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Cited by 133Technology Use by Older AdultsHealth Literacy and Information AccessibilityDigital literacy in education

The DOI matches its Crossref record; 50 of the 50 references it cites were found in a registry or an index; none of the 30 sources its claims cite is checked for support yet.

Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study

Open access
Liu, Siqi, Zhao, Hongyan, Fu, Jingjing, Kong, Dehui, Zhong, Zhu, Hong, Yan, Tan, Jing, Luo, Yu·2022·BMC Public Health
DOI 10.1186/s12889-022-13378-4PMC PMC9112275
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Abstract

Background: The rapid development of digital health has reduced the time and cost of medical treatment, bringing efficient and economical benefits. However, older adults all over the world are deficient in digital health knowledge and skills to varying degrees. This study intends to investigate the current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China, so as to provide theoretical reference for global digital health researches and the construction of gerontological digital health service models. Methods: A cross-sectional survey was conducted from September 2020 to April 2021 in Chongqing, China. 572 community-dwelling older adults (≥ 65 years) were surveyed by stratified sampling. Data on sociodemographic characteristics, Internet usage, attitude towards Internet health information and digital health literacy were collected. Wherein, the digital health literacy assessment adopted the Digital Health Literacy Assessment Scale for community-dwelling older adults, which was developed by the research group, proven to be with good internal consistency (0.941), split-half reliability (0.889), test–retest reliability (0.941), content validity (0.967), criterion validity (0.938) and construct validity. The influencing factors were explored by univariate analysis and multiple linear regression analysis. Results: The average score of digital health literacy was 37.10 (SD 18.65). Univariate analysis showed that there were statistically significant differences in the comparison of digital health literacy according to 16 variables, such as different age and education levels. Multiple linear regression analysis showed that education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy, while age and perceived risk were negatively correlated with digital health literacy. Conclusion: The overall digital health literacy of community-dwelling older adults in Southwest China is relatively low. In the future, health professionals should fully consider the diverse influencing factors of digital health literacy, assess individual differences and provide targeted intervention programs. Meanwhile, global public health authorities should integrate health resources effectively, and seek health service models for older adults in line with the development of the digital age to narrow the digital divide.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This cross-sectional study assessed digital health literacy among 572 community-dwelling older adults in Southwest China and found an overall low level, with a mean score of 37.10 (SD 18.65) on a 15–75 scale. Multiple factors, including education, Internet use, family guidance, and attitudes toward Internet health information, were associated with digital health literacy.

Key findings

  • The mean digital health literacy score was 37.10 (SD 18.65), ranging from 15 to 74; the mean item score was 2.47 (SD 1.68), indicating a relatively low perceived level. Dimension scores were highest for acquisition and evaluation ability (2.89, SD 1.71), followed by interaction ability (2.18, SD 1.56) and application ability (1.51, SD 1.03).
  • Univariate analysis found statistically significant differences in digital health literacy for 16 variables, including age, education level, living arrangement, marital status, monthly household income per capita, self-rated health status, health concerns, Internet use duration/frequency/time, family guidance, and perceived usefulness, ease of use, risk, and reliability of Internet health information (P < 0.01).
  • Multiple linear regression showed 13 factors entered the equation, jointly accounting for 83.5% of the total variation (adjusted R² = 0.835; F = 222.510, P < 0.001). Education level, marital status, self-rated health status, health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use, and perceived reliability were positively correlated with digital health literacy; age and perceived risk were negatively correlated.
  • More than two-thirds of participants used the Internet (389/572, 68.01%), but 42.48% spent less than 1 h online per day; 51.75% never/seldom actively asked family for help acquiring Internet health information, while 48.43% never/seldom received guidance passively from family members.

Methods

  • A cross-sectional survey was conducted from September 2020 to April 2021 in the main urban areas of Chongqing, China, using stratified sampling. Participants were 572 community-dwelling older adults aged ≥65 years; 600 questionnaires were distributed, 589 collected, and 572 valid questionnaires obtained (effective recovery rate 95.33%).
  • Data were collected on sociodemographic characteristics, Internet usage, attitude toward Internet health information, and digital health literacy. Digital health literacy was measured with the Digital Health Literacy Assessment Scale for community-dwelling older adults, a 15-item, 3-dimension scale with a total score range of 15–75; Cronbach’s alpha in this study was 0.959.
  • Analyses included descriptive statistics, t-tests and ANOVA for univariate comparisons, and multiple linear stepwise regression to identify influencing factors; statistical significance was set at 0.05.

