ABSTRACT Background Digital exclusion has been linked to adverse health outcomes among older adults. However, its relationship with health literacy, a midstream determinant of health outcomes in aging populations, remains insufficiently explored. Aim To investigate the relationship between digital exclusion and health literacy among older adults, and to assess the mediating effects of social support and self‐efficacy. Design A cross‐sectional study. Methods Data from the 2021 Psychology and Behaviour Investigation of Chinese Residents (PBICR) survey were used. Digital exclusion was assessed through self‐reported non‐use of computers or smartphones. Health literacy, social support and self‐efficacy were measured using the Short‐Form Health Literacy Instrument, the 12‐item Perceived Social Support Scale and the New General Self‐Efficacy Scale. Generalised linear models (GLM) were employed to examine the relationships between digital exclusion and health literacy, while mediation analysis with bootstrapping assessed the mediating roles of social support and self‐efficacy. Results A total of 1147 older adults participated in the study, with 27.64% identified as digitally excluded and a moderate level of health literacy. GLM analysis identified several significant factors influencing health literacy, including digital exclusion, social support, self‐efficacy, higher education levels, household monthly income per capita > 3000 RMB, non‐agricultural hukou, chronic conditions and medication use. Mediation analysis revealed that digital exclusion negatively impacted health literacy. Social support and self‐efficacy partially mediated the relationship between digital exclusion and health literacy. Conclusion Digital exclusion is negatively associated with health literacy among older adults, with social support and self‐efficacy partially mediating the relationship. Implications for the Profession and/or Patient Care This study underscores the importance of addressing digital exclusion, as well as promoting social support and self‐efficacy to enhance health literacy in ageing populations. Impact This study provides insights into the relationship between digital exclusion and health literacy among older adults, as well as the mediating effects of social support and self‐efficacy, offering potential targets for health literacy improvement. Reporting Method STROBE Statement (STrengthening the Reporting of OBservational studies in Epidemiology). Patient or Public Contribution No patient or public contribution was involved.
Zhou et al. (Sun,) studied this question.