The correlation between psychological resilience and digital health literacy of undergraduate nursing students: the mediating role of healthy lifestyle

The correlation between psychological resilience and digital health literacy of undergraduate nursing students: the mediating role of healthy lifestyle | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The correlation between psychological resilience and digital health literacy of undergraduate nursing students: the mediating role of healthy lifestyle Qin Lin, Mengxue Fu, Pei Chen, Di Dong, Kun Sun, Qin Guo, Linfeng Liu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6556958/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Digital health literacy plays a crucial role in personal health management, as it enables individuals to filter and obtain appropriate, accurate information and useful health services from a multitude of options. Nursing students are the future backbone of the healthcare industry. Psychological resilience, as a stable intrinsic psychological trait, may potentially influence digital health literacy by affecting individuals’ choices regarding a healthy lifestyle. The pathways and magnitude of this effect remain to be empirically tested. This study aims to investigate the impact of psychological resilience on digital health literacy among Chinese undergraduate nursing students and to explore the mediating role of healthy lifestyle in this relationship. Methods This study employed a descriptive cross-sectional design. From June to October 2023, we conducted a survey among eligible Chinese undergraduate nursing students using the Psychological Resilience Scale, the College Student Digital Health Literacy Scale, and the Healthy Lifestyle Scale. Results This study elucidated the impact mechanism of digital health literacy among Chinese undergraduate nursing students through multiple linear regression analysis and mediation model testing. Multiple linear regression revealed that gender, academic performance, physical fitness, psychological resilience, and healthy lifestyle were significant predictors of digital health literacy, accounting for 45.1% of the variance in digital health literacy (adjusted R² = 43.7%). Sobel test results showed that the indirect effect (Z = 2.992, P = 0.003), direct effect (Z = 2.284, P = 0.022), and total effect (Z = 6.094, P < 0.001) were all significant. Bootstrap analysis indicated that the direct effect of psychological resilience on healthy lifestyle was 0.408 (95% CI: 0.022, 0.292), the total effect on digital health literacy was 0.832 (95% CI: 0.217, 0.423), and the indirect effect mediated by healthy lifestyle was 0.424 (95% CI: 0.079, 0.247), with all paths being significant (p < 0.05). Conclusions The development of digital health literacy among nursing students requires a comprehensive intervention that addresses both psychological resilience and healthy lifestyle. It is recommended that psychological resilience training and healthy lifestyle guidance be integrated into the curriculum to systematically enhance the digital health competence of the future nursing workforce. Nursing College students Psychological resilience Digital health literacy Healthy lifestyle Mediating effect Figures Figure 1 Figure 2 Background Advances in technology, the integration of the internet into daily life, and the widespread use of mobile phones, laptops, and tablets have enabled people to rapidly and directly access a vast amount of information [ 1 ]. These developments have made information on almost any subject accessible to everyone in every country/region, regardless of their location [ 2 ]. Health-related information is particularly in demand. Evidence indicates that searching for health information online has become a common practice worldwide. Yoon and Kim et al. found that individuals from South Korea, especially international students from South Korea, use the internet as their primary source of health information [ 3 ]. A survey by Osei Asibey et al. revealed that 67.7% of university students in Ghana use the internet for health-related purposes [ 4 ]. Additionally, research by Schäfer et al. showed that over 90% of university students in Germany search for health information online [ 5 ]. In the digital context, digital health literacy has emerged. It is defined as the ability of users, due to technological advancements, to seek, find, understand, and evaluate health-related information from electronic resources and to utilize the obtained information to address and resolve any health issues [ 6 ]. It is important to emphasize that users are not merely passive recipients but actively participate in the dissemination process by interacting with existing content or sharing their own health-related information [ 7 ]. Digital health literacy encompasses six components: computer literacy, traditional literacy, information literacy, health literacy, scientific literacy, and media literacy [ 8 ]. It is considered a public health goal for the 21st century [ 9 ]. Digital health literacy can support nursing practice, enhance patient safety, and improve medical decision-making. Nurses with digital health literacy are able to use digital health tools more effectively, enhance their health knowledge and skills, and contribute to improved health outcomes [ 10 – 12 ]. College students are digital natives with strong abilities to embrace new things and technologies, making them one of the most active groups on the internet. Undergraduate nursing students, as a special subgroup of college students, are in the golden stage of their development and value formation. They are the future reserve force in the healthcare field and the backbone for promoting the development of the social health industry. To adapt to the increasingly digitalized healthcare environment, digital health literacy is not only a reflection of personal ability for nursing students but also a core competency for professional development. Nursing students need to possess digital health literacy skills [ 13 ]. The digital health literacy of nursing students directly affects the quality of care provided to patients and their ability to promote health. It is also an important resource for clinical practice, lifelong learning, and conducting educational activities [ 14 ]. However, globally, nursing students often find themselves in high-pressure environments due to heavy academic workloads and the challenges of clinical practice [ 15 , 16 ]. An important protective factor mentioned in academic literature [ 17 ] and education and workforce policies [ 18 , 19 ] is psychological resilience. Although there are various definitions of psychological resilience, it is generally described as a complex and dynamic phenomenon, not merely the ability to cope with adversity, but a dynamic process of "bouncing back" and achieving positive adaptation when facing challenges [ 20 ]. For nursing students, good psychological resilience can act as a "strong shield," with highly resilient individuals more likely to actively seek and use digital health resources when facing health challenges. Although there is limited literature directly studying the relationship between psychological resilience and digital health literacy, research by Levin-Zamir et al. indicates a significant correlation between psychological resources (including resilience) and media health literacy (an aspect of digital health literacy) [ 21 ]. A healthy lifestyle refers to the beneficial behaviors and habits that individuals develop in their daily lives to promote physical and mental well-being. It encompasses multiple dimensions, including healthy eating habits, regular physical exercise, good sleep patterns, and positive psychological adjustment. These dimensions interact with each other to form a behavioral system that helps individuals protect and enhance their well-being [ 22 ]. Psychological resilience plays a significant role in the selection and maintenance of a healthy lifestyle. Several cross-sectional studies have examined the relationship between psychological resilience and healthy lifestyle, revealing a positive correlation between self-reported resilience traits and health outcomes [ 23 – 25 ]. Research by Kristen et al. found that individuals with higher psychological resilience are often better able to cope with life stressors and challenges, and they are more likely to choose healthier lifestyle behaviors when faced with temptations such as unhealthy eating or lack of exercise [ 26 ]. Students with higher levels of psychological resilience also tend to engage in more positive health behaviors, such as regular exercise, balanced diet, and good sleep habits [ 27 ]. During the COVID-19 pandemic, psychological resilience has played an even more important role. Studies have shown that students with higher psychological resilience are better able to establish and maintain exercise routines and healthy eating habits in the face of pandemic-related stress [ 28 , 29 ]. Health literacy is an acknowledged determinant of individual health behaviors and outcomes [ 30 ]. As an extension of health literacy, digital health literacy has been supported by numerous studies for its role in promoting a healthy lifestyle [ 31 – 33 ]. It should be noted that nearly all studies have treated digital health literacy as an independent variable to explore how it affects individuals’ health behaviors. The transactional model of digital health literacy indicates that individuals’ health behaviors, in turn, influence their motivation to use digital health services, thereby indirectly affecting their digital health literacy [ 34 ]. Conceptual Framework and Research Hypotheses Psychological resilience is significantly correlated with a healthy lifestyle, which is also closely linked to digital health literacy. Thus, a healthy lifestyle may connect psychological resilience and digital health literacy. The Health Belief Model (HBM), comprising five dimensions: susceptibility, severity, efficacy, benefits, and barriers, indicates that beliefs are crucial for health behaviors [ 35 ]. HBM explains that individuals' health behavior decisions are influenced by their perceived susceptibility and severity of disease threats, and their cognitive evaluation of the efficacy, benefits, and barriers of health actions. People with high psychological resilience are more confident in overcoming challenges to adopt healthy lifestyles and better recognize the long-term benefits of health behaviors. This positive health belief is expected to make them more proactive in choosing and maintaining a healthy lifestyle. In digital contexts, adopting a healthy lifestyle requires corresponding information literacy, especially digital health literacy. When individuals are motivated to maintain health, they are more likely to actively seek and use online health resources. Based on HBM, this research develops the theoretical model in Fig. 1 and proposes the following hypotheses: Hypothesis 1 Psychological resilience is positively correlated with digital health literacy. Higher levels of psychological resilience are associated with higher levels of digital health literacy. Hypothesis 2 A healthy lifestyle mediates the relationship between psychological resilience and digital health literacy. a) Psychological resilience positively predicts a healthy lifestyle (Hypothesis 2 a). b) A healthy lifestyle positively predicts digital health literacy (Hypothesis 2 b). c) Psychological resilience enhances digital health literacy through improving the level of a healthy lifestyle (Hypothesis 2 c). Hypothesis 3 Psychological resilience has both direct and indirect effects on digital health literacy through a healthy lifestyle, that is, a healthy lifestyle partially mediates the relationship between psychological resilience and digital health literacy. Research Contributions Although existing literature has made some progress in the study of digital health literacy, most research has primarily focused on individual-level factors such as age, gender, and education level, with limited exploration of the potential impact of psychological resilience, a key psychological resource, on digital health literacy. Compared with previous studies, this research makes the following two main contributions: Firstly, this study introduces psychological resilience as an emerging variable in the research on digital health literacy, filling the gap in the existing research that has overlooked this psychological resource. Secondly, this study not only reveals the relationship between psychological resilience and digital health literacy but also further elucidates the important mediating role of a healthy lifestyle in this process. Methods Study Design This was a cross-sectional study conducted using an online questionnaire survey from June to October 2023. Participants and Sample According to the research [ 36 ], a sample size of 250 to 500 is considered suitable for most structural equation modeling (SEM) analyses. Considering the complexity of the questionnaire survey data and the potentially weak mediating effects, the final sample size was determined to be 500. A stratified cluster sampling method was used. Two nursing colleges were selected in two provincial capitals in China, namely Chengdu and Hangzhou. Students from grades one to four were selected as the study participants based on grade stratification. Inclusion criteria: (1) Full-time undergraduate nursing students who took the national entrance examination; (2) Informed consent and voluntary participation in the study. Exclusion criteria: (1) Students who could not return to school on time or could not participate in this study due to personal or sick leave; (2) Undergraduate nursing students who were not Chinese citizens; (3) Participants who could not complete the questionnaire in full. Instruments Psychological Resilience The Connor-Davidson Resilience Scale (CD-RISC) was used to assess the psychological resilience of the study participants. This scale was originally developed by Connor KM et al. [ 37 ] in 2003 and was translated and revised by Yu X et al. [ 38 ] in 2007. The CD-RISC comprises three dimensions: tenacity, strength, and optimism, which include 13, 8, and 4 items respectively. All items are scored using a 5-point Likert scale, with the options “never,” “rarely,” “sometimes,” “often,” and “always” assigned values of 0, 1, 2, 3, and 4 respectively. The scores for each dimension range from 0 to 52 for tenacity, 0 to 32 for strength, and 0 to 16 for optimism, with a total score ranging from 0 to 100. The sum of the scores of the 25 items represents the total score of the scale, with higher scores indicating better psychological resilience of the study participants. In this study, the Cronbach's α coefficients