Limitations

  • The paper states that digital health literacy was assessed with a self-assessment scale, which inevitably led to self-reported bias and could not fully reflect participants’ actual digital health literacy operation ability; future research should consider additional operational experiments.
  • The paper states that the study only investigated community-dwelling older adults in the main urban areas of Chongqing, China, and that results cannot represent the overall level of community-dwelling older adults in China; additional large-scale studies in other regions are necessary.
  • Evident from the design: the cross-sectional design cannot establish causal direction among the identified associations, though the paper does not explicitly list this as a limitation.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12889-022-13378-4

Cites

50 of 50 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 30 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In multiple linear regression analysis, frequency of Internet usage was positively correlated with digital health literacy among community-dwelling older adults.

    “education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy”
    Quote in the paperSubstantial claim
  • Findingown data

    The mean score of digital health information interaction ability was 2.18 (SD 1.56).

    “The mean score of items in each dimension from high to low were as follows: digital health information acquisition and evaluation ability 2.89 (SD 1.71), digital health information interaction ability 2.18 (SD 1.56), digital health information application ability 1.51 (SD 1.03).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In multiple linear regression analysis, duration of Internet usage was positively correlated with digital health literacy among community-dwelling older adults.

    “education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy”
    Quote in the paperSubstantial claim
  • Findingown data

    In multiple linear regression analysis, degree of health concerns was positively correlated with digital health literacy among community-dwelling older adults.

    “education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy”
    Quote in the paperSubstantial claim
  • Findingown data

    The mean score per item of digital health literacy was 2.47 (SD 1.68), ranging from 1 to 5.

    “The mean score of each item was 2.47 (SD 1.68), ranging from 1 to 5.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one. 22
  • The quote only partly states this claim. 2
  • Probably not a substantial claim. 16

  • It may state two separate claims as one.

    Findingown data

    Most older adults in this study had a low sense of media participation and were accustomed to acting as receivers rather than communicators, consistent with previous research.

    “This study showed that most older adults had a low sense of media participation, and they were accustomed to acting as receivers rather than communicators, which was consistent with previous research results [19, 51].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] Choi NG, DiNitto DM. The digital divide among low-income homebound older adults: internet use patterns, eHealth literacy, and attitudes toward computer/internet use. J Med Internet Res. 2013;15(5):e93. https://doi.org/10.2196/jmir.2645. source
    • cites [51] Wang W, Zhuang X, Shao P. Exploring health information sharing behavior of Chinese elderly adults on WeChat. Healthcare. 2020;8(3):207. https://doi.org/10.3390/healthcare8030207. source

  • It may state two separate claims as one. The quote only partly states this claim.

    Findingown data

    In multiple linear regression, education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health

    “Among them, education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    In this study, the digital health application ability of the older adults was weak, and most lacked the ability to turn Internet health knowledge into action and apply it to health self-management.

    “In this study, the digital health application ability of the older adults was weak, most of whom lacked the ability to turn the Internet health knowledge into action and apply it to health self-management.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingcitation

    The younger, better educated and married older adults had higher digital health literacy, consistent with previous research.

    “The younger, better educated and married older adults had higher digital health literacy, which was consistent with previous research results [14, 26].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [14] Li S, Cui G, Yin Y, Wang S, Liu X, Chen L. Health-promoting behaviors mediate the relationship between eHealth literacy and health-related quality of life among Chinese older adults: a cross-sectional study. Qual Life Res. 2021;30(8):2235–43. https://doi.org/10.1007/s11136-021-02797-2. source
    • cites [26] Tennant B, Stellefson M, Dodd V, Chaney B, Chaney D, Paige S, Alber J. EHealth literacy and web 2.0 health information seeking behaviors among baby boomers and older adults. J Med Internet Res. 2015;17(3):e70. https://doi.org/10.2196/jmir.3992. source

  • It may state two separate claims as one.

    Findingown data

    In multiple linear regression, age and perceived risk were negatively correlated with digital health literacy.

    “while age and perceived risk were negatively correlated with digital health literacy.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The mean digital health literacy score among surveyed community-dwelling older adults in Chongqing was 37.10 (SD 18.65), ranging from 15 to 74.

