Work

Neonatal nurses’ e-health literacy and technology‑mediated clinical practice: a cross-sectional analysis of digital health competencies and practice patterns

Year: 2025

Type: article

Abstract: BACKGROUND: Digital transformation in Level III NICUs demands advanced e‑health literacy, yet evidence tying these competencies to observable nurse behaviors and safety endpoints remains scarce. OBJECTIVE: To examine associations between NICU nurses’ e-health literacy levels and their technology-mediated clinical practice patterns through a comprehensive analysis of digital health competencies and observable care delivery behaviors. METHODS: A cross-sectional, multi-site study was conducted with 95 nurses from four Al-Jouf Health Cluster NICUs in Saudi Arabia. Data triangulation combined validated scales (eHEALS, TIGER), structured observations of short care episodes, and a 30-day EHR audit. Hierarchical regression and structural equation modeling were employed to examine the direct, mediated, and moderated relationships among literacy domains, alert-response performance, and system optimization behaviors. RESULTS: Systems Integration competency showed the strongest associations with technology-mediated care (β = -0.62 for alert response time, β = 0.67 for system optimization, p < 0.001). Nurses in the highest e-health literacy tertile demonstrated 43% faster alert responses (26.3-second improvement, 95% CI [22.1, 30.5]) and superior system optimization behaviors (Cohen’s d = 2.05, 95% CI [1.62, 2.48]). Technology Acceptance Model constructs mediated 35–38% of e-health literacy-clinical outcome relationships. Trust in Technology (β = -0.21, p < 0.01) and Motivation to Use (β = 0.23, p < 0.01) significantly moderated these associations. SEM demonstrated an excellent fit (CFI = 0.961, RMSEA = 0.049). Prior informatics training was associated with enhanced performance across all outcomes (Cohen’s d = 0.58–0.67). CONCLUSIONS: E-health literacy competencies, particularly Systems Integration capabilities, are strongly associated with effective technology-mediated clinical practice in NICUs. These digital competencies relate to critical patient safety indicators, including alert response efficiency and system optimization behaviors. The cross-sectional design limits causal inferences; longitudinal research is needed to establish whether improving e-health literacy leads to enhanced clinical performance. CLINICAL TRIAL NUMBER: Not applicable.

Source: BMC Nursing

DOI: 10.1186/s12912-025-03839-7