A 3-Wave Longitudinal Study of eHealth Literacy and Older People's Health-Related Quality of Life in China: The Mediating Role of General Self-Efficacy

Abstract

Background and ObjectivesHealth-related quality of life (HRQoL) is an important indicator to reflect the independence and well-being of older adults in their later life. Improving the HRQoL of older adults is of great importance for achieving healthy aging. The internet provides extensive health information and being able to effectively use the electronic health (eHealth) resources (reflected as “eHealth literacy”) potentially empowers older adults to manage health and improve HRQoL. However, there is limited evidence about the relationship between eHealth literacy and HRQoL in this population. This study aims to examine the longitudinal association and temporal relationship between eHealth literacy and HRQoL among older adults, and to explore potential underlying mechanisms. DesignA 3-wave longitudinal study. Setting and ParticipantsChinese older adults aged 55 or older in Jiangxi Province, China. MethodsData were collected at baseline (T1) and 3-month (T2) and 6-month (T3) follow-ups during February to December 2022, using online self-reported questionnaires. eHealth literacy, HRQoL, and general self-efficacy were measured using validated tools. Statistical analyses, including longitudinal Tobit regression, cross-lagged panel model (CLPM), and longitudinal mediation analysis were performed. ResultsA total of 611 participants were included at T1, and 464 (75.9%) completed both 3- and 6-month follow-ups. Longitudinal Tobit regression suggested that older individuals with higher eHealth literacy showed better HRQoL over time (adjusted β, 0.023; 95% CI, 0.011–0.035; P < .001), after accounting for covariates. The CLPM supported that higher eHealth literacy significantly predicts improved HRQoL over time (standardized β, 0.09, P = .008), but not the reverse. In addition, general self-efficacy at T2 fully mediated the relationship from eHealth literacy at T1 and HRQoL at T3, with mediated proportion of 28.3%. Conclusions and ImplicationsThis study highlighted the importance of eHealth literacy and self-efficacy in improving HRQoL among older adults, supporting the development of tailored interventions to promote their HRQoL.