Bullying victimization is a significant public health issue affecting millions worldwide. Despite recognizing it as a significant issue across countries, the rates of bullying victimization are dramatically higher in developing countries compared to developed countries (Huang & Vidourek, 2019). Bullying is defined as “aggressive goal-directed behavior that harms another individual within the context of a power imbalance” (Volk et al., 2014, p 328). Bullying victimization could take place in different settings, including educational institutes such as schools (Li et al., 2019) and universities (Pörhölä et al., 2020).

Gladden et al. (2014) identified four main types of bullying victimization, including physical, verbal, relational, and damage to property. Physical bullying involves using physical force such as hitting, punching, and pushing. Verbal bullying indicates using oral or written communication to cause harm to the victim, such as name-calling and verbal or written threatening (Gladden et al., 2014). Relational bullying happens when a person's reputation or relationships are harmed due to the perpetrator's behavior. This type is also referred to as social bullying, and examples of it include socially isolating and/or spreading rumors about the victim (Huang & Vidourek, 2019). The damage to the property type of bullying involves theft, alteration, or damage of the victim's property to cause harm. With the rapid spread of technology, the term cyberbullying has become more popular, and it occurs through the use of technology such as emails, mobile phones, chat rooms, instant messaging, and websites (Centers for Disease Control and Prevention, 2021).

Regarding its risk factors, many demographic and socioeconomic variables increase the risk of bullying victimization. Examples of such variables include gender differences, family conflicts, economic difficulties, and the use of tobacco or alcohol (Sánchez et al., 2016; Yu et al., 2022). The prevalence of bullying in university students is alarming; more than half of Jordanian university students reported exposure to bullying victimization (Awawdeh et al., 2023). Undergraduate nursing students are considered at high risk for bullying victimization and clinical training increases this risk (Qutishat, 2019). Another fact that increases the risk for bullying is having limited health literacy (Saihu et al., 2021).

The consequences of bullying and cyberbullying victimization affect several aspects of university students' life, and bullying victimization was associated with poor mental well-being and resilience (Víllora et al., 2020). In addition, bullying victimization negatively affects university students' emotional well-being, mental health, academic performance, and health-related quality of life (Chen & Huang, 2015; Huang & Vidourek, 2019; Warshawski, 2021; Yubero et al., 2021). The literature also reported that bullying victimization increases the risk for suicidal ideation and behaviors among university students (Sinyor et al., 2014; Wang et al., 2020). For newly graduated nurses, bullying was identified as a barrier of achieving successful transition into professional roles (Kim & Shin, 2020).

Bullying victimization and its consequences are preventable. The literature provides tremendous evidence regarding the effectiveness of different programs and interventions to prevent bullying, role-playing as a strategy to improve decision-making for example (Donohoe, 2020; Oyekoya et al., 2021). The authors argue that one of the factors that could significantly decrease the risk of being bullied by improving the decision-making ability is health literacy. According to the World Health Organization (WHO), health literacy is:

Linked to literacy and entails people's knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life during the life course (World health Organization, 2013, p 4).

This definition indicates that health literacy enables individuals to make informed decisions to manage their own health. In addition, health literacy can play a crucial role in decreasing any risks that might affect the individual's health, for example as a result of being bullied. To the author's knowledge, only one study investigated the association between health literacy and bullying victimization (Saihu et al., 2021). Saihu and colleagues reported that lower levels of health literacy increase the risk of experiencing bullying victimization in a sample of middle school students. While this phenomenon has been addressed only in a single study, the authors of the current study believe that various justifications could support the importance of investigating the role of health literacy in preventing bullying and cyberbullying victimization.

The first justification stems from the central role of health literacy in empowering individuals to take responsibility for their health and well-being and make decisions in everyday life (Sørensen et al., 2012; World health Organization, 2013). This applies not only to situations when individuals experience illness but also to any circumstance with the potential of threatening physical, psychological, or social well-being. As discussed earlier, bullying negatively impacts individuals' health and well-being, which could be prevented by enhancing health literacy. Another justification concerns how health literacy helps individuals build stronger social systems (Osborne et al., 2013; Nutbeam et al., 2018; Sørensen et al., 2012; World health Organization, 2013). Through such established social connections, individuals find help and support to advocate for their health needs and promote well-being. In addition, health literacy facilitates communication of information related to health and well-being between individuals and their healthcare providers and social networks (Osborne et al., 2013; Nutbeam et al., 2018; Sørensen et al., 2012; World health Organization, 2013). Since bullying negatively impacts physical and mental well-being, health-literate individuals could be more capable of discussing the health consequences of bullying with their healthcare providers. That is because individuals with adequate health literacy are more capable of identifying their health needs and seeking advice from healthcare providers (Osborne et al., 2013). Consequently, health literacy could be a significant factor in detecting and preventing bullying and cyberbullying victimization.

Based on this discussion, it is necessary to study whether health literacy is associated with reduced rate of experiencing bullying and cyberbullying victimization. Therefore, this study was conducted to investigate the association between health literacy and bullying and cyberbullying victimization in a sample of undergraduate nursing students. There were two research questions in the current study: a) do the scores of undergraduate nursing students' bullying and cyberbullying victimization differ based on their levels of health literacy? and b) are there any statistically significant mean differences in the health literacy dimensions between undergraduate nursing students with and without a history of bullying and cyberbullying victimization?