Chenxi Zhou, Yangchun Xiao, Mei Wang, Yun Wang, Xiao Yue
{"title":"Digital Exclusion and Health Literacy Among Older Adults: The Mediating Effects of Social Support and Self-Efficacy.","authors":"Chenxi Zhou, Yangchun Xiao, Mei Wang, Yun Wang, Xiao Yue","doi":"10.1111/jocn.70004","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Digital exclusion has been linked to adverse health outcomes among older adults. However, its relationship with health literacy, a midstream determinant of health outcomes in aging populations, remains insufficiently explored.</p><p><strong>Aim: </strong>To investigate the relationship between digital exclusion and health literacy among older adults, and to assess the mediating effects of social support and self-efficacy.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Methods: </strong>Data from the 2021 Psychology and Behaviour Investigation of Chinese Residents (PBICR) survey were used. Digital exclusion was assessed through self-reported non-use of computers or smartphones. Health literacy, social support and self-efficacy were measured using the Short-Form Health Literacy Instrument, the 12-item Perceived Social Support Scale and the New General Self-Efficacy Scale. Generalised linear models (GLM) were employed to examine the relationships between digital exclusion and health literacy, while mediation analysis with bootstrapping assessed the mediating roles of social support and self-efficacy.</p><p><strong>Results: </strong>A total of 1147 older adults participated in the study, with 27.64% identified as digitally excluded and a moderate level of health literacy. GLM analysis identified several significant factors influencing health literacy, including digital exclusion, social support, self-efficacy, higher education levels, household monthly income per capita > 3000 RMB, non-agricultural hukou, chronic conditions and medication use. Mediation analysis revealed that digital exclusion negatively impacted health literacy. Social support and self-efficacy partially mediated the relationship between digital exclusion and health literacy.</p><p><strong>Conclusion: </strong>Digital exclusion is negatively associated with health literacy among older adults, with social support and self-efficacy partially mediating the relationship.</p><p><strong>Implications for the profession and/or patient care: </strong>This study underscores the importance of addressing digital exclusion, as well as promoting social support and self-efficacy to enhance health literacy in ageing populations.</p><p><strong>Impact: </strong>This study provides insights into the relationship between digital exclusion and health literacy among older adults, as well as the mediating effects of social support and self-efficacy, offering potential targets for health literacy improvement.</p><p><strong>Reporting method: </strong>STROBE Statement (STrengthening the Reporting of OBservational studies in Epidemiology).</p><p><strong>Patient or public contribution: </strong>No patient or public contribution was involved.</p>","PeriodicalId":50236,"journal":{"name":"Journal of Clinical Nursing","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Nursing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/jocn.70004","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Digital exclusion has been linked to adverse health outcomes among older adults. However, its relationship with health literacy, a midstream determinant of health outcomes in aging populations, remains insufficiently explored.
Aim: To investigate the relationship between digital exclusion and health literacy among older adults, and to assess the mediating effects of social support and self-efficacy.
Design: A cross-sectional study.
Methods: Data from the 2021 Psychology and Behaviour Investigation of Chinese Residents (PBICR) survey were used. Digital exclusion was assessed through self-reported non-use of computers or smartphones. Health literacy, social support and self-efficacy were measured using the Short-Form Health Literacy Instrument, the 12-item Perceived Social Support Scale and the New General Self-Efficacy Scale. Generalised linear models (GLM) were employed to examine the relationships between digital exclusion and health literacy, while mediation analysis with bootstrapping assessed the mediating roles of social support and self-efficacy.
Results: A total of 1147 older adults participated in the study, with 27.64% identified as digitally excluded and a moderate level of health literacy. GLM analysis identified several significant factors influencing health literacy, including digital exclusion, social support, self-efficacy, higher education levels, household monthly income per capita > 3000 RMB, non-agricultural hukou, chronic conditions and medication use. Mediation analysis revealed that digital exclusion negatively impacted health literacy. Social support and self-efficacy partially mediated the relationship between digital exclusion and health literacy.
Conclusion: Digital exclusion is negatively associated with health literacy among older adults, with social support and self-efficacy partially mediating the relationship.
Implications for the profession and/or patient care: This study underscores the importance of addressing digital exclusion, as well as promoting social support and self-efficacy to enhance health literacy in ageing populations.
Impact: This study provides insights into the relationship between digital exclusion and health literacy among older adults, as well as the mediating effects of social support and self-efficacy, offering potential targets for health literacy improvement.
Reporting method: STROBE Statement (STrengthening the Reporting of OBservational studies in Epidemiology).
Patient or public contribution: No patient or public contribution was involved.
期刊介绍：
The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice.
JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice.
We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.
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