Xie Luyao, Mo Phoenix K H
Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
Soc Sci Med. 2025 Jan;364:117166. doi: 10.1016/j.socscimed.2024.117166. Epub 2024 Aug 5.
Improving older people's health-promoting lifestyle (HPL) may slow the progression of health conditions and improve quality of life. Electronic health (eHealth) literacy is increasingly important for individuals managing health in the digital age. Previous cross-sectional studies have shown a positive association between eHealth literacy and HPL among older adults. However, no longitudinal studies have examined the association over time, their temporal relationship, and the potential underlying mechanisms.
To examine the longitudinal association and temporal relationship between eHealth literacy and HPL among older adults, and to explore their underlying mechanisms based on the Integrated Model of eHealth Use (iMeHU).
This longitudinal study was conducted among older adults in Jiangxi Province, China, from February to November 2022. Data were collected at baseline (T1) and 3-month (T2) and 6-month follow-up (T3), using online self-reported questionnaires. Older people's eHealth literacy and HPL were measured using the Digital Health Literacy Instrument and Health-Promoting Lifestyle Profile-II. Statistical analyses included Linear mixed model (LMM), cross-lagged panel model (CLPM), longitudinal mediation analysis, and multi-group analysis.
611 participants were included at T1; 464 (75.9%) completed the follow-ups at T2 and T3. The LMM results suggested that older individuals with higher eHealth literacy levels showed better HPL over time (adjusted β = 0.31, 95%CI: 0.27-0.35, p < 0.001), after adjusting for covariates. CLPMs supported that eHealth literacy could predict older people's improved HPL subsequently, but not the reverse. Attitude towards eHealth mediated the relationship from eHealth literacy to improved HPL, with a mediated proportion of 17.2%. In addition, the prospective relationships were stronger and only significant in older patients.
From a longitudinal perspective, this study highlighted the important roles of eHealth literacy and attitude towards eHealth in improving older people's HPL, especially for the patients. The findings provide robust evidence and practical implications to develop targeted interventions.
改善老年人的健康促进生活方式（HPL）可能会减缓健康状况的进展并提高生活质量。在数字时代，电子健康（eHealth）素养对于个人管理健康日益重要。先前的横断面研究表明，老年人的电子健康素养与HPL之间存在正相关。然而，尚无纵向研究考察这种关联随时间的变化、它们的时间关系以及潜在的潜在机制。
研究老年人电子健康素养与HPL之间的纵向关联和时间关系，并基于电子健康使用综合模型（iMeHU）探索其潜在机制。
这项纵向研究于2022年2月至11月在中国江西省的老年人中进行。使用在线自我报告问卷在基线（T1）、3个月随访（T2）和6个月随访（T3）时收集数据。老年人的电子健康素养和HPL分别使用数字健康素养工具和健康促进生活方式概况-II进行测量。统计分析包括线性混合模型（LMM）、交叉滞后面板模型（CLPM）、纵向中介分析和多组分析。
T1纳入611名参与者；464名（75.9%）在T2和T3完成随访。LMM结果表明，在调整协变量后，电子健康素养水平较高的老年人随时间推移表现出更好的HPL（调整后的β = 0.31，95%CI：0.27 - 0.35，p < 0.001）。CLPM支持电子健康素养可以预测老年人随后HPL的改善，但反之则不然。对电子健康的态度介导了从电子健康素养到HPL改善的关系，介导比例为17.2%。此外，前瞻性关系更强，且仅在老年患者中显著。
从纵向角度来看，本研究强调了电子健康素养和对电子健康的态度在改善老年人HPL方面的重要作用，尤其是对患者而言。研究结果为制定有针对性的干预措施提供了有力证据和实际意义。
