Multi-Level Factors Influencing eHealth Literacy Among Chinese Older Adults: A Longitudinal Study

Aims: Based on the socio-ecological model, the present study examined influencing factors of eHealth literacy among Chinese older adults at individual-level (e.g., socio-demographics, Internet use, and health status), interpersonal (e.g., informational support and instrumental support), and community-level (e.g., available public facilities).

Design: A longitudinal study was conducted among 611 Chinese older adults aged 55 or over.

Methods: From February to December 2022, older people's eHealth literacy was collected at baseline, 3-month and 6-month follow-up surveys and other variables were collected only at baseline, using online questionnaires.

Results: Among 611 participants, 464 (75.9%) completed both follow-up surveys. At the individual level, participants who were older, female gender, rural residents, living alone, had lower education, occupational levels and income, and had chronic conditions and long-term medication showed lower eHealth literacy. Older adults with longer Internet use history, online health information seeking, more frequent health-related Internet use, higher self-rated Internet skills and positive perceptions towards online health information exhibited higher eHealth literacy over time. In terms of interpersonal and community-level factors, perceiving informational and instrumental support when using digital health, and having access to health facilities (e.g., health education) and technological training provided by the community could predict older individuals' higher eHealth literacy over time, after adjusting for covariates.

Conclusion: Older people's eHealth literacy can be influenced by factors at individual, interpersonal, and community levels.

Implications and impact: This longitudinal study identified significant factors influencing older individuals' eHealth literacy at different levels. Understanding unmodifiable factors at the individual level can help identify the subgroups that may need targeted support and interventions for promoting eHealth literacy. Furthermore, findings can guide tailored interventions to improve eHealth literacy through modifiable factors at the technological, interpersonal and community levels.

Reporting method: Adhered to the STROBE guidelines.

Patient or public contribution: No patient or public contribution.