Digital Health Literacy and Attitudes Toward Telehealth Use in Practice Among Nursing Students in Saudi Arabia: Cross-Sectional Study

Clinical Snapshot

Key Findings

• P Value: P<.001 for digital health literacy; P=.03 for sex; academic year, telehealth workshops, and informatics courses were not statistically significant

• Effect Size: Adjusted odds ratio (AOR) 1.48 per unit increase in Digital Health Care Literacy Scale score; male sex associated with AOR 0.62 for positive attitudes compared to female students

• Primary Outcome: Digital health literacy as a predictor of positive attitudes toward telehealth use in clinical practice among nursing students

• Nnt Or Sensitivity: Not applicable for this cross-sectional association study; no NNT, sensitivity, or specificity reported. The OR of 1.48 per scale unit suggests a moderate association; absolute risk differences and number needed to educate are not calculable from reported data

• Confidence Interval: AOR 1.48 (95% CI 1.28–1.71) for digital health literacy; AOR 0.62 (95% CI 0.39–0.97) for male sex

Clinical Application

The study suggests that targeted digital health literacy interventions in nursing curricula may improve telehealth readiness. However, the null finding for existing workshops and informatics courses raises questions about the quality and intensity of current educational interventions rather than their inherent futility. Curriculum redesign would require institutional investment and faculty development. Australia has a well-developed telehealth infrastructure, significantly expanded post-COVID-19, with Medicare Benefits Schedule (MBS) telehealth item numbers now embedded in primary and specialist care. The Australian Digital Health Agency (ADHA) has published national digital health strategies emphasising workforce digital capability. RACGP and ANMF (Australian Nursing and Midwifery Federation) have both highlighted digital health literacy as a core competency for the nursing workforce. Australian nursing curricula, governed by ANMAC accreditation standards, increasingly incorporate digital health competencies. This Saudi study's findings — that formal coursework alone may be insufficient — resonate with Australian nursing education reform discussions. However, direct application of these findings to Australian nursing students is not warranted given the single-institution, culturally specific sample. TGA and PBS considerations are not directly relevant to this educational study. Undergraduate nursing students in Saudi Arabia; findings may have limited transferability to nursing students in other Middle Eastern, Asian, or Western contexts without replication. Not directly applicable to registered nurses in clinical practice.

Abstract

BACKGROUND: Nursing students are the future workforce, and their readiness to use digital health tools is important. Previous studies have focused on knowledge and attitudes; however, they have not examined the wide range of digital health literacy levels that may influence nursing students' attitudes toward using telehealth in clinical settings. OBJECTIVE: This study aimed to determine the relationship between nursing students' digital health literacy and their attitudes toward telehealth use in practice. METHODS: A cross-sectional design was used. The sample consisted of undergraduate nursing students enrolled in a Bachelor of Nursing program at a selected Saudi Arabian university. The online survey used 2 scales: the Digital Health Care Literacy Scale and the Nurses' Attitudes Toward Use of a Telehealth Scale. RESULTS: A total of 273 students participated (mean age 21.3, SD 1.9 years). Most of the nursing students demonstrated a high digital health literacy level (n=184, 67.4%; mean Digital Health Care Literacy Scale score 11.9 out of 15, SD 3.1). Digital health literacy was a significant predictor of positive attitudes toward telehealth use in practice (adjusted odds ratio 1.48, 95% CI 1.28-1.71; P<.001). Male students were significantly less likely to report positive attitudes than female students (adjusted odds ratio 0.62, 95% CI 0.39-0.97; P=.03). However, academic year, telehealth workshops, and informatics courses were not significantly associated with positive attitudes toward telehealth use in practice. CONCLUSIONS: Higher levels of literacy appear to correlate with more positive attitudes toward telehealth use in practice. However, current formal education and workshops had no apparent influence on digital health literacy. This suggests a potential need for strengthening digital training and development in nursing education. This may enhance telehealth readiness and support future digital health care delivery.

References

1. 1.Alharbi, M., Alharthi, A. S., Azab, A. A., & Alharthi, R. (2026). Digital health literacy and attitudes toward telehealth use in practice among nursing students in Saudi Arabia: Cross-sectional study. JMIR Nursing. https://doi.org/10.2196/94722