ArticleDigital health
Self-assessed economic status and eHealth utilization among Chinese rural residents: A serial mediation model of electronic device ownership and eHealth literacy.
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Abstract
Objective: This study aimed to explore the associations between self-assessed economic status and eHealth utilization among rural residents, and to examine the chain mediating roles of electronic device ownership and eHealth literacy. Methods: A cross-sectional survey of 2,891 rural Shandong residents was conducted in 2023. Self-assessed economic status was measured by 5-point Likert scale. The dependent variable, eHealth utilization, was measured as a binary variable. Two mediators were included in this study. Electronic device ownership was calculated by counting owned digital equipment, while eHealth literacy was assessed with the validated eHEALS scale. Chain mediation was tested using Hayes' PROCESS Macro (Model 6) with logistic regression, and 5,000 bootstrap replications were used for significance evaluation. Results: The overall eHealth utilization rate among sampled rural residents in Shandong Province was 16.9%, calculated as the percentage of respondents who reported having used any form of internet-based medical service. Self-assessed economic status was positively linked to eHealth; neutral (OR=4.38,95%CI 0.913-21.098, P=0.065) and somewhat comfortable (OR=4.849,95%CI 0.981-23.983, P=0.053) versus the very comfortable reference. Device ownership (OR=4.064, 95%CI 2.757-5.991, P<0.001) and eHealth literacy (OR=1.120, 95%CI 1.103-1.137, P<0.001) were positively correlated with eHealth utilization. The direct association of self-assessed economic status on eHealth utilization was not significant (β = 0.0787), but total indirect effect included independent mediation by electronic device ownership (β=0.1247, 71.38%) and serial mediation (electronic device ownership→eHealth literacy, β=0.0285, 16.32%), with both indirect pathways statistically significant. Conclusion: eHealth utilization among rural Chinese residents remains low, which may be related to limited electronic device ownership and eHealth literacy. These factors explained most of the observed association, and device ownership exerted the dominant mediating effect. Interventions should prioritize subsidized digital equipment and rural network construction alongside grassroots eHealth literacy training.
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