Background: The digital revolution has transformed health information dissemination among middle-aged and elderly populations in China. With over 140 million internet users aged 60 and above, social media platforms have become primary health information channels. However, this demographic faces significant challenges including digital divide constraints and high susceptibility to health-related rumors, which account for 42% of all rumors targeting older adults. Objective: This study investigates mechanisms underlying health information dissemination behaviors among middle-aged and elderly social media users, examining how health information literacy, social support networks, and cognitive processing ability influence information acquisition capabilities and rumor dissemination propensity. Methods: A mixed-methods design surveyed 472 active social media users aged 50-75 in Changsha using structural equation modeling to test eight hypotheses across five constructs: health information literacy, social support networks, cognitive processing ability, health information acquisition ability, and rumor dissemination propensity. Qualitative analysis conducted in-depth interviews with 15 participants, analyzed through NVivo14 thematic coding. Results: All hypotheses received empirical support with exceptional explanatory power (R² = 92.3%, 81.5%, 73.3% for key constructs). Health information literacy demonstrated extraordinarily strong influence on cognitive processing ability (β = 0.856, f² = 2.747), establishing itself as the foundational element of health communication ecology. Cognitive processing and information acquisition abilities both significantly suppressed rumor dissemination (β = -0.589, β = -0.572). Social support networks indirectly influenced rumor propensity through information acquisition mediation (β = 0.221). Qualitative analysis revealed "authority orientation plus experiential verification" evaluation patterns and socially-driven dissemination behaviors shaped by socioeconomic stratification. Conclusion: Health information dissemination among older adults constitutes a complex adaptive system involving individual cognitive schemas, social networks, economic constraints, and institutional supports. The research provides theoretical foundations for understanding digital health communication and practical guidance for designing targeted interventions to enhance information literacy and reduce rumor propagation in aging societies.
Guo et al. (Sat,) studied this question.