for the scale and its three dimensions were 0.961, 0.875, 0.832, and 0.893 respectively. The KMO value was 0.935, and the Bartlett's test value was 4974.56 (P < 0.001). Digital Health Literacy The College Student Digital Health Literacy Scale was developed by Tang Zeng et al. [ 39 ] and is primarily used for assessing the digital health literacy of college students. The scale consists of 20 items across three dimensions: digital health information literacy (7 items), digital health evaluation skills (8 items), and digital health practice skills (5 items). All items are scored using a 5-point Likert scale, ranging from “strongly disagree” to “strongly agree,” with scores from 1 to 5. The total score of the scale ranges from 20 to 100, with the total score for each respondent being the sum of all item scores. Higher scores indicate higher levels of digital health literacy. The Cronbach’s α coefficients for the three dimensions range from 0.836 to 0.895, and the overall Cronbach’s α coefficient for all items is 0.915, indicating good internal consistency of the scale. The correlation coefficients range from 0.191 to 0.708, suggesting good content validity of the scale. In this study, the Cronbach’s α coefficient for the scale was 0.962, and the Cronbach’s α coefficients for the three dimensions were 0.921, 0.926, and 0.909 respectively. The KMO value was 0.973, and the Bartlett’s test value was 41,017.730 (P < 0.001). Healthy Lifestyle The College Student Healthy Lifestyle Assessment Scale was developed by Wang Dong and revised by Jiao Jianpeng [ 40 – 41 ]. The scale consists of 33 items across eight dimensions: exercise behavior (3 items), regular lifestyle behavior (3 items), nutritional behavior (4 items), health risk behavior (2 items), health responsibility behavior (5 items), interpersonal support behavior (6 items), stress management behavior (5 items), and appreciation of life behavior (5 items). All items are scored using a 5-point Likert scale, ranging from “never” to “always,” with scores from 1 to 5. Items 11 and 12 are reverse-scored. The total score ranges from 33 to 165, with higher scores indicating a higher level of healthy lifestyle. In this study, the Cronbach’s α coefficient for the scale was 0.949, and the Cronbach’s α coefficients for the eight dimensions ranged from 0.751 to 0.889. The KMO value was 0.966, and the Bartlett’s test value was 49,133.63 (P < 0.001). Ethical Considerations The study was approved by the ethics committee of the college, with the ethics approval number 2023010. Students who voluntarily completed the survey were considered to have provided implicit informed consent. The investigators informed the students that they could withdraw from the study at any time without any prejudice. The privacy and confidentiality of the students were strictly maintained. Data Collection Prior to the actual data collection, the questionnaire underwent a reliability pretest. The study was conducted using a Chinese online survey platform (Questionnaire Star). Initially, contact was established with the investigators at the two universities to be surveyed, and the content of the survey was explained and their consent was obtained. The investigators then distributed the electronic questionnaire to the classes that met the criteria for participation, utilizing the 10 minutes before class to do so. The instructions for completing the questionnaire were read aloud in a unified manner, emphasizing that the data collected would be used solely for scientific research and that anonymity and confidentiality would be maintained. The survey was administered collectively and collected on-site, with each ID being permitted to submit only one questionnaire. After completing the questionnaire, the class monitor tallied the number of participants who had filled it out to prevent duplicate submissions. The data collection process took approximately 20 to 30 minutes. A total of 500 undergraduate nursing students were recruited for this study, and after data cleaning, 467 valid questionnaires were obtained, resulting in an effective response rate of 93.40%. Data Analysis Data analyses were conducted using IBM SPSS Statistics 26.0 software. For continuous data, those that passed the normality test were described using the mean ± standard deviation (x̄ ± s), while those that failed the normality test were described using the median and interquartile range [M (P25, P75)]. Categorical data were described using frequencies and percentages. The Harman single-factor test was used to assess the presence of common method bias among variables. Pearson correlation analysis was employed to examine the relationships between variables. Differences in digital health literacy among undergraduate nursing students with different sociodemographic characteristics were evaluated using independent samples t-tests and analysis of variance (ANOVA). Stepwise regression analysis was used to identify the determinants of digital health literacy among undergraduate nursing students. In the regression analysis, to avoid multicollinearity among explanatory variables in the model, a variance inflation factor (VIF) greater than 10.0 in the collinearity diagnostics was considered indicative of severe multicollinearity between variables. Mediating effects were analyzed and verified using the mediation effect test procedure and the Bootstrap procedure. The Sobel test was used to rigorously test whether the indirect effect was significantly different from zero. If the Z value obtained from the Sobel test exceeded 1.96, the indirect effect was considered significant. To determine the effect size and obtain a 95% confidence interval, the direct, indirect, and total effects were assessed using the Bootstrap method with 5,000 replications. A 95% confidence interval that did not include zero indicated a significant effect. All statistical tests were two-sided, with a significance level of α = 0.05. Results Common Method Bias Test The Harman single-factor test [ 42 ] was used to assess common method bias. The results showed that there were three factors with eigenvalues greater than 1, and the maximum variance explained by a single factor was 25.20%, which is below the critical value of 40%. This indicates that there is no severe common method bias in the data of this study. Characteristics of participants The 467 undergraduate nursing students ranged in age from 18 to 24 years, with a mean age of 20.33 ± 1.06 years. Among them, there were 129 males (27.62%) and 338 females (72.38%). The distribution across grades was as follows: first-year students accounted for 20.34%, second-year students for 32.76%, third-year students for 22.06%, and fourth-year students for 24.84%. The majority of the students were from rural areas, representing 55.25%. Most were only children, accounting for 87.37%. The predominant family structure was nuclear families, representing 75.37%. A significant proportion of the participants had leadership experience in student organizations, accounting for 61.03%. Most of the participants reported average family economic status, moderate study pressure, average physical fitness, and average psychological quality, accounting for 50.75%, 58.89%, 50.11%, and 48.39%, respectively. Academic performance was mainly concentrated in the passing and good grades, accounting for 39.16% and 38.33%, respectively. Univariate Analysis of Digital Health Literacy among Undergraduate Nursing Students with Different Characteristics Differences in digital health literacy scores among undergraduate nursing students with different characteristics in terms of gender, family economic situation, academic performance, physical fitness, and psychological quality were statistically significant (P < 0.05) (Table 1 ). Table 1 Comparison of Digital Health Literacy Scores among Undergraduate Nursing Students with Different Characteristics Variables Categories Frequency Percentage Mean ± SD t/F P-value Gender male 129 27.62 76.09 ± 7.83 2.930 0.004** female 338 72.38 73.63 ± 8.72 Place of Birth Urban area 89 19.06 74.30 ± 9.03 0.150 0.699 Township 258 55.25 74.50 ± 8.40 Rural area 120 25.7 73.91 ± 8.56 Family Structure Traditional family 352 75.37 74.66 ± 8.58 3.405 0.066 Blended family 76 16.27 73.89 ± 8.38 Single-parent family 39 8.35 72.00 ± 8.40 Family Economic Situation Poor 81 17.34 71.22 ± 8.74 19.400 < 0.001*** Moderate 237 50.75 74.11 ± 8.04 Good 149 31.91 76.31 ± 8.74 Only Child yes 408 87.37 74.11 ± 8.47 -1.256 0.213 no 59 12.63 75.68 ± 9.01 Student Leadership Experience yes 285 61.03 73.82 ± 8.59 -1.567 0.118 no 182 38.97 75.08 ± 8.46 Grade First year 95 20.34 73.27 ± 8.76 0.310 0.578 Second year 153 32.76 74.57 ± 8.72 Third year 103 22.06 75.34 ± 9.03 Fourth year 116 24.84 73.91 ± 7.65 Academic Pressure Low level 58 12.42 72.93 ± 8.74 0.003 0.954 Moderate level 275 58.89 74.92 ± 8.63 High level 134 28.69 73.66 ± 8.23 Academic Performance Fail 30 6.42 64.33 ± 7.60 54.290 < 0.001*** Pass 185 39.61 73.51 ± 8.08 Good 179 38.33 75.06 ± 7.83 Excellent 73 15.63 78.59 ± 8.25 Physical Fitness Poor 86 18.42 69.51 ± 8.24 31.095 < 0.001*** Fair 234 50.11 74.88 ± 8.19 Good 147 31.48 76.22 ± 8.30 Psychological Quality Poor 54 11.56 70.15 ± 7.64 33.596 < 0.001*** Fair 226 48.39 73.28 ± 8.59 Good 187 40.04 76.76 ± 8.06 Note: * p < 0.05, ** p < 0.01, *** p < 0.001. Scores and Correlation Analysis of Psychological Resilience, Digital Health Literacy, and Healthy Lifestyle among Undergraduate Nursing Students The score of digital health literacy among Chinese undergraduate nursing students was 74.31 ± 8.54. The scores for the three dimensions of digital health literacy—Digital Health Information Literacy (DHL1), Digital Health Practice Skills (DHL2), and Digital Health Evaluation Skills (DHL3)—were 27.06 ± 3.79, 17.73 ± 2.99, and 29.51 ± 4.46, respectively. Significant positive correlations were found among these dimensions (p < 0.001). The highest correlation coefficient with overall digital health literacy (DHL) was observed for DHL3 (r = 0.815, p < 0.001), followed by DHL1 (r = 0.749, p < 0.001) and DHL2 (r = 0.690, p < 0.001). The score of healthy lifestyle among Chinese undergraduate nursing students was 125.18 ± 9.21. The scores for the eight dimensions of healthy lifestyle were as follows: Exercise Behavior (HL1) = 8.76 ± 1.95, Regular Lifestyle Behavior (HL2) = 10.58 ± 1.98, Nutritional Behavior (HL3) = 14.39 ± 1.97, Health Risk Behavior (HL4) = 7.39 ± 1.64, Health Responsibility Behavior (HL5) = 20.59 ± 2.53, Interpersonal Support Behavior (HL6) = 24.40 ± 3.09, Stress Management Behavior (HL7) = 19.58 ± 2.54, and Appreciation of Life Behavior (HL8) = 19.46 ± 2.51. Most of these dimensions were significantly positively correlated with each other (p < 0.001). The correlation coefficients between the total healthy lifestyle (HL) score and its sub-dimensions ranged from 0.370 to 0.617 (p < 0.001), with the highest correlation observed for HL6 (r = 0.617, p < 0.001). The score of psychological resilience among Chinese undergraduate nursing students was 77.28 ± 10.37. The scores for the three dimensions of psychological resilience—Tenacity (PR1), Strength (PR2), and Optimism (PR3)—were 36.73 ± 8.45, 26.89 ± 3.11, and 13.64 ± 1.79, respectively. Significant positive correlations were found among these dimensions (p < 0.001). The strongest correlation with overall psychological resilience (PR) was observed for PR1 (r = 0.939, p < 0.001), followed by PR2 (r = 0.560, p < 0.001) and PR3 (r = 0.390, p < 0.001). Significant positive correlations were found among DHL, HL, and PR. The correlation coefficients were as follows: DHL and HL (r = 0.518, p < 0.001), DHL and PR (r = 0.471, p < 0.001), and HL and PR (r = 0.397, p < 0.001). The results of the scores and correlation analysis of psychological resilience, digital health literacy, and healthy lifestyle among undergraduate nursing students are presented in Table 2 . Table 2 Scores and Correlation Analysis of Psychological Resilience, Digital Health Literacy, and Healthy Lifestyle (n = 467) Variable Mean SD DHL1 DHL2 DHL3 HL1 HL2 HL3 HL4 HL5 HL6 HL7 HL8 PR1 PR2 PR3 DHL HL PR DHL1 27.06 3.79 1.000 *** DHL2 17.73 2.99 0.327 *** 1.000 *** DHL3 29.51 4.46 0.364 *** 0.373 *** 1.000 *** HL1 8.76 1.95 0.225 *** 0.364 *** 0.272 *** 1.000 *** HL2 10.58 1.98 0.327 *** 0.343 *** 0.318 *** 0.326 *** 1.000 *** HL3 14.39 1.97 0.265 *** 0.328 *** 0.304 *** 0.230 *** 0.335 *** 1.000 *** HL4 7.39 1.64 0.094 * 0.173 *** 0.092 * 0.179 *** 0.099 * 0.212 *** 1.000 *** HL5 20.59 2.53 0.135 ** 0.194 *** 0.183 *** 0.136 ** 0.239 *** 0.075 0.128 ** 1.000 *** HL6 24.40 3.09 0.143 ** 0.237 *** 0.187 *** 0.204 *** 0.190 *** 0.273 *** 0.168 *** 0.137 ** 1.000 *** HL7 19.58 2.54 0.149 ** 0.156 *** 0.143 ** 0.187 *** 0.071 0.068 0.061 0.065 0.116 * 1.000 *** HL8 19.46 2.51 0.120 ** 0.136 ** 0.079 0.141 ** 0.104 * 0.05 -0.046 0.109 * 0.142 ** 0.124 ** 1.000 *** PR1 36.73 8.45 0.332 *** 0.285 *** 0.341 *** 0.303 *** 0.292 *** 0.234 *** 0.140 ** 0.135 ** 0.202 *** 0.111 * 0.086 1.000 *** PR2 26.89 3.11 0.144 ** 0.198 *** 0.241 *** 0.164 *** 0.135 ** 0.207 *** 0.024 0.045 0.119 ** 0.03 0.136 ** 0.291 *** 1.000 *** PR3 13.64 1.79 0.189 *** 0.161 *** 0.241 *** 0.158 *** 0.205 *** 0.177 *** 0.069 0.101 * 0.092 * 0.075 0.091 * 0.215 *** 0.138 ** 1.000 *** DHL 74.31 8.54 0.749 *** 0.690 *** 0.815 *** 0.370 *** 0.432 *** 0.391 *** 0.151 ** 0.224 *** 0.244 *** 0.196 *** 0.142 ** 0.426 *** 0.259 *** 0.266 *** 1.000 *** HL 125.18 9.21 0.350 *** 0.465 *** 0.382 *** 0.560 *** 0.551 *** 0.518 *** 0.379 *** 0.487 *** 0.617 *** 0.447 *** 0.440 *** 0.361 *** 0.210 *** 0.232 *** 0.518 *** 1.000 *** PR 77.28 10.37 0.347 *** 0.320 *** 0.392 *** 0.323 *** 0.314 *** 0.283 *** 0.133 ** 0.141 ** 0.216 *** 0.113 * 0.127 ** 0.939 *** 0.560 *** 0.390 *** 0.471 *** 0.397 *** 1.000 *** Note: DHL1: Digital Health Information Literacy; DHL2: Digital Health Practice Skills; DHL3: Digital Health Evaluation Skills; DHL: Digital Health Literacy; HL1: Exercise Behavior; HL2: Regular Lifestyle Behavior; HL3: Nutritional Behavior; HL4: Health Risk Behavior; HL5: Health Responsibility Behavior; HL6: Interpersonal Support Behavior; HL7: Stress Management Behavior; HL8: Appreciation of Life Behavior; HL: Healthy Lifestyle; PR1: Tenacity; PR2: Strength; PR3: Optimism; PR: Psychological Resilience. * p < 0.05, ** p < 0.01, *** p < 0.001. Multivariate Analysis of Digital Health Literacy among Undergraduate Nursing Students A multiple linear regression analysis was conducted with digital health literacy score as the dependent variable and gender, family economic situation, academic performance, physical fitness, psychological quality, psychological resilience score, and healthy lifestyle score as independent variables. Categorical variables were included in the model as dummy variables, while the