SPSS 25 and Stata 15 package programmes were used in the analysis of the data obtained within the scope of the research. The variables used in the study were structured according to the scope of the data collection tools and by utilising the literature in accordance with the purpose of the study. The total scores obtained from the TSOY-32 scale, which was used to measure the participants’ levels of understanding, evaluating and using health information, were defined as the dependent variable to determine their health literacy levels. Media literacy was assessed through four main sub-dimensions: access, analysis, evaluation and communication. The access dimension aims to measure the participants’ capacity to access information and their ability to use media sources effectively. The analysis dimension assesses the ability to critically analyze media content. The evaluation dimension measures the ability to evaluate the reliability and accuracy of media content. The communication dimension aims to assess the skills to share information and communicate using media tools. In addition, a scoring system between 1 and 10 was used to measure the participants’ trust in health advice published through the media and the effects of these advice on health.
Measurement tools
In this study, self-administered online questionnaire method was used in line with the findings in the literature and the aim of the research. The study was conducted in accordance with the principles defined by the Declaration of Helsinki, and informed consent was obtained from the participants. Ethical approval (date: 08 July 2024, no: 586) was obtained from Istanbul Beykent University Scientific Research and Publication Ethics Board for Social Sciences and Humanities.
The main population of the study consisted of adult individuals residing in Turkey who had access to the internet and were reachable through digital platforms such as university e-mails, online education portals, and social media networks. A sample group consisting of individuals selected by convenience sampling method was determined to represent the main population.
The survey was conducted online between August and September 2024, and voluntary participation was encouraged through anonymous distribution links. Individuals aged 18 and above, from various educational and socio-economic backgrounds, were included in the target group. In this context, a total of 485 people were surveyed, and 477 usable questionnaires were included in the analysis [28].
During the sampling process, the recommendations in the literature were taken into consideration in order to ensure that the sample is representative of the main population and to minimise sampling errors.
In determining the adequacy of the sample size, it was ensured that the number of observations was sufficient to provide reliable results. According to Young [29] a sufficient sample is one that includes enough units to yield reliable findings. In addition, Meyers et al. [30] recommend at least 10 observations per variable in multivariate analyses, and Velicer and Fava [31] support this rule of thumb. Considering the number of variables in this study, the sample size of 477 was deemed sufficient for conducting reliable statistical analyses such as factor analysis and the Generalized Ordered Logit Model.
Although the sampling method was non-probabilistic, efforts were made to ensure demographic diversity in terms of age, gender, education level, and regional distribution.
In order to measure health literacy, the Turkish Health Literacy Scale (TSOY-32) [32], consisting of 32 items and developed by the Ministry of Health, was used. The five-point Likert-type scale includes options from “Very Easy” to “Very Difficult”. The scale results were converted to a standard index in the range of 0–50 and the following formula was applied for the conversion: Index Score = (Arithmetic Mean—1) × (50/3). The obtained scores were classified according to the categories defined in the literature: 0–25 points were categorised as “Inadequate Health Literacy”, > 25–33 points as “Problematic—Limited Health Literacy”, > 33–42 points as “Adequate Health Literacy” and > 42–50 points as “Excellent Health Literacy”. High reliability values were obtained in the total and sub-dimensions of the scale. Cronbach’s alpha coefficient was calculated as 0.88 for the overall scale, 0.94 for the “Treatment and Service” sub-dimension and 0.90 for the “Disease Prevention and Health Promotion” sub-dimension. When the distribution of Turkey Health Literacy Scale scores by categories was analysed, 46.86% of the participants were in the “Problematic-Limited Health Literacy” category, 21.97% in the “Inadequate Health Literacy” category, 20.92% in the “Adequate Health Literacy” category and 10.25% in the “Excellent Health Literacy” category. These results show that most of the participants have a problematic-limited level of health literacy. The mean total score of the scale was calculated as 30.41 ± 8.37 and it was observed that this value was close to the “Problematic-Limited Health Literacy” category. As a result of the Kaiser–Meyer–Olkin (KMO) test, the sampling adequacy index was found to be 0.94. As a result of this value, it was decided that it was perfectly suitable for factor analysis. Therefore, it was supported that the data were suitable for factor analysis.
The 45-item Media Literacy Skills Scale developed by Erişti and Erdem [33] was used to assess media literacy. The scale consists of four sub-dimensions: Access (items 1–11), Analysis (items 12–26), Evaluation (items 27–33) and Communication (items 34–45).
