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Cited by 78Health Literacy and Information AccessibilityCommunication and COVID-19 ImpactE-Learning and COVID-19

Digital health literacy, online information-seeking behaviour, and satisfaction of Covid-19 information among the university students of East and South-East Asia

Open access
Htay, Mila Nu Nu, Parial, Laurence Lloyd, Tolabing, Ma. Carmen, Dadaczynski, Kevin, Okan, Orkan, Leung, Angela Yee Man, Su, Tin Tin·2022·PLOS ONE
DOI 10.1371/journal.pone.0266276PMC PMC9007389
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Abstract

During the COVID-19 pandemic, there is a growing interest in online information about coronavirus worldwide. This study aimed to investigate the digital health literacy (DHL) level, information-seeking behaviour, and satisfaction of information on COVID-19 among East and South-East Asia university students. This cross-sectional web-based study was conducted between April to June 2020 by recruiting students from universities in China, Malaysia, and the Philippines. University students who have Internet access were invited to participate in the study. Items on sociodemographic variables, DHL, information-seeking behaviour, and information satisfaction were included in the questionnaire. Descriptive statistics and logistic regression analysis were conducted. A total of 5302 university students responded to the survey. The overall mean score across the four DHL subscales was 2.89 (SD: 0.42). Search engines (e.g., Google, Bing, Yahoo) (92.0%) and social media (88.4%) were highly utilized by the students, whereas Websites of doctors or health insurance companies were of lower utilization (64.7%). Across the domains (i.e., adding self-generated content, determining relevance, evaluating reliability, and protecting privacy) higher DHL was positively associated with higher usage of trustworthy resources. Providing online information on COVID-19 at official university websites and conducting health talks or web-based information dissemination about the strategies for mental health challenges during pandemic could be beneficial to the students. Strengthening DHL among university students will enhance their critical thinking and evaluation of online resources, which could direct them to the quality and trustworthy information sources on COVID-19.

AI snapshot

Written from the paper’s full text.

TL;DR

This cross-sectional survey of 5,302 university students in China, Malaysia, and the Philippines found moderate digital health literacy (DHL) and high use of search engines and social media for COVID-19 information. Higher DHL skills, especially information searching and evaluating reliability, were associated with greater use of trustworthy sources and higher satisfaction with online COVID-19 information.

Key findings

  • The overall mean DHL score across four subscales was 2.89 (SD = 0.42); country means were 2.89 (SD = 0.43) for China, 2.88 (SD = 0.43) for the Philippines, and 2.93 (SD = 0.40) for Malaysia.
  • Search engines (92.0%) and social media (88.4%) were the most highly utilized online sources, while websites of doctors or health insurance companies had lower utilization (64.7%).
  • The most searched COVID-19 topics were current spread of the coronavirus (91.2%), symptoms (83.8%), and individual protective measures (70.1%); only 39.1% searched for information on dealing with psychological stress.
  • About 61% reported being satisfied or very satisfied with COVID-19 information; DHL information searching (AOR = 1.83–1.98) and evaluating reliability (AOR = 1.41–3.23) were significantly associated with better information satisfaction across countries.

Methods

  • Web-based cross-sectional study conducted 12 April to 09 June 2020 among university students in China, Malaysia, and the Philippines, recruited from 80 universities via emails and social networking sites; 5,302 students responded.
  • DHL was measured with 15 items from the Digital Health Literacy Instrument covering five domains: information searching, adding self-generated content, evaluating reliability, determining relevance, and protecting privacy; information-seeking sources and topics and satisfaction with COVID-19 information were also assessed.
  • Descriptive statistics and binary logistic regression were used to examine associations between DHL and trustworthy source use and predictors of information satisfaction, adjusted for age, gender, country, study program, study level, and financial support.

Limitations

  • The authors state the cross-sectional design could not capture changes in DHL and information satisfaction over time.
  • The authors state the sample was self-selective and based on convenience sampling, limiting generalizability; data were collected in English except in China, possibly limiting participation of students not fluent in English; and findings may not generalize to people with lower educational attainment or other groups such as the elderly.
  • Evident from the text: the privacy subscale was excluded from the overall DHL mean because its items were not applicable to all respondents, and some variables had missing values (e.g., gender 0.8%, study programme 0.4%).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0266276

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

71 of 93 cited sources checked · 39 supported · 2 flagged · accuracy not yet measured

  • Premisecitation

    In Malaysia, 80.5% had adequate knowledge about COVID-19 during the early phase of the pandemic.

    “In Malaysia, a high level of adequate knowledge could be found for 80.5%, however, the actual behavioural practice of wearing facemask was less common (51.2%) during the early phase of pandemic [34].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [34] AA Azlan, 2020, Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia., PLoS One source

      The Results (Assessment of knowledge) identify 80.5% as the overall correct-answer rate, not the percentage of participants with adequate knowledge. They report that 77.2% scored above 10, representing an acceptable level of knowledge. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Interpretationown data

    The internal consistency of all scales included in the study was acceptable to good.

    “These findings suggested an acceptable to good internal consistency of all the scales included in this study [39].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [39] KS Taber, 2018, The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education., Research in Science Education source
  • Premisecitation

    This topic was the uncommon with lowest frequency of search that could be found university students in Vietnam.

    “This topic was the uncommon with lowest frequency of search that could be found university students in Vietnam [41].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [41] LHT Nguyen, 2021, Digital Health Literacy About COVID-19 as a Factor Mediating the Association Between the Importance of Online Information Search and Subjective Well-Being Among University Students in Vietnam., Front Digit Health. source
  • Premisecitation

    During the COVID-19 pandemic, information satisfaction was reported in approximately half of participants in Mainland China, Hong Kong, Macau, and Vietnam.

