JMIR Publications

ABSTRACT

Background:

Ischemic heart disease (IHD) is becoming increasingly prevalent, with a rising trend significantly impacting the quality of life (QoL) of young Malaysians.

Objective:

This study aimed to investigate the direct and indirect relationships between eHealth literacy (eHealth) and patient adherence (PA), and their mediating effects on the associations of health consciousness (HC) and perceived severity of chronic disease (PS) with QoL among young IHD patients.

Methods:

A cross-sectional study was carried out at two hospitals, recruiting eligible patients through consecutive sampling at outpatient cardiology clinics. Data were collected via a validated self-administered questionnaire encompassing sociodemographic and socioeconomic status; medical history; and PS, HC, eHealth, PA, and QoL data. Structural equation modeling (SEM) analysis was employed to evaluate the relationships.

Results:

A total of 136 young IHD patients participated in the study. SEM analysis revealed that eHealth had the strongest positive effect on QoL (β=0.287, P=.002), followed by PA (β=0.245, P=.017) and HC (β=0.218, P=.017). Two significant mediation models were identified, aligning with the Transactional Model of eHealth literacy theory. The first model demonstrated parallel mediation, where eHealth (β=0.125, P=.008) and PA (β=0.083, P=.046) significantly mediated the relationship between HC and QoL. The second model indicated serial mediation through eHealth and PA between HC and QoL (β=0.042, P=.049). The parallel mediation model exhibited medium predictive power and was deemed the best-fit model.

Conclusions:

The direct and indirect effects of eHealth and PA on QoL were most effective when they were initiated by HCs in parallel, with eHealth having the greatest impact. Strengthening the utilization of eHealth among young IHD patients is crucial, and eHealth should be actively promoted by healthcare providers, developers, and policymakers to increase their QoL. Clinical Trial: National Medical Research Register (NMRR-21-178-57942) and the approval from the Ethical Committee of Universiti Kebangsaan Malaysia Medical Centre (FF-2021-117).