When Digital Health Skills Backfire: eHealth Literacy Amplifies the Relationship Between Loneliness and Quality of Life Among Chinese Older Adults
1
Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
2
School of Population and Health, Renmin University of China, Beijing, China
3
Key Laboratory of Health System Reform and Governance, National Health Commission of China, Beijing, China
4
General Practice Department, Second Outpatient Section, Peking University Third Hospital, Beijing, China
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Loneliness is a growing public health challenge among older adults and is associated with a wide range of adverse health outcomes. The role of eHealth literacy in shaping the relationship between loneliness and quality of life remains unclear. This study aimed to examine the contributing role of eHealth literacy in moderating the associations between loneliness and quality of life among older adults.
METHODS:
A community-based survey was conducted in 2025 among older adults aged 60 years or above living in northwestern China. A total of 2,110 participants were included. Multiple linear regression and interaction models were used to assess associations and moderating effects.
RESULTS:
Loneliness showed a consistent negative association with quality of life (β = −0.83, 95% CI = −1.18, −0.49). Higher overall eHealth literacy and its three dimensions were associated with better quality of life (β = 0.41, 95% CI = 0.35, 0.47), with the strongest association observed for decision-making literacy (β = 2.89, 95% CI = 2.45, 3.33). Interaction models indicated a risk amplification pattern: the negative association between loneliness and quality of life was steeper among older adults with higher eHealth literacy (β = −0.04, 95% CI = −0.08, −0.002), with decision-making literacy showing the most pronounced amplification (β = −0.32, 95% CI = −0.62, −0.03). Sensitivity analyses produced similar results across alternative outcomes and subgroups.
CONCLUSIONS:
Higher eHealth literacy didn’t buffer the adverse association between loneliness and quality of life and instead intensified it, with decision-making literacy showing the strongest amplification. These findings indicate that initiatives to strengthen eHealth literacy should account for its divergent components and potential unintended consequences, and may incorporate emotional regulation and complementary support to assist older adults in navigating complex online health information.
Loneliness is a growing public health challenge among older adults and is associated with a wide range of adverse health outcomes. The role of eHealth literacy in shaping the relationship between loneliness and quality of life remains unclear. This study aimed to examine the contributing role of eHealth literacy in moderating the associations between loneliness and quality of life among older adults.
METHODS:
A community-based survey was conducted in 2025 among older adults aged 60 years or above living in northwestern China. A total of 2,110 participants were included. Multiple linear regression and interaction models were used to assess associations and moderating effects.
RESULTS:
Loneliness showed a consistent negative association with quality of life (β = −0.83, 95% CI = −1.18, −0.49). Higher overall eHealth literacy and its three dimensions were associated with better quality of life (β = 0.41, 95% CI = 0.35, 0.47), with the strongest association observed for decision-making literacy (β = 2.89, 95% CI = 2.45, 3.33). Interaction models indicated a risk amplification pattern: the negative association between loneliness and quality of life was steeper among older adults with higher eHealth literacy (β = −0.04, 95% CI = −0.08, −0.002), with decision-making literacy showing the most pronounced amplification (β = −0.32, 95% CI = −0.62, −0.03). Sensitivity analyses produced similar results across alternative outcomes and subgroups.
CONCLUSIONS:
Higher eHealth literacy didn’t buffer the adverse association between loneliness and quality of life and instead intensified it, with decision-making literacy showing the strongest amplification. These findings indicate that initiatives to strengthen eHealth literacy should account for its divergent components and potential unintended consequences, and may incorporate emotional regulation and complementary support to assist older adults in navigating complex online health information.
| eISSN: | 2654-1459 |
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