    “During the COVID-19 pandemic, information satisfaction was reported approximately in half of the participants in Mainland China, Hong Kong, Macau, and Vietnam [35, 41].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [35] PPK Kor, 2021, Are People With Chronic Diseases Satisfied With the Online Health Information Related to COVID-19 During the Pandemic?, J Nurs Scholarsh. source

      The Discussion (p. 17) reports that less than 50% of respondents were satisfied with the information. The study’s sample was from mainland China, Hong Kong, and Macau (Design, Data Collection, and Participants, p. 8); this source does not provide a finding for Vietnam. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [41] LHT Nguyen, 2021, Digital Health Literacy About COVID-19 as a Factor Mediating the Association Between the Importance of Online Information Search and Subjective Well-Being Among University Students in Vietnam., Front Digit Health. source
  • Premisecitation

    In Malaysia, 51.2% reported wearing facemask during the early phase of the pandemic.

    “In Malaysia, a high level of adequate knowledge could be found for 80.5%, however, the actual behavioural practice of wearing facemask was less common (51.2%) during the early phase of pandemic [34].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [34] AA Azlan, 2020, Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia., PLoS One source
  • Classified as probably not a substantial claim. 59
  • May combine two claims. 13
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Thailand, 48.7% of patients, caregivers, and general population had limited health literacy.

    “Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
    Quote in the paperNot a substantial claim3 of 5 sources checked
    • cites [21] HK Chan, 2015, Exploring health literacy and difficulty in comprehending pediatric medication labels among caregivers in Malaysia: a pilot study. source
    • cites [22] E Azreena, 2016, Factors associated with health literacy among Type 2 Diabetes Mellitus patients attending a government health clinic, 2016., International Journal of Public Health and Clinical Sciences.

      The Results in the ABSTRACT (p. 1) report 85.8% limited health literacy among type 2 diabetes patients, not the quoted 48.7% in Thailand. Searches for “Thailand” and “48.7” found no passage addressing the Thai figure, so this copy cannot verify that claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [23] XH Zhang, 2009, The impact of health literacy on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases., Value Health source

      The Subjects and Study Design section (pp. 106–109) places the study in Singapore, not Thailand. Subject Characteristics reports low health literacy in 87 of 199 patients (43.7%), not 48.7% among patients, caregivers, and the general population. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [24] P Wannasirikul, 2016, Health Literacy, Medication Adherance, and Blood Pressure Level among Hypertensive Older Adults Treated at Primary Health Care Centers, Southeast Asian J Trop Med Public Health
    • cites [25] WM Oo, 2015, Status and determinants of health literacy: a study among adult population in selected areas of Myanmar., International Journal of Community Medicine and Public Health source

      The Methods describe a household sample of adults in Myanmar, and the Results report 28.2% with poor health literacy there. A search for Thailand and 48.7% found no passage in our copy reporting the claimed Thai figure or population. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Germany in Spring 2020, half of the adult population (50.1%) had problematic or inadequate health literacy.

    “A recent study on coronavirus-specific health literacy conducted in Germany in Spring 2020 reported that half of the adult population (50.1%) had problematic or inadequate health literacy [14].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] O Okan, 2020, Coronavirus-Related Health Literacy: A Cross-Sectional Study in Adults during the COVID-19 Infodemic in Germany., Int J Environ Res Public Health source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Exposure to misinformation negatively influenced compliance with COVID-19 prevention guidelines and willingness to receive vaccination in five Western countries.

    “Another study conducted in five Western countries, including the U.K., Ireland, USA, Spain, and Mexico, reported that exposure to misinformation negatively influenced the people’s compliance with COVID-19 prevention guidelines and their willingness to receive vaccination for themselves and recommend it for other vulnerable people [15].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] J Roozenbeek, 2020, Susceptibility to misinformation about COVID-19 around the world., R Soc Open Sci source

      The Introduction (page unavailable) names the five countries, and the Results and Discussion (pages unavailable) link greater susceptibility to misinformation with lower self-reported compliance and lower willingness to receive or recommend vaccination. The study measured belief in misinformation, not exposure to it; its regression results do not establish that exposure caused those outcomes. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Germany, 47.8% of adults experienced difficulties judging the trustworthiness of information from (online) media.

    “Moreover, 47.8% of adults were found to experience difficulties judging the trustworthiness of information from (online) media [14].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] O Okan, 2020, Coronavirus-Related Health Literacy: A Cross-Sectional Study in Adults during the COVID-19 Infodemic in Germany., Int J Environ Res Public Health source

      The Discussion (§4.2) reports that 47.8% of participants found it difficult or very difficult to judge whether they could trust media information on the coronavirus. The cited sentence gives the correct percentage but omits the coronavirus-specific scope, making the finding sound applicable to media information generally. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Students in Slovenia faced difficulties in accessing the reliability of online information.

    “Similarly, students in Slovenia faced difficulties in accessing the reliability of the online information [20].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] M Vrdelja, 2021, Facing the Growing COVID-19 Infodemic: Digital Health Literacy and Information-Seeking Behaviour of University Students in Slovenia., Int J Environ Res Public Health source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    DHL varies among people depending on literacy levels, socioeconomic status, presenting health issues, motivation to seek online information, and familiarity with technology and electronic gadgets.

    “DHL varies among people depending on their literacy levels and socioeconomic status, presenting health issues, motivation to seek online information, and familiarity with technology and electronic gadgets [11, 13].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [11] CD Norman, 2006, eHealth Literacy: Essential Skills for Consumer Health in a Networked World., J Med Internet Res source

      The Lily Model section says eHealth literacy is influenced by a person’s presenting health issue, educational background, health status, motivation for seeking information, and technologies used. The Access Barriers and Computer Literacy sections also discuss literacy, income, and access to technology, but the paper does not specifically establish socioeconomic status as a determinant of eHealth literacy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [13] C Stormacq, 2019, Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review., Health Promot Int source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is rapid amplification of both accurate and inaccurate information on digital platforms worldwide.

    “In addition to the physical health impacts of COVID-19, there is a rapid amplification of both accurate and inaccurate information on digital platforms worldwide [3].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [3] J. Zarocostas, 2020, How to fight an infodemic, Lancet source

  • May combine two claims.

