Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Lisa L. Heelan-Fancher

Second Advisor

Laura L. Hayman

Third Advisor

Ling L. Shi


The utilization of the internet for health-related intentions has witnessed a surge in recent times, primarily attributable to the progress and evolution of information and communication technology, as well as the emergence of social media platforms. The adoption and utilization of the internet for health information-seeking behaviors, health literacy, and self-efficacy may promote healthier behaviors among marginalized women. Previous literature that has examined the relationship between online health information-seeking behaviors (OHISB) and health behaviors has mainly focused on White populations. The primary purpose of this study was to examine the association between OHISBs, health literacy, perceived health-related self-efficacy and health behaviors, smoking, and physical activity among marginalized women and to examine the mediating effect of health literacy on the relationship between OHISBs and health behaviors. A secondary data analysis was conducted using 2011, 2013, and 2017 datasets from the Health Information National Trends Survey (HINTS). Slightly more US adult women (ages 18-64) were included in the analysis for the smoking outcome (N = 1,521) compared to participants for the physical activity outcome (N = 1,235). The results of this study showed that 1) no statistically significant association exists between OHISBs, health literacy, smoking, and PA after controlling for the socio-demographic variables, marital status, age, race, occupation, income, and education. However, a positive trend was observed; 2) A statistically significant and positive relationship was observed between self-efficacy, smoking, and physical activity; 3) healthy literacy partially mediated the relationship between OHISBs and smoking. This study highlighted that low socioeconomic status and lack of economic resources are significant barriers to engagement in OHISBs and health behaviors among non-Hispanic Black and Hispanic women. To reduce disparities in OHISBs and health literacy, nurses should promote public health policies that promote free internet access to communities with low socioeconomic status and improve health literacy through patient education and teaching. Future longitudinal and interventional studies are needed to confirm this study's findings and to examine whether interventions promoting OHISBs, health literacy, and self-efficacy help promote smoking cessation and physical activity among non-Hispanic Black and Hispanic women.


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