Level of eHealth Literacy and Its Associations With Health Behaviors and Outcomes in Chinese Older Adults: Cross-Sectional Analysis of Baseline Data From a Large-Scale Community Project.

Background: eHealth literacy is important for older adults to be able to seek and evaluate online health information. However, there is a scarcity of large-scale data on their eHealth literacy levels, particularly among the oldest older individuals (aged >75 years) in unique, high-income Asian regions such as Hong Kong. A comprehensive understanding of how eHealth literacy is associated with specific health behaviors, mental well-being, and physical health outcomes in this population is lacking. Objective: This study aims to assess the level of eHealth literacy and its associations with health behaviors and health-related outcomes among older adults in Hong Kong. Methods: We conducted a cross-sectional analysis of baseline data from the Generations Connect Project. This is an ongoing large-scale community-based project, where we trained university students to conduct home visits and assess the health status of older adults (N=6704) in Hong Kong. eHealth literacy was measured using the eHealth Literacy Scale (eHEALS; score: 8-40). Health behavior measurements included physical activity levels (metabolic equivalent of task minutes per week) and smoking, drinking, and eating habits. Mental well-being was measured using the World Health Organization-Five Well-Being Index (percentage score: 0-100) and UCLA 3-item Loneliness Scale (score: 3-9). Physical health was assessed on the basis of self-reported medical diagnosis of noncommunicable diseases (yes/no), including hypertension, diabetes, cardiovascular disease, and stroke. Adjusted unstandardized coefficients (b) and odds ratios (ORs) were calculated to determine the associations between variables. Results: Among the 6704 participants (mean age 77.8, SD 7.0 years), the mean eHEALS score was 18.2 (SD 10.2), and 44.1% (2897/6566) of the participants had inadequate eHealth literacy (score: 8-15.99). Increasing age (adjusted b -0.32, 95% CI -0.35 to -0.28; P<.001), support from the Comprehensive Social Security Assistance Scheme (adjusted b -1.49, 95% CI -2.04 to -0.95; P<.001), and living in public housing (adjusted b -1.60, 95% CI -2.69 to -0.50; P=.004) were associated with a lower eHEALS score. Participants with moderate eHealth literacy (score: 24-31.99) were less likely to be current smokers (adjusted OR 0.60, 95% CI 0.38-0.95; P=.04), more physically active (adjusted b 39.83, 95% CI 2.04-77.62; P=.04), more likely to be community health center members (adjusted OR 1.52, 95% CI 1.30-1.77; P<.001) and to have healthy diets (adjusted b 0.034, 95% CI 0.006-0.063; P=.04), and less likely to have a medical diagnosis of diabetes (adjusted OR 0.73, 95% CI 0.62-0.85; P<.001). Moreover, they had a higher score on the World Health Organization-Five Well-being Index (adjusted b 2.89, 95% CI 1.42-4.36; P<.001) and a lower score on the UCLA 3-item Loneliness Scale (adjusted b -0.26, 95% CI -0.37 to -0.15; P<.001). Conclusions: The level of eHealth literacy was low among older adults in Hong Kong. eHealth literacy was associated with positive health behaviors and health-related outcomes. Interventions are warranted to boost their eHealth literacy in the future.