The association between digital health literacy and healthy lifestyle behaviors among youth: Systematic review of cross-sectional studies

Objective: To systematically identify and critically evaluate research evidence on the association between digital health literacy (DHL) and healthy lifestyle behaviors (HLB) among youth. Methods: A systematic search was conducted of five English-language databases-Web of Science, Scopus, ProQuest, EBSCO, and PubMed-covering publications from January 2006 to October 2025. This search was supplemented by reference list screening, resulting in the inclusion of 33 studies in the final review. Results: Overall, youth exhibit a relatively high level of DHL, and the eHealth Literacy Scale (eHEALS) is the most frequently employed instrument for its assessment. HLB associated with DHL primarily encompassed domains such as physical activity, sleep, diet and nutrition, as well as mental health and stress management. Higher levels of DHL among youth were associated with more favorable HLB, but the magnitude and consistency of these associations varied across behavioral domains. Conclusion: This study aims to examine variations in the role of DHL across different HLB domains, guided by the COM-B behavior change model, which emphasizes the interaction of capability, opportunity, and motivation. Further research is warranted to clarify the mechanisms linking DHL with specific HLB, particularly through high-quality longitudinal and intervention studies. In addition, DHL measurement instruments should be refined to ensure their validity and applicability within the rapidly evolving digital health environment.