    “The mean score of digital health literacy of participants was 37.10 (SD 18.65), ranging from 15 to 74.”
    • Also stated in: § Results · plain
      “The average score of digital health literacy was 37.10 (SD 18.65).”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    The multiple linear regression model predicting digital health literacy was significant (F = 222.510, P < 0.001) and 13 factors entered the equation, jointly accounting for 83.5% of the total variation.

    “The results showed that the regression model was significant (F = 222.510, P < 0.001), and 13 factors entered the regression equation, which could jointly account for 83.5% of the total variation, as shown in Table 3.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    Univariate analysis showed statistically significant differences in digital health literacy across age, education level, residential status, marital status, monthly household income per capita, self-rated health status, degree of health concerns, duration of Internet usage, frequency of Internet usage, time spent using the Internet per day, frequency of asking for help actively and receiving guide

    “As shown in Table 1 and Table 2, respondents with different age, education level, residential status, marital status, monthly household income per capita, self-rated health status, degree of health concerns, duration of Internet usage, frequency of Internet usage, time spent using the Internet per day, frequency of asking for help actively and receiving guidance passively from family members on”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    In terms of Internet usage factors, duration of Internet usage, frequency of Internet usage, time spent using the Internet per day, and frequency of receiving guidance passively from family members were influencing factors of digital health literacy of older adults.

    “In terms of Internet usage factors, duration of Internet usage, frequency of Internet usage, time spent using the Internet per day, and the frequency of receiving guidance passively from family members were the influencing factors of the digital health literacy of older adults.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingown data

    In this study, 48.42% of older adults lived with their spouses and children/grandchildren or lived with children/grandchildren only, having the advantage of family education.

    “In this study, 48.42% of older adults lived with their spouses and children/grandchildren or live with children/grandchildren only, having the advantage of family education.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Frequency of asking for help actively from family members did not enter the regression equation, while frequency of receiving guidance passively from family members entered the final regression equation.

    “It was worth noting that frequency of asking for help actively from family members did not enter the regression equation, while the frequency of receiving guidance passively from family members entered the final regression equation.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Study design and conductnone given

    The Digital Health Literacy Assessment Scale for community-dwelling older adults had good internal consistency (0.941), split-half reliability (0.889), test-retest reliability (0.941), content validity (0.967), criterion validity (0.938), and construct validity.

    “the digital health literacy assessment adopted the Digital Health Literacy Assessment Scale for community-dwelling older adults, which was developed by the research group, proven to be with good internal consistency (0.941), split-half reliability (0.889), test–retest reliability (0.941), content validity (0.967), criterion validity (0.938) and construct validity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    The number of Internet users in China aged 60 and over has tripled in the past five years, making them the fastest growing group.

    “The number of Internet users in China aged 60 and over has tripled in the past five years, making them the fastest growing group [48, 49].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [48] China Internet Network Information Center (CNNIC). The 47th China statistical report on internet development. 2021. http://www.cnnic.net.cn/hlwfzyj/hlwxzbg/hlwtjbg/202102/P020210203334633480104.pdf. Accessed 27 Jul 2021.
    • cites [49] China Internet Network Information Center (CNNIC). The 37th China statistical report on internet development. 2016. http://www.cnnic.net.cn/hlwfzyj/hlwxzbg/hlwtjbg/201601/P020160122444930951954.pdf. Accessed 27 Jul 2021.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductown data

    The item-level CVIs of all questions in the Internet usage and attitude questionnaire were 1.000, and the scale-level CVI was 1.000.

    “The item-level CVIs of all questions were rated 1.000, and the scale-level CVI thus computed was also 1.000.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In the process of seeking health guidance from the Internet, the ability to acquire and evaluate Internet health information has been gradually established among older adults.

    “In this process, the ability to acquire and evaluate Internet health information has been gradually established [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Yang E, Chang SJ, Ryu H, Kim HJ, Jang SJ. Comparing factors associated with eHealth literacy between young and older adults. J Gerontol Nurs. 2020;46(8):46–56. https://doi.org/10.3928/00989134-20200707-02. source

  • It may state two separate claims as one.

    Premisecitation

    Existing research on influencing factors of digital health literacy among older adults mainly focuses on objective factors such as sociodemographic characteristics and digital factors, with less attention to subjective factors such as attitude towards Internet health information and social environment factors such as family support.

