Associations of eHealth literacy, physical literacy and physical fitness among urban middle school students in Guiyang, China: a multi-school cross-sectional study.

Objective: To assess the overall levels, disparities, and interrelations of eHealth literacy and physical literacy among urban junior high school students in Guiyang, examine their associations with physical health status, and develop a multifactorial predictive model to inform evidence-based health promotion strategies targeting urban adolescents. Methods: A stratified cluster sampling method was used to recruit students from grades 7 to 9 in multiple urban junior high schools across Guiyang. The study employed a cross-sectional quantitative design incorporating structured questionnaires and standardized physical fitness assessments. Validated instruments-including an established eHealth Literacy Scale and a physical literacy assessment tool-were used alongside data derived from the National Student Physical Fitness Standards. Demographic and familial educational background data were also collected. Descriptive statistics, non-parametric analyses, Spearman partial correlation, and multivariate logistic regression were conducted to systematically explore the relationships among eHealth literacy, physical literacy, and physical health levels. Results: Urban junior high school students in Guiyang demonstrated generally above-average levels of eHealth literacy, though a substantial subset fell below the expected proficiency threshold. Statistically meaningful disparities in both eHealth and physical literacy were observed across gender, grade level, parental education, and the frequency of digital health information instruction provided by families and teachers ( Conclusion: The physical health of urban junior high school students in Guiyang is shaped not only by their physical literacy but also by their capacity to navigate and utilize digital health information. Higher levels of eHealth literacy may facilitate adolescents' ability to acquire and evaluate digital health information, which can further support the development of physical literacy and promote healthier behavioral patterns. Enhancing adolescent physical health therefore requires simultaneous investment in both digital health competencies and foundational physical literacy, supported by a coordinated framework across schools, families, and communities. This study elucidates the interactive dynamics among eHealth literacy, physical literacy, and physical health from an urban youth perspective, offering critical guidance for the design of localized digital health education, physical literacy enhancement, and integrated intervention strategies.