scores for psychological resilience and healthy lifestyle were entered as continuous variables. The coding of independent variables is shown in Table 3 . Model diagnostics, including residual analysis and checks for multicollinearity, indicated no significant violations of assumptions, thus confirming that the regression model met the basic assumptions and ensuring the reliability and validity of the regression results. The results of the multiple linear regression analysis showed that family economic situation and psychological quality did not enter the regression equation. Gender, academic performance, physical fitness, psychological resilience, and healthy lifestyle were identified as factors influencing digital health literacy among Chinese undergraduate nursing students (P < 0.05). The overall model was statistically significant (F = 31.142, p < 0.001) and accounted for approximately 45.1% of the variance in digital health literacy. Considering the number of independent variables in the model, the adjusted R² was 43.7% (Table 4 ). Table 3 Coding of Independent Variables Independent Variables Coding Methods Gender male = 0, female = 1 Family Economic Situation Poor (0,0,0), Moderate (0,1,0), Good (0,0,1) Academic Performance Fail (0,0,0,0), Pass (0,1,0,0), Good (0,0,1,0), Excellent (0,0,0,1) Physical Fitness Poor (0,0,0), Fair (0,1,0), Good (0,0,1) Psychological Quality Poor (0,0,0), Fair (0,1,0), Good (0,0,1) Psychological Resilience Original Value Healthy Lifestyle Original Value Table 4 Multiple Linear Regression Analysis of Digital Health Literacy among Undergraduate Nursing Students (n = 467) Variable B S.E. Beta t p 95%CI VIF Constant 10.788 4.238 -0.825 2.546 0.011 [2.460, 19.116] 1 Gender female -1.710 0.672 -0.200 -2.544 0.011 [-3.030, -0.389] 1.025 Family Economic Situation Moderate 0.801 0.842 0.094 0.951 0.342 [-0.854, 2.456] 2.011 Good 1.251 0.932 0.146 1.342 0.180 [-0.580, 3.082] 2.141 Academic Performance Pass 5.104 1.289 0.597 3.959 <0.001 [2.57, 7.637] 4.512 Good 6.750 1.293 0.790 5.220 <0.001 [4.209, 9.292] 4.487 Excellent 8.908 1.44 1.042 6.187 <0.001 [6.079, 11.738] 3.103 Physical Fitness Fair 3.596 1.069 0.421 3.364 0.001 [1.495, 5.696] 3.242 Good 1.963 1.150 0.230 1.707 0.088 [-0.297, 4.222] 3.235 Psychological Quality Fair -2.215 1.273 -0.259 -1.740 0.082 [-4.716, 0.286] 4.592 Good 0.333 1.295 0.039 0.257 0.797 [-2.212, 2.878] 4.571 Psychological Resilience 0.186 0.034 0.226 5.480 <0.001 [0.119, 0.253] 1.404 Healthy Lifestyle 0.336 0.036 0.363 9.473 <0.001 [0.267, 0.406] 1.213 Note: F = 31.142 P < 0.001, R 2 = 0.451, adjusted R 2 = 0.437. B : unstandardized regression coefficient; SE : standard errors; β : standardized regression coefficient; CI : confidence interval; VIF : Variance inflation factor. Pathways of the Relationship among Psychological Resilience, Healthy Lifestyle, and Digital Health Literacy among Undergraduate Nursing Students To meet the requirements of statistical analysis, the parceling method was used to combine multiple observed variables from the Healthy Lifestyle Scale into three new parcel indicators. This approach was adopted to reduce the number of model parameter estimates and improve model fit. The structural model was tested using maximum likelihood estimation, and the mediating effect was examined using the Bootstrap method. The model fit indices were as follows: χ²/df = 1.195, RMSEA = 0.020, GFI = 0.987, AGFI = 0.976, CFI = 0.993, TLI = 0.989, SRMR = 0.027. The relationships and path coefficients among psychological resilience, healthy lifestyle, and digital health literacy are shown in Fig. 2 . Mediating Role of Healthy Lifestyle between Psychological Resilience and Digital Health Literacy Sobel and Bootstrap tests were conducted to examine the direct, indirect, and total effects. As shown in Table 5 , the Sobel test indicated that the indirect effect (Z = 2.992, p < 0.05), direct effect (Z = 2.284, p < 0.05), and total effect (Z = 6.094, p < 0.001) were all significant. This suggests that psychological resilience influences digital health literacy through its effect on healthy lifestyle. The Bootstrap test revealed that the direct effect of psychological resilience on healthy lifestyle was 0.408 (95% CI: 0.022, 0.292), and the total effect was 0.832 (95% CI: 0.217, 0.423). The indirect effect of psychological resilience on digital health literacy mediated by healthy lifestyle was 0.424 (95% CI: 0.079, 0.247). All paths were significant, indicating the robustness of the mediating model results. Table 5 Sobel and Bootstrap tests for mediation models Paths Observed_Coefficient Sobel_Z Sobel_P Bootstrap_SE Bootstrap_P LLCI ULCI Indirect effect 0.424 2.992 0.003 0.043 0.000 0.079 0.247 Direct effect 0.408 2.284 0.022 0.069 0.022 0.022 0.292 Total effect 0.832 6.094 0.000 0.052 0.000 0.217 0.423 Note: LLCI, lower level for confidence interval; ULCI, upper level for confidence interval. Discussion The number of individuals using the internet to search for health-related information is on the rise. The ability to locate the best health information online, evaluate its quality, and subsequently utilize this information to advise on health decisions for patients is an essential skill in the nursing process [ 43 ]. Previous studies have demonstrated that medical students possess higher digital health literacy compared to students in non-medical fields [ 44 ]. In this study, the digital health literacy of Chinese undergraduate nursing students was found to be at a moderate level. A substantial body of literature has identified that nursing students exhibit similar moderate digital health literacy skills as observed in this study [ 45 , 46 ]. Differences in digital health literacy levels among college students of different genders have been noted. A cross-sectional survey study on the digital health literacy of German college students revealed that female students had lower digital health literacy across all subscales [ 47 ]. Further survey research on Slovenian college students indicated that female students reported lower digital health literacy in the subscales of information reliability evaluation and information searching [ 48 ]. The results of the multiple linear regression analysis in this study also showed that male students had higher digital health literacy scores than female students. From a sociological perspective, the definitions and expectations of gender roles in sociocultural contexts significantly influence the behavioral norms of men and women in the use of technology and information acquisition. Traditional gender norms often dictate that men should be self-reliant, determined, and emotionally restrained, whereas women are expected to be emotionally perceptive, empathetic, caring, and engaged in supportive roles [ 49 ]. This socialization process encourages men to participate more actively in activities related to technology and information technology, thereby becoming more proficient in using electronic devices and obtaining information. Evolutionary psychology theory further elucidates the origins of gender cognitive differences, suggesting that the different environmental pressures faced by men and women during evolution have led to differences in cognitive abilities [ 50 ]. Traditionally, men have shouldered more technical and decision-making responsibilities, which may result in better spatial abilities and systematic information processing skills in men. These abilities facilitate more effective utilization of digital health tools. Undergraduate nursing students with excellent academic performance have higher digital health literacy, which is consistent with Kim’s study [ 51 ]. Superior academic performance typically reflects a solid foundation in professional knowledge and critical thinking abilities. Nursing students need to translate nursing theory into practice, and those with better grades are able to integrate health knowledge more effectively and verify the reliability of information through digital tools. In recent years, the educational environment for college students has been rapidly changing due to the development of digital technology. Students are required to quickly master technological tools, and nursing students with excellent grades are usually able to adapt to such environments more rapidly [ 52 ]. Moreover, students with higher grades often exhibit stronger self-efficacy in their studies [ 53 ]. This sense of self-efficacy is not only reflected in managing the course system, handling academic tasks, and interacting with teachers and students but also extends to the search, evaluation, and application of digital health information, thereby enhancing their efficiency in processing health information. Self-rated health, as one of the motivational factors for digital health literacy, refers to an individual’s comprehensive evaluation of their physical condition, psychological state, and social functioning [ 54 ]. Regarding the impact of self-rated health status on the digital health literacy of college students, different scholars have varying opinions [ 55 ]. The results of this study show that the better the self-rated health status, the higher the level of digital health literacy, which is consistent with previous research findings [ 55 ]. This may be because college students with better health status are usually more concerned about their own health. They are more proactive in searching for, accurately identifying, and consciously practicing digital health information to enhance their health, thus possessing a higher level of digital health literacy. However, study] found through empirical surveys that there is no significant association between self-rated health status and digital health literacy among Israeli adults [ 56 ]. A study also indicated that health status does not significantly affect the level of digital health literacy [ 57 ]. These contradictory results suggest that the relationship between self-rated health and digital health literacy may vary depending on the population and context, and further research is urgently needed to clarify the underlying mechanisms. The direct positive impact of psychological resilience on digital health literacy indicates that psychological resilience, as an individual’s ability to cope with adversity and stress, is closely related to the ability to obtain and apply health information [ 58 ]. Individuals with high psychological resilience tend to exhibit stronger proactive learning and coping abilities when facing health issues, thereby directly promoting the enhancement of digital health literacy. Additionally, studies on COVID-19 survivors have shown that individuals with stronger psychological resilience are more proactive in obtaining health knowledge through digital channels after the pandemic, with a significantly greater increase in digital health literacy compared to those with lower resilience. This suggests that psychological resilience can enhance individuals’ learning motivation in crisis situations and directly drive the development of digital health literacy [ 59 ]. Mediation analysis further reveals that psychological resilience indirectly affects digital health literacy through a healthy lifestyle. A healthy lifestyle includes regular sleep patterns, balanced diets, and moderate exercise. Individuals with stronger psychological resilience are more inclined to maintain a healthy lifestyle, which helps improve their physical and mental states, enabling them to more effectively cope with external pressures and internal anxiety. This, in turn, makes them more willing to actively seek health information and apply it to improve their health status. Moreover, healthy behaviors themselves require continuous support from health information, thereby promoting individuals to frequently use digital tools to obtain knowledge [ 60 ]. Studies have shown that changes in health behaviors can significantly increase individuals’ search frequency for precise health information [ 61 ]. In the digital age, good living habits are often associated with more proactive health information search behaviors. Studies have shown that students who adhere to a healthy lifestyle are more likely to actively verify the scientific nature of health information [ 62 ]. Limitations Although this study provides important insights into the relationships among psychological resilience, healthy lifestyle, and digital health literacy, several limitations should be acknowledged. First, the study was conducted only among undergraduate nursing students at two universities in China. The geographical and institutional limitations of the sample restrict the generalizability of the results to all nursing schools or broader populations, potentially introducing sampling bias. Future research should validate the model’s applicability across different cultural and professional groups. Second, the cross-sectional design of this study, despite supporting the mediating pathways through statistical models, does not allow for the establishment of causal relationships between variables. Longitudinal tracking data would be beneficial for further verifying the direction of causality. Additionally, the measurement of digital health literacy relied on self-reported scales completed by students, reflecting their perceived levels rather than actual skills, which may deviate from their true digital health capabilities due to subjective bias. Future studies could incorporate objective behavioral data to enhance measurement accuracy. Moreover, although the model had a high explanatory power, approximately 54.9% of the variance remained unexplained, indicating the presence of important variables not included in the model. Lastly, this study treated healthy lifestyle as a single variable, simplifying its complexity and potentially obscuring the differential mediating effects of specific dimensions. Subsequent research should disaggregate these dimensions and explore variations in relationships across different contexts to more comprehensively promote students’ digital health literacy and nursing education development. Conclusion This study found that psychological resilience not only directly predicts digital health literacy positively but also indirectly enhances digital health literacy by promoting the formation of a healthy lifestyle. This finding challenges the traditional linear model of digital health literacy that unidirectionally drives behavior and psychology, and for the first time, it validates the mechanism by which psychological resilience affects digital health literacy through a healthy lifestyle. This study enriches the understanding of the relationship among the three factors. It suggests that nursing educators should develop multidimensional intervention strategies to enhance the core competence of nursing