Determinants of Digital Health Literacy Among Hypertensive Adults: A Community-Based Cross-Sectional Study

Digital health literacy (DHL) is a critical component for the effective self-management and secondary prevention of hypertension. However, the multi-level determinants of DHL in community settings are not yet fully understood. This study aimed to assess the status of DHL and identify its key sociodemographic, psychosocial, and health system determinants among adults with hypertension in China.

A cross-sectional survey was conducted (October 2024-January 2025) across 1 tertiary general hospital and 3 community health service centers in Changzhou, China. Data were collected from 660 hypertensive adults using a structured questionnaire, including the eHealth Literacy Scale (eHEALS), and scales for physician-patient interaction, perceived internet health information quality, and perceived family support. Determinants were analyzed using multivariate logistic regression and a random forest model to rank factor importance.

Nearly half of the participants (49.45%) demonstrated low DHL. Multivariate logistic regression indicated that older age (specifically ≥75 years: OR = 13.33, 95% CI = 1.73-99.88), limited internet use (<1 h/day: OR = 2.50, 95% CI = 1.04-5.88), and concerns regarding data privacy (OR = 3.42, 95% CI = 1.01-11.58) were significant predictors of low DHL. Additionally, higher perceived quality of internet health information (OR = 0.72, 95% CI = 0.67-0.78), better physician-patient interaction (OR = 0.92, 95% CI = 0.86-0.99), and greater family support (OR = 0.37, 95% CI = 0.25-0.55) were associated with lower odds of low DHL. The random forest model identified the perceived quality of internet health information as the most influential predictor, followed by age and data privacy.

DHL levels among individuals with hypertension in the community are suboptimal. These findings highlight the potential importance of a multilevel approach to supporting DHL. Efforts to improve the perceived quality of internet health information and strengthen social support systems may be beneficial, and primary care providers could play an important role in guiding patients' use of digital health resources.