# The Relationship Between Electronic Health Literacy and Health-Related Quality of Life Among Chinese Older Adults: Cross-Sectional Study

## TL;DR

Higher electronic health literacy improves health-related quality of life in older Chinese adults, especially through better attitudes and self-efficacy.

## Contribution

This study identifies psychosocial mediators and subgroup differences in the EHL-HRQoL relationship among Chinese older adults.

## Key findings

- EHL positively correlates with physical, mental health, and life satisfaction in older adults.
- Attitudes toward aging and self-efficacy mediate the relationship between EHL and health outcomes.
- Younger-old adults, urban residents, and nonexercisers benefit most from higher EHL.

## Abstract

The rapid digitalization of health care has reshaped access to medical services. However, older adults often remain disadvantaged due to the digital divide. Electronic health literacy (EHL) is increasingly recognized as a determinant of health-related quality of life (HRQoL); however, its mechanisms and subgroup differences in China remain underexplored.

This study aimed to examine the association between EHL and multidimensional HRQoL among Chinese older adults, with a focus on the mediating roles of attitudes toward own aging (ATOA) and self-efficacy (SE), and heterogeneity by age, residence, and lifestyle.

A cross-sectional survey (July-November 2024) included 8364 adults aged ≥55 years from 4 provinces using stratified multistage sampling. HRQoL was measured by physical health (PH), mental health (MH), and life satisfaction (LS). EHL was assessed with the eHealth Literacy Scale (eHEALS), ATOA with the Philadelphia Geriatric Center Morale Scale subscale, and SE with the General Self-Efficacy Scale. Analyses used seemingly unrelated regressions, PROCESS (Andrew F. Hayes) macro mediation with 5000 bootstraps, and subgroup regressions.

EHL was positively associated with PH (β=0.273; P<.001), MH (β=0.190; P<.001), and LS (β=0.082; P<.001). ATOA and SE significantly mediated these associations (all P<.001). For PH, the association was partially mediated by ATOA and SE. The total effect was 0.273 (P<.001), with indirect effects accounting for 52.7% of the total. For MH, inconsistent mediation was observed. The direct effect was negative (β=–0.069; P<.01), but indirect effects were positive, yielding a positive total effect. For LS, the effect was fully mediated by ATOA and SE. Subgroup analyses showed stronger effects in the younger-old adults (PH: β=0.288, MH: β=0.188, LS: β=0.089; all P<.001), urban residents (PH: β=0.237, MH: β=0.214, LS: β=0.083; all P<.001), and nonexercisers (PH: β=0.322; P<.001).

EHL is strongly associated with HRQoL among Chinese older adults. Its effects on MH and LS operate primarily through psychosocial pathways, while PH benefits directly. The findings highlight EHL’s compensatory role, particularly for the younger-old group, rural residents, and nonexercisers, underscoring its importance in digital inclusion and healthy aging policies.