    Premisecitation

    During the COVID-19 pandemic, university students face psychological impact threatening their health and well-being and experience challenges when seeking reliable online information.

    “During the COVID 19 pandemic, university student population is facing psychological impact threatening their health and well-being and at the same time they experience challenges when seeking reliable online information [18].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [18] RH Dodd, 2021, Psychological Wellbeing and Academic Experience of University Students in Australia during COVID-19, Int J Environ Res Public Health source

      The Results (section 3.3) report low or very low wellbeing in 65.3% of the surveyed Australian university students, supporting the psychological-wellbeing part of the claim. The Introduction mentions health information seeking as a topic of the wider collaboration, but the paper does not report that students had difficulty finding reliable online information; the online challenges it discusses concern learning. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    During the pandemic, frequent social media exposure was significantly associated with anxiety and depression.

    “During this pandemic, frequent social media exposure was significantly associated with anxiety and depression [17].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] J Gao, 2020, Mental health problems and social media exposure during COVID-19 outbreak., PLoS One source

      The Results sections “Anxiety and SME” and “Combination of depression and anxiety and SME” report significant positive associations with frequent social media exposure. But “Depression and SME” says the adjusted association with depression alone was statistically insignificant, so the claim overstates that part of the finding. Page numbers are unavailable in our copy. (LLM, conf=0.93)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The broad public reach of the Internet and social media favours the spread of rumours and dissemination of unreliable information.

    “The broad public reach of the Internet and social media favours the spread of rumours and dissemination of unreliable information [7].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [7] M Cinelli, 2020, The COVID-19 social media infodemic., Scientific Reports. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Approximately two-thirds of students in Australia have low or very low self-perceived psychological well-being.

    “A study among students in Australia revealed that approximately two-thirds of the students have low or very low self-perceived psychological well-being [18].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [18] RH Dodd, 2021, Psychological Wellbeing and Academic Experience of University Students in Australia during COVID-19, Int J Environ Res Public Health source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Malaysia, 94.2% of caregivers in 2015 had limited health literacy.

    “Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
    Quote in the paperNot a substantial claim3 of 5 sources checked
    • cites [21] HK Chan, 2015, Exploring health literacy and difficulty in comprehending pediatric medication labels among caregivers in Malaysia: a pilot study. source
    • cites [22] E Azreena, 2016, Factors associated with health literacy among Type 2 Diabetes Mellitus patients attending a government health clinic, 2016., International Journal of Public Health and Clinical Sciences.

      The Abstract (p. 1) reports limited health literacy in 85.8% of type 2 diabetes patients studied in 2016, which corresponds to a different figure in the citing sentence. Searches for “94.2%” and caregivers found no passage in our copy addressing the 2015 caregiver claim. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
    • cites [23] XH Zhang, 2009, The impact of health literacy on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases., Value Health source

      The Subjects and Study Design section describes patients with rheumatic diseases recruited in Singapore, not caregivers in Malaysia. Subject Characteristics reports 87 of 199 patients with low health literacy (43.7%). Our copy does not address the claimed 94.2% prevalence among Malaysian caregivers in 2015; searching for that figure and population found no matching passage. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [24] P Wannasirikul, 2016, Health Literacy, Medication Adherance, and Blood Pressure Level among Hypertensive Older Adults Treated at Primary Health Care Centers, Southeast Asian J Trop Med Public Health
    • cites [25] WM Oo, 2015, Status and determinants of health literacy: a study among adult population in selected areas of Myanmar., International Journal of Community Medicine and Public Health source

      The Results (Table 3) report 28.2% poor health literacy among participants in Myanmar, not 94.2% limited health literacy among Malaysian caregivers. Searches for “94.2% caregivers Malaysia 2015” and “Malaysian caregivers limited health literacy” found no passage addressing the Malaysian claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Health literacy is an important concept during the COVID-19 pandemic, when health information is available mostly in digital and online forms.

    “Health literacy is an important concept during the COVID-19 pandemic, when health information is available mostly in digital and online forms [12], while people need the skills to navigate these information environments and process and filter information to make health decisions.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] L Paakkari, 2020, COVID-19: health literacy is an underestimated problem, Lancet Public Health source

      In the main text (page not specified), the paper calls health literacy important for preventing communicable diseases during COVID-19 and discusses the need to acquire and use health information. It does not say that health information is available mostly in digital or online forms. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The protecting privacy subscale was excluded from the overall DHL mean score calculation because its items are not applicable to all respondents.

    “Subscale 5, “Protecting privacy”, was excluded in the overall DHL mean score calculation because the items in this subscale are not applicable to all respondents [4].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [4] R van der Vaart, 2017, Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills., J Med Internet Res. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    University students in Germany have difficulties finding correct information on specific health-related topics and evaluating the reliability of online information.

    “Dadaczynski et al. reported difficulties in finding the correct information on the specific health-related topics, evaluating the reliability of online information among university students in Germany [19].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [19] K Dadaczynski, 2021, Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study., J Med Internet Res source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Portuguese students with sufficient DHL skills in reliability and validity assessment were more likely to search public institution websites and health portals (Rosário et al., 2020).

    “Similar findings were reported by Rosário et al. (2020) were Portuguese students with sufficient DHL skills in the area of reliability and validity assessment were more likely to search on public institution websites and health portals [40].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [40] R Rosário, 2020, Associations between COVID-19-Related Digital Health Literacy and Online Information-Seeking Behavior among Portuguese University Students., Int J Environ Res Public Health source

      The Discussion reports that Portuguese students who searched public institution websites and health portals more often were more likely to have sufficient DHL for assessing information reliability. The Methods identify “evaluating reliability” and “determining relevance” as DHL dimensions, but not validity assessment; that part of the claim is unsupported. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent study assessed the pattern of information dissemination about COVID 19 in search engines and reported that Google, Bing search engines mainly disseminate information from the legacy media, government, and healthcare information.

