Configurational analysis of improving digital health literacy among older patients with non-communicable diseases: A fuzzy-set qualitative comparative analysis (Preprint)

BACKGROUND The ageing of the population and the digitalisation of information are currently developing in parallel worldwide. The rapid development of digital health has created a digital inequality for many older patients with chronic diseases. The generally low level of digital health literacy (DHL) among older patients with non-communicable diseases (NCDs) cannot be ignored. Although some studies have investigated the factors influencing digital health literacy in older patients with NCDs, few studies have examined the causal relationship between different combinations of factors and DHL from a configurational perspective. OBJECTIVE To analyse the causal relationship between different combinations of factors and the level of digital health literacy in older patients with NCDs, in order to clarify the path of digital health literacy improvement in older patients with NCDs. METHODS In this study, older patients with NCDs were recruited from September to December 2023 using convenience sampling method. Fuzzy-set qualitative comparative analysis (fs-QCA) was then employed by conducting necessity and sufficiency analysis. RESULTS A total of 538 older patients with NCDs participated in the survey. The necessity analysis showed that digital health literacy in older patients with NCDs doesn't have the necessary conditions. Sufficiency analyses generated six different groups of digital health literacy for older patients with NCDs. Of these six pathways, the combination of high educational attainment, lower number of NCDs, high health concern, and positive attitudes towards digital technology is the most important path. In addition, we analyzed the sufficiency of the three dimensions of digital health literacy to derive the most important pathways for each of the three different dimensions. CONCLUSIONS The results of this study differ from those reported in traditional regression analyses or path analyses. It considers the combined effect of each of the different variables on the level of digital health literacy of older patients with NCDs. This suggests that health workers should consider a combination of influences rather than focusing on a single factor