A double-edged sword: How social support and loneliness mediate the impact of digital health literacy on well-being among Chinese older adults

ObjectiveAs digitalization accelerates, understanding the relationship between digital health literacy (DHL) and health-related quality of life (HRQoL) among older adults is critical. This study investigated the complex, double-edged impact of DHL on HRQoL, specifically examining the serial mediating roles of social support and loneliness among Chinese older adults.MethodsA cross-sectional study was conducted using questionnaire data from 469 older adults in China. A serial mediation model was constructed and tested using structural equation modeling (SEN) to analyze the pathways from DHL to HRQoL.ResultsThe model revealed a surprising and significant negative total effect of DHL on HRQoL. However, DHL was positively associated with both social support (β = 0.45, p < .001) and, unexpectedly, also with loneliness (β = 0.57, p < .001). The analysis confirmed a significant positive serial mediating pathway, where higher DHL increased social support, which in turn reduced loneliness, ultimately leading to better HRQoL. Despite this positive indirect effect, the strong positive association between DHL and loneliness contributed to the overall negative effect on HRQoL.ConclusionThese findings provide theoretical insights for developing health promotion policies for the elderly that emphasize integrated interventions that combine digital empowerment with psychosocial support.