eHealth literacy and decisional conflict in patients with coronary heart disease: chain mediation of cyberchondria and psychological inflexibility and a latent profile analysis.
Huang Y, She T, et al. • Frontiers in public health • 2026
eHealth literacy was significantly and negatively associated with decisional conflict in patients with coronary heart disease, mediated by cyberchondria and psychological inflexibility, and two latent subgroups of eHealth literacy were identified with significant differences in decisional conflict, cyberchondria, and psychological inflexibility.
Key Findings
Results
eHealth literacy was significantly and negatively associated with decisional conflict in patients with coronary heart disease.
A cross-sectional design was employed with patients recruited from tertiary Grade A hospitals.
The eHealth Literacy Scale and the Decisional Conflict Scale were among the instruments used.
Higher eHealth literacy corresponded with lower levels of decisional conflict in this CHD population.
The association suggests that patients better able to find and use online health information experience less uncertainty in treatment decisions.
Results
Cyberchondria and psychological inflexibility jointly mediated the relationship between eHealth literacy and decisional conflict in a chain-mediation pathway.
The study tested a chain-mediation model in which eHealth literacy influenced decisional conflict through sequential effects on cyberchondria and then psychological inflexibility.
Cyberchondria was measured using the Cyberchondria Severity Scale.
Psychological inflexibility was measured using the psychological inflexibility subscale of the Multidimensional Psychological Flexibility Inventory.
The findings elucidate psychological pathways through which eHealth literacy shapes treatment decision-making.
Results
Latent profile analysis identified two distinct subgroups of eHealth literacy among CHD patients: a high eHealth literacy profile and a low eHealth literacy profile.
A person-centered analytic approach (latent profile analysis) was used to identify subgroups.
Two profiles were extracted from the data: a high eHealth literacy profile and a low eHealth literacy profile.
This person-centered perspective complements the variable-centered mediation analyses.
The identification of two profiles supports the use of heterogeneity-informed, tailored clinical interventions.
Results
The two latent eHealth literacy profiles differed significantly in decisional conflict, cyberchondria, and psychological inflexibility.
One-way analysis of variance (ANOVA) was used to compare the profiles on outcome variables.
The optimal latent profiles differed significantly in decisional conflict, cyberchondria, and psychological inflexibility.
These differences indicate that profile membership is meaningfully associated with the key psychological and decisional variables examined.
Patients in the low eHealth literacy profile presumably experienced higher decisional conflict, cyberchondria, and psychological inflexibility relative to the high eHealth literacy profile.
Background
Coronary heart disease management requires patients to make complex, preference-sensitive treatment decisions, and decisional conflict in this population adversely affects treatment adherence and outcomes.
CHD is described as the leading cause of cardiovascular mortality worldwide.
Decisional conflict is characterized as common in this population.
The association between eHealth literacy and decisional conflict and the underlying psychological mechanisms were previously unclear.
The study was designed to identify priority targets for interventions addressing decisional conflict in CHD patients.
What This Means
This research suggests that when people with coronary heart disease are better at finding, understanding, and using health information online (higher eHealth literacy), they tend to feel less uncertain and conflicted about their medical treatment decisions. The study surveyed patients at major hospitals and found a clear link between these two factors. Importantly, the research also uncovered two psychological steps that help explain why this connection exists: patients with lower eHealth literacy are more prone to health anxiety triggered by online searching (cyberchondria), which in turn makes them more psychologically rigid and less able to adapt their thinking (psychological inflexibility), ultimately leading to greater difficulty making treatment decisions.
The researchers also used a statistical technique called latent profile analysis to sort patients into groups based on their eHealth literacy patterns. They found two distinct groups — those with high eHealth literacy and those with low eHealth literacy — and confirmed that these groups differed meaningfully in how much decisional conflict, health-related internet anxiety, and psychological inflexibility they experienced. This person-centered approach highlights that CHD patients are not all the same and that tailored interventions may be more effective than one-size-fits-all approaches.
This research matters because treatment decisions for coronary heart disease are complex and consequential, and patients who feel uncertain or conflicted about their options may be less likely to follow through with recommended treatments. By identifying cyberchondria and psychological inflexibility as the pathways connecting internet health literacy to decisional conflict, this study points toward specific targets — such as helping patients develop healthier online health-seeking habits and greater mental flexibility — that could be addressed in clinical settings to support better decision-making among heart disease patients.
Huang Y, She T, Gao P, Zhang P, Cai Y, Zeng G, et al.. (2026). eHealth literacy and decisional conflict in patients with coronary heart disease: chain mediation of cyberchondria and psychological inflexibility and a latent profile analysis.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1964166