    “At the same time, the existing researches on influencing factors of digital health literacy among older adults mainly focus on objective factors such as sociodemographic characteristics and digital factors [13, 33, 34]. Less attention is paid to subjective factors such as attitude towards Internet health information and social environment factors such as family support, which is lack of systematic”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [13] Hoogland AI, Mansfield J, Lafranchise EA, Bulls HW, Johnstone PA, Jim HSL. EHealth literacy in older adults with cancer. J Geriatr Oncol. 2020;11(6):1020–2. https://doi.org/10.1016/j.jgo.2019.12.015. source
    • cites [33] Lwin MO, Panchapakesan C, Sheldenkar A, Calvert GA, Lim LKS, Lu J. Determinants of eHealth literacy among adults in China. J Health Commun. 2020;25(5):385–93. https://doi.org/10.1080/10810730.2020.1776422. source
    • cites [34] Cherid C, Baghdadli A, Wall M, Mayo NE, Berry G, Harvey EJ, Albers A, Bergeron SG, Morin SN. Current level of technology use, health and eHealth literacy in older Canadians with a recent fracture—a survey in orthopedic clinics. Osteoporosis Int. 2020;31(7):1333–40. https://doi.org/10.1007/s00198-020-05359-3. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductreasoning

    The estimated minimum sample size for the study was 418.

    “our estimated minimum sample size was 418.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationcitation

    The higher digital health literacy of married older adults may be due to older adults with good family functions being more likely to get family emotional support, thus having more family involvement and guidance when using digital health services.

    “The higher digital health literacy of the married older adults may be due to the fact that older adults with good family functions are more likely to get family emotional support, thus having more family involvement and guidance when using digital health services [52, 53].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [52] Terp R, Kayser L, Lindhardt T. Older patients’ competence, preferences, and attitudes toward digital technology use: explorative study. JMIR Hum Factors. 2021;8(2):e27005. https://doi.org/10.2196/27005. source
    • cites [53] Portz JD, Fruhauf C, Bull S, Boxer RS, Bekelman DB, Casillas A, Gleason K, Bayliss EA. “Call a teenager… that’s what I do!” - grandchildren help older adults use new technologies: qualitative study. JMIR aging. 2019;2(1):e13713. https://doi.org/10.2196/13713. source
    • Rests on an assumption: Under the background of Chinese social culture, older adults often live with their children and grandchildren.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationreasoning

    One possible reason for the gap is that China gained full access to the Internet in 1994, later than many developed countries.

    “One possible reason is that China gained full access to the Internet in 1994, later than many developed countries.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: China gained full access to the Internet in 1994, later than many developed countries.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Digital Health Literacy 2.0 emphasizes that users should not only be passive receivers, but also have the ability to actively participate in communication by interacting and sharing health-related information.

    “Digital Health Literacy 2.0 emphasizes that users should not only be passive receivers, but also have the ability to actively participate in communication by interacting and sharing health-related information [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Paige SR, Stellefson M, Krieger JL, Anderson-Lewis C, Cheong J, Stopka C. Proposing a transactional model of eHealth literacy: concept analysis. J Med Internet Res. 2018;20(10):e10175. https://doi.org/10.2196/10175. source

  • It may state two separate claims as one.

    Premisecitation

    The eHEALS has problems such as unclear score boundary, inability to accurately judge the actual level of users' digital health literacy, and lack of evaluation of critical and interactive health literacy.

    “However, it still has some problems, such as unclear score boundary [28], inability to accurately judge the actual level of users' digital health literacy [29], and lack of evaluation of critical and interactive health literacy [30, 31].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [28] Quinn S, Bond R, Nugent C. Quantifying health literacy and eHealth literacy using existing instruments and browser-based software for tracking online health information seeking behavior. Comput Hum Behav. 2017;69:256–67. https://doi.org/10.1016/j.chb.2016.12.032. source
    • cites [29] van der Vaart R, van Deursen AJ, Drossaert CH, Taal E, van Dijk JA, van de Laar MA. Does the eHealth literacy scale (eHEALS) measure what it intends to measure? Validation of a dutch version of the eHEALS in two adult populations. J Med Internet Res. 2011;13(4):e86. https://doi.org/10.2196/jmir.1840. source
    • cites [30] Norman C. EHealth literacy 2.0: problems and opportunities with an evolving concept. J Med Internet Res. 2011;13(4):e125. https://doi.org/10.2196/jmir.2035. source
    • cites [31] van der Vaart R, Drossaert C. Development of the digital health literacy instrument: measuring a broad spectrum of health 1.0 and health 2.0 skills. J Med Internet Res. 2017;19(1):e27. https://doi.org/10.2196/jmir.6709. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Previous research showed a gap between the digital health literacy level of Chinese older adults and that of developed countries.

