Introduction <p>University students interact with the complexities of public health knowledge in digital environments. Digital health literacy (DHL), in this regard, is crucial as an upstream skill for ensuring safe, inclusive, and knowledgeable health care engagement among university students where mis-information, algorithm amplification, and AI-based content exist.</p> Objective <p>This systematic review synthesizes global evidence on DHL among university students. It examines measurement approaches, socio-demographic determinants, online health information-seeking behaviours, mental health and well-being correlates, and the gap between literacy assessment and tested university-based interventions.</p> Methods <p>This systematic review followed PRISMA 2020 guidance. Searches were conducted in PubMed, Scopus, and Web of Science for peer-reviewed studies indexed up to March 31, 2024; backward and forward citation tracking was updated to January 2025 to capture directly related empirical papers. Two reviewers independently performed screening, data extraction, and quality appraisal using design-appropriate tools: JBI for analytical cross-sectional studies, CASP for qualitative evidence, and AMSTAR 2-informed criteria for review-derived or pilot evidence. Because of heterogeneity in design, instruments, and outcomes, findings were synthesized narratively and thematically.</p> Results <p>Twenty-one studies met the eligibility criteria. Most were cross-sectional studies conducted during or after the COVID-19 pandemic. Five themes were identified: DHL as a competence for appraising online health information; socioeconomic, gender, health-status, and contextual determinants of DHL; associations with mental health, well-being, fear, and sense of coherence; measurement heterogeneity and psychometric maturation; and a persistent literacy-to-intervention gap.</p> Conclusion <p>DHL is a relevant competency for Health Promoting Universities, but the current evidence base remains dominated by descriptive self-report and cross-sectional designs. Future research should prioritize longitudinal studies, objective task-based competence assessment, and theory-driven intervention trials embedded within campus health systems, library infrastructures, and digital mental health pathways.</p> <p>The future research must focus on conducting longitudinal research, assessing task-based competency objectively, and testing theory-based interventions that operate through campus health systems, library infrastructure, and pathways for digital mental health.</p>