Digital health literacy and self-efficacy among older adults: Mediating roles of social support and life satisfaction and the moderating role of health consciousness

Abstract

Objective: This mixed-methods investigation examined relationships between digital health literacy and self-efficacy among older adults, focusing on mediating pathways involving social support and life satisfaction and the moderating effect of health consciousness. Methods: Quantitative data from 1016 community-dwelling older adults across six Chinese provinces were analyzed using structural equation modeling with bias-corrected bootstrapping procedures. A multi-stage probability sampling strategy ensured geographic and socioeconomic diversity. Complementary in-depth semi-structured interviews with 30 purposively selected participants were conducted to explore underlying mechanisms. Results: Digital health literacy was significantly and directly associated with self-efficacy (β = 0.21, p < .05) and indirectly associated through social support (β = 0.10, 95% CI [0.06, 0.14]) and life satisfaction (β = 0.17, 95% CI [0.12, 0.22]). A sequential mediation pathway was identified whereby digital health literacy was related to social support, which in turn was associated with life satisfaction and subsequently with self-efficacy (β = 0.05, 95% CI [0.01, 0.09]). Health consciousness significantly moderated these relationships, with stronger associations among participants with high health consciousness (direct path: β = 0.32 vs. β = 0.09; sequential indirect path: β = 0.06 vs. β = 0.01). Integrated qualitative analysis revealed information-processing strategies, social validation processes, and goal-directed feedback loops that helped translate digital competencies into psychological resources. Conclusion: Findings clarify mechanisms through which technological competencies relate to psychological resources in later life. Digital health interventions for older adults should therefore integrate social components, emphasize feedback systems that strengthen efficacy beliefs, and adapt content based on individual levels of health consciousness to optimize psychological benefits.