    “A recent study assessed the pattern of information dissemination about COVID 19 in search engines and reported that Google, Bing search engines mainly disseminate information from the legacy media, government, and healthcare information [56].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [56] M Makhortykh, 2020, How search engines disseminate information about COVID-19 and why they should do better., The Harvard Kennedy School Misinformation Review. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among Filipino university students, social media was one of the main information sources.

    “Among Filipino university students, social media was one of the main information sources [32].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [32] JM Santiago, 2020, Knowledge about COVID-19 among university students before the implementation of the enhanced community quarantine in Philippines., International Journal of Public Health Science source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    During the early phase of the COVID-19 pandemic, knowledge on COVID-19 among Filipino students was average (63.83%) to good (23.08%).

    “During the early phase of COVID-19 pandemic, knowledge on COVID-19 among the Filipino students was average (63.83%) to good (23.08%) [32].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [32] JM Santiago, 2020, Knowledge about COVID-19 among university students before the implementation of the enhanced community quarantine in Philippines., International Journal of Public Health Science source

      Section 3.2 reports the exact figures: 63.83% of respondents had average knowledge and 23.08% had good knowledge. The study’s Abstract limits those findings to students at Nueva Ecija University of Science and Technology’s San Isidro Campus, rather than Filipino students generally. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Lower health-literate individuals are more likely to use less-reliable sources such as social media and blogs (Chen et al., 2018).

    “In their study, Chen et al. (2018) reported that lower health-literate individuals are more likely to use less-reliable sources, such as social media and blogs [57].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [57] X Chen, 2018, Health Literacy and Use and Trust in Health Information., J Health Commun. source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Protecting personal identity and privacy is essential in electronic health records and in joining online health-related groups, searching online information, and using health-related applications.

    “Protecting personal identity and privacy is essential in the electronic health record and in joining online health-related groups, searching online information, and health-related applications [58].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [58] X. Li, 2018, Understanding eHealth Literacy From a Privacy Perspective: eHealth Literacy and Digital Privacy Skills in American Disadvantaged Communities., American Behavioral Scientis. source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Evaluating online information for reliability, possible commercial bias, and consistency across different websites are essential skills within digital health literacy (DHL).

    “Evaluating online information with regard to its reliability, possible bias on commercial interest, and consistency in different websites are essential skills under the scope of DHL [4].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [4] R van der Vaart, 2017, Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills., J Med Internet Res. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    COVID-19 pandemic was reported to have a psychological impact on the students.

    “COVID-19 pandemic was reported to have a psychological impact on the students [51–53].”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [51] C Son, 2020, Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study., J Med Internet Res source
    • cites [52] M Irfan, 2020, The psychological impact of coronavirus on university students and its socio-economic determinants in Malaysia. source
    • cites [53] ML Tee, 2020, Psychological impact of COVID-19 pandemic in the Philippines., J Affect Disord source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Search engines and social media were commonly used by university students in Egypt and Vietnam.

    “Search engines and social media were commonly used by university students in Egypt and Vietnam [41, 43].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [41] LHT Nguyen, 2021, Digital Health Literacy About COVID-19 as a Factor Mediating the Association Between the Importance of Online Information Search and Subjective Well-Being Among University Students in Vietnam., Front Digit Health. source
    • cites [43] S Hassan, 2020, Online health information seeking and health literacy among non-medical college students: gender differences., Journal of Public Health. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Singapore, 43.7% of patients, caregivers, and general population had limited health literacy.

    “Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
    Quote in the paperNot a substantial claim3 of 5 sources checked
    • cites [21] HK Chan, 2015, Exploring health literacy and difficulty in comprehending pediatric medication labels among caregivers in Malaysia: a pilot study. source
    • cites [22] E Azreena, 2016, Factors associated with health literacy among Type 2 Diabetes Mellitus patients attending a government health clinic, 2016., International Journal of Public Health and Clinical Sciences.

      The Abstract (p. 1) reports 85.8% limited health literacy among type 2 diabetes patients attending a government clinic, not a Singapore prevalence estimate. Searches for “Singapore” and “43.7” found no passage in our copy addressing the claimed figure or population. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
    • cites [23] XH Zhang, 2009, The impact of health literacy on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases., Value Health source

      The Subject Characteristics section (pp. 106–109) reports that 87 of 199 Singapore patients with rheumatic diseases had low health literacy, which is 43.7%. The study did not sample caregivers or the general population, so it does not support applying that percentage to those groups. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [24] P Wannasirikul, 2016, Health Literacy, Medication Adherance, and Blood Pressure Level among Hypertensive Older Adults Treated at Primary Health Care Centers, Southeast Asian J Trop Med Public Health
    • cites [25] WM Oo, 2015, Status and determinants of health literacy: a study among adult population in selected areas of Myanmar., International Journal of Community Medicine and Public Health source

      The Results report 28.2% poor health literacy among participants in Myanmar, which corresponds to the Myanmar figure in the citing sentence. Our copy does not report a Singapore estimate of 43.7% or identify a Singapore population; searches for that figure and population found no supporting passage. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The DHL mean score among Vietnamese university students was 2.87.

    “Our finding was comparable with a study among Vietnamese university students, in that DHL mean score was 2.87 [41].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [41] LHT Nguyen, 2021, Digital Health Literacy About COVID-19 as a Factor Mediating the Association Between the Importance of Online Information Search and Subjective Well-Being Among University Students in Vietnam., Front Digit Health. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The DHL levels of university students in Portugal were above the third quartile of the scale.

    “findings from the Portuguese survey of the COVID-HL Network found that the DHL levels of university students in Portugal were above the third quartile of the scale [40].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [40] R Rosário, 2020, Associations between COVID-19-Related Digital Health Literacy and Online Information-Seeking Behavior among Portuguese University Students., Int J Environ Res Public Health source

      The Discussion (page not provided) says Portuguese university students tended to score mostly in the third and fourth quartiles of the DHL response range. That supports generally high scores, but not the more specific claim that their levels were above the third quartile. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Some proportion of students in Malaysia reported misconception regarding COVID-19 transmission, not following social distancing, and not practicing hand hygiene.