students in the digital healthcare environment through the synergistic mechanism of psychological resilience training and healthy behavior guidance. Implications for nursing education This study underscores the pivotal role of psychological resilience and healthy lifestyle behaviors in shaping the digital health literacy of undergraduate nursing students, offering novel insights for nursing education. Educators should integrate psychological resilience training into the nursing curriculum to bolster students' ability to cope with academic and clinical stress. Techniques such as mindfulness, stress management workshops, and resilience-building exercises can equip students with the mental fortitude needed to navigate the complexities of modern healthcare. Moreover, promoting a healthy lifestyle among nursing students is crucial. Educators can design programs that encourage regular physical activity, balanced nutrition, and adequate sleep, recognizing that these behaviors not only enhance overall well-being but also indirectly boost digital health literacy. Interactive sessions on the importance of a healthy lifestyle and its link to effective digital health information management can further reinforce this connection. Innovatively, nursing schools could leverage digital platforms to deliver tailored interventions that combine resilience training and health promotion. Mobile apps and online modules could provide students with accessible resources to support their mental and physical health, while fostering their digital literacy skills. By addressing both psychological and lifestyle factors, nursing education can holistically prepare students to excel in the digital health landscape, ultimately enhancing patient care and advancing the nursing profession. Declarations Acknowledgements We extend our sincere thanks to the 500 undergraduate nursing students who participated in this survey, as your support was crucial to the conduct of this study. Author Contributions Qin Lin, Di Dong, Pei Chen, Kun Sun, Qin Guo, and Linfeng Liu contributed to the conception of the study and the preparation of the manuscript, encompassing the initial draft, subsequent revisions, and the final version. Pei Chen, Kun Sun, and Qin Guo undertook the tasks of data collection, management, and analysis. Mengxue Fu, Bin Cao, Jijun Wu, and Zhixian Feng provided guidance on the conceptual framework, methodological approach, analytical support, and critical review of the study. All authors reviewed and endorsed the final manuscript prior to submission. Funding This study was funded by the 2024 Zhejiang Shuren University Teaching Reform Project (Grant Number: jg2024010). Data availability The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request. Ethical Approval Ethical approval for this study was obtained from the Medical Ethics Committee of Sichuan Nursing Vocational College under approval number 2023010. The study adhered to the ethical guidelines outlined in the Helsinki Declaration. All participants were fully informed about the study and provided their consent to participate. Consent for publication Not applicable. Conflict of interest None. References Tanaka J, Kuroda H, Igawa N, Sakurai T, Ohnishi M. 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Health information seeking behaviors on social media during the COVID-19 pandemic among American social networking site users: survey study. J Med Internet Res. 2021;23(6):e29802. Bak CK, Krammer JØ, Dadaczynski K, Orkan O, von Seelen J, Prinds C, et al. Digital health literacy and information-seeking behavior among university college students during the COVID-19 pandemic: a cross-sectional study from Denmark. Int J Environ Res Public Health. 2022;19(6):3676. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6556958","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":467842700,"identity":"a7c079ac-3aef-43bb-abc2-4069fd82f5cd","order_by":0,"name":"Qin Lin","email":"","orcid":"","institution":"Shulan International Medical College, Zhejiang Shuren University","correspondingAuthor":false,"prefix":"","firstName":"Qin","middleName":"","lastName":"Lin","suffix":""},{"id":467842701,"identity":"08a3fb36-ebdd-4372-9709-cc73524b27f8","order_by":1,"name":"Mengxue Fu","email":"","orcid":"","institution":"People's Hospital of 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Medical College, Zhejiang Shuren University","correspondingAuthor":true,"prefix":"","firstName":"Zhixian","middleName":"","lastName":"Feng","suffix":""}],"badges":[],"createdAt":"2025-04-29 13:38:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6556958/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6556958/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84194094,"identity":"a6c1d53d-e75b-4f5e-987e-d065cfb8a55e","added_by":"auto","created_at":"2025-06-09 07:21:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1061922,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual model of the relationships among psychological resilience, healthy lifestyle, and digital health literacy\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-6556958/v1/6400e80975b2c72efab5dce9.png"},{"id":84194730,"identity":"ca58455d-a3f2-4fad-be0e-2f48d58d1621","added_by":"auto","created_at":"2025-06-09 07:29:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1892477,"visible":true,"origin":"","legend":"\u003cp\u003eStructural Model of the Relationships among Variables and Path Coefficients\u003c/p\u003e\n\u003cp\u003eNote: DHL1: Digital Health Information Literacy; DHL2: Digital Health Practice Skills; DHL3: Digital Health Evaluation Skills; DHL: Digital Health Literacy; HL_P1: Exercise Behavior, Regular Lifestyle Behavior and Nutritional Behavior; HL_P2: Health Risk Behavior, Health Responsibility Behavior and Interpersonal Support Behavior; HL_P3: Stress Management Behavior and Appreciation of Life Behavior; HL: Healthy Lifestyle; PR1: Tenacity; PR2: Strength; PR3: Optimism; PR: Psychological Resilience.\u003c/p\u003e","description":"","filename":"Fig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-6556958/v1/0ec6874c4ba1954ec39683fa.png"},{"id":91817563,"identity":"45c5bcb7-dd9d-414d-a6ca-723ef3c1cabb","added_by":"auto","created_at":"2025-09-22 06:56:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4965005,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6556958/v1/c977a015-296f-4ab3-b957-1514c8a8df84.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The correlation between psychological resilience and digital health literacy of undergraduate nursing students: the mediating role of healthy lifestyle","fulltext":[{"header":"Background","content":"\u003cp\u003eAdvances in technology, the integration of the internet into daily life, and the widespread use of mobile phones, laptops, and tablets have enabled people to rapidly and directly access a vast amount of information [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]. These developments have made information on almost any subject accessible to everyone in every country/region, regardless of their location [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]. Health-related information is particularly in demand. Evidence indicates that searching for health information online has become a common practice worldwide. Yoon and Kim et al. found that individuals from South Korea, especially international students from South Korea, use the internet as their primary source of health information [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. A survey by Osei Asibey et al. revealed that 67.7% of university students in Ghana use the internet for health-related purposes [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. Additionally, research by Sch\u0026auml;fer et al. showed that over 90% of university students in Germany search for health information online [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the digital context, digital health literacy has emerged. It is defined as the ability of users, due to technological advancements, to seek, find, understand, and evaluate health-related information from electronic resources and to utilize the obtained information to address and resolve any health issues [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is important to emphasize that users are not merely passive recipients but actively participate in the dissemination process by interacting with existing content or sharing their own health-related information [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. Digital health literacy encompasses six components: computer literacy, traditional literacy, information literacy, health literacy, scientific literacy, and media literacy [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. It is considered a public health goal for the 21st century [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. Digital health literacy can support nursing practice, enhance patient safety, and improve medical decision-making. Nurses with digital health literacy are able to use digital health tools more effectively, enhance their health knowledge and skills, and contribute to improved health outcomes [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eCollege students are digital natives with strong abilities to embrace new things and technologies, making them one of the most active groups on the internet. Undergraduate nursing students, as a special subgroup of college students, are in the golden stage of their development and value formation. They are the future reserve force in the healthcare field and the backbone for promoting the development of the social health industry. To adapt to the increasingly digitalized healthcare environment, digital health literacy is not only a reflection of personal ability for nursing students but also a core competency for professional development. Nursing students need to possess digital health literacy skills [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. The digital health literacy of nursing students directly affects the quality of care provided to patients and their ability to promote health. It is also an important resource for clinical practice, lifelong learning, and conducting educational activities [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, globally, nursing students often find themselves in high-pressure environments due to heavy academic workloads and the challenges of clinical practice [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. An important protective factor mentioned in academic literature [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e] and education and workforce policies [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e] is psychological resilience. Although there are various definitions of psychological resilience, it is generally described as a complex and dynamic phenomenon, not merely the ability to cope with adversity, but a dynamic process of \u0026quot;bouncing back\u0026quot; and achieving positive adaptation when facing challenges [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. For nursing students, good psychological resilience can act as a \u0026quot;strong shield,\u0026quot; with highly resilient individuals more likely to actively seek and use digital health resources when facing health challenges. Although there is limited literature directly studying the relationship between psychological resilience and digital health literacy, research by Levin-Zamir et al. indicates a significant correlation between psychological resources (including resilience) and media health literacy (an aspect of digital health literacy) [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eA healthy lifestyle refers to the beneficial behaviors and habits that individuals develop in their daily lives to promote physical and mental well-being. It encompasses multiple dimensions, including healthy eating habits, regular physical exercise, good sleep patterns, and positive psychological adjustment. These dimensions interact with each other to form a behavioral system that helps individuals protect and enhance their well-being [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. Psychological resilience plays a significant role in the selection and maintenance of a healthy lifestyle. Several cross-sectional studies have examined the relationship between psychological resilience and healthy lifestyle, revealing a positive correlation between self-reported resilience traits and health outcomes [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Research by Kristen et al. found that individuals with higher psychological resilience are often better able to cope with life stressors and challenges, and they are more likely to choose healthier lifestyle behaviors when faced with temptations such as unhealthy eating or lack of exercise [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. Students with higher levels of psychological resilience also tend to engage in more positive health behaviors, such as regular exercise, balanced diet, and good sleep habits [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. During the COVID-19 pandemic, psychological resilience has played an even more important role. Studies have shown that students with higher psychological resilience are better able to establish and maintain exercise routines and healthy eating habits in the face of pandemic-related stress [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eHealth literacy is an acknowledged determinant of individual health behaviors and outcomes [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]. As an extension of health literacy, digital health literacy has been supported by numerous studies for its role in promoting a healthy lifestyle [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]. It should be noted that nearly all studies have treated digital health literacy as an independent variable to explore how it affects individuals\u0026rsquo; health behaviors. The transactional model of digital health literacy indicates that individuals\u0026rsquo; health behaviors, in turn, influence their motivation to use digital health services, thereby indirectly affecting their digital health literacy [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eConceptual Framework and Research Hypotheses\u003c/h3\u003e\n\u003cp\u003ePsychological resilience is significantly correlated with a healthy lifestyle, which is also closely linked to digital health literacy. Thus, a healthy lifestyle may connect psychological resilience and digital health literacy. The Health Belief Model (HBM), comprising five dimensions: susceptibility, severity, efficacy, benefits, and barriers, indicates that beliefs are crucial for health behaviors [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e]. HBM explains that individuals\u0026apos; health behavior decisions are influenced by their perceived susceptibility and severity of disease threats, and their cognitive evaluation of the efficacy, benefits, and barriers of health actions. People with high psychological resilience are more confident in overcoming challenges to adopt healthy lifestyles and better recognize the long-term benefits of health behaviors. This positive health belief is expected to make them more proactive in choosing and maintaining a healthy lifestyle. In digital contexts, adopting a healthy lifestyle requires corresponding information literacy, especially digital health literacy. When individuals are motivated to maintain health, they are more likely to actively seek and use online health resources. Based on HBM, this research develops the theoretical model in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and proposes the following hypotheses:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePsychological resilience is positively correlated with digital health literacy. Higher levels of psychological resilience are associated with higher levels of digital health literacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA healthy lifestyle mediates the relationship between psychological resilience and digital health literacy.