Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 31, 2023
Date Accepted: Aug 30, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
How do E-Health Literacy and Perceived Information Quality Influence the Effect of Online Health Information Seeking on Health Behaviors: A Nationally Representative Survey among Chinese Internet Users
ABSTRACT
Background:
The Internet has become an increasingly vital platform for health-related information, especially in developing countries like China. While previous research has suggested that online health information seeking (OHIS) can significantly impact individuals’ engagement in health behaviors, most focused on patient-centered health communication instead of the health wellness of the general population.
Objective:
This paper aims to extend the integrative model of e-health use (IMEHU) to explore the underlying mechanism of how seeking health-related information via digital devices affects Chinese internet users’ engagement in health behaviors. In particular, we focus on how people’s e-health literacy and their perceptions of online health information influence the relationships.
Methods:
This study conducted a web-based cross-sectional survey in November 2021. We selected stratified random samples with quotas considering national representativeness in terms of sex, age groups, and urban/rural residence, using data documented in the 48th Statistical Report on Internet Development of China (SRIDC). Univariate and multivariate analysis, as well as zero-order correlation analysis were conducted preliminarily using SPSS 29. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were conducted using the Lavaan package in R for hypothesis and model testing.
Results:
Our samples included 10,000 participants from the 31 provinces of mainland China (48.8%=female/51.2%=male; 70.6%=urban area/29.4%=rural area). We found that social disparities and personal health status influence user engagement with e-health. Overall, participants in different demographic groups exhibit more variability in terms of their functional literacy compared to critical literacy. Female internet users have higher functional literacy than their male counterparts (t(9,998) = -3.20, P<.001), but not significantly different in terms of their critical e-health literacy (t(9,998) = 0.32, P = .38). There are significant differences in functional and critical literacy between various age groups, rural/urban residential areas, educational background, and health conditions (all P<.001). Our conceptual framework proposes a structural model that emphasizes how users’ functional and critical e-health literacy are interrelated with online health information seeking, and ultimately affect their health outcomes(model fit: X2/df = 10.38, P <.001, RMSEA = .030 (95% CI: .030-.031), SRMR = .030, CFI = .950). The results show reciprocal associations between e-health literacy and online health information seeking. Both functional and critical e-health literacy positively predicts health behavioral engagement. Our model also shows that perceived information quality mediates the pathways between OHIS and subsequent health behaviors (b= .003, 95% CI [.002, .004], P<.001).
Conclusions:
Our model uncovered the pathways linking social-demographic determinants of Chinese internet users to e-health literacy, the reciprocal associations between e-health literacy and OHIS, the mediating mechanisms of perceived information quality, and how they ultimately contribute to health outcomes.
Citation