    “Some proportion of students in Malaysia also reported about misconception regarding COVID-19 transmission, not following the social distancing, and not practicing hand hygiene [31].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] ISA Rahim, 2021, Knowledge, Attitudes And Practices Towards COVID-19 among Medical Students in International Islamic University Malaysia: An Online Cross-Sectional Study., IIUM Medical Journal Malaysia source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Growing interest in the current COVID-19 pandemic and online information search about COVID-19 were reported in many countries in Asia, Europe, and the United States.

    “Similarly, the growing interest in the current COVID-19 pandemic and online information search about COVID-19 were reported in many countries in Asia, Europe, and the United States [16, 45–48].”
    Quote in the paperNot a substantial claim5 of 5 sources checked
    • cites [16] A Rovetta, 2020, COVID-19-Related Web Search Behaviors and Infodemic Attitudes in Italy: Infodemiological Study., JMIR Public Health Surveill. source
    • cites [45] U Venkatesh, 2020, Prediction of COVID-19 Outbreaks Using Google Trends in India: A Retrospective Analysis., Healthc Inform Res. source
    • cites [46] TS Higgins, 2020, Correlations of Online Search Engine Trends With Coronavirus Disease (COVID-19) Incidence: Infodemiology Study., JMIR Public Health Surveill. source

      The Methods (no page listed) describe COVID-19 search-trend data from China, Italy, Spain, and two US states; the Results report high search volumes in Italy, Spain, and the United States. This supports online interest across those regions, but the paper does not establish growing interest in many countries across Asia and Europe: its country-level regional analyses cover only China, Italy, and Spain. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [47] A Husnayain, 2020, Understanding the Community Risk Perceptions of the COVID-19 Outbreak in South Korea: Infodemiology Study., J Med Internet Res source

      The Results section reports surges in COVID-19 information searches in South Korea, supporting the claim for one Asian country. This paper does not establish that growing searches were reported in many countries across Asia, Europe, and the United States. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [48] A Rovetta, 2020, Global Infodemiology of COVID-19: Analysis of Google Web Searches and Instagram Hashtags., J Med Internet Res source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Greece, 85.4% were satisfied with the adequacy of health information on websites.

    “A study conducted in Greece with a national representative sample of 1277 adults demonstrated that 90% of the university students used the internet to seek health information and 85.4% were satisfied with the adequacy of the information on health issues by searching on websites, 61.2% on blogs and 34.2% on social networking sites [28].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [28] E. Simou, 2016, Health information sources: trust and satisfaction., International Journal of Healthcare source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A sufficient level of DHL in university students was reported in the German survey of the COVID-HL Network, which assessed DHL among 14,916 from 130 universities.

    “A sufficient level of DHL in university students was also reported in the German survey of the COVID-HL Network, which assessed DHL among 14,916 from 130 universities [19].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [19] K Dadaczynski, 2021, Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study., J Med Internet Res source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among people with chronic diseases in mainland China, Hong Kong and Macau, online information satisfaction during COVID-19 was related to DHL, online searching of COVID-19 symptoms, perceived importance of quickly learning from information search, and less frequent searches about dealing with psychological stress.

    “Among the people with chronic diseases in mainland China, Hong Kong and Macau, the online information satisfaction during COVID-19 was related to the DHL, online searching of COVID-19 symptoms, their perceived importance of quickly learning from the information search and less frequent searches about dealing with psychological stress [35].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [35] PPK Kor, 2021, Are People With Chronic Diseases Satisfied With the Online Health Information Related to COVID-19 During the Pandemic?, J Nurs Scholarsh. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Malaysia, 85.8% of type 2 diabetes mellitus patients in 2016 had limited health literacy.

    “Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
    Quote in the paperNot a substantial claim3 of 5 sources checked
    • cites [21] HK Chan, 2015, Exploring health literacy and difficulty in comprehending pediatric medication labels among caregivers in Malaysia: a pilot study. source
    • cites [22] E Azreena, 2016, Factors associated with health literacy among Type 2 Diabetes Mellitus patients attending a government health clinic, 2016., International Journal of Public Health and Clinical Sciences.

      The Abstract (p. 1) reports that 85.8% of respondents had limited health literacy. Its Materials and Methods section specifies that the respondents were 360 type 2 diabetes patients selected from one government health clinic in 2016; the result does not establish that percentage for type 2 diabetes patients across Malaysia. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [23] XH Zhang, 2009, The impact of health literacy on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases., Value Health source

      The Subjects and Study Design and Subject Characteristics sections (pp. 106–109) describe patients with rheumatic diseases in Singapore, not patients with type 2 diabetes in Malaysia. The paper supports the Singapore figure in the surrounding sentence (87 of 199 patients, or 43.7%), but a search for Malaysia, diabetes, and 85.8% found no passage addressing the attributed claim. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
    • cites [24] P Wannasirikul, 2016, Health Literacy, Medication Adherance, and Blood Pressure Level among Hypertensive Older Adults Treated at Primary Health Care Centers, Southeast Asian J Trop Med Public Health
    • cites [25] WM Oo, 2015, Status and determinants of health literacy: a study among adult population in selected areas of Myanmar., International Journal of Community Medicine and Public Health source

      The Results report 28.2% poor health literacy among adults in selected areas of Myanmar, matching a different part of the citing sentence. Searches for Malaysia, 85.8%, and type 2 diabetes patients found no passage in this paper addressing the quoted Malaysian claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Greece, 90% of university students used the internet to seek health information.

    “A study conducted in Greece with a national representative sample of 1277 adults demonstrated that 90% of the university students used the internet to seek health information and 85.4% were satisfied with the adequacy of the information on health issues by searching on websites, 61.2% on blogs and 34.2% on social networking sites [28].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [28] E. Simou, 2016, Health information sources: trust and satisfaction., International Journal of Healthcare source

      Section 3.1 reports that 90% of participants used the internet to seek health information, but this was a national sample of adults, not university students. The Methods give the sample size as 1,227, not 1,277; Table 1 does not report a separate rate for university students. The cited sentence’s website, blog, and social-networking satisfaction percentages do appear in Table 1 as overall figures. (LLM, conf=0.91)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Malaysia and the Philippines, the first wave of COVID-19 started in the first quarter of 2020.

