Association of eHealth Literacy, Self-Care and Glycemic Outcomes among Middle-Aged and Older Diabetes Patients: A Structural Equation Model Analysis of a Population-based Study (Preprint)

BACKGROUND Background: Consumers are increasingly seeking health-related information via electronic devices. Consequently, electronic health (eHealth) has received a great deal of attention in the domain of Internet studies. Identifying the relationship between patient mobile eHealth literacy (mobile eHL) and diabetes outcomes is important to ensure these electronic tools have far-reaching utility. However, only a fraction of these studies focuses on the impact of mobile eHL among population with diabetes. OBJECTIVE Objective: This study aims to flesh out the relationship between eHealth literacy (eHL), mobile health literacy (mHL), and health outcomes among middle-aged and older diabetes patients. METHODS Methods: Participants were recruited from October 2020 to May 2022 in the outpatient departments of 5 community health centers and 2 comprehensive hospitals in Guangdong. A total of 358 patients with diabetes voluntarily completed a cross-sectional survey including sociodemographic characteristics, lifestyle status, mobile eHL and patient outcomes (self-care behaviors, self-rated health, blood glucose). We applied structural equation modeling (SEM) to examine the model fit of mobile eHL scores and the interrelationships between observable variables and latent constructs. RESULTS Results: Of the 358 diabetes patients, 65.08% (233 / 358) reported they had Willingness to use health-related Apps and 58.94% (211 / 358) had Willingness to pay for them. Our empirical model had adequate goodness-of fit indexes: 2 61 = 92.000, P = 0.006; comparative fit index (CFI) = 0.988; root mean square of approximation (RMSEA)= 0.038; 2/df = 1.508. Mobile eHL is negatively related to self-rated health, but positively with diabetes self-care. No significant correlation was found between diabetes self-care and FBG level. Participants with higher self-rated health were more likely to achieve lower FBG level. CONCLUSIONS Conclusions: Our study reveals that mobile eHL had a direct effect on self-care behavior as well as knowledge and skills of computers, and had an indirect impact on health outcomes (self-rated health status and blood glucose value). Our findings suggest that to promote the adoption of preventive eHealth services among chronic patients, it is essential to not only investing in the expertise of using eHealth technologies, but also increasing the general awareness of healthy behavior.