Digital health literacy as a predictor of patient safety culture: evidence from a multi-centre study of Jordanian nurses.

Abstract

Background: The digitalisation of healthcare requires nurses to possess strong Digital Health Literacy (DHL) to ensure patient safety. This study aimed to evaluate the relationship between DHL and perceptions of PSC among registered nurses in Jordan and to identify the demographic and professional factors associated with varying levels of DHL.

Methods: A multi-center, cross-sectional survey was conducted from July to September 2025 across five public, private, and university-affiliated hospitals in Jordan. A sample of 500 registered nurses was recruited using stratified random sampling. Data were collected using a validated, seven-part composite questionnaire. Data were analyzed using descriptive statistics, reliability analysis (Cronbach's alpha), and structural equation modelling.

Results: The results confirmed the study's primary hypothesis, revealing a significant and strong positive predictive relationship between DHL and PSC (β = 0.42, p < 0.001), with DHL explaining 28.1% of the variance in PSC. Nurses reported moderately high DHL overall (M = 3.28), with strengths in operational skills but lower confidence in evaluating information reliability. Perceptions of patient safety culture were positive (M = 3.71), with Teamwork Climate rated highest (M = 4.21) and Perceptions of Management lowest (M = 3.34). Significant disparities in DHL were found; higher levels of education (p < .001) and working in a university-affiliated hospital (p = 0.001) were associated with higher competency. Notably, no significant differences were observed based on age or years of experience. Lack of adequate training and insufficient time were identified as the primary organisational barriers to technology use.

Conclusion: Digital health literacy was significantly associated with better patient safety culture among Jordanian nurses, driven more by organisational and educational factors than generational stereotypes. To realise the safety benefits of digital health investments, institutions should strengthen nurses' digital and critical appraisal skills and remove organisational barriers.