JMIR Publications

ABSTRACT

Background:

The evolution of global societal structures has brought about the undeniable trend of population aging. Simultaneously, digitalization, as a significant trend, is profoundly influencing various aspects of social life. The internet has emerged as a critical avenue for the public to access health information resources. With declining physical capabilities, older adults exhibit a more urgent need for health information. Online health information stands out as a crucial channel for older adults to acquire health information and merits attention.

Objective:

To examine the developmental trajectories and influencing factors of online health information seeking behaviors (OHISB) among community-dwelling older adults.

Methods:

A longitudinal mixed-methods study, conducted from September 2023 to January 2025, involved 346 older adults from three communities in Shandong Province, China. In the quantitative phase,data were collected at three time points: baseline (T1), 6 months post-baseline (T2), and 12 months post-baseline (T3). Latent class growth modeling (LCGM) and logistic regression identified heterogeneous trajectories and influencing factors of OHISB. A cross-lagged panel mediation model examined the longitudinal relationships among digital health literacy (DHL), technology anxiety (TA), and OHISB. After the quantitative study, we conducted semi-structured, in-depth interviews with 16 older adults from different OHISB trajectory subgroups using descriptive phenomenological approach.

Results:

LCGM identified three heterogeneous trajectories of OHISB: “Low-Level Declining Group” (26.6%), “Medium-Level Stable Group” (54.0%), and “High-Level Declining Group” (19.4%). Multivariate logistic regression identified household registration, education, income, chronic disease status, internet frequency and duration, online health information attitude and experience, DHL, and TA as significant predictors of OHISB trajectory (P < 0.05). The cross-lagged panel mediation model showed T1 DHL negatively predicted T2 TA (β=-0.170, P<0.01), T2 TA negatively predicted T3 OHISB (β=-0.163, P<0.001), and T1 DHL positively predicted T3 OHISB (β=0.179, P<0.001). TA mediated the relationship between DHL and OHISB, with an effect size of 0.040 (SE=0.014, 95% CI: 0.0123–0.068). The qualitative findings identified four central themes: personal cognition, emotional experience, external environment, and behavioral choices.

Conclusions:

Both quantitative and qualitative findings clarified the developmental process of OHISB among older adults in communities, and the important effects of DHL, TA and risk perception on OHISB. Although self-efficacy, health anxiety, self-perceived aging, social support, and healthcare environment were not addressed in the quantitative study, they emerged as important factors shaping older adults’ OHISB in qualitative interviews.