The level of electronic health literacy among older adults: a systematic review and meta-analysis

Abstract

BackgroundIn the context of deeper integration of the internet and healthcare services, eHealth literacy levels have become an important predictor of public health outcomes and health-promoting behaviors. However, there is a lack of comprehensive understanding of eHealth literacy levels among older adults.ObjectiveTo systematically assess the level of eHealth literacy among older adults.MethodsWe conducted searches in MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, China National Knowledge Infrastructure Database (CNKI), Wanfang Database, Weipu Database (VIP), and Chinese Biomedical Database (Sinomed) to collect survey studies on the eHealth literacy levels of the older adults, with a search timeframe from the establishment of the database to May 2024. The quality of the included literature was assessed using the Agency for Healthcare Research and Quality (AHRQ) and the Newcastle-Ottawa Scale (NOS). Additionally, subgroup analysis and meta-regression were conducted to detect sources of heterogeneity. Funnel plots and Egger’s test were used to assess publication bias.ResultsA total of 48 relevant studies were included, including 45 cross-sectional, 2 cohort studies and 1 longitudinal study, comprising 33,919 older adults. The quality of the studies was all above moderate, with 10 high-quality publications. Meta-integration results showed that the eHealth literacy score of older adults was 21.45 (95% CI:19.81–23.08). Subgroup analysis showed that among the elderly population, females had lower eHealth literacy at 19.13 (95% CI:15.83–22.42), those aged 80 years and older had lower eHealth literacy at 16.55 (95% CI:11.73–21.38), and elderly individuals without a spouse and living alone had even lower eHealth literacy at 18.88 (95% CI:15.71–22.04) and 16.03 (95% CI:16.51–21.79). Based on region, eHealth literacy was lower among older adults in developing countries at 20.71 (95% CI:18.95–22.48). Meta-regression results indicate that sample size and region can significantly impact heterogeneity.ConclusionOur results found that the average eHealth literacy score of the elderly was 21.45, which was much lower than the passing level (≥ 32), suggesting that more attention should be paid to the eHealth literacy aspect of the elderly. Meanwhile, due to the limitation of the literature sources, the global representativeness of the results of this study still needs to be supported by more research data from other countries.