Li Jiaying, Wu Xiaobing, Wu Yibo, Fong Daniel Yee Tak, Song Yang, Xu Siyi, Kim Changhwan, Lin Xiaohong, Pandian Vinciya
School of Nursing, Johns Hopkins University, Baltimore, MD, United States.
Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Med Internet Res. 2025 May 5;27:e70822. doi: 10.2196/70822.
Nonpharmacological management plays a key role in enhancing the quality of life for individuals with chronic obstructive pulmonary disease (COPD), asthma, or both. However, disparities in their physical, mental, and health empowerment outcomes have not been fully explored, particularly in relation to the moderating effect of eHealth literacy.
This study aims to assess these disparities and examine how eHealth literacy moderates them to guide the development of tailored nonpharmacological strategies.
We analyzed data from 2 waves of the nationally representative "Psychology and Behavior Investigation of Chinese Residents" surveys to identify participants who self-reported asthma, COPD, or both. We assessed 5 physical outcomes (quality of life, physical activity, sleep quality, appetite, nicotine dependence), 4 mental outcomes (anxiety, depression, perceived stress, resilience), and 3 health empowerment measures (social support, self-efficacy, eHealth literacy). Multiple regression with Holm-Bonferroni corrections revealed health disparities and the moderation effect of eHealth literacy.
This unfunded study enrolled 1044 participants between June 2022 and August 2023, with data analysis completed within 7 months following data collection. The sample included 254 (24.3%) participants with asthma, 696 (66.7%) participants with COPD, and 95 (9.1%) participants with both conditions. The mean age of the participants was 48.61 (SD 19.70) years, and 536 (51.3%) participants were male. Linear regression showed that individuals with both COPD and asthma had lower health-related quality of life and higher anxiety and depression compared with those with either condition alone (b ranges from -0.15 to 3.35). This group also showed higher nicotine dependence than asthma-only (b=0.88) and lower resilience than COPD-only groups (b=-0.76) (all adjusted P<.05). eHealth literacy significantly moderated the effect of the disease group on all outcomes except physical activity (all adjusted P for interaction <.05). Nine disease pairs showed disparities in both eHealth literacy groups, 4 only in high literacy, and 8 only in low literacy (all P<.05).
Individuals with both COPD and asthma had poorer quality of life, greater anxiety and depression, higher nicotine dependence, and lower resilience, underscoring the need for integrated psychosocial and behavioral interventions. Although higher eHealth literacy was associated with improved quality of life, sleep quality, and resilience, it also widened disparities in anxiety and depression. Therefore, while enhancing eHealth literacy may help reduce overall health inequities among patients with chronic respiratory diseases, its potential adverse effects on mental well-being warrant careful attention. Moreover, lower eHealth literacy was linked to more pronounced disparities, indicating that outreach efforts and digital resources should be specifically designed to reach and empower vulnerable populations. Overall, our findings advocate for condition-specific, eHealth-enhanced care pathways that not only foster digital literacy but also integrate comprehensive mental health services, thereby mitigating health disparities among individuals with chronic respiratory diseases.
非药物管理在提高慢性阻塞性肺疾病（COPD）、哮喘或两者兼具患者的生活质量方面起着关键作用。然而，其在身体、心理和健康赋权结果方面的差异尚未得到充分探讨，特别是在电子健康素养的调节作用方面。
本研究旨在评估这些差异，并研究电子健康素养如何对其进行调节，以指导制定量身定制的非药物策略。
我们分析了具有全国代表性的“中国居民心理与行为调查”两轮调查的数据，以确定自我报告患有哮喘、COPD或两者皆有的参与者。我们评估了5项身体结果（生活质量、身体活动、睡眠质量、食欲、尼古丁依赖）、4项心理结果（焦虑、抑郁、感知压力、心理弹性）和3项健康赋权指标（社会支持、自我效能感、电子健康素养）。采用带有霍尔姆 - 邦费罗尼校正的多元回归分析揭示健康差异以及电子健康素养的调节作用。
这项无资金支持的研究在2022年6月至2023年8月期间招募了1044名参与者，数据分析在数据收集后的7个月内完成。样本包括254名（24.3%）哮喘患者、696名（66.7%）COPD患者和95名（9.1%）两种疾病都有的患者。参与者的平均年龄为48.61（标准差19.70）岁，536名（51.3%）参与者为男性。线性回归显示，与仅患有一种疾病的患者相比，同时患有COPD和哮喘的个体健康相关生活质量较低，焦虑和抑郁程度较高（b值范围为 -0.15至3.35）。该组的尼古丁依赖程度也高于仅患哮喘的患者（b = 0.88），心理弹性低于仅患COPD的组（b = -0.76）（所有校正P <.05）。电子健康素养显著调节了疾病组对除身体活动外所有结果的影响（所有交互作用的校正P <.05）。九个疾病对在两个电子健康素养组中均显示出差异，4个仅在高素养组中显示出差异，8个仅在低素养组中显示出差异（所有P <.05）。
同时患有COPD和哮喘的个体生活质量较差，焦虑和抑郁程度更高，尼古丁依赖程度更高，心理弹性更低，这突出了综合心理社会和行为干预的必要性。虽然较高的电子健康素养与改善生活质量、睡眠质量和心理弹性相关，但它也扩大了焦虑和抑郁方面的差异。因此，虽然提高电子健康素养可能有助于减少慢性呼吸道疾病患者之间的总体健康不平等，但其对心理健康的潜在不利影响值得密切关注。此外，较低的电子健康素养与更明显的差异相关，这表明应专门设计外展努力和数字资源，以覆盖并增强弱势群体的能力。总体而言，我们的研究结果倡导针对特定疾病、电子健康增强的护理途径，这些途径不仅能培养数字素养，还能整合全面的心理健康服务，从而减轻慢性呼吸道疾病患者之间的健康差异。
