Artificial Intelligence for Health Citizenship Education: Bridging Civic Competence and Physical Health Literacy in Universities

Abstract

The growing use of artificial intelligence (AI) in information environments requires higher education to equip students with the ability to critically evaluate AI-mediated health information and apply it to healthy behaviors, yet civic education and health education are rarely treated as interdependent despite sharing core capacities such as critical thinking, self-regulation, and responsible decision-making. This study examined whether participation in an AI-Assisted Health Citizenship Learning (AIHCL) program predicts university students' civic competence and physical health literacy, and whether civic competence bridges the relationship between AI-assisted learning and health literacy. A sequential explanatory mixed-methods design was conducted with 210 undergraduate students from four universities in South Sulawesi, Indonesia. Quantitative data were analyzed using Structural Equation Modeling-Partial Least Squares (SEM-PLS), while qualitative data were collected through 20 semi-structured interviews and analyzed thematically. AIHCL engagement significantly predicted civic competence (beta = 0.59, p < .001) and physical health literacy (beta = 0.47, p < .001). Civic competence also significantly predicted physical health literacy (beta = 0.42, p < .001), confirming a partial bridging effect. Four themes emerged from the qualitative data: AI as a Civic Information Filter, Digital Deliberation as Civic Practice, From Personal Data to Collective Health Responsibility, and Algorithmic Trust Under Critical Scrutiny. The findings indicate that AI-assisted instruction can simultaneously strengthen civic competence and physical health literacy, with civic competence serving as a critical bridge linking AI engagement to health outcomes. The study provides a validated model and a practical framework for AI-based health citizenship education in higher education.