How digital health literacy shapes health: Mediating role of physical activity and heterogeneity in China

Abstract

Purpose This study systematically examines the impact of digital health literacy (DHL) on the physical and mental health of Chinese adults, particularly focusing on how DHL might enhance physical health through physical activity (PA) mediation. Methods Drawing on nationally representative Chinese data, this study employed multivariable linear regression combined with mediation analysis to assess the association between DHL and adult health outcomes, while evaluating the mediating role of PA. Robustness was verified through propensity score matching (PSM), logistic regression, and mediation effect pathway tests. Heterogeneity analyses stratified by gender, household registration status, and other demographic factors further elucidated variations in DHL’s impacts on physical and mental health. Results DHL demonstrated a positive association with physical health outcomes, while no statistically significant association was observed with mental health. PA served as a partial mediator in the relationship between DHL and physical health enhancement. Stratified analyses revealed significant beneficial effects of DHL on physical health in the following subgroups: males, adults aged ≥60 years, individuals with agricultural household registration, those attaining junior high school education or higher, high-income populations, and participants with health insurance and pension coverage. Conclusion This study substantiates the critical influence of DHL on physical health advancement among Chinese adults. Policy formulation should strategically integrate (1) standardized DHL education frameworks, (2) demographically customized digital health management systems, and (3) expanded insurance coverage with optimized reimbursement mechanisms for healthcare and pension schemes. These strategies collectively aim to elevate DHL proficiency, enhance digital platform operational competencies, foster sustainable health-promoting behaviors, and ensure stable health-life equilibrium within China’s adult demographic.