Digital Health Engagement Regarding Lumbar Disc Herniation in Terms of Exercise Adherence: Integrating Variable-Centered and Person-Centered Perspectives

Abstract

Background: Exercise adherence is pivotal for Lumbar Disc Herniation (LDH) rehabilitation, yet remains suboptimal. Digital health offers support, but patient engagement varies significantly. Current research lacks an integrated perspective examining variable-centered general mechanisms and person-centered heterogeneity in digital health engagement and adherence. Aim: This study aimed to: (1) elucidate the variable-centered mechanism by testing the mediating role of health information seeking behavior (HISB) between eHealth literacy and exercise adherence; and (2) identify person-centered latent profiles of digital health engagement to predict adherence levels. Methods: This cross-sectional study (from July to November 2025) involved 346 LDH patients. Digital health engagement was operationalized using the eHealth Literacy Scale (eHEALS) and the Health Information Seeking Behavior Scale (HISB). Exercise adherence was assessed using a validated LDH-specific scale. Data were analyzed using Structural Equation Modeling (SEM) and Latent Profile Analysis (LPA). Results: SEM confirmed eHealth literacy positively predicted adherence directly and indirectly via HISB (mediation effect: 30.6%). LPA identified four profiles: “Digital Disengaged” (36.4%), “Passive Spectators” (36.1%), “Digital Champions” (22.3%), and “Distress-Driven Seekers” (5.2%). While youth and higher socioeconomic status predicted “Digital Champions”, severe functional disability (ODI) was the strongest predictor for “Distress-Driven Seekers” (OR=2.76, P<0.05). “Distress-Driven Seekers” achieved high adherence, comparable to “Digital Champions” (P>0.05) and superior to others (P<0.001). Conclusion: HISB serves as a crucial mechanism linking eHealth literacy to rehabilitation adherence. Severe disability distress drives high-intensity information seeking, compensating for low literacy and enabling high adherence in “Distress-Driven Seekers”. Personalized digital health interventions should be developed to accommodate diverse engagement patterns. Notably, “Distress-Driven Seekers” require targeted clinical guidance and “information prescriptions” to mitigate risks of medical misinformation, health anxiety, and potential secondary injuries caused by inappropriate self-management.