# Associations between eHealth literacy and 24-hour movement behaviors in older adults: the mediating and moderating roles of self-efficacy

## TL;DR

This study finds that higher eHealth literacy in older adults is linked to more physical activity and less sedentary behavior, with self-efficacy playing a small mediating and moderating role.

## Contribution

The study explores the novel mediation and moderation roles of self-efficacy in the relationship between eHealth literacy and 24-hour movement behaviors in older adults.

## Key findings

- Higher eHealth literacy is associated with increased light and moderate-to-vigorous physical activity and reduced sedentary behavior.
- Self-efficacy partially mediates the relationship between eHealth literacy and physical activity and sedentary behavior.
- Self-efficacy also moderates the associations for light physical activity, sedentary behavior, and sleep duration.

## Abstract

Older adults increasingly rely on digital health resources, yet evidence regarding the relationship between eHealth literacy (eHL) and 24-hour movement behaviors (24-HMB), including physical activity (PA), sedentary behavior (SB), and sleep, remains underexplored. This study examined the associations between eHL and 24-HMB in Chinese older adults and examined self-efficacy as a potential mediator and moderator.

Using a convenience sampling approach, 564 community-dwelling older adults (aged 60–74 years) were recruited from four urban Chinese cities via an online survey. A total of 553 valid cases were retained for analyses. eHL was assessed using the eHealth Literacy Scale–Web 3.0, and self-efficacy was assessed using a validated Self-Efficacy Scale. PA and SB were assessed objectively using ActiGraph GT3X+ accelerometers over three consecutive days (two weekdays and one weekend day). Sleep duration was derived from accelerometer-based estimates anchored by daily sleep logs. Multiple linear regression analyses were conducted to examine associations, and mediation and moderation were tested using PROCESS macro (Model 4 and Model 1, respectively), adjusting for age, sex, and education.

After adjustment for covariates (n = 553), higher eHL was associated with greater light physical activity (LPA) (b = 0.43, p < 0.001) and moderate-to-vigorous physical activity (MVPA) (b = 0.19, p < 0.001) as well as lower SB (b = −0.43, p < 0.001). eHL was also positively associated with self-efficacy (b = 0.47, p < 0.001). Mediation analyses showed small but statistically significant indirect effects via self-efficacy for LPA [0.04, 95% CI (0.00, 0.09)], MVPA [0.08, 95% CI (0.03, 0.13)], and SB [−0.06, 95% CI (−0.10, −0.02)], whereas no mediation was observed for sleep duration [0.02, 95% CI (−0.03, 0.07)]. Moderation analyses showed significant interactions for LPA (F = 76.82, p < 0.001), SB (F = 75.07, p < 0.001), and sleep duration (F = 4.74, p < 0.001), but not MVPA. Interaction effects for sleep were small in magnitude and should therefore be interpreted with caution. Mediation models explained 26% of the variance in LPA, 6% in MVPA, and 30% in SB.

In this cross-sectional, urban, device-using sample of older adults, higher eHL was associated with a more favorable 24-HMB profile, particularly higher LPA and lower SB, while associations with sleep duration were weaker. Self-efficacy showed modest indirect associations consistent with partial mediation for PA and SB and also acted as a moderator of several associations. Given the observational design and modest effect sizes, findings should be interpreted cautiously and require confirmation in longitudinal or experimental studies with more representative sampling and improved sleep assessment.