| ObjectiveIn order to provide theoretical reference and empirical basis for improving the gerontological design of digital health platform,carrying out accurate intervention of digital health literacy of the elderly,and making public health decisions to improve the quality of life of the elderly under the background of active aging,this study develops Digital Health Literacy Assessment Scale for the community-dwelling elderly,which is suitable for the Internet medical situation and the media usage characteristics of the elderly in China.And then taking the community-dwelling elderly in the main urban areas of Chongqing as an example to investigate and analyze the status quo and factors which influence digital health literacy of the community-dwelling elderly.Besides,we also attempt to explore the effect of the elderly’s digital health literacy on their quality of life.Methods1.Development and validation of Digital Health Literacy Assessment Scale for community-dwelling elderlyBased on the theoretical framework of Transaction Model of e Health Literacy and literature analysis,the scale item pool is formed.Through Delphi method and small sample pre-survey,the items are preliminarily screened and revised to form a pre-test scale.A total of457 elderly people were investigated.In the first round,204 community-dwelling elderly in the main urban areas of Chongqing were conveniently investigated by using the pre-test scale.The obtained data were analyzed by item analysis and exploratory factor analysis to further screen the items of the scale,so as to establish a formal scale.In the second round,253community-dwelling elderly in the main urban areas of Chongqing were conveniently investigated with the formal scale,the reliability and validity of which were verified based on the data.2.Current status and influencing factors of digital health literacy among community-dwelling elderlyBy a multi-stage stratified sampling method,572 community-dwelling elderly in the main urban areas of Chongqing were selected.We conducted a cross-sectional survey by using self-designed general data questionnaire,Internet usage and attitude towards Internet health information questionnaire,and Digital Health Literacy Assessment Scale for community-dwelling elderly developed in this study.Using SPSS 23.0 software,independent sample t-test,one-way ANOVA and multiple linear regression analysis were used to explore the influencing factors of digital health literacy of the elderly.3.The impact of digital health literacy on quality of life among community-dwelling elderlyWe conducted a cross-sectional survey by using the self-designed general data questionnaire,Digital Health Literacy Assessment Scale for community-dwelling elderly developed in this study,Health Promoting Lifestyle Profile-Ⅱ,revise(HPLP-ⅡR)and 12-item short form health survey(SF-12)among the same participants in the previous stage.Using SPSS 23.0 software,independent sample t-test and one-way ANOVA were used to compare the differences in the scores of quality of life among the community-dwelling elderly in different general data and different digital health literacy.Pearson correlation analysis was used to explore the relationship among digital health literacy,health-promoting lifestyle,and quality of life.The SPSS PROCESS macro was used to test the intermediary role of health promotion lifestyle between digital health literacy and quality of life.Results1.Development and validation of Digital Health Literacy Assessment Scale for community-dwelling elderlyDigital Health Literacy Assessment Scale for community-dwelling elderly consists of 15items in 3 dimensions:the ability to obtain and evaluate digital health information,the ability to interact with digital health information,and the ability to apply digital health information.Exploratory factor analysis extracted three common factors that explained 78.726%of total variance.The confirmatory factor analysis indicated model fitted well:χ~2/df=2.591,RMSEA=0.079,CFI=0.958,GFI=0.900,IFI=0.959,TLI=0.945,NFI=0.934.In the test of convergent validity and discriminant validity,the factor load of each item in the corresponding dimension was 0.645～0.910,AVE of each dimension was 0.514～0.695,and CR was 0.759～0.945.The correlation coefficient among the three dimensions was0.536～0.804(P<0.001).The S-CVI/Ave was 0.967,and the I-CVI was 0.833～1.000.The criterion validity coefficient was 0.938.The Cronbach’sαcoefficient of the scale was 0.941,the split-half reliability coefficient was 0.889,2-week test-retest reliability was 0.941.2.Current status and influencing factors of digital health literacy among community-dwelling elderlyThe average score of digital health literacy was(37.10±18.65)(total score ranges from15 to 75).Univariate analysis showed that there were statistically significant differences in the comparison of digital health literacy according to 16 variables,such as different age,education levels and so on(P<0.01).Multiple linear regression analysis showed that the influencing factors of digital health literacy among community-dwelling elderly were age,marital status,education level,self-rated health status,degree of health concerns,duration of Internet usage,time spent using the Internet per day,frequency of Internet usage,frequency of receiving guidance passively from family members,perceived usefulness,perceived ease of use,perceived risk and perceived reliability(P<0.05).They can jointly explain the total variation of 83.5%of digital health literacy for community-dwelling elderly.3.The impact of digital health literacy on quality of life among community-dwelling elderlyIn this study,the average score of quality of life among community-dwelling elderly was(97.97±11.45)(total score ranges from 0 to 200),among which physical component score was(44.70±9.45)(total score ranges from 0 to 100)and mental component score was(53.26±6.81)(total score ranges from 0 to 100).The results of univariate analysis showed that there were significant differences in quality of life among the community-dwelling elderly with different age,sex,education level,monthly household income per capita,and marital status(P<0.05).The elderly with high digital health literacy reported higher scores of quality of life than those with low digital health literacy(P<0.001).There was a positive correlation among digital health literacy,health-promoting lifestyle and quality of life,and the correlation coefficient was 0.416～0.706(P<0.001).Digital health literacy had a positive predictive effect on quality of life.Health-promoting lifestyle played an intermediary role in the impact of digital health literacy on quality of life,and the intermediary effect was 0.175.Conclusions1.Digital Health Literacy Assessment Scale for the community-dwelling elderly developed in this study has good reliability,validity and practicability,and it may serve as an ideal tool to evaluate the digital health literacy level of the community-dwelling elderly.2.The overall digital health literacy of the community-dwelling elderly who live in main urban areas of Chongqing is still at a low level,which is influenced by three factors:sociodemographic characteristics,Internet usage and attitude towards Internet health information.Specifically,older adults with advanced age,low education level,unmarried/divorced/widowed,poor health status,low degree of health concern,less access to the Internet and low recognition of Internet health information have lower digital health literacy,who need more attention from health-related practitioners.3.The quality of life among the community-dwelling elderly in Chongqing’s main urban areas needs to be improved,and digital health literacy can have an impact on their quality of life through the intermediary role of health-promotion lifestyle.It is suggested that in the future,management organizations,communities,families and individuals should strengthen the cultivation of digital health literacy of the elderly,promote them to advance quality of life by health-promoting lifestyle modification,and finally motivate the development of active aging in our country. |
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