Correlation between habits of using online health information and e-health literacy in middle-aged and older Chinese adults^☆

Abstract

Background:Along with increased online dependency of supplying and obtaining health knowledge, e-health literacy emerges as one of essential skills for people with chronic diseases.
Objective:This study aimed to explore the current experience and challenges associated with online health information use behaviors and e-health literacy in middle-aged and older adults, and offer insights for improving e-health literacy level and developing tailored Internet-based health knowledge dissemination services.
Methods:From June to September 2021, a questionnaire survey was administered to 1 061 middle-aged and older adults in Shanghai communities, using a multi-stage sampling method. The survey instruments included General Information Questionnaire and the Chinese version of the eHealth Literacy Scale (eHEALS). These tools helped measure participants' online health information use behavior and their e-health literacy levels. Multilinear stepwise regression analysis was employed to explore the relationship between internet health information use habits, other potential influencing factors, and e-health literacy levels.
Results:Of the distributed questionnaires, 1,019 were returned, yielding a 96.04 % response rate. In terms of approaches accessing online health information, 40.33 % (411 participants) used health media platform accounts, 32.97 % (336 participants) used search engines, 24.93 % (254 participants) engaged with health management apps or mini programs, and a smaller number, 65 cases participated in online health group. Regarding information sources, a relatively small number of residents relied on medical institutions (38.96 %, 397 participants) and medical personnel (18.35 %, 187 participants). The average eHEALS score was 27.62 ± 8.57. Participants demonstrated limited awareness in using online health information to solve their health problems (item 2 of eHEALS, 3.36 ± 1.27) and in discerning reliable from unreliable health information on Internet (item 6 of eHEALS, 3.38 ± 1.23). Multiple linear regression analysis indicated that e-health literacy was influenced by several factors, including age, coverage of both social and commercial medical insurances, the use of at least two online health information sources and search approaches, behaviors of forwarding and sharing online health information, and holding positive attitude of accepting online health information.
Conclusion:The e-health literacy of these middle-aged and older adults is moderate and influenced by various factors, including online health information use behaviors. To help them make better use of online health information and improve their e-health literacy, the authors recommended to provide authoritative information integration and retrieval platform, to strengthen regulation and supervision of health information providers, to develop older people friendly health information online platforms, and to help middle aged and older adults to better use online health information by mobilizing the resources of communities, families, health associations, and medical and insurance institutions.

Keywords

Middle-aged and elderly / E-health literacy / Health information / Usage habits / Internet / Community health services / Shanghai

Declarations

Not applicable.

Authors' contributions

Conceptualization, Y.C.; Methodology, Y.C.; Data curation, Y.C. and L.H.; Formal analysis, Y.C. and J.Z.; Funding acquisition, not applicable; Project administration, W.X. and W.X.; Resources, not applicable; Supervision, W.X. and W.X.; Validation, Y.C.; Writing—original draft, Y.C.; Writing—review and editing, W.X. and W.X. All authors have read and agreed to the published version of the manuscript.

Ethics approval and consent to participate

The study received approval from Shanghai Municipal Center for Health Promotion Ethics Review Committee (IRB-SHPERC-202,201).

Consent for publication

Not applicable.

Availability of data and materials

Not applicable

Declaration of competing interest

The authors declare that they have no competing interests.

Funding

This research was supported by grants from the Shanghai Municipal Health Commission (2021HP80) (GWV-8) (GWV-10.1-XK14).

Acknowledgements

Thanks to all the experts who participated in this study for the support provided. Thanks to the participants who voluntarily agreed to complete the questionnaire after understanding the purpose and content of this survey.

Authors' other information: Not applicable

References

[1] Health China Action Promotion Committee. Health China Action (2019-2030)[Internet]. 2019 Jul 15 [cited 2022 Oct 30]. Available from: http://www.gov.cn/xinwen/2019-07/15/content_5409694.htm.

[2] Jing YR, Qin WZ, Zhang J, et al. Association of e-health literacy with lifestyle among 18-59 years old residents in Taian city. (Chinese). Chin J Public Health. 2021; 37(9):1323-1327. doi: 10.11847/zgggws1134059.

[3] Guo SH, Hsing HC, Lin JL, et al. Relationships between mobile eHealth literacy, diabetes self-care, and glycemic outcomes in Taiwanese patients with type 2 diabetes: a cross-sectional study. JMIR Mhealth Uhealth. 2021; 9(2):e18404. doi: 10.2196/18404.

[4] Shiferaw KB, Tilahun BC, Endehabtu BF, et al. E-health literacy and associated factors among chronic patients in a low-income country: a cross-sectional survey. BMC Med Inform Decis Mak. 2020; 20(1):181. doi: 10.1186/s12911-020-01202-1.

[5] Yang ZH, Lan XL. Research review on eHealth literacy of the elderly person. (Chinese). Chin J Health Educ. 2018; 34(11):1023-1026. doi: 10.16168/j.cnki.issn.1002-9982.2018.11.014.

[6] Wang G, Gao HY, Li YH. Review of e-health literacy in China and abroad. (Chinese). Chin J Health Educ. 2017; 33(6):556-558. doi: 10.16168/j.cnki.issn.1002-9982.2017.06.020.

[7] Li MH, Qin WZ, Xu LZ, et al. E-health literacy and its influencing factors among middle-aged and elderly community residents in different regions of Tai’an city. (Chinese). Chin J Public Health. 2021; 37(9):1328-1332. doi: 10.11847/zgggws1135052.