    “In Malaysia and the Philippines, the first wave of COVID-19 started in the first quarter of 2020 [31, 32].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [31] ISA Rahim, 2021, Knowledge, Attitudes And Practices Towards COVID-19 among Medical Students in International Islamic University Malaysia: An Online Cross-Sectional Study., IIUM Medical Journal Malaysia source
    • cites [32] JM Santiago, 2020, Knowledge about COVID-19 among university students before the implementation of the enhanced community quarantine in Philippines., International Journal of Public Health Science source

      The paper states that the Philippines placed Luzon under enhanced community quarantine by March 2020 because of local COVID-19 transmission (Research Method, p. 423). That supports COVID-19 activity in the Philippines during the first quarter, but the paper does not identify when a first wave began or address Malaysia. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Myanmar, 28.2% of patients, caregivers, and general population had limited health literacy.

    “Previous studies in Southeast Asia reported a high prevalence of limited health literacy in Malaysia (94.2% among caregivers in 2015 and 85.8% among type 2 DM patients in 2016), while in the neighbour countries such as Singapore (43.7%), Thailand (48.7%) and Myanmar (28.2%) a lower percentage could be found among patients, caregivers, and general population [21–25].”
    Quote in the paperNot a substantial claim3 of 5 sources checked
    • cites [21] HK Chan, 2015, Exploring health literacy and difficulty in comprehending pediatric medication labels among caregivers in Malaysia: a pilot study. source
    • cites [22] E Azreena, 2016, Factors associated with health literacy among Type 2 Diabetes Mellitus patients attending a government health clinic, 2016., International Journal of Public Health and Clinical Sciences.

      The Abstract (p. 1) reports 85.8% limited health literacy among type 2 diabetes patients attending a government health clinic. Searches for Myanmar and 28.2% found no passage addressing the claimed Myanmar figure or population; the different figure for this study does not contradict a finding about Myanmar. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
    • cites [23] XH Zhang, 2009, The impact of health literacy on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases., Value Health source

      The Subjects and Study Design section describes patients with rheumatic diseases recruited in Singapore, and the Discussion reports 44% with inadequate health literacy in that study. A search for Myanmar and 28.2% found no passage addressing the claimed Myanmar prevalence or its stated population. This source appears to support the Singapore figure in the longer citing sentence, not the extracted Myanmar claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [24] P Wannasirikul, 2016, Health Literacy, Medication Adherance, and Blood Pressure Level among Hypertensive Older Adults Treated at Primary Health Care Centers, Southeast Asian J Trop Med Public Health
    • cites [25] WM Oo, 2015, Status and determinants of health literacy: a study among adult population in selected areas of Myanmar., International Journal of Community Medicine and Public Health source

      The Results report 28.2% with *poor* health literacy among adults sampled from households in selected areas of Myanmar. The Methods distinguish poor literacy from the 40.3% classified as intermediate, so the paper does not report 28.2% as the prevalence of limited health literacy overall. It does not identify the Myanmar sample specifically as patients or caregivers. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Individuals with sufficient skills in protecting privacy could reduce concern about sharing personal and health-related information, increase participation in online health activities, and better evaluate online resources' quality, credibility, and reliability.

    “Individuals with sufficient skills in protecting privacy could reduce the concern to share their personal information, health-related information, and increase participation in online health activities, and better evaluate the online resources’ quality, credibility, and reliability [4, 58].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [4] R van der Vaart, 2017, Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills., J Med Internet Res. source

      The Introduction describes protecting privacy when posting online and evaluating whether search results are reliable as digital health literacy skills. It does not say that privacy skills reduce concern about sharing personal or health information or increase participation in online health activities; the Discussion addresses the instrument’s measurement properties rather than those effects. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [58] X. Li, 2018, Understanding eHealth Literacy From a Privacy Perspective: eHealth Literacy and Digital Privacy Skills in American Disadvantaged Communities., American Behavioral Scientis. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The overall electronic health literacy among Taiwanese college students was reported to have medium and above.

    “Although a different measurement scale was utilized in another study by Luo et al. (2018), the overall electronic health literacy among Taiwanese college students was reported to have medium and above [42].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [42] YF Luo, 2018, Associations of eHealth Literacy With Health Services Utilization Among College Students: Cross-Sectional Study., J Med Internet Res source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Germany, lower health literacy level was associated with confusion on COVID-19 related information.

    “In Germany, a study of adults reported that lower health literacy level was associated with confusion on COVID-19 related information [14].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] O Okan, 2020, Coronavirus-Related Health Literacy: A Cross-Sectional Study in Adults during the COVID-19 Infodemic in Germany., Int J Environ Res Public Health source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In China, 56% of college students reported adequate knowledge about the COVID-19 disease and respective symptoms.

    “In China, 56% of college students reported the adequate knowledge about the COVID-19 disease and respective symptoms [33].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [33] R Jiang, 2020, Knowledge, attitudes and mental health of university students during the COVID-19 pandemic in China., Child Youth Serv Rev source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Dramatic increment of searching the topics about 'Coronavirus' or 'Pneumonia' on Google, Baidu Index, and Sina Weibo Index were observed in China at the beginning of the COVID-19 pandemic.

    “Dramatic increment of searching the topics about ‘Coronavirus’ or ‘Pneumonia’ on Google, Baidu Index, and Sina Weibo Index were observed in China at the beginning of the COVID-19 pandemic [44].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [44] C Li, 2020, Retrospective analysis of the possibility of predicting the COVID-19 outbreak from Internet searches and social media data, China, 2020., Euro Surveill. source

  • May combine two claims.

    Premisecitation

    Uncertainty of disease condition, rapid changes of recommendations, and amplification of information during the pandemic could lead to confusion, which in turn results in lower satisfaction.