\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003ea) Psychological resilience positively predicts a healthy lifestyle (Hypothesis\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003eb) A healthy lifestyle positively predicts digital health literacy (Hypothesis\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb).\u003cbr\u003e\u003c/span\u003e\u003cspan\u003ec) Psychological resilience enhances digital health literacy through improving the level of a healthy lifestyle (Hypothesis \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ec).\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis 3\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePsychological resilience has both direct and indirect effects on digital health literacy through a healthy lifestyle, that is, a healthy lifestyle partially mediates the relationship between psychological resilience and digital health literacy.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eResearch Contributions\u003c/h2\u003e\n \u003cp\u003eAlthough existing literature has made some progress in the study of digital health literacy, most research has primarily focused on individual-level factors such as age, gender, and education level, with limited exploration of the potential impact of psychological resilience, a key psychological resource, on digital health literacy. Compared with previous studies, this research makes the following two main contributions:\u003c/p\u003e\n \u003cp\u003eFirstly, this study introduces psychological resilience as an emerging variable in the research on digital health literacy, filling the gap in the existing research that has overlooked this psychological resource. Secondly, this study not only reveals the relationship between psychological resilience and digital health literacy but also further elucidates the important mediating role of a healthy lifestyle in this process.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study conducted using an online questionnaire survey from June to October 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Sample\u003c/h3\u003e\n\u003cp\u003eAccording to the research [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], a sample size of 250 to 500 is considered suitable for most structural equation modeling (SEM) analyses. Considering the complexity of the questionnaire survey data and the potentially weak mediating effects, the final sample size was determined to be 500.\u003c/p\u003e \u003cp\u003eA stratified cluster sampling method was used. Two nursing colleges were selected in two provincial capitals in China, namely Chengdu and Hangzhou. Students from grades one to four were selected as the study participants based on grade stratification. Inclusion criteria: (1) Full-time undergraduate nursing students who took the national entrance examination; (2) Informed consent and voluntary participation in the study. Exclusion criteria: (1) Students who could not return to school on time or could not participate in this study due to personal or sick leave; (2) Undergraduate nursing students who were not Chinese citizens; (3) Participants who could not complete the questionnaire in full.\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePsychological Resilience\u003c/h2\u003e \u003cp\u003eThe Connor-Davidson Resilience Scale (CD-RISC) was used to assess the psychological resilience of the study participants. This scale was originally developed by Connor KM et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] in 2003 and was translated and revised by Yu X et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] in 2007. The CD-RISC comprises three dimensions: tenacity, strength, and optimism, which include 13, 8, and 4 items respectively. All items are scored using a 5-point Likert scale, with the options \u0026ldquo;never,\u0026rdquo; \u0026ldquo;rarely,\u0026rdquo; \u0026ldquo;sometimes,\u0026rdquo; \u0026ldquo;often,\u0026rdquo; and \u0026ldquo;always\u0026rdquo; assigned values of 0, 1, 2, 3, and 4 respectively. The scores for each dimension range from 0 to 52 for tenacity, 0 to 32 for strength, and 0 to 16 for optimism, with a total score ranging from 0 to 100. The sum of the scores of the 25 items represents the total score of the scale, with higher scores indicating better psychological resilience of the study participants. In this study, the Cronbach's α coefficients for the scale and its three dimensions were 0.961, 0.875, 0.832, and 0.893 respectively. The KMO value was 0.935, and the Bartlett's test value was 4974.56 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDigital Health Literacy\u003c/h3\u003e\n\u003cp\u003eThe College Student Digital Health Literacy Scale was developed by Tang Zeng et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] and is primarily used for assessing the digital health literacy of college students. The scale consists of 20 items across three dimensions: digital health information literacy (7 items), digital health evaluation skills (8 items), and digital health practice skills (5 items). All items are scored using a 5-point Likert scale, ranging from \u0026ldquo;strongly disagree\u0026rdquo; to \u0026ldquo;strongly agree,\u0026rdquo; with scores from 1 to 5. The total score of the scale ranges from 20 to 100, with the total score for each respondent being the sum of all item scores. Higher scores indicate higher levels of digital health literacy. The Cronbach\u0026rsquo;s α coefficients for the three dimensions range from 0.836 to 0.895, and the overall Cronbach\u0026rsquo;s α coefficient for all items is 0.915, indicating good internal consistency of the scale. The correlation coefficients range from 0.191 to 0.708, suggesting good content validity of the scale. In this study, the Cronbach\u0026rsquo;s α coefficient for the scale was 0.962, and the Cronbach\u0026rsquo;s α coefficients for the three dimensions were 0.921, 0.926, and 0.909 respectively. The KMO value was 0.973, and the Bartlett\u0026rsquo;s test value was 41,017.730 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003ch3\u003eHealthy Lifestyle\u003c/h3\u003e\n\u003cp\u003eThe College Student Healthy Lifestyle Assessment Scale was developed by Wang Dong and revised by Jiao Jianpeng [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The scale consists of 33 items across eight dimensions: exercise behavior (3 items), regular lifestyle behavior (3 items), nutritional behavior (4 items), health risk behavior (2 items), health responsibility behavior (5 items), interpersonal support behavior (6 items), stress management behavior (5 items), and appreciation of life behavior (5 items). All items are scored using a 5-point Likert scale, ranging from \u0026ldquo;never\u0026rdquo; to \u0026ldquo;always,\u0026rdquo; with scores from 1 to 5. Items 11 and 12 are reverse-scored. The total score ranges from 33 to 165, with higher scores indicating a higher level of healthy lifestyle. In this study, the Cronbach\u0026rsquo;s α coefficient for the scale was 0.949, and the Cronbach\u0026rsquo;s α coefficients for the eight dimensions ranged from 0.751 to 0.889. The KMO value was 0.966, and the Bartlett\u0026rsquo;s test value was 49,133.63 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e The study was approved by the ethics committee of the college, with the ethics approval number 2023010. Students who voluntarily completed the survey were considered to have provided implicit informed consent. The investigators informed the students that they could withdraw from the study at any time without any prejudice. The privacy and confidentiality of the students were strictly maintained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003ePrior to the actual data collection, the questionnaire underwent a reliability pretest. The study was conducted using a Chinese online survey platform (Questionnaire Star). Initially, contact was established with the investigators at the two universities to be surveyed, and the content of the survey was explained and their consent was obtained. The investigators then distributed the electronic questionnaire to the classes that met the criteria for participation, utilizing the 10 minutes before class to do so. The instructions for completing the questionnaire were read aloud in a unified manner, emphasizing that the data collected would be used solely for scientific research and that anonymity and confidentiality would be maintained. The survey was administered collectively and collected on-site, with each ID being permitted to submit only one questionnaire. After completing the questionnaire, the class monitor tallied the number of participants who had filled it out to prevent duplicate submissions. The data collection process took approximately 20 to 30 minutes. A total of 500 undergraduate nursing students were recruited for this study, and after data cleaning, 467 valid questionnaires were obtained, resulting in an effective response rate of 93.40%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData analyses were conducted using IBM SPSS Statistics 26.0 software. For continuous data, those that passed the normality test were described using the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; s), while those that failed the normality test were described using the median and interquartile range [M (P25, P75)]. Categorical data were described using frequencies and percentages. The Harman single-factor test was used to assess the presence of common method bias among variables. Pearson correlation analysis was employed to examine the relationships between variables. Differences in digital health literacy among undergraduate nursing students with different sociodemographic characteristics were evaluated using independent samples t-tests and analysis of variance (ANOVA). Stepwise regression analysis was used to identify the determinants of digital health literacy among undergraduate nursing students. In the regression analysis, to avoid multicollinearity among explanatory variables in the model, a variance inflation factor (VIF) greater than 10.0 in the collinearity diagnostics was considered indicative of severe multicollinearity between variables. Mediating effects were analyzed and verified using the mediation effect test procedure and the Bootstrap procedure. The Sobel test was used to rigorously test whether the indirect effect was significantly different from zero. If the Z value obtained from the Sobel test exceeded 1.96, the indirect effect was considered significant. To determine the effect size and obtain a 95% confidence interval, the direct, indirect, and total effects were assessed using the Bootstrap method with 5,000 replications. A 95% confidence interval that did not include zero indicated a significant effect. All statistical tests were two-sided, with a significance level of α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eCommon Method Bias Test\u003c/p\u003e \u003cp\u003eThe Harman single-factor test [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] was used to assess common method bias. The results showed that there were three factors with eigenvalues greater than 1, and the maximum variance explained by a single factor was 25.20%, which is below the critical value of 40%. This indicates that there is no severe common method bias in the data of this study.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of participants\u003c/h2\u003e \u003cp\u003eThe 467 undergraduate nursing students ranged in age from 18 to 24 years, with a mean age of 20.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06 years. Among them, there were 129 males (27.62%) and 338 females (72.38%). The distribution across grades was as follows: first-year students accounted for 20.34%, second-year students for 32.76%, third-year students for 22.06%, and fourth-year students for 24.84%. The majority of the students were from rural areas, representing 55.25%. Most were only children, accounting for 87.37%. The predominant family structure was nuclear families, representing 75.37%. A significant proportion of the participants had leadership experience in student organizations, accounting for 61.03%. Most of the participants reported average family economic status, moderate study pressure, average physical fitness, and average psychological quality, accounting for 50.75%, 58.89%, 50.11%, and 48.39%, respectively. Academic performance was mainly concentrated in the passing and good grades, accounting for 39.16% and 38.33%, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate Analysis of Digital Health Literacy among Undergraduate Nursing Students with Different Characteristics\u003c/h2\u003e \u003cp\u003eDifferences in digital health literacy scores among undergraduate nursing students with different characteristics in terms of gender, family economic situation, academic performance, physical fitness, and psychological quality were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Digital Health Literacy Scores among Undergraduate Nursing Students with Different Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003et/F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e76.09\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.930\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.004**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.63\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePlace of Birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e74.30\u0026thinsp;\u0026plusmn;\u0026thinsp;9.