eHealth literacy and health responsibility among older adults: the serial indirect roles of self-efficacy and social support based on the health promotion model.

Introduction: Guided by the Health Promotion Model and informed by Social Cognitive Theory, this cross-sectional study examined the association between eHealth literacy and health responsibility among older adults and explored whether self-efficacy and social support were indirectly involved in this association in a serial pattern. Methods: A convenience sample of 865 adults aged 60 years and older in Shandong Province, China, was surveyed using the eHealth Literacy Scale, the General Self-Efficacy Scale, the Social Support Rating Scale, and the health responsibility subscale of the Health-Promoting Lifestyle Profile II. Data were analyzed using SPSS 27.0 and the PROCESS macro. Results: eHealth literacy was positively associated with health responsibility and was also positively associated with self-efficacy and social support. The analysis further showed significant indirect associations involving self-efficacy alone, social support alone, and the serial combination of self-efficacy and social support in the association between eHealth literacy and health responsibility. Discussion: Higher eHealth literacy co-occurred with greater health responsibility, stronger self-efficacy, and greater social support in this cross-sectional sample of older adults. The findings are consistent with a theory-informed pattern linking eHealth literacy, self-efficacy, social support, and health responsibility. These results may inform future longitudinal research and health promotion efforts targeting older adults.