Association Between mHealth Literacy and Hypertension-Related KAP Among Older Adults with Hypertension: Chain-Mediating Roles of Health Empowerment and Patient Activation

Background: As mobile health (mHealth) technologies become increasingly integrated into chronic disease management, understanding how mHealth literacy is associated with hypertension-related knowledge, attitudes, and practices (KAPs) is important. However, the psychosocial factors involved in this association remain unclear. This study aimed to examine the association between mHealth literacy and hypertension-related KAP among older adults with hypertension and to explore whether health empowerment and patient activation were involved in statistically significant indirect pathways. Methods: A cross-sectional survey was conducted among 1500 community-dwelling older adults with hypertension in Hebei Province, China, between December 2024 and June 2025. Data were collected using the Problem-Based mHealth Literacy Scale, the Health Empowerment Scale for Elderly Patients with Chronic Disease, the Patient Activation Measure, and the Community Elderly Hypertension Patients Health Science Popularization Cognitive Scale. Partial correlation analyses were performed after controlling for sociodemographic covariates. An adjusted structural equation model was used to examine the hypothesized indirect pathway structure, and indirect effects were tested using bootstrapping with 5000 resamples. Results: mHealth literacy was positively associated with hypertension-related KAP. The total effect of mHealth literacy on hypertension-related KAP was 0.399 (95% CI: 0.347–0.499), including a direct effect of 0.290 (95% CI: 0.238–0.341) and a total indirect effect of 0.108 (95% CI: 0.082–0.137). The indirect pathway through health empowerment was statistically significant and accounted for the largest proportion of the total effect (indirect effect = 0.079, 95% CI: 0.059–0.103). The indirect pathway through patient activation was also statistically significant (indirect effect = 0.019, 95% CI: 0.003–0.035), as was the sequential indirect pathway through health empowerment and patient activation (indirect effect = 0.010, 95% CI: 0.006–0.016). Conclusions: In this cross-sectional sample of older adults with hypertension, mHealth literacy was positively associated with hypertension-related KAP. The data were consistent with indirect associations involving health empowerment and patient activation, with the largest indirect association observed through health empowerment. These findings suggest that mHealth literacy and psychosocial self-management resources may both be relevant to hypertension-related KAP. Further longitudinal or intervention studies are needed to clarify the temporal and causal nature of these associations.