Tan Gangrui, Chao Jianqian, Jin Shengxuan, Wang Leixia, Wu Yanqian, Du Yongqi, Yang Shishuo, Yang Beibei
Health Management Research Center, School of Public Health, Southeast University, Nanjing, China.
Digit Health. 2025 Jun 20;11:20552076251349901. doi: 10.1177/20552076251349901. eCollection 2025 Jan-Dec.
With the rapid advancement of digital transformation, digital health literacy (DHL) has emerged as a crucial determinant influencing health outcomes and health inequalities among older adults. However, empirical evidence on how DHL affects health inequalities remains relatively limited. This study aims to investigate the association between DHL and health inequalities while analyzing the potential mechanisms through which DHL exerts its influence via mechanism testing among older adults in China.
From June to November 2024, a multicenter cross-sectional study was conducted by five research groups from four universities in China. DHL was assessed using the eHEALS scale, while health inequalities were measured using an index of relative deprivation. Multivariate regression models examined the association between DHL and health inequalities. The Baron and Kenny stepwise regression method was used to examine the mediating effect, and bias-corrected bootstrap resampling with 5000 iterations was applied to calculate 95% confidence intervals (95% CI) to confirm the significance of the mediating effect.
Overall, 8696 valid individuals were included. DHL demonstrated a significant positive association with self-rated health (SRH) ( = 0.015, < .01) and a significant negative association with health inequalities ( = -0.016, < .01). DHL indirectly reduced health inequalities through the mediating effects of alleviating depressive symptoms ( = -0.005, 95%CI: -0.0066, -0.0045) and promoting physical activity ( = -0.001, 95%CI: -0.0020, -0.0011), respectively. However, the role in promoting health service utilization and regulating unhealthy behaviors was not significant. Bootstrap tests confirmed the significance of the mediating role.
DHL was associated with health inequalities and mitigates them by alleviating depressive symptoms and promoting physical activity. It is recommended that while bridging the digital divide, more attention could be paid to DHL and the translation of competencies among older adults to reduce health disparities and promote equitable aging.
随着数字转型的迅速推进，数字健康素养（DHL）已成为影响老年人健康结果和健康不平等的关键决定因素。然而，关于DHL如何影响健康不平等的实证证据仍然相对有限。本研究旨在调查DHL与健康不平等之间的关联，同时通过在中国老年人中进行机制测试来分析DHL发挥影响的潜在机制。
2024年6月至11月，中国四所大学的五个研究小组开展了一项多中心横断面研究。使用eHEALS量表评估DHL，使用相对剥夺指数衡量健康不平等。多变量回归模型检验DHL与健康不平等之间的关联。采用Baron和Kenny逐步回归方法检验中介效应，并应用5000次迭代的偏差校正自助重抽样计算95%置信区间（95%CI）以确认中介效应的显著性。
总体而言，纳入了8696名有效个体。DHL与自评健康（SRH）呈显著正相关（β = 0.015，P <.01），与健康不平等呈显著负相关（β = -0.016，P <.01）。DHL分别通过减轻抑郁症状（β = -0.005，95%CI：-0.0066，-0.0045）和促进身体活动（β = -0.001，95%CI：-0.0020，-0.0011）的中介作用间接减少了健康不平等。然而，其在促进健康服务利用和调节不健康行为方面的作用不显著。自助检验证实了中介作用的显著性。
DHL与健康不平等相关，并通过减轻抑郁症状和促进身体活动来缓解健康不平等。建议在弥合数字鸿沟的同时，更多关注老年人的DHL及能力转化，以减少健康差距，促进公平老龄化。
