# Health-promoting behaviors mediate the relationship between eHealth literacy and health-related quality of life among Chinese older adults: a cross-sectional study

## TL;DR

This study shows that health-promoting behaviors help explain how digital health skills improve quality of life for older adults in China.

## Contribution

Demonstrates health-promoting behaviors mediate the link between eHealth literacy and quality of life in older Chinese adults.

## Key findings

- eHealth literacy significantly predicts health-promoting behaviors (B = 0.487, p < 0.001).
- Health-promoting behaviors significantly predict health-related quality of life (B = 0.257, p < 0.001).
- Health-promoting behaviors mediate 40.6% of the effect of eHealth literacy on quality of life.

## Abstract

The aim of this study was to examine the association between eHealth literacy and health-related quality of life (HRQoL) and explore whether health-promoting behaviors mediate the association between eHealth literacy and HRQoL among Chinese older adults.

An anonymous cross-sectional survey was conducted among 2300 adults aged 60 or older from Jinan, China. The eHealth Literacy Scale, Short-Form Health-Promoting Lifestyle Profile, and Short-Form Health Survey (SF-12) were used to measure eHealth literacy, health-promoting behaviors, and HRQoL. Multivariate linear regression analyses were conducted to test the association between eHealth literacy, health-promoting behaviors, and HRQoL. The mediation analyses, composed of PROCESS analysis and bootstrapping method, were preformed to test both total (c), direct (c'), and indirect effects (a*b) of eHealth literacy on HRQOL through health-promoting behaviors.

Regression analyses indicated that eHealth literacy (B = 0.487, p < 0.001) was significantly positively associated with health-promoting behaviors, and health-promoting behaviors (B = 0.257, p < 0.001) were associated with HRQoL. The mediation analyses indicated that eHealth literacy had a significant direct (c' = 0.183, p < 0.001) and indirect effect on older adults’ HRQoL through health-promoting behaviors (a*b = 0.125, bootstrapped 95% confidence interval (CI) = 0.094–0.157). The indirect effect accounted for 40.6% of the total effect (c = 0.308, bootstrapped 95% CI 0.241–0.376) of eHealth literacy on HRQoL.

Health-promoting behaviors mediated the association between eHealth literacy and HRQoL in Chinese older adults. The establishment of interventions focused on health-promoting behavior may be an effective way to help older adults with low eHealth literacy improve their HRQoL.