    “Previous research results showed that there was a gap between the digital health literacy level of Chinese older adults and that of developed countries [14, 27].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] Li S, Cui G, Yin Y, Wang S, Liu X, Chen L. Health-promoting behaviors mediate the relationship between eHealth literacy and health-related quality of life among Chinese older adults: a cross-sectional study. Qual Life Res. 2021;30(8):2235–43. https://doi.org/10.1007/s11136-021-02797-2. source
    • cites [27] Li S, Yin Y, Cui G, Xu H. The associations among health-promoting lifestyle, eHealth literacy, and cognitive health in older Chinese adults: a cross-sectional study. Int J Env Res Pub He. 2020;17(7):2263. https://doi.org/10.3390/ijerph17072263. source

  • It may state two separate claims as one.

    Study design and conductnone given

    The Digital Health Literacy Assessment Scale has been proved to have good discrimination and practicability.

    “The scale has been proved to have good discrimination, reliability, validity and practicability”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The application ability of digital health literacy is the highest cognitive level of digital health literacy, cultivated by acquiring information from all lower-level digital health literacy dimensions (acquisition and evaluation ability and interaction ability).

    “The application ability of digital health literacy is the highest cognitive level of digital health literacy, which is cultivated by acquiring information from all lower-level digital health literacy dimensions (namely, acquisition and evaluation ability and interaction ability) [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Paige SR, Stellefson M, Krieger JL, Anderson-Lewis C, Cheong J, Stopka C. Proposing a transactional model of eHealth literacy: concept analysis. J Med Internet Res. 2018;20(10):e10175. https://doi.org/10.2196/10175. source

  • It may state two separate claims as one.

    Interpretationreasoning

    Older adults with high perceived usefulness, ease of use, reliability and low perceived risk of Internet health information may have more active attitude towards digital health services usage, which directly affects their behavior intention and leads to more positive usage behaviors, thus having higher digital health literacy.

    “Older adults with high perceived usefulness, ease of use, reliability and low perceived risk of Internet health information may have more active attitude towards digital health services usage, which directly affects their behavior intention and leads to more positive usage behaviors, thus having higher digital health literacy.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationown data

    Older adults were more inclined to learn passively than to seek guidance actively from their family members for obtaining Internet health information, and family members' teaching of acquiring Internet health information skills can improve digital health knowledge and skills more effectively.

    “It was suggested that older adults were more inclined to learn passively than to seek guidance actively from their family members for obtaining Internet health information, and family members' teaching of acquiring Internet health information skills can improve the digital health knowledge and skills more effectively.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Under the background of Chinese social culture, older adults often live with their children and grandchildren.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductreasoning

    The digital health literacy assessment used a self-assessment scale, which inevitably led to self-reported bias and could not fully reflect the actual digital health literacy operation ability of the participants.

    “the digital health literacy assessment used the self-assessment scale, which inevitably led to self-reported bias and could not fully reflect the actual digital health literacy operation ability of the participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Computer literacy is one of the six core literacies of digital health literacy and is the foundation of digital health literacy cultivation.

    “As one of the six core literacy of digital health literacy, computer literacy is the foundation of digital health literacy cultivation [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Norman CD, Skinner HA. EHealth literacy: essential skills for consumer health in a networked world. J Med Internet Res. 2006;8(2):e9. https://doi.org/10.2196/jmir.8.2.e9. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The study by Yang et al. showed that attitude towards Internet health information was the most important predictor of digital health literacy.

    “The study by Yang et al. also showed that the attitude towards Internet health information was the most important predictor of digital health literacy [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Yang E, Chang SJ, Ryu H, Kim HJ, Jang SJ. Comparing factors associated with eHealth literacy between young and older adults. J Gerontol Nurs. 2020;46(8):46–56. https://doi.org/10.3928/00989134-20200707-02. source

  • It may state two separate claims as one.

    Premisecitation

    Older adults who perceive themselves to be in good health and pay more attention to health have stronger self-care awareness and health information needs, and are more likely to actively seek online health knowledge and skills and practice them in daily life.