The selection of these four media literacy sub-dimensions—access, analysis, evaluation, and communication—is theoretically grounded in prior research emphasizing that these skills are central to individuals’ ability to navigate and critically engage with health information [13, 14, 18]. Each dimension reflects a distinct cognitive or behavioral process that influences how media content is interpreted and used for health-related decision-making.
The overall reliability coefficient of the scale was calculated as 0.9747. Cronbach alpha values for the sub-dimensions were determined as 0.9194, 0.9559, 0.9181 and 0.9038, respectively. As a result of factor analysis, it was determined that the first factor, which explained 73.18%, had the highest eigenvalue (21.52699). We also developed an additional scoring section ranging from 1 (lowest) to 10 (highest) to assess the impact of health advice provided through the media on individuals’ health perception, confidence, and decision-making processes. This section was created specifically for this study to assess how participants evaluated the health information they obtained from media sources and its subsequent impact on both individual and societal health. In developing this variable, content validity was prioritized, as existing trust scales in the literature did not sufficiently reflect the multidimensional nature of media-based health communication in the digital era. Internal consistency analysis showed high reliability, with a Cronbach’s alpha coefficient of 0.89. Moreover, the inclusion of a media trust variable is theoretically supported by prior research demonstrating that trust in media-based health information significantly influences individuals’ health behaviors and literacy outcomes. This justifies its integration into the current model to better capture the mediating role of trust in the relationship between media literacy and health literacy. This trust construct was used as an independent variable in the regression model. Theoretical and empirical support for including such a variable stems from prior research that links media trust to individuals’ health behaviors and attitudes [34, 35].
Sample structure
The demographic characteristics of the participants are presented in Table 1. As shown, the gender distribution indicates that 60% of the respondents were female, 35% were male, and 5% preferred not to disclose their gender. This result suggests a higher representation of female participants in the sample. This distribution is considered normal and contextually relevant, as the proportion of female employees in the healthcare sector in Turkey is considerably higher than that of males, particularly in nursing, public health, and caregiving roles.
The participants’ age ranged from 18 to 73 years, with a mean of 35 and a median of 33. In terms of age groups, 25% were between 18–29 years, 35% between 30–39 years, 20% between 40–49 years, and another 20% were aged 50 and above.
Regarding education level, 35% of the participants held a bachelor’s degree, 20% had an associate degree, 15% completed secondary education, 12% held a master’s degree, 10% held a doctorate, and 6% had only primary education. Additionally, 2% of the respondents were literate but had not completed formal schooling. The data suggest that individuals with postgraduate degrees (master’s and doctorate) generally had income levels above the sample average, indicating a correlation between educational attainment and economic status.
In terms of income distribution, the average income was 68,000 TL, while the median was 50,000 TL. The income range spanned from 0 TL to 800,000 TL. Notably, 10% of the participants reported no income, and 5% earned 200,000 TL or more annually. Furthermore, 20% reported income between 40,000 and 60,000 TL. These findings highlight considerable income inequality within the sample. It was also observed that the average income of female participants was 12% lower than that of males. Younger participants (ages 18–29) tended to fall into the lower income brackets, while participants aged 50 and above were more likely to be in higher income groups.
In the research, various findings were obtained through the questions asked about the media use and digital access habits of the participants. In the participants’ preference of television programmes, news programmes were the most watched content type with a total of 297 preferences. These programmes were followed by films with 226 preferences, documentaries with 199 preferences, TV series with 187 preferences and information-culture competitions with 161 preferences. These results show that the participants attach high importance to informative and educational content. In particular, the fact that news programmes are the most preferred genre indicates the sensitivity of individuals to access current events. When the internet usage habits of the participants are analysed, the most common reason for using the internet for research and information purposes was stated by 157 people (32.9%). This category includes activities such as searching for information and doing homework. This was followed by communication use (e-mail, chat, etc.) with 72 respondents (15.1%) and entertainment use (games, surfing, etc.) with 50 respondents (10.5%). Internet use for commercial purposes (shopping, banking/investment transactions, etc.) was preferred by only 28 people (5.9%). The research findings also provide some important points about media literacy and digital access levels. Regarding media literacy education, the majority of the participants (84.3%) stated that they had not taken a media literacy course before. This situation indicates that media literacy trainings should be made widespread. In terms of computer access, 4.6% of the participants (22 people) stated that they do not have a computer that they can use whenever they want. Although internet access is quite common, only 1.3 per cent of the participants (6 people) stated that they cannot access the internet whenever they want. Finally, when newspaper reading habits are analysed, 39.2% (187 people) of the participants stated that they do not have a newspaper that they follow constantly.