    “Uncertainty of disease condition [59], rapid changes of recommendations [60], and amplification of information during the pandemic could lead to confusion, which in turn results in lower satisfaction.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [59] B Satici, 2020, Intolerance of Uncertainty and Mental Wellbeing: Serial Mediation by Rumination and Fear of COVID-19., Int J Ment Health Addict. source

      The Present Study section says that rapid information flow during COVID-19 leads to confusion and increased uncertainty, and that psychological wellbeing may deteriorate. The Discussion also links intolerance of uncertainty to poorer wellbeing. The paper does not establish that rapidly changing recommendations caused confusion or that confusion resulted in lower satisfaction; it addresses mental wellbeing rather than satisfaction. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [60] AL-y Chan, 2020, To wear or not to wear: WHO’s confusing guidance on masks in the covid-19 pandemic., The BMJ opinion

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    52.6% of the students were studying health science programmes.

    “Among them, 52.6% were studying health science programmes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Approximately 75% of the university students were female.

    “The mean age of university students was 21.8 (SD = 4.01) years and approximately 75% were female.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of students were studying at an undergraduate level (84.1%).

    “The majority of the students were studying at an undergraduate level (84.1%) and most of them were financially supported by their parents (85%).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    The highest DHL score was observed for the protecting privacy subscale across China, Malaysia, and the Philippines.

    “In the country specific analysis, the highest score was observed for the protecting privacy subscale across three countries (S1 Table).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most students were financially supported by their parents (85%).

    “The majority of the students were studying at an undergraduate level (84.1%) and most of them were financially supported by their parents (85%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The mean age of university students was 21.8 years (SD = 4.01).

    “The mean age of university students was 21.8 (SD = 4.01) years and approximately 75% were female.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The perceived importance of quality in internet information search was a significant predictor of information satisfaction in China and the Philippines, but not in Malaysia.

    “The perceived importance of quality in internet information search remained a significant predictor of information satisfaction, except for respondents from Malaysia (Table 4).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Adjustment for age, gender, country, study program, study level, and financial support is sufficient to control confounding in the association between DHL and information satisfaction.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    All VIF values were less than 10.

    “Predictor variables were tested for multicollinearity (all VIF < 10).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    False news spreads faster on social media such as Twitter than factual information.

    “A study conducted in the United States of America analysing tweets from 3 million people reported that false news spreads faster in social media such as Twitter than factual information [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] S Vosoughi, 2018, The spread of true and false news online, Science source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Ethical approval was granted from the Hong Kong Polytechnic University, Monash University, Melaka Manipal Medical College, and University of Santo Tomas-College of Nursing.

    “Ethical approval was granted from the Hong Kong Polytechnic University (Ref. No: HSEARS20200407001), Monash University (Project No: 24295), Melaka Manipal Medical College (Ref. No: 5/2020), and University of Santo Tomas–College of Nursing (Ref. No.: USTCON-2020-OR16).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Informed consent was obtained from university students before they took part in the online survey.

    “Before taking part in the online survey, informed consent was obtained from the university students by requiring them to press the consent button on the first page of the survey link, which contained information on the background and aims of the study, data protection and use as well as ethical information of this study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Higher engagement of false information was reported on Facebook just before the US presidential campaign.

    “Similarly, higher engagement of false information was reported on Facebook just before the US presidential campaign [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] C. Silverman, 2016

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Chinese version of the questionnaire was prepared using forward translation and back-translation.

    “The forward translation and back-translation method was used to prepare the Chinese version of the questionnaire [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] WHO, 2007

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Responses from minors (n = 49) were removed from the data analysis.

    “There were a few minors less than 18 years of age who completed the survey. Thus, we removed the responses from minors (n = 49) from the data analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Variance inflation factor (VIF) was assessed to check possible collinearity between independent variables.

    “To check possible collinearity between the independent variables, the variance inflation factor (VIF) was assessed.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Binary logistic regression was used to identify predictors of information satisfaction while controlling for age, gender, study program, study level, and financial support.

    “Binary logistic regression analysis was carried out to identify the predictors of information satisfaction while controlling for age, gender, study program, study level, and financial support of the university students.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    COVID-19 is a major global health challenge due to rapid transmission and disease uncertainty, particularly at the beginning of the pandemic.

    “The emergence of the novel coronavirus (COVID-19) is a major global health challenge due to the rapid transmission and disease uncertainty, particularly at the beginning of the pandemic [1, 2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] YT Xiang, 2020, Joint International Collaboration to Combat Mental Health Challenges During the Coronavirus Disease 2019 Pandemic., JAMA Psychiatry source
    • cites [2] M Bassetti, 2020, The novel Chinese coronavirus (2019-nCoV) infections: Challenges for fighting the storm., Eur J Clin Invest source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Valid and standardized data collection tools were used in this study.

    “Valid and standardized data collection tools were used in this study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There was no collinearity among the variables in the models.

    “There was no collinearity among the variables.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    All models in Table 4 were adjusted for age, gender, country, study program, study level, and financial support of the university students.

    “All models were adjusted for age, gender, country, study program, study level, and financial support of the university students.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Turkey, adolescent health literacy level was positively associated with health promoting behaviours and health responsibility.

    “In Turkey, the adolescent health literacy level was positively associated with their health promoting behaviours and health responsibility [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] FO Ozturk, 2020, Health Literacy and Health Promotion Behaviors of Adolescents in Turkey, J Pediatr Nurs source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The estimated statistical power in this study was high (99.99%).

    “Furthermore, the estimated power was high (99.99%) in this study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    DHL is a key concept for utilizing trustworthy online sources and achieving higher satisfaction with online information sources, which in turn could be beneficial in making appropriate health-related decisions.

    “Our study revealed that DHL is a key concept to utilize trustworthy online sources and to achieve higher satisfaction with online information sources, which in turn could be beneficial in making appropriate decisions related to their health.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Health literacy was positively linked with health awareness and satisfaction among 1055 Turkish adult patients at primary healthcare.