    “Older adults who perceive themselves to be good health and pay more attention to health have stronger self-care awareness and health information needs, and they are more likely to actively seek online health knowledge and skills and practice them in daily life [55].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] Aponte J, Nokes KM. Validating an electronic health literacy scale in an older Hispanic population. J Clin Nurs. 2017;26(17–18):2703–11. https://doi.org/10.1111/jocn.13763. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Increasing the frequency of subjects using professional health websites is an effective intervention measure to improve digital health literacy.

    “Studies have shown that increasing the frequency of subjects using professional health websites is an effective intervention measure to improve digital health literacy [56, 57].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [56] Melholt C, Joensson K, Spindler H, Hansen J, Andreasen JJ, Nielsen G, Noergaard A, Tracey A, Thorup C, Kringelholt R, Dinesen BI. Cardiac patients’ experiences with a telerehabilitation web portal: implications for eHealth literacy. Patient Educ Couns. 2018;101(5):854–61. https://doi.org/10.1016/j.pec.2017.12.017. source
    • cites [57] Mitsuhashi T. Effects of two-week e-learning on eHealth literacy: a randomized controlled trial of Japanese Internet users. PeerJ. 2018;6:e5251. https://doi.org/10.7717/peerj.5251. source

  • Probably not a substantial claim.

    Premisecitation

    The level of digital health literacy is closely related to the Internet penetration rate and the level of economic development.

    “Considering that the level of digital health literacy is closely related to the Internet penetration rate and the level of economic development [19]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Choi NG, DiNitto DM. The digital divide among low-income homebound older adults: internet use patterns, eHealth literacy, and attitudes toward computer/internet use. J Med Internet Res. 2013;15(5):e93. https://doi.org/10.2196/jmir.2645. source

  • It may state two separate claims as one.

    Study design and conductnone given

    This study only investigated community-dwelling older adults in the main urban areas of Chongqing, China, with other limitations in sample selection explained in the methodological section.

    “this study only investigated community-dwelling older adults in the main urban areas of Chongqing, China, as well as other limitations in the selection associated with the sample design already explained in the methodological section.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Communication with peers can enhance digital health literacy.

    “The research by Paek et al. proved that communication with peers can enhance digital health literacy [54].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Paek HJ, Hove T. Social cognitive factors and perceived social influences that improve adolescent eHealth literacy. Health Commun. 2012;27(8):727–37. https://doi.org/10.1080/10410236.2011.616627. source

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Interpretationown data

    The lack of interactive ability and application ability of digital health literacy among community-dwelling older adults in Southwest China deserves more attention from health professionals, public health policy makers and implementers.

    “among which the lack of interactive ability and application ability of digital health literacy deserved more attention from not only health professionals, but also public health policy makers and implementers.”
    Quote in the paperNot a substantial claim
35 of 35

  • The paper relies on this without support.

    The sample of community-dwelling older adults in Chongqing represents community-dwelling older adults in Southwest China.

    “This study was a cross-sectional study, which was carried out in the main urban areas of Chongqing, China from September 2020 to April 2021.”

  • The paper relies on this without support.

    The lack of knowledge of the overall digital health literacy level of community-dwelling older adults in China hinders the long-term development of digital health and smart elderly care.

    “However, at present, the lack in the knowledge of the overall digital health literacy level of community-dwelling older adults in China virtually hinders the long-term development of digital health and smart elderly care.”

  • The paper relies on this without support.

    This study is the first to use a localized original assessment tool to evaluate digital health literacy among community-dwelling older adults in China.

    “As far as we know, our study is the first attempt to use the localized original assessment tool to evaluate the digital health literacy of community-dwelling older adults in China.”

  • The paper relies on this without support.

    The localized original assessment tool is more in line with the current era context and cultural background than the introduced universal scale, and its results are more targeted and accurate.

    “Compared with the introduced universal scale used in previous studies, it is more in line with the current era context and cultural background, and the results are more targeted and accurate.”

  • The paper relies on this without support.

    China gained full access to the Internet in 1994, later than many developed countries.

    “China gained full access to the Internet in 1994, later than many developed countries.”

  • The paper relies on this without support.

    Older adults failed to keep pace with the emergence and development of the Internet, and some were marginalized by the Internet.

    “Older adults failed to keep pace with the emergence and development of the Internet, some of whom were marginalized by the Internet.”

