Toward enhanced e-health literacy: A qualitative exploration of facilitators, barriers, and behavioral triggers among Chinese older adults with diabetes

Objective This qualitative study explores the facilitators, barriers, and behavioral triggers that shape e-health literacy (e-HL) among Chinese older adults with diabetes. Methods In this descriptive qualitative study guided by the Health Belief Model (HBM), we purposively recruited 19 older adults with diabetes. Semistructured interviews using an HBM-aligned topic guide were analyzed with reflexive thematic analysis to examine facilitators, barriers, and behavioral triggers of e-HL. Results Thematic analysis identified three themes-facilitators, barriers, and behavioral triggers, six subthemes and twenty-one categories. Facilitators comprised (a) perceived benefits (e.g. ease and convenience of digital health tools, improved self-management and quality of life, trust in institutional/governmental platforms) and (b) self-efficacy (e.g. previous successful digital experience, skill improvement methods, family or peer support). Barriers included (a) perceived barriers (e.g. operational difficulties with digital health tools, lack of time for digital health tools, reliance and preference for traditional methods) and (b) self-efficacy (e.g. lack of confidence and digital skills, and low perceived competence). Behavioral triggers reflected perceived severity/susceptibility (e.g. lifestyle impact post-diagnosis, and anxiety and worries about long-term complications) and cues to action (e.g. recommendations and encouragement from doctors or others, peer modeling and informal learning, health deterioration or new symptoms). Conclusion The HBM provides a robust explanation of e-HL in older Chinese adults with diabetes, with the model's constructs mapping to the relevant facilitators, barriers, and behavioral triggers. A scalable, three-component strategy targeting the HBM, focusing on the needs of older users and integrating at a system level can sustain e-health adoption and help bridge digital health divides in ageing populations.