Digital access, digital health information engagement, and self-reported preventive behavior among rural adults in Guizhou, China: media-use ecologies and cross-sectional associations.

Background: Digital health education may help reduce health-information inequality in underdeveloped rural areas, but evidence remains limited on how rural residents encounter health information across different media environments and how digital access, usability, engagement, and self-reported preventive behavior are interrelated. This study examined media-use ecologies and cross-sectional associations among digital access and skills, digital health information engagement, and self-reported preventive behavior among rural adults in Guizhou, China. Methods: A cross-sectional survey was conducted among 1,265 adult rural residents recruited from five selected counties/districts in Guizhou Province using a multistage non-probability sampling design. Latent class analysis was used to characterize health-information media-use ecologies based on nine indicators of information channels and social media platforms. Regression-based cross-sectional association models examined associations among digital access and skills, perceived ease of understanding digital health content, lower operational difficulty, digital health information engagement, attitudes and willingness toward health education, and self-reported preventive behavior, adjusting for sex, age, education, income, and media-use ecology. Results: Five media-use ecologies were identified, reflecting different combinations of offline interpersonal/professional channels, traditional media, and digital platforms. Residents in omnichannel and short-video/social-platform-centered ecologies reported higher digital health information engagement, whereas those in the offline village doctor/traditional channels ecology reported the lowest engagement. Higher digital access and skills were associated with stronger engagement, and this association was attenuated after accounting for perceived ease of understanding and lower operational difficulty. Greater engagement was associated with more frequent self-reported preventive behavior, and this association was attenuated after accounting for attitudes toward health education and willingness to adopt new forms of health education. Conclusion: In this non-probability adult sample from selected rural sites in Guizhou, digital health inequality was reflected not only in unequal access to devices and networks, but also in differences in understanding, usability, engagement, and self-reported preventive behavior. The findings should be interpreted as cross-sectional associations among field-feasible indicators rather than evidence of causal mechanisms.