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTownship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e74.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.91\u0026thinsp;\u0026plusmn;\u0026thinsp;8.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFamily Structure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e74.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlended family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.89\u0026thinsp;\u0026plusmn;\u0026thinsp;8.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle-parent family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e72.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFamily Economic Situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e71.22\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e19.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e74.11\u0026thinsp;\u0026plusmn;\u0026thinsp;8.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e76.31\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOnly Child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e87.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e74.11\u0026thinsp;\u0026plusmn;\u0026thinsp;8.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-1.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e75.68\u0026thinsp;\u0026plusmn;\u0026thinsp;9.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudent Leadership Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-1.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e75.08\u0026thinsp;\u0026plusmn;\u0026thinsp;8.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e74.57\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e75.34\u0026thinsp;\u0026plusmn;\u0026thinsp;9.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFourth year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.91\u0026thinsp;\u0026plusmn;\u0026thinsp;7.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAcademic Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e72.93\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.954\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e74.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAcademic Performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e64.33\u0026thinsp;\u0026plusmn;\u0026thinsp;7.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e54.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.51\u0026thinsp;\u0026plusmn;\u0026thinsp;8.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e75.06\u0026thinsp;\u0026plusmn;\u0026thinsp;7.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e78.59\u0026thinsp;\u0026plusmn;\u0026thinsp;8.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePhysical Fitness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e69.51\u0026thinsp;\u0026plusmn;\u0026thinsp;8.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e31.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e74.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e76.22\u0026thinsp;\u0026plusmn;\u0026thinsp;8.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePsychological Quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e70.15\u0026thinsp;\u0026plusmn;\u0026thinsp;7.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e33.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e73.28\u0026thinsp;\u0026plusmn;\u0026thinsp;8.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e76.76\u0026thinsp;\u0026plusmn;\u0026thinsp;8.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eScores and Correlation Analysis of Psychological Resilience, Digital Health Literacy, and Healthy Lifestyle among Undergraduate Nursing Students\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe score of digital health literacy among Chinese undergraduate nursing students was 74.31\u0026thinsp;\u0026plusmn;\u0026thinsp;8.54. The scores for the three dimensions of digital health literacy\u0026mdash;Digital Health Information Literacy (DHL1), Digital Health Practice Skills (DHL2), and Digital Health Evaluation Skills (DHL3)\u0026mdash;were 27.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79, 17.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99, and 29.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46, respectively. Significant positive correlations were found among these dimensions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The highest correlation coefficient with overall digital health literacy (DHL) was observed for DHL3 (r\u0026thinsp;=\u0026thinsp;0.815, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), followed by DHL1 (r\u0026thinsp;=\u0026thinsp;0.749, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and DHL2 (r\u0026thinsp;=\u0026thinsp;0.690, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe score of healthy lifestyle among Chinese undergraduate nursing students was 125.18\u0026thinsp;\u0026plusmn;\u0026thinsp;9.21. The scores for the eight dimensions of healthy lifestyle were as follows: Exercise Behavior (HL1)\u0026thinsp;=\u0026thinsp;8.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95, Regular Lifestyle Behavior (HL2)\u0026thinsp;=\u0026thinsp;10.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98, Nutritional Behavior (HL3)\u0026thinsp;=\u0026thinsp;14.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97, Health Risk Behavior (HL4)\u0026thinsp;=\u0026thinsp;7.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64, Health Responsibility Behavior (HL5)\u0026thinsp;=\u0026thinsp;20.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53, Interpersonal Support Behavior (HL6)\u0026thinsp;=\u0026thinsp;24.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09, Stress Management Behavior (HL7)\u0026thinsp;=\u0026thinsp;19.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54, and Appreciation of Life Behavior (HL8)\u0026thinsp;=\u0026thinsp;19.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51. Most of these dimensions were significantly positively correlated with each other (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The correlation coefficients between the total healthy lifestyle (HL) score and its sub-dimensions ranged from 0.370 to 0.617 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with the highest correlation observed for HL6 (r\u0026thinsp;=\u0026thinsp;0.617, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe score of psychological resilience among Chinese undergraduate nursing students was 77.28\u0026thinsp;\u0026plusmn;\u0026thinsp;10.37. The scores for the three dimensions of psychological resilience\u0026mdash;Tenacity (PR1), Strength (PR2), and Optimism (PR3)\u0026mdash;were 36.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.45, 26.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11, and 13.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79, respectively. Significant positive correlations were found among these dimensions (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The strongest correlation with overall psychological resilience (PR) was observed for PR1 (r\u0026thinsp;=\u0026thinsp;0.939, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), followed by PR2 (r\u0026thinsp;=\u0026thinsp;0.560, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and PR3 (r\u0026thinsp;=\u0026thinsp;0.390, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eSignificant positive correlations were found among DHL, HL, and PR. The correlation coefficients were as follows: DHL and HL (r\u0026thinsp;=\u0026thinsp;0.518, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), DHL and PR (r\u0026thinsp;=\u0026thinsp;0.471, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and HL and PR (r\u0026thinsp;=\u0026thinsp;0.397, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe results of the scores and correlation analysis of psychological resilience, digital health literacy, and healthy lifestyle among undergraduate nursing students are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScores and Correlation Analysis of Psychological Resilience, Digital Health Literacy, and Healthy Lifestyle (n\u0026thinsp;=\u0026thinsp;467)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"20\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDHL1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDHL2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDHL3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHL1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHL2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHL3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHL4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHL5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eHL6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eHL7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eHL8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003ePR1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003ePR2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c17\"\u003e \u003cp\u003ePR3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c18\"\u003e \u003cp\u003eDHL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c19\"\u003e \u003cp\u003eHL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c20\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDHL1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDHL2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.327\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDHL3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.364\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.373\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.225\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.364\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.272\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.327\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.343\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.318\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.326\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.265\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.328\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.304\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.230\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.335\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.173\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.092\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.179\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.099\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.212\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.135\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.194\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.183\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.136\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.239\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.128\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.143\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.237\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.187\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.204\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.190\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.273\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.168\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.137\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.149\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.156\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.143\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.187\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.116\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.120\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.136\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.141\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.104\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.109\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.142\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0.124\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePR1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.332\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.285\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.341\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.303\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.292\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.234\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.140\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.135\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.202\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0.111\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.198\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.241\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.164\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.135\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.207\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.119\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.136\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e0.291\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePR3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.189\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.161\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.241\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.158\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.205\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.177\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.101\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.092\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.091\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e0.215\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e0.138\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c17\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDHL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.749\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.690\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.815\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.370\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.432\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.391\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.151\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.224\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.244\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0.196\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.142\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e0.426\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e0.259\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c17\"\u003e \u003cp\u003e0.266\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c18\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e125.