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. 2025 Apr 29;25(1):293.
doi: 10.1186/s12877-025-05952-3.

Path analysis of the influence of digital health literacy on self-management behaviour among elderly patients with chronic diseases in rural China

Xuefang Liu  1 , Xiaomin Gan  1 , Guangqin Ren  1 , Zhongrui Mao  1 , Jiuying Hu  2 , Chengcheng Sha  3 , Juan Wu  4   5
Affiliations

Path analysis of the influence of digital health literacy on self-management behaviour among elderly patients with chronic diseases in rural China

Xuefang Liu et al. BMC Geriatr. .

Abstract

Background: Chronic disease self-management is very important for the progression and treatment of diseases worldwide. The management of chronic diseases among elderly individuals in rural areas is an urgent public health concern in China. The purpose of this study was to investigate the relationship between digital health literacy and chronic disease self-management behaviour in elderly Chinese patients with chronic diseases in rural areas, as well as the chain mediating effects of social support and depression. The objective was to provide a scientific basis for improving the active health behaviour of rural elderly patients with chronic diseases in China and worldwide.

Methods: Using convenience sampling, the survey subjects were elderly patients with chronic diseases in rural areas of Anhui Province, China. A self-designed questionnaire was used to collect general survey data, digital health literacy scale scores, social support scale scores, depression scale scores, and chronic disease self-management behaviour scale scores. Common method bias tests, descriptive statistics and correlation analyses were performed via SPSS 29.0. The structural equation model was constructed and tested via AMOS 27.0. Differences for which p < 0.05 were considered statistically significant.

Results: In all, 202 elderly patients with chronic diseases who resided in rural areas were enrolled. The digital health literacy score was 39.25 ± 9.00, and the chronic disease self-management behaviour score was 27.82 ± 9.56. The self-management behaviours of rural elderly patients with chronic diseases were positively correlated with digital health literacy and social support and were negatively correlated with depression (p < 0.01). After the mediating effect test, the total indirect effect value of social support and depression was 0.167, which accounted for 36.07% of the total effect. Among them, social support and depression were partial mediators of digital health literacy and chronic disease self-management behaviour, with effect values of 0.055 (95% CI: 0.012, 0.127) and 0.094 (95% CI: 0.024, 0.201), which accounted for 11.88% and 20.3% of the total effect, respectively. Social support and depression were chain mediators of digital health literacy and chronic disease self-management behaviour, with an effect value of 0.018 (95% CI: 0.004, 0.055) and an effect share of 3.89%.

Conclusion: The self-management level of elderly patients with chronic diseases in rural China is low. Digital health literacy not only directly affects the chronic disease self-management behaviour of elderly individuals but also indirectly predicts chronic disease self-management behaviour through the mediating effects of social support and depression.

Keywords: Chain mediation analysis; Depression; Digital health literacy; Rural elderly patients with chronic diseases; Self-management behaviour of chronic diseases; Social support.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All experimental protocols of this study were approved by the Ethics Committee of Anhui Medical University(No.83243452), and all methods were conducted according to the guidelines of the Declaration of Helsinki and relevant Chinese laws and regulations. We confirm that informed consent was obtained from all participants and/or their legal guardians. Considering that the study participants were all rural residents with generally low literacy levels, we used plain language to prepare the informed consent form, avoiding jargon and ensuring the clarity of the content. At the same time, before signing the informed consent form, the investigator explained the study purpose, procedures, potential risks and rights and benefits to the participants line by line, and for participants with limited comprehension, their family members or members of the village committee were invited to assist in the explanations to ensure that they fully understood the content of the study. Written informed consent was obtained from all participants before any study procedures were performed. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual mediation model for digital health literacy, social support, depression, and chronic disease self-management behaviour
Fig. 2
Fig. 2
Diagram of the standardized path coefficients of the model
See this image and copyright information in PMC

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