Level of eHealth Literacy and Its Associations With Health Behaviors and Outcomes in Chinese Older Adults:...

eHealth literacy is important for older adults to be able to seek and evaluate online health information. However, there is a scarcity of large-scale data on their eHealth literacy levels, particularly among the oldest older individuals (aged >75 years) in unique, high-income Asian regions such as Hong Kong. A comprehensive understanding of how eHealth literacy is associated with specific health behaviors, mental well-being, and physical health outcomes in this population is lacking.

This study aims to assess the level of eHealth literacy and its associations with health behaviors and health-related outcomes among older adults in Hong Kong.

We conducted a cross-sectional analysis of baseline data from the Generations Connect Project. This is an ongoing large-scale community-based project, where we trained university students to conduct home visits and assess the health status of older adults (N=6704) in Hong Kong. eHealth literacy was measured using the eHealth Literacy Scale (eHEALS; score: 8-40). Health behavior measurements included physical activity levels (metabolic equivalent of task minutes per week) and smoking, drinking, and eating habits. Mental well-being was measured using the World Health Organization-Five Well-Being Index (percentage score: 0-100) and UCLA 3-item Loneliness Scale (score: 3-9). Physical health was assessed on the basis of self-reported medical diagnosis of noncommunicable diseases (yes/no), including hypertension, diabetes, cardiovascular disease, and stroke. Adjusted unstandardized coefficients (b) and odds ratios (ORs) were calculated to determine the associations between variables.

Among the 6704 participants (mean age 77.8, SD 7.0 years), the mean eHEALS score was 18.2 (SD 10.2), and 44.1% (2897/6566) of the participants had inadequate eHealth literacy (score: 8-15.99). Increasing age (adjusted b -0.32, 95% CI -0.35 to -0.28; P<.001), support from the Comprehensive Social Security Assistance Scheme (adjusted b -1.49, 95% CI -2.04 to -0.95; P<.001), and living in public housing (adjusted b -1.60, 95% CI -2.69 to -0.50; P=.004) were associated with a lower eHEALS score. Participants with moderate eHealth literacy (score: 24-31.99) were less likely to be current smokers (adjusted OR 0.60, 95% CI 0.38-0.95; P=.04), more physically active (adjusted b 39.83, 95% CI 2.04-77.62; P=.04), more likely to be community health center members (adjusted OR 1.52, 95% CI 1.30-1.77; P<.001) and to have healthy diets (adjusted b 0.034, 95% CI 0.006-0.063; P=.04), and less likely to have a medical diagnosis of diabetes (adjusted OR 0.73, 95% CI 0.62-0.85; P<.001). Moreover, they had a higher score on the World Health Organization-Five Well-being Index (adjusted b 2.89, 95% CI 1.42-4.36; P<.001) and a lower score on the UCLA 3-item Loneliness Scale (adjusted b -0.26, 95% CI -0.37 to -0.15; P<.001).

The level of eHealth literacy was low among older adults in Hong Kong. eHealth literacy was associated with positive health behaviors and health-related outcomes. Interventions are warranted to boost their eHealth literacy in the future.