The study was led by İlknur Sayan and Didem İstafiloğlu of the Department of Health Management at Istanbul Kent University, together with independent researcher Serem Akdal. The team focused on health sciences students for a specific reason: this population represents the future healthcare workforce, the people who will eventually design, deliver, and explain digital health services to patients. If digital competency shapes how these students perceive the healthcare system, the implications could ripple outward into clinical practice, health policy, and patient education for years to come. Evidence linking e-health literacy to perceived healthcare access had remained limited in the Turkish context, and the researchers set out to fill that gap with a rigorously validated measurement approach.

Participants completed a structured questionnaire containing two established instruments. The first was the eHealth Literacy Scale, widely known as eHEALS, which measures an individual’s self-assessed ability to seek, find, and appraise health information from electronic sources. The second was a 23-item Perceived Access to Healthcare Services Scale, organized around four dimensions drawn from the classic access framework in health services research: accessibility, meaning the physical and geographic reach of services; acceptability, meaning whether services align with patients’ expectations and social norms; accommodation, meaning how well service organization fits patients’ needs, such as opening hours and appointment flexibility; and affordability, meaning the financial burden of obtaining care. The study received ethics approval from the Social and Human Sciences Ethics Committee of Istanbul Kent University, with written informed consent obtained from all participants in accordance with the Declaration of Helsinki.

The analytical machinery behind the study is where it earns its technical credibility. Rather than simply correlating two questionnaire scores, the researchers employed Confirmatory Factor Analysis to verify that the survey items actually clustered into the intended constructs, and then built a second-order Structural Equation Model in LISREL 9.3 to test whether e-health literacy predicted the higher-order construct of perceived access. The resulting model demonstrated good fit across the standard battery of indices: a chi-square to degrees-of-freedom ratio of 1.97, a Root Mean Square Error of Approximation of 0.051, a Comparative Fit Index of 0.96, a Tucker-Lewis Index of 0.95, and a Standardized Root Mean Square Residual of 0.047. For readers unfamiliar with these metrics, values in these ranges indicate that the theoretical model reproduces the observed data patterns well, rather than forcing the data into an ill-fitting structure.

The headline result is striking in its magnitude. E-health literacy was significantly and positively associated with perceived healthcare access, with a standardized path coefficient of 0.62, a p-value below 0.001, and an R-squared of 0.38. In practical terms, the model accounted for 38 percent of the variance in how students perceived their access to healthcare services, a substantial share for a social science model built on individual-level survey data. Students who felt more confident in their ability to find and evaluate health information online consistently rated the healthcare system as more accessible, more acceptable, better accommodated to their needs, and more affordable.

Within the four dimensions of access, the structural model revealed an interesting hierarchy. Acceptability, with a loading of 0.92, and accommodation, with a loading of 0.90, contributed most strongly to the higher-order access construct, while accessibility and affordability weighed somewhat less. This suggests that among young, digitally fluent students, judgments about healthcare access hinge less on geography or cost and more on whether services feel compatible with their expectations and whether the system’s organization fits their lives. It is a pattern consistent with the idea that for a generation accustomed to on-demand digital services, the friction of scheduling, communication, and service design matters as much as the location of a clinic.

The authors were careful about measurement quality, and one honest caveat emerged from their validation work. Discriminant validity, the statistical test of whether two constructs are genuinely distinct rather than measuring the same thing twice, was evaluated using both the Fornell-Larcker criterion and Heterotrait-Monotrait ratios. Most construct pairs passed cleanly. However, the acceptability and accommodation dimensions showed a Fornell-Larcker violation and an HTMT ratio of 0.916, exceeding the conservative 0.85 threshold. This indicates limited discriminant validity between these two closely related dimensions, meaning that in this sample, students may have experienced acceptability and accommodation as overlapping facets of a single impression of service fit. The team also screened for common method bias using Harman’s single-factor test, a standard safeguard when all data come from self-reported questionnaires.

The researchers themselves are explicit about the limits of what can be concluded. Because the study is cross-sectional, capturing all participants at a single point in time, the findings should be read as an association rather than evidence of a causal pathway. It is possible that higher e-health literacy genuinely improves how students perceive access to care, perhaps by giving them more tools to connect with services and more confidence in navigating them. It is equally possible that students who already view the health system favorably are more motivated to engage with digital health resources, or that some unmeasured factor, such as general digital fluency or socioeconomic background, drives both. Disentangling these possibilities requires longitudinal designs that follow students over time, and the authors recommend exactly that, alongside cross-cultural replication to test whether the pattern holds beyond Istanbul.

Even with those caveats, the practical implications are hard to ignore. The authors suggest that structured digital health competency training embedded in health sciences curricula may be a useful direction to explore further. If e-health literacy is associated with more favorable perceptions of healthcare access among the people who will soon staff hospitals, clinics, and public health agencies, then teaching those skills systematically could pay dividends not only for the professionals themselves but for the patients they will eventually guide through increasingly digital systems. Health literacy has long been recognized as a determinant of health outcomes; this study extends that logic into the digital domain, where appointment booking, prescription refills, and health information seeking increasingly live.

The study also arrives at a moment when the gap between digital haves and have-nots has become a central concern of health equity research. Although this sample consisted of university students, a relatively digitally connected population, the strong association between e-health literacy and perceived access hints at what might happen in populations with lower digital skills: if confidence with electronic health tools shapes how reachable care feels, then digital exclusion could quietly translate into perceived exclusion from healthcare itself. The Istanbul findings, published open access under a Creative Commons license and citable at DOI 10.1186/s12913-026-15732-3, offer a measured but provocative data point in that conversation, and they set a clear agenda for the longitudinal and cross-cultural studies that must now follow.

Subject of Research: The association between e-health literacy and perceived access to healthcare services among health sciences students in Istanbul, Turkey

Article Title: The impact of e-health literacy on perceived access to healthcare services: a cross-sectional study among health sciences students in Istanbul, Turkey

Article References: Sayan, İ., İstafiloğlu, D., & Akdal, S. (2026). The impact of e-health literacy on perceived access to healthcare services: a cross-sectional study among health sciences students in Istanbul, Turkey. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15732-3

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15732-3

Keywords: e-health literacy, healthcare access, health sciences students, structural equation modeling, eHEALS, Turkey, health services research, digital health, confirmatory factor analysis, HTMT, health equity, Istanbul