge existing disparities and improve healthcare utilization outcomes. Integrating digital health literacy education into primary healthcare services may further empower individuals to make informed healthcare decisions and effectively navigate increasingly digital healthcare environments. Overall, the present study demonstrates that digital health literacy is a significant determinant of healthcare-seeking behavior among adults attending primary healthcare centers. Enhancing digital health literacy may contribute to improved healthcare utilization, increased adoption of digital health services, reduced inappropriate self-medication practices, and better health outcomes across diverse populations.

The present study assessed digital health literacy and its impact on healthcare-seeking behavior among adults attending primary healthcare centers in urban and rural communities. The findings revealed that 58.5% of participants possessed adequate digital health literacy, while 41.5% demonstrated inadequate digital health literacy. Furthermore, significant associations were observed between digital health literacy and multiple indicators of healthcare-seeking behavior, including prompt healthcare utilization, telemedicine use, consultation with healthcare professionals following online information searches, and reduced self-medication practices.

In the present study, more than half of the participants exhibited adequate digital health literacy. This finding is consistent with the growing penetration of digital technologies and internet-based health information resources worldwide. Similar findings were reported by Lee et al., who observed that individuals with higher levels of health literacy were more likely to access and effectively utilize online health information resources [9]. Likewise, Yuen et al., in their systematic review, reported that educational attainment, internet accessibility, and digital competency significantly influence digital health literacy levels among adults [12]. The relatively high prevalence of adequate digital health literacy observed in the current study may reflect increasing exposure to smartphones, internet services, and digital health platforms in both urban and rural settings.

A notable finding of the present study was the significant urban–rural disparity in digital health literacy. Urban participants demonstrated substantially higher levels of adequate digital health literacy than rural participants (72.0% vs. 45.0%). This finding aligns with previous research indicating that urban populations generally have greater access to digital infrastructure, internet connectivity, educational opportunities, and healthcare information resources. A study by Sundell et al. reported that digital health literacy was significantly associated with educational level, internet access, and geographic location, with urban residents exhibiting superior digital competencies compared with rural populations [13]. Similarly, Wang et al. found that rural populations often experience barriers related to digital access and health information utilization, contributing to lower digital health literacy levels [14]. These findings underscore the persistent digital divide and the need for targeted interventions aimed at improving digital health literacy among rural populations.

The study also demonstrated that online health information-seeking behavior was common among participants, with 66.0% reporting that they searched for health information online before seeking professional medical care. This observation is consistent with the findings of Jia et al., who reported that online health information seeking has become an increasingly prevalent component of healthcare decision-making globally [8]. Increased availability of internet-based health information empowers individuals to participate actively in health-related decisions; however, the quality and reliability of accessed information remain important concerns.

Telemedicine utilization was reported by 44.5% of participants, indicating a substantial acceptance of digital healthcare services. Participants with adequate digital health literacy were significantly more likely to utilize telemedicine services than those with inadequate digital health literacy. Similar observations have been reported by Kim and Xie, who found that higher eHealth literacy levels were associated with greater engagement in digital health services and improved health outcomes [2]. The increasing integration of telemedicine into healthcare delivery systems highlights the importance of strengthening digital health literacy to maximize the benefits of digital healthcare innovations.

An important finding of this study was the significant relationship between digital health literacy and prompt healthcare-seeking behavior. Participants with adequate digital health literacy were significantly more likely to seek professional healthcare within 48 hours of symptom onset compared with those having inadequate digital health literacy. These findings support the concept that individuals possessing greater abilities to obtain, evaluate, and apply digital health information are more likely to make informed decisions regarding timely healthcare utilization. Similar findings were reported by Nutakor et al., who demonstrated that higher digital health literacy was positively associated with health-promoting behaviors and improved self-management practices [11].

The present study further revealed that participants with adequate digital health literacy were significantly more likely to consult healthcare professionals after obtaining health information online. This finding suggests that digitally literate individuals are better able to critically appraise online information and recognize the importance of professional medical advice. Lee et al. similarly reported that individuals with higher health literacy levels are more likely to engage in informed discussions with healthcare providers and utilize health information appropriately [9].

Conversely, self-medication practices were significantly more prevalent among participants with inadequate digital health literacy. Individuals with limited digital health literacy may have difficulty distinguishing reliable from unreliable online health information, potentially leading to inappropriate self-diagnosis and self-treatment. Al-Ruzzieh et al. reported that inadequate eHealth literacy is associated with poor interpretation of online health information and increased vulnerability to misinformation [6]. This finding highlights the need for educational interventions that improve individuals' abilities to critically evaluate digital health content and reduce harmful self-medication practices.

Multivariable logistic regression analysis identified adequate digital health literacy as the strongest independent predictor of appropriate healthcare-seeking behavior. Participants with adequate digital health literacy were more than three times as likely to demonstrate positive healthcare-seeking practices compared with those having inadequate literacy. This finding is supported by evidence from Fitzpatrick et al., who emphasized that digital health literacy facilitates informed decision-making, enhances patient engagement, and promotes appropriate utilization of healthcare services [5]. Additionally, graduate-level education, urban residence, and regular internet access were independently associated with appropriate healthcare-seeking behavior. These findings are consistent with previous studies indicating that socioeconomic and educational factors play important roles in shaping health information utilization and healthcare decision-making [12,15].

The findings of the present study have important public health implications. As healthcare systems continue to expand digital service delivery, improving digital health literacy becomes essential for ensuring equitable access to healthcare resources. Community-based digital literacy programs, targeted interventions for rural populations, promotion of reliable health information sources, and strengthening digital infrastructure may help bridge existing disparities and improve healthcare utilization outcomes. Integrating digital health literacy education into primary healthcare services may further empower individuals to make informed healthcare decisions and effectively navigate increasingly digital healthcare environments.

Overall, the present study demonstrates that digital health literacy is a significant determinant of healthcare-seeking behavior among adults attending primary healthcare centers. Enhancing digital health literacy may contribute to improved healthcare utilization, increased adoption of digital health services, reduced inappropriate self-medication practices, and better health outcomes across diverse populations

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