# How digital health literacy shapes health: Mediating role of physical activity and heterogeneity in China

## TL;DR

Digital health literacy improves physical health in Chinese adults, partly through increased physical activity, with benefits varying by demographics.

## Contribution

This study identifies physical activity as a mediator linking digital health literacy to better physical health outcomes in China.

## Key findings

- Digital health literacy is positively associated with physical health outcomes.
- Physical activity partially mediates the relationship between digital health literacy and physical health.
- Benefits of digital health literacy on physical health are stronger in specific subgroups like males and older adults.

## Abstract

This study systematically examines the impact of digital health literacy (DHL) on the physical and mental health of Chinese adults, particularly focusing on how DHL might enhance physical health through physical activity (PA) mediation.

Drawing on nationally representative Chinese data, this study employed multivariable linear regression combined with mediation analysis to assess the association between DHL and adult health outcomes, while evaluating the mediating role of PA. Robustness was verified through propensity score matching (PSM), logistic regression, and mediation effect pathway tests. Heterogeneity analyses stratified by gender, household registration status, and other demographic factors further elucidated variations in DHL’s impacts on physical and mental health.

DHL demonstrated a positive association with physical health outcomes, while no statistically significant association was observed with mental health. PA served as a partial mediator in the relationship between DHL and physical health enhancement. Stratified analyses revealed significant beneficial effects of DHL on physical health in the following subgroups: males, adults aged ≥60 years, individuals with agricultural household registration, those attaining junior high school education or higher, high-income populations, and participants with health insurance and pension coverage.

This study substantiates the critical influence of DHL on physical health advancement among Chinese adults. Policy formulation should strategically integrate (1) standardized DHL education frameworks, (2) demographically customized digital health management systems, and (3) expanded insurance coverage with optimized reimbursement mechanisms for healthcare and pension schemes. These strategies collectively aim to elevate DHL proficiency, enhance digital platform operational competencies, foster sustainable health-promoting behaviors, and ensure stable health-life equilibrium within China’s adult demographic.