[8] Li SJ, Xu HL, Cui GH. Analysis of eHealth literacy and its influencing factors among the elderly. (Chinese). Chin J Disease Control Prev. 2019; 23(11):1318-1322. doi: 10.16462/j.cnki.zhjbkz.2019.11.004.

[9] Li HM, Gao Y, Mao Q, et al. Analysis on the status quo of Internet medical health consultation for residents in China. (Chinese). Chin Res Hosp. 2019; 6(4):19-23. doi: 10.19450/j.cnki.jcrh.2019.04.005.

[10] Zhao Y, Chen H, Zou C, et al. Correlation of e-Health literacy and health information seeking behavior among adult internet users. (Chinese). Chin J Health Educ. 2018; 34(9):812-816. doi: 10.16168/j.cnki.issn.1002-9982.2018.09.011.

[11] Kang DQ, Lu YH, Wang Y. Survey and research on eHealth literacy and influencing factors among cancer patients. (Chinese). Chin J Modern Nurs. 2020; 26(22):2998-3004. doi: 10.3760/cma.j.cn115682-20200407-02535.

[12] Guo SJ, Yu XM, Sun YY, et al. Adaptation and evaluation of Chinese version of eHEALS and its usage among senior high school students. (Chinese). Chin J Health Educ. 2013; 29(2):106-108.

[13] Cheng H, Zhou Q, Liu XL, et al. Opportunity and reflection of the Internet + medical under COVID-19 epidemic situation. (Chinese). Chin Hospital Manag. 2020; 40(6):38-40.

[14] Xiang X, Wang Y. The current situation, characteristics, causes, and strategies of population aging in China. (Chinese). Chin J Gerontol. 2021; 41(18):4149-4152. doi: 10.3969/j.issn.1005-9202.2021.18.072.

[15] Shanghai Municipal Health Commission. 2021 Statistical information on the elderly population and aging cause monitoring in Shanghai [Internet]. 2022 Jul 28 [cited 2022 Oct 30]. Available from: http://wsjkw.sh.gov.cn/tjsj2/20220728/23e3fe0692d744a6b994309de7b2493d.html.

[16] Evangelista L, Steinhubl SR, Topol EJ. Digital health care for older adults. Lancet. 2019; 393(10180):1493. doi: 10.1016/S0140-6736(19)30800-1.

[17] Zhao Y, Chen H, Zou C, et al. Analysis on status and influencing factor of e-health literacy among outpatients. (Chinese). Mod Prev Med. 2019; 46(6):1070-1073 1078.

[18] Neter E, Brainin E. eHealth literacy: extending the digital divide to the realm of health information. J Med Internet Res. 2012; 14(1):e19. doi: 10.2196/jmir.1619.

[19] Ware P, Bartlett SJ, Pare G, et al. Using eHealth technologies: interests, preferences, and concerns of older adults. Interact J Med Res. 2017; 6(1):e3. doi: 10.2196/ijmr.4447.

[20] Wei XX, Hu YF, Chen RJ, et al. Analysis of health-promoting lifestyle and influencing factors of health self-management group members in 2018 in Shanghai. (Chinese). Health Educ Health Promot. 2020; 15(1):47-51. doi: 10.16117/j.cnki.31-1974/r.202001014.

[21] Chen J, Gan LB. Towards information-seeking relationships: a study on the health information sharing behavior of the elderly based on WeChat. Shanghai Journalism Review. (Chinese). 2021; 39(9):10-24. doi: 10.16057/j.cnki.31-1171/g2.2021.09.003.

[22] Wang W. Study on health information adoption behavior of elderly WeChat users. (Chinese). Chin J Journalism & Commun. 2020; 42(3):91-107. doi: 10.13495/j.cnki.cjjc.20200409.006.

[23] Yuan FJ. Correlation of eHealth literacy and self-efficacy and self-management with diabetes. (Chinese). Xinxiang: Xinxiang Medical University; 2016.

[24] Qi ZP, Zhou YC, Xia L. Analysis of health performance of commercial health insurance for middle and aged people in China —empirical evidence based on the CHARLS. (Chinese). China Soft Sci. 2019; 21(1):31-44. doi: 10.3969/j.issn.1002-9753.2019.01.004.

[25] Li SD. Research on the application of mobile medical care in commercial health insurance (Chinese). Mod Marketing (Business Edition). 2018; 25(6):32-33. doi: 10.19921/j.cnki.1009-2994.2018.06.018.

[26] U.S. Food and Drug Administration. Digital Health Innovation Action Plan [Internet]. 2017 Jul 27 [cited 2022 Oct 30]. Available from: https://www.fda.gov/downloads/MedicalDevices/DigitalHealth/UCM568735.pdf.

[27] Gong WQ, Guo Q, Jiang L. The boomerang effect in health communication: a study on the impact of intergenerational communication on infectious disease prevention behavior among middle-aged and elderly people (Chinese). Journal of Zhejiang University(Humanities and Social Sciences). 2021; 51(2):42-53. doi: 10.3785/j.issn.1008-942X.CN.33-6000/C.2020.09.163.

[28] Central Committee of the Communist Party of China, State Council. "Healthy China 2030" Planning Outline[A/OL]. 2016 Oct 25 [cited 2022 Oct 30]. Available from: http://www.gov.cn/xinwen/2016-10/25/content_5124174.htm.

[29] Loss J, Uslar CV. How German health insurance providers use social online networks to promote healthy lifestyles: a content analysis of Facebook? accounts. BMC Med Inform Decis Mak. 2021; 21(1):64. doi: 10.1186/s12911-021-01433-w.