    “Furthermore, health literacy was found to be positively linked with health awareness and satisfaction among 1055 Turkish adult patients at primary healthcare [30].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Ö Örsal, 2019, Analysis of the relationship among health awareness and health literacy, patient satisfaction levels with primary care in patients admitting to primary care health centers., Patient Educ Couns. source

  • May combine two claims.

    Study design and conductreasoning

    The sample was self-selective based on convenience sampling, so generalization of the findings may be limited.

    “The sample is self-selective based on a convenient sampling method. Hence, the generalization of the findings might be limited.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Data were collected in English except in China, which may have limited participation of students not fluent in English.

    “We collected the data in the English language (except in China), which might limit the participation of students who are not fluent in English.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    As technology is used in various sectors in daily life, health literacy is extended as digital health literacy in the context of technology.

    “As technology is used in various sectors in daily life, health literacy is extended as digital health literacy in the context of technology [55].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] P Dunn, 2019, Technology approaches to digital health literacy., Int J Cardiol source
69 of 69

  • The paper relies on this without support.

    There is scarce information about DHL and information-seeking behaviours among young adults in Asia.

    “However, there is scarce information about these aspects among young adults in Asia.”

  • The paper relies on this without support.

    Little is known about information satisfaction on COVID-19 online information and its associated factors for university students from East and South-East Asia.

    “Little is known about the information satisfaction on COVID-19 online information and its associated factors for university students from East and South-East Asia.”

  • The paper relies on this without support.

    The overabundance of information during COVID-19 makes it more difficult to search for verified facts about COVID-19.

    “The overabundance of information, or the infodemic (short of ‘information epidemic’), is threatening to people, making it more difficult to search for verified facts about COVID-19.”

  • The authors state this as an assumption.

    Websites of public bodies, health portals, websites of doctors or health insurance companies, and news portals are trustworthy online information sources.

    “Websites of public bodies, health portals (such as respective country’s government health portals), websites of doctors or health insurance companies, news portals (such as newspapers and TV stations) were considered as trustworthy online information sources.”

  • The paper relies on this without support.

    Improving DHL in the population is one of the main pillars to combat the infodemic, which in turn could prevent the undesirable consequences of dis- and misinformation.

    “Improving the DHL in population is one of the main pillars to combat the infodemic, which in turn could prevent the undesirable consequences of dis- and misinformation.”

  • The paper relies on this without support.

    Adjustment for age, gender, country, study program, study level, and financial support is sufficient to control confounding in the association between DHL and information satisfaction.

    “All models were adjusted for age, gender, country, study program, study level, and financial support of the university students.”

  • The paper relies on this without support.

    This is the first multi-country study in East and South-East Asia to address the knowledge gap on DHL and information searching behaviour among university students during the COVID-19 pandemic.

    “To our knowledge, this is the first multi-countries study in East and South-East Asia to address the knowledge gap on the DHL and information searching behaviour among the university students during the COVID-19 pandemic.”

  • The paper relies on this without support.

    Awareness of mental wellbeing during the COVID-19 pandemic is limited.

    “Awareness on mental wellbeing during the pandemic is limited.”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Type II error probability does not match reported power

    Minor

    Power of 99.99% implies a Type II error probability of 0.0001 (or 0.01%), not the stated probability of 0.01 (1%).

  • Country-specific models said to adjust for country

    Minor

    Table 4 reports separate models for China, the Philippines, and Malaysia. Country cannot vary within any of those models, contrary to the statement that all models were adjusted for country.

  • Reported confidence interval excludes its odds ratio

    Minor

    For evaluating reliability and use of Chinese doctors' or insurance-company websites, the reported odds ratio is 1.67, but its stated confidence interval is 1.29-1.16. The interval is reversed and does not contain the estimate.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. C. Silverman, 2016, This Analysis Shows How Viral Fake Election News Stories Outperformed Real News On Facebook
  2. WHO, 2007, Process of translation and adaptation of instruments Geneva
  3. K Dadaczynski, 2020, Digitale Gesundheitskompetenz von Studierenden in Deutschland während der Corona-Pandemie. Ergebnisse einer bundesweiten Online-Befragung
  4. AL-y Chan, 2020, To wear or not to wear: WHO’s confusing guidance on masks in the covid-19 pandemic., The BMJ opinion

Cited by

Sorted by citations

Related

Authors
Htay, M. N. N., Parial, L. L., Tolabing, M. C., Dadaczynski, K., Okan, O., Leung, A. Y. M., & Su, T. T.
Affiliations
  • Manipal University College Malaysia (MY)
  • Hong Kong Polytechnic University (HK)
  • University of the Philippines Manila (PH)
  • Leuphana University of Lüneburg (DE)
  • Technical University of Munich (DE)
  • Monash University Malaysia (MY)
Corresponding author
Su, Tin Tin
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2022-04-13
Volume
17
Issue
4
Pages
e0266276
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0266276
PMC
PMC9007389
OpenAlex
W4224076430
Semantic Scholar
3d902a7c800a5213fc4c368b5be415d120b3c2e2
Cited by
78
References
59
Citations by year
2026: 17 · 2025: 16 · 2024: 18 · 2023: 19 · 2022: 8
FWCI
17.50
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Multilingual Matters (Channel View Publications) (publishedVersion, cc-by)
  • Monash University Research Portal (Monash University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
  • mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion, other-oa)
  • Greater South Information System
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
  • Social Sciences › Communication › Communication and COVID-19 Impact
  • Social Sciences › Education › E-Learning and COVID-19
Keywords
digital health literacy, COVID-19 information, information satisfaction, university students, social media use, search engines, information evaluation, privacy preservation, mental health during pandemic, East and Southeast Asia
MeSH terms
COVID-19, China, Cross-Sectional Studies, Humans, Personal Satisfaction, Surveys and Questionnaires, Students, Universities, Reproducibility of Results, Health Literacy, Information Seeking Behavior, Pandemics

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-11-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-11-04.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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