Testing the mediating effect of risk perception on the relationship between e-health literacy and infectious disease prevention behaviors among young adults based on the IMB model

Background This study aimed to investigate the influence of e-health literacy on infectious disease prevention behaviors among young adults in their 20s and 40s based on the information–motivation–behavioral skills model and to test the mediating effect of infectious disease risk perception on this relationship. Methods This cross-sectional survey study included young adults aged 20–40 years recruited through anonymous snowball sampling using online communities and social media. Variables were measured using the Korean version of the K-eHealth Literacy Scale, infectious disease risk perception, and self-reported infectious disease prevention behaviors. Data were analyzed using descriptive statistics, t -tests, and Pearson’s correlation analysis, and the mediating effect of infectious disease risk perception was tested using Hayes’ PROCESS macro (Model 4). Results The mean of the main variables in this study was 3.55 for e-health literacy, 3.09 for risk perception, and 3.99 for preventive behaviors. Correlation analysis showed that preventive behaviors were significantly positively related to e-health literacy ( r = 0.22, p 0.001) and risk perception ( r = 0.40, p 0.001), and that e-health literacy was significantly positively related to risk perception ( r = 0.22, p 0.001). Preventive behaviors differed significantly according to sex, employment status, diagnosis experience, and quarantine experience. In the regression analysis, e-health literacy had a significant effect on risk perception ( B = 0.120, p = 0.005) and in its total effect on preventive behaviors ( B = 0.103, p = 0.041). However, after controlling for risk perception, the direct effect of e-health literacy was not significant ( B = 0.055, p = 0.255), and only risk perception had a significant effect on preventive behaviors ( B = 0.401, p 0.001). A significant indirect effect of e-health literacy on preventive behaviors was confirmed by the mediation analysis ( B = 0.048, 95% confidence interval 0.016, 0.086) and a full mediation effect of risk perception. Conclusion e-health literacy education alone is insufficient, and interventions that combine accurate risk communication and perception enhancement are needed. Tailored programs that consider life contexts, such as the workplace, may be effective in improving preventive behaviors among young adults.