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.350\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.465\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.382\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.560\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.551\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.518\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.379\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.487\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.617\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0.447\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.440\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e0.361\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e0.210\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c17\"\u003e \u003cp\u003e0.232\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c18\"\u003e \u003cp\u003e0.518\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c19\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.347\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.320\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.392\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.323\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.314\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.283\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.133\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.141\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.216\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c13\"\u003e \u003cp\u003e0.113\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e \u003cp\u003e0.127\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e0.939\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e0.560\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c17\"\u003e \u003cp\u003e0.390\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c18\"\u003e \u003cp\u003e0.471\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c19\"\u003e \u003cp\u003e0.397\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c20\"\u003e \u003cp\u003e1.000\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"20\"\u003eNote: DHL1: Digital Health Information Literacy; DHL2: Digital Health Practice Skills; DHL3: Digital Health Evaluation Skills; DHL: Digital Health Literacy; HL1: Exercise Behavior; HL2: Regular Lifestyle Behavior; HL3: Nutritional Behavior; HL4: Health Risk Behavior; HL5: Health Responsibility Behavior; HL6: Interpersonal Support Behavior; HL7: Stress Management Behavior; HL8: Appreciation of Life Behavior; HL: Healthy Lifestyle; PR1: Tenacity; PR2: Strength; PR3: Optimism; PR: Psychological Resilience. * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eMultivariate Analysis of Digital Health Literacy among Undergraduate Nursing Students\u003c/h2\u003e \u003cp\u003eA multiple linear regression analysis was conducted with digital health literacy score as the dependent variable and gender, family economic situation, academic performance, physical fitness, psychological quality, psychological resilience score, and healthy lifestyle score as independent variables. Categorical variables were included in the model as dummy variables, while the scores for psychological resilience and healthy lifestyle were entered as continuous variables. The coding of independent variables is shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eModel diagnostics, including residual analysis and checks for multicollinearity, indicated no significant violations of assumptions, thus confirming that the regression model met the basic assumptions and ensuring the reliability and validity of the regression results. The results of the multiple linear regression analysis showed that family economic situation and psychological quality did not enter the regression equation. Gender, academic performance, physical fitness, psychological resilience, and healthy lifestyle were identified as factors influencing digital health literacy among Chinese undergraduate nursing students (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The overall model was statistically significant (F\u0026thinsp;=\u0026thinsp;31.142, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and accounted for approximately 45.1% of the variance in digital health literacy. Considering the number of independent variables in the model, the adjusted R\u0026sup2; was 43.7% (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCoding of Independent Variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent Variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoding Methods\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u0026thinsp;=\u0026thinsp;0, female\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Economic Situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor (0,0,0), Moderate (0,1,0), Good (0,0,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic Performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFail (0,0,0,0), Pass (0,1,0,0), Good (0,0,1,0), Excellent (0,0,0,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Fitness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor (0,0,0), Fair (0,1,0), Good (0,0,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological Quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor (0,0,0), Fair (0,1,0), Good (0,0,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological Resilience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginal Value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy Lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginal Value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple Linear Regression Analysis of Digital Health Literacy among Undergraduate Nursing Students (n\u0026thinsp;=\u0026thinsp;467)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eS.E.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVIF\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[2.460, 19.116]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[-3.030, -0.389]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Economic Situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[-0.854, 2.456]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[-0.580, 3.082]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic Performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[2.57, 7.637]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.512\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[4.209, 9.292]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[6.079, 11.738]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Fitness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[1.495, 5.696]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[-0.297, 4.222]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological Quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[-4.716, 0.286]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.592\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[-2.212, 2.878]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological Resilience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.119, 0.253]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.404\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy Lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e[0.267, 0.406]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.213\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: \u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;31.142 \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.451, adjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.437. \u003cem\u003eB\u003c/em\u003e: unstandardized regression coefficient; \u003cem\u003eSE\u003c/em\u003e: standard errors; \u003cem\u003eβ\u003c/em\u003e: standardized regression coefficient; \u003cem\u003eCI\u003c/em\u003e: confidence interval; \u003cem\u003eVIF\u003c/em\u003e: Variance inflation factor.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePathways of the Relationship among Psychological Resilience, Healthy Lifestyle, and Digital Health Literacy among Undergraduate Nursing Students\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTo meet the requirements of statistical analysis, the parceling method was used to combine multiple observed variables from the Healthy Lifestyle Scale into three new parcel indicators. This approach was adopted to reduce the number of model parameter estimates and improve model fit. The structural model was tested using maximum likelihood estimation, and the mediating effect was examined using the Bootstrap method. The model fit indices were as follows: \u003cem\u003eχ\u0026sup2;/df\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.195, RMSEA\u0026thinsp;=\u0026thinsp;0.020, GFI\u0026thinsp;=\u0026thinsp;0.987, AGFI\u0026thinsp;=\u0026thinsp;0.976, CFI\u0026thinsp;=\u0026thinsp;0.993, TLI\u0026thinsp;=\u0026thinsp;0.989, SRMR\u0026thinsp;=\u0026thinsp;0.027. The relationships and path coefficients among psychological resilience, healthy lifestyle, and digital health literacy are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eMediating Role of Healthy Lifestyle between Psychological Resilience and Digital Health Literacy\u003c/h2\u003e \u003cp\u003eSobel and Bootstrap tests were conducted to examine the direct, indirect, and total effects. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the Sobel test indicated that the indirect effect (Z\u0026thinsp;=\u0026thinsp;2.992, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), direct effect (Z\u0026thinsp;=\u0026thinsp;2.284, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and total effect (Z\u0026thinsp;=\u0026thinsp;6.094, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were all significant. This suggests that psychological resilience influences digital health literacy through its effect on healthy lifestyle. The Bootstrap test revealed that the direct effect of psychological resilience on healthy lifestyle was 0.408 (95% CI: 0.022, 0.292), and the total effect was 0.832 (95% CI: 0.217, 0.423). The indirect effect of psychological resilience on digital health literacy mediated by healthy lifestyle was 0.424 (95% CI: 0.079, 0.247). All paths were significant, indicating the robustness of the mediating model results.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSobel and Bootstrap tests for mediation models\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaths\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObserved_Coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSobel_Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSobel_P\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBootstrap_SE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBootstrap_P\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLLCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eULCI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.423\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: LLCI, lower level for confidence interval; ULCI, upper level for confidence interval.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe number of individuals using the internet to search for health-related information is on the rise. The ability to locate the best health information online, evaluate its quality, and subsequently utilize this information to advise on health decisions for patients is an essential skill in the nursing process [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Previous studies have demonstrated that medical students possess higher digital health literacy compared to students in non-medical fields [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. In this study, the digital health literacy of Chinese undergraduate nursing students was found to be at a moderate level. A substantial body of literature has identified that nursing students exhibit similar moderate digital health literacy skills as observed in this study [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDifferences in digital health literacy levels among college students of different genders have been noted. A cross-sectional survey study on the digital health literacy of German college students revealed that female students had lower digital health literacy across all subscales [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Further survey research on Slovenian college students indicated that female students reported lower digital health literacy in the subscales of information reliability evaluation and information searching [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. The results of the multiple linear regression analysis in this study also showed that male students had higher digital health literacy scores than female students. From a sociological perspective, the definitions and expectations of gender roles in sociocultural contexts significantly influence the behavioral norms of men and women in the use of technology and information acquisition. Traditional gender norms often dictate that men should be self-reliant, determined, and emotionally restrained, whereas women are expected to be emotionally perceptive, empathetic, caring, and engaged in supportive roles [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. This socialization process encourages men to participate more actively in activities related to technology and information technology, thereby becoming more proficient in using electronic devices and obtaining information. Evolutionary psychology theory further elucidates the origins of gender cognitive differences, suggesting that the different environmental pressures faced by men and women during evolution have led to differences in cognitive abilities [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Traditionally, men have shouldered more technical and decision-making responsibilities, which may result in better spatial abilities and systematic information processing skills in men. These abilities facilitate more effective utilization of digital health tools.\u003c/p\u003e \u003cp\u003eUndergraduate nursing students with excellent academic performance have higher digital health literacy, which is consistent with Kim\u0026rsquo;s study [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Superior academic performance typically reflects a solid foundation in professional knowledge and critical thinking abilities. Nursing students need to translate nursing theory into practice, and those with better grades are able to integrate health knowledge more effectively and verify the reliability of information through digital tools. In recent years, the educational environment for college students has been rapidly changing due to the development of digital technology. Students are required to quickly master technological tools, and nursing students with excellent grades are usually able to adapt to such environments more rapidly [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Moreover, students with higher grades often exhibit stronger self-efficacy in their studies [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. This sense of self-efficacy is not only reflected in managing the course system, handling academic tasks, and interacting with teachers and students but also extends to the search, evaluation, and application of digital health information, thereby enhancing their efficiency in processing health information.