The Impact of E-Health Literacy on Perceived Access to Healthcare Services: A Cross-Sectional Study Among Health Sciences Students in Istanbul, Turkey

<title>Abstract</title> <p>Background The rapid digitalization of healthcare delivery has elevated e-health literacy to a critical competency for navigating modern health systems. Despite growing scholarly attention, evidence linking e-health literacy to perceived healthcare access among health sciences students — who represent the future healthcare workforce — remains limited, particularly in the Turkish context. This study examined the structural effect of e-health literacy on perceived access to healthcare services among health sciences students in Istanbul. Methods A quantitative cross-sectional study was conducted with 500 health sciences students from six universities in Istanbul, Turkey (ethics approval: Meeting No: 2026/02; Decision Date: 06 February 2026). The eHealth Literacy Scale (eHEALS) and a 23-item Perceived Access to Healthcare Services Scale (four dimensions: Accessibility, Acceptability, Accommodation, Affordability) were administered via structured questionnaire. Common method bias was assessed using Harman's single-factor test. Confirmatory Factor Analysis (CFA) and second-order Structural Equation Modeling (SEM) were performed in LISREL 9.3. Discriminant validity was evaluated through both the Fornell–Larcker criterion and Heterotrait–Monotrait (HTMT) ratios. Results Harman's single-factor test yielded a largest component of 15.72% of total variance, well below the 25% common method bias threshold. The structural model demonstrated good fit (χ²/df = 1.97; RMSEA = 0.051; CFI = 0.96; TLI = 0.95; SRMR = 0.047). E-health literacy exerted a significant positive effect on perceived healthcare access (β = 0.62, p &lt; 0.001, R² = 0.38). The Acceptability (λ = 0.92) and Accommodation (λ = 0.90) dimensions contributed most strongly to the higher-order access construct. All HTMT ratios fell below 0.60, confirming discriminant validity. Conclusions Higher e-health literacy is positively associated with more favorable perceptions of healthcare access among health sciences students. Integrating structured digital health competency training into health sciences curricula may strengthen future professionals' engagement with health systems and reduce digital health inequities. Longitudinal and cross-cultural replication studies are warranted.</p>