  • The paper relies on this without support.

    Age-related barriers to technology use have been gradually weakened by high Internet penetration.

    “Age-related barriers to technology use have been gradually weakened by the high Internet penetration.”

  • The paper relies on this without support.

    Under the background of Chinese social culture, older adults often live with their children and grandchildren.

    “Under the background of Chinese social culture, older adults often live with their children and grandchildren.”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Studies from China and South Korea suggest that lower digital health literacy is often observed in older adults, individuals with lower education levels, and those residing in rural areas.

    “For instance, studies from China and South Korea suggest that lower digital health literacy is often observed in older adults, individuals with lower education levels, and those residing in rural areas (Jang & Je, 2022; Liu et al., 2022).”

    From Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany (2025) · cites this paper as Liu et al., 2022

    The Discussion reports that younger and better-educated older adults had higher digital health literacy, supporting the age and education parts of the claim. But the Methods and Limitations say the study sampled only older adults in Chongqing’s main urban areas; it does not establish a rural–urban difference. The South Korean study has a separate citation and is not assessed here. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Individuals with higher digital health literacy are more likely to adopt and integrate digital health interventions into their daily lives.

    “Our findings align with previous research showing that individuals with higher digital health literacy are more likely to adopt and integrate digital health interventions into their daily lives (Liu et al., 2022).”

    From Sociodemographics and Digital Health Literacy in Using Wearables for Health Promotion and Disease Prevention: Cross-Sectional Nationwide Survey in Germany (2025) · cites this paper as Liu et al., 2022

    The Background (page not provided) says that a lack of digital health literacy hinders older adults from using digital health services. The Discussion (page not provided) links positive service-use behaviors with higher literacy, but the study does not establish that people with higher literacy are more likely to adopt digital health interventions and integrate them into daily life; its population is also limited to community-dwelling older adults in Southwest China. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two different values are given for δ in the sample-size calculation

    Minor

    The methods state that δ was set to 0.11, then state that δ = 0.03 was used for the same sample-size estimate.

  • Reported Internet-use SD is incompatible with the duration categories

    Minor

    The reported mean is 6.74 years, but 202 of the 389 Internet users had used it for at most 5 years. Those 202 observations alone imply a sample SD of at least 1.25 years, not 0.23.

2 of 2

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. DeVellis RF. Scale development: theory and application. Chongqing: Chongqing University Press; 2016.
  2. Tang Z, Wang F, Fu H. Development and assessment on the eHealth literacy scale for college students. Chin J Health Educ. 2014;30(1):35–8.
  3. Wu YM, Zhang M, Zhu LY. The research on the evaluation of consumer’s electronic health literacy and application in mobile health. Consum Econ. 2017;33(1):90–6, 55.
  4. Liu SQ, Fu JJ, Kong DH, Zhong Z, Gu CY, Luo Y. Development and reliability and validation test of the digital health literacy assessment scale for the community-dwelling elderly. Chin Nurs Res. 2021;35(23):4169–74. https://doi.org/10.12102/j.issn.1009-6493.2021.23.006. · DOI

Cited by

Sorted by citations

Related

Metadata

Authors
Liu, S., Zhao, H., Fu, J., Kong, D., Zhong, Z., Hong, Y., Tan, J., & Luo, Y.
Affiliations
Army Medical University (CN)
Corresponding author
  • Tan, Jing
  • Luo, Yu
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2022-05-17
Volume
22
Issue
1
Pages
996-996
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-022-13378-4
PMC
PMC9112275
OpenAlex
W4280523621
Semantic Scholar
a84b34bd4e77efa6ac3e464ecb8ad210956d6f1a
Cited by
133
References
50
Citations by year
2026: 43 · 2025: 49 · 2024: 29 · 2023: 10 · 2022: 2
FWCI
37.74
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
National Social Science Fund of China (Grant No. 19XRK001)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Technology Use by Older Adults
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
  • Social Sciences › Education › Digital literacy in education
Keywords
digital health literacy, community-dwelling older adults, internet use, perceived usefulness, perceived ease of use, perceived reliability, health concerns, educational attainment, digital divide, Southwest China
MeSH terms
Aged, China, Cross-Sectional Studies, Humans, Surveys and Questionnaires, Reproducibility of Results, Telemedicine, Internet, Independent Living, Health Literacy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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