\u003c/p\u003e \u003cp\u003eSelf-rated health, as one of the motivational factors for digital health literacy, refers to an individual\u0026rsquo;s comprehensive evaluation of their physical condition, psychological state, and social functioning [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Regarding the impact of self-rated health status on the digital health literacy of college students, different scholars have varying opinions [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. The results of this study show that the better the self-rated health status, the higher the level of digital health literacy, which is consistent with previous research findings [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. This may be because college students with better health status are usually more concerned about their own health. They are more proactive in searching for, accurately identifying, and consciously practicing digital health information to enhance their health, thus possessing a higher level of digital health literacy. However, study] found through empirical surveys that there is no significant association between self-rated health status and digital health literacy among Israeli adults [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. A study also indicated that health status does not significantly affect the level of digital health literacy [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. These contradictory results suggest that the relationship between self-rated health and digital health literacy may vary depending on the population and context, and further research is urgently needed to clarify the underlying mechanisms.\u003c/p\u003e \u003cp\u003eThe direct positive impact of psychological resilience on digital health literacy indicates that psychological resilience, as an individual\u0026rsquo;s ability to cope with adversity and stress, is closely related to the ability to obtain and apply health information [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Individuals with high psychological resilience tend to exhibit stronger proactive learning and coping abilities when facing health issues, thereby directly promoting the enhancement of digital health literacy. Additionally, studies on COVID-19 survivors have shown that individuals with stronger psychological resilience are more proactive in obtaining health knowledge through digital channels after the pandemic, with a significantly greater increase in digital health literacy compared to those with lower resilience. This suggests that psychological resilience can enhance individuals\u0026rsquo; learning motivation in crisis situations and directly drive the development of digital health literacy [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMediation analysis further reveals that psychological resilience indirectly affects digital health literacy through a healthy lifestyle. A healthy lifestyle includes regular sleep patterns, balanced diets, and moderate exercise. Individuals with stronger psychological resilience are more inclined to maintain a healthy lifestyle, which helps improve their physical and mental states, enabling them to more effectively cope with external pressures and internal anxiety. This, in turn, makes them more willing to actively seek health information and apply it to improve their health status. Moreover, healthy behaviors themselves require continuous support from health information, thereby promoting individuals to frequently use digital tools to obtain knowledge [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Studies have shown that changes in health behaviors can significantly increase individuals\u0026rsquo; search frequency for precise health information [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. In the digital age, good living habits are often associated with more proactive health information search behaviors. Studies have shown that students who adhere to a healthy lifestyle are more likely to actively verify the scientific nature of health information [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAlthough this study provides important insights into the relationships among psychological resilience, healthy lifestyle, and digital health literacy, several limitations should be acknowledged. First, the study was conducted only among undergraduate nursing students at two universities in China. The geographical and institutional limitations of the sample restrict the generalizability of the results to all nursing schools or broader populations, potentially introducing sampling bias. Future research should validate the model\u0026rsquo;s applicability across different cultural and professional groups. Second, the cross-sectional design of this study, despite supporting the mediating pathways through statistical models, does not allow for the establishment of causal relationships between variables. Longitudinal tracking data would be beneficial for further verifying the direction of causality. Additionally, the measurement of digital health literacy relied on self-reported scales completed by students, reflecting their perceived levels rather than actual skills, which may deviate from their true digital health capabilities due to subjective bias. Future studies could incorporate objective behavioral data to enhance measurement accuracy. Moreover, although the model had a high explanatory power, approximately 54.9% of the variance remained unexplained, indicating the presence of important variables not included in the model. Lastly, this study treated healthy lifestyle as a single variable, simplifying its complexity and potentially obscuring the differential mediating effects of specific dimensions. Subsequent research should disaggregate these dimensions and explore variations in relationships across different contexts to more comprehensively promote students\u0026rsquo; digital health literacy and nursing education development.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found that psychological resilience not only directly predicts digital health literacy positively but also indirectly enhances digital health literacy by promoting the formation of a healthy lifestyle. This finding challenges the traditional linear model of digital health literacy that unidirectionally drives behavior and psychology, and for the first time, it validates the mechanism by which psychological resilience affects digital health literacy through a healthy lifestyle. This study enriches the understanding of the relationship among the three factors. It suggests that nursing educators should develop multidimensional intervention strategies to enhance the core competence of nursing students in the digital healthcare environment through the synergistic mechanism of psychological resilience training and healthy behavior guidance.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eImplications for nursing education\u003c/h2\u003e \u003cp\u003eThis study underscores the pivotal role of psychological resilience and healthy lifestyle behaviors in shaping the digital health literacy of undergraduate nursing students, offering novel insights for nursing education. Educators should integrate psychological resilience training into the nursing curriculum to bolster students' ability to cope with academic and clinical stress. Techniques such as mindfulness, stress management workshops, and resilience-building exercises can equip students with the mental fortitude needed to navigate the complexities of modern healthcare. Moreover, promoting a healthy lifestyle among nursing students is crucial. Educators can design programs that encourage regular physical activity, balanced nutrition, and adequate sleep, recognizing that these behaviors not only enhance overall well-being but also indirectly boost digital health literacy. Interactive sessions on the importance of a healthy lifestyle and its link to effective digital health information management can further reinforce this connection. Innovatively, nursing schools could leverage digital platforms to deliver tailored interventions that combine resilience training and health promotion. Mobile apps and online modules could provide students with accessible resources to support their mental and physical health, while fostering their digital literacy skills. By addressing both psychological and lifestyle factors, nursing education can holistically prepare students to excel in the digital health landscape, ultimately enhancing patient care and advancing the nursing profession.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our sincere thanks to the 500 undergraduate nursing students who participated in this survey, as your support was crucial to the conduct of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQin Lin, Di Dong, Pei Chen, Kun Sun, Qin Guo, and Linfeng Liu contributed to the conception of the study and the preparation of the manuscript, encompassing the initial draft, subsequent revisions, and the final version. Pei Chen, Kun Sun, and Qin Guo undertook the tasks of data collection, management, and analysis. Mengxue Fu, Bin Cao, Jijun Wu, and Zhixian Feng provided guidance on the conceptual framework, methodological approach, analytical support, and critical review of the study. All authors reviewed and endorsed the final manuscript prior to submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the 2024 Zhejiang Shuren University Teaching Reform Project (Grant Number: jg2024010).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Medical Ethics Committee of Sichuan Nursing Vocational College under approval number 2023010. The study adhered to the ethical guidelines outlined in the Helsinki Declaration. All participants were fully informed about the study and provided their consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTanaka J, Kuroda H, Igawa N, Sakurai T, Ohnishi M. Perceived eHealth literacy and learning experiences among Japanese undergraduate nursing students: a cross-sectional study. CIN: Comput Inform Nurs. 2020;38(4):198\u0026ndash;203.\u003c/li\u003e\n\u003cli\u003eDaraz L, Morrow AS, Ponce OJ, Beuschel B, Farah MH, Katabi A, et al. Can patients trust online health information? A meta-narrative systematic review addressing the quality of health information on the internet. 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Int J Environ Res Public Health. 2022;19(6):3676.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nursing, College students, Psychological resilience, Digital health literacy, Healthy lifestyle, Mediating effect","lastPublishedDoi":"10.21203/rs.3.rs-6556958/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6556958/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDigital health literacy plays a crucial role in personal health management, as it enables individuals to filter and obtain appropriate, accurate information and useful health services from a multitude of options. Nursing students are the future backbone of the healthcare industry. Psychological resilience, as a stable intrinsic psychological trait, may potentially influence digital health literacy by affecting individuals\u0026rsquo; choices regarding a healthy lifestyle. The pathways and magnitude of this effect remain to be empirically tested. This study aims to investigate the impact of psychological resilience on digital health literacy among Chinese undergraduate nursing students and to explore the mediating role of healthy lifestyle in this relationship.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study employed a descriptive cross-sectional design. From June to October 2023, we conducted a survey among eligible Chinese undergraduate nursing students using the Psychological Resilience Scale, the College Student Digital Health Literacy Scale, and the Healthy Lifestyle Scale.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThis study elucidated the impact mechanism of digital health literacy among Chinese undergraduate nursing students through multiple linear regression analysis and mediation model testing. Multiple linear regression revealed that gender, academic performance, physical fitness, psychological resilience, and healthy lifestyle were significant predictors of digital health literacy, accounting for 45.1% of the variance in digital health literacy (adjusted R\u0026sup2; = 43.7%). Sobel test results showed that the indirect effect (Z\u0026thinsp;=\u0026thinsp;2.992, P\u0026thinsp;=\u0026thinsp;0.003), direct effect (Z\u0026thinsp;=\u0026thinsp;2.284, P\u0026thinsp;=\u0026thinsp;0.022), and total effect (Z\u0026thinsp;=\u0026thinsp;6.094, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were all significant. Bootstrap analysis indicated that the direct effect of psychological resilience on healthy lifestyle was 0.408 (95% CI: 0.022, 0.292), the total effect on digital health literacy was 0.832 (95% CI: 0.217, 0.423), and the indirect effect mediated by healthy lifestyle was 0.424 (95% CI: 0.079, 0.247), with all paths being significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe development of digital health literacy among nursing students requires a comprehensive intervention that addresses both psychological resilience and healthy lifestyle. It is recommended that psychological resilience training and healthy lifestyle guidance be integrated into the curriculum to systematically enhance the digital health competence of the future nursing workforce.\u003c/p\u003e","manuscriptTitle":"The correlation between psychological resilience and digital health literacy of undergraduate nursing students: the mediating role of healthy lifestyle","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 07:21:05","doi":"10.21203/rs.3.rs-6556958/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2ba232bf-cc56-46ee-b9ee-a1f1bc75372a","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T05:39:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-09 07:21:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6556958","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6556958","identity":"rs-6556958","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}