| ObjectivesTo investigate the current situation of eHealth literacy among older people living in communities and explore its influencing factors,and to analyze the correlation between eHealth literacy and self-efficacy,self-care ability,and health promotion behaviors.Finally,based on two mediating variables,self-efficacy,and self-care ability,to clarify the influence of eHealth literacy on health promotion behaviors.This study will provide a theoretical basis for improving the eHealth literacy level of the older people and clarifying the influence of eHealth literacy on health promotion behaviors.MethodsThis cross-sectional study used data from 446 older adults in 4 communities in Qingdao,Shandong Province in Northeastern China,from June to December at the year of 2021.The survey was conducted using the general information questionnaire,family care degree questionnaire,eHealth literacy scale,general self-efficacy scale,the self-care ability scale for the elderly scale,and health-promoting lifestyle profile-Ⅱ,revised scale.SPSS 24.0,Amos 24.0 software,and PROCESS program were used for data statistics;The independent sample t-test and one-way ANOVA were applied to compare the variations in eHealth literacy among different older people;Pearson correlation analysis was used to explore the relationship between eHealth literacy,self-efficacy,self-care ability,and health promotion behaviors among older people living in communities.Amos24.0 software was used to construct a structural equation model,which can clarify the mechanism of the influence of older adults’ eHealth literacy on health promotion behaviors.Results1.The eHealth literacy score of the community older people was(16.55 ± 3.79),and the overall level was low.The dimensional scores from high to low in turn was:application ability dimension(2.21 ± 0.45),decision making ability dimension(1.93 ±0.80),and judgment ability dimension(1.77 ± 0.55).2.The results of the univariate analysis showed that age,marriage status,educational level,monthly income of per capita,profession,self-rated health condition,type of health insurance,family functional status,years of using the Internet,Internet usage frequency,and daily Internet access time were influence factors(P < 0.05).The findings of multiple linear regression analysis showed that age,educational level,profession,self-rated health condition,family function,years of using the Internet,Internet usage frequency,and daily Internet time were the affecting factors of eHealth literacy among older people(P < 0.05).The above variables together explained 59.10% of the total variance in eHealth literacy among older people.3.The self-efficacy score of older people was(24.80 ± 4.09),and the self-care ability score was(60.37 ± 6.75),of which 365(81.84%)of older people had low self-care ability.The score of health promotion behaviors was(101.50 ± 10.89),the dimensional scores from high to low in turn was: nutrition dimensions(3.34 ± 0.33),interpersonal relationship dimensions(2.71 ± 0.49),spiritual growth dimensions(2.57 ± 0.43),stress management dimensions(2.46 ± 0.46),health responsibility dimensions(2.39 ± 0.40),and physical activity dimensions(2.06 ± 0.44),and the score of physical activity dimension was relatively low.4.The correlation results showed that the scores of eHealth literacy and each dimension of community older people were positively correlated with self-efficacy,self-care ability,health promotion behaviors and each of its dimensions(r=0.152～0.940,P < 0.01).5.The results of structural equation modeling path effect analysis showed that the total effect of eHealth literacy on health promotion behaviors was 0.616,and there were four specific influence paths: a)eHealth literacy can directly affect health promotion behaviors,with a direct effect of 0.241.b)eHealth literacy can act indirectly on health promotion behaviors through the partial mediating effect of self-efficacy,in which the mediating effect of self-efficacy was 0.157(0.478*0.329).c)eHealth literacy can act indirectly on health promotion behaviors through the partially mediated role of self-care ability,where the mediating effect of self-care ability is 0.171(0.397*0.430).d)In addition,the chain mediation effect was identified in the relationship of eHealth literacy and health promotion behaviors: eHealth literacy → self-efficacy → self-care ability →health promotion behaviors.This pathway effect value was 0.047(0.478*0.231*0.430),accounting for 7.63% of the total effect.Conclusions1.The eHealth literacy levels of older people living in communities are low and need to be improved,among which the elderly who are older,less educated,have a poorer family function,and lack experience related to Internet use need more focused attention.2.The correlations among eHealth literacy,self-efficacy,self-care ability,and health promotion behaviors are pairwise positive.3.The eHealth literacy can act directly on health promotion behaviors,and indirectly through self-efficacy and self-care ability.It indicates that improving eHealth literacy is the key to promoting health promotion behaviors in older people. |
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