Beyond knowledge: The role of digital health literacy and food environment in Iron Deficiency Anemia management among Bangladeshi university communities- A Structural Equation Modeling approach

Aim The present study aims to find out the association of digital health literacy (eHEALS) and the university food environment (FE) in managing Iron Deficiency Anemia (IDA). Methods A cross-sectional online survey (n = 2,600) in Bangladeshi universities was conducted among students and academic/administrative staff. Using validated questionnaire, participants reported IDA knowledge, Health Belief Model (HBM) constructs, eHEALS, food-environment perceptions, dietary practices, IDA symptoms, and productivity. Reliability and construct validity were assessed using Cronbach’s alpha, confirmatory factor analysis, average variance extracted, and composite reliability. Structural equation modelling (SEM) tested direct, indirect, and moderating relationships. Results Participants had a mean age of 25.1 years; 22.4% reported prior IDA diagnosis and 27.7% reported chronic digestive problems. Most scales showed good internal consistency (α = 0.73–0.96), except productivity (α = 0.64). IDA knowledge was positively associated with perceived severity, benefits, self-efficacy, and dietary practices, and inversely associated with perceived barriers (p < 0.001). Knowledge influenced diet both directly and indirectly through HBM constructs. Digital health literacy (β = 0.14) and a more supportive FE (β = 0.19) promoted healthier dietary practices (p < 0.001). Healthier diet was associated with more self-reported symptoms (β = 0.22), which predicted higher productivity (β = 0.22), indicating an indirect diet- productivity pathway (B = 0.25, p < 0.001). Digital health literacy also weakened the direct knowledge- diet link (β = -0.09, p < 0.001). Conclusions IDA knowledge, health beliefs, digital literacy, and FE shape dietary practices affecting symptoms and productivity. Interventions should